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Related Concept Videos

Structural Joints: Cartilaginous Joints01:17

Structural Joints: Cartilaginous Joints

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As the name indicates, at a cartilaginous joint, the adjacent bones are united by cartilage, a tough but flexible type of connective tissue. Unlike synovial joints, these types of joints lack a joint cavity and involve bones joined together by either hyaline cartilage or fibrocartilage.
There are two types of cartilaginous joints:
Synchondrosis
A synchondrosis ("joined by cartilage") is a cartilaginous joint where bones are connected by hyaline cartilage. Synchondrosis may be temporary...
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Related Experiment Video

Updated: Mar 18, 2026

Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts
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The Lower Lateral Cartilage-Spanning Spring Graft (The Gullwing Effect).

Ahmed Mohamed Salah1, Luiz Carlos Ishida2

  • 1Avara Plastic Surgery Center, 5, Sphinx Square, Mohandessin, Cairo, Postal code: 11352, Egypt. drahmedsalahga3far@yahoo.com.

Aesthetic Plastic Surgery
|March 17, 2026
PubMed
Summary

A novel cartilage graft technique effectively corrects bulbous nasal tips in patients with thick skin. This method, the lower lateral cartilage spanning spring graft (LCSSG) integrated with a septal extension graft (SEG), improves outcomes and avoids complications.

Keywords:
Lateral crural spanning graftPseudo-malpositionResting angle

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Area of Science:

  • Plastic Surgery
  • Rhinoplasty Techniques
  • Nasal Anatomy

Background:

  • Bulbous nasal tip surgery in patients with medium-to-thick skin and weak cartilage presents significant challenges.
  • Suture-only techniques often fail to adequately maintain lateral crural support in these cases.

Purpose of the Study:

  • To evaluate the efficacy of a modified lateral crural spanning graft technique for correcting bulbous nasal tips caused by lateral-crural pseudo-malposition.
  • To assess the impact of this technique on rhinoplasty outcome evaluation (ROE) scores and complication rates.

Main Methods:

  • A modified lateral crural spanning graft, termed the lower lateral cartilage spanning spring graft (LCSSG), was integrated with a septal extension graft (SEG).
  • This cross-shaped construct was used in 17 primary rhinoplasty patients with bulbous nasal tip deformities.
  • The graft was fixed to the cephalic borders of the lateral crura, creating a dynamic spring to reorient the crura and reinforce the alar rim.

Main Results:

  • Seventeen patients (13 women, 4 men; mean age 32) with medium-to-thick skin were followed for a mean of 16.2 months.
  • Mean ROE scores significantly improved from 12.6 preoperatively to 19.4 postoperatively (mean ΔROE of 6.8).
  • The slit-anchored group (n=13) showed no complications, whereas the early suture-only group (n=4) had a 50% rate of mild supratip fullness and rim retraction.

Conclusions:

  • The LCSSG-SEG construct effectively functions as a dynamic spring to reorient the lateral crus.
  • This technique provides crucial support to the alar rim in primary rhinoplasty cases with lateral-crural pseudo-malposition and medium-to-thick skin.
  • The slit-anchored LCSSG-SEG method demonstrates superior outcomes and safety compared to suture-only approaches in this patient population.