Lower Lateral Crural Release: A potential workhorse for nasal tip deformities
摘要
Mastering tip aesthetics in rhinoplasty is always very challenging for any rhinoplasty surgeon because of numerous treatment algorithms for various tip deformities.Understanding tip anatomy with respect to various tip deformities and which treatment algorithm should be followed to deal with these deformities is big debatable question always. To simplify the management of various tip deformities we conducted present study in our department.Principal objective of present study was to give one stop solution for various tip deformities to both young and experienced rhinoplasty surgeons so that there is uniform treatment algorithm for various tip deformities. Current study is Single institutional prospective interventional study which was conducted ENT department of Sri Guru Ram Das University of Health sciences from January 2023 to January 2025. 107 patients who were having cosmetic complains of nose and want to change aesthetic appearance of nose and tip were enrolled in this study. Follow up was carried on for one year. After thorough preoperative photographic evaluation with psychological assessment written informed video consent was taken. They were fully explained about pros and cons of lower lateral crura release for various tip deformities.After completion of basic steps for structural rhinoplasty, management of tip was done with lower lateral crura release as first step in treatment algorithm of every tip deformity, where in lower lateral cartilage was released from vestibular skin and separated from sesamoid cartilage. After achieving flat configuration of lower lateral cartilage with favourable resting position of LLC wherein caudal end of cartilage is at higher position than cranial, released cartilage was placed in new alar pockets. Flat configuration was achieved with the help of various grafts and suturing techniques. Assessment of results were done with various validated scales which assessed aesthetic outcome of this technique when compared preoperatively and postoperatively in terms of patient satisfaction. Among Aesthetic scales used were, Rhinoplasty Outcome Evaluation Scale (ROE), SCHNOS scale, UTRECT scale, Global Aesthetic Outcome Scale. Data was carefully studied and relevant statistical methods were applied to know the clinical significance. Results of current study clearly indicated that there is statistical significance difference between pre op and post op aesthetic outcome scores when using this technique of lower lateral cartilage release for tip deformities. Major indication of above mentioned technique in current study was for projection (95.32%), malpositioned tip/parenthesis deformity (64.48%), tip asymmetry (21.49%),and ball bulbous tip (17.75%).There was no major complication expect for short term change of smell (15.88%).All aesthetic outcome score used in current study like Rhinoplasty Surgery Outcome Evaluation Score (ROE), Pre and Post op UTRECT score, SCHNOS score, Global Aesthetic Outcome scale for tip favoured use of lower lateral cartilage release for various tip deformities.Lower lateral cartilage is very effective and powerful technique managing various tip deformities, although there is long learning curve involved in this technique, but if it is learnt properly with understanding of relevant anatomy of tip, this technique can be a single stop solution for various tip deformities.