Anatomical Study of the Lateral Crural Strut Graft in Rhinoplasty and Its Clinical Application

Overview

The lateral crural strut graft is widely used to correct a bulbous tip, a misplaced tip cartilage, a pulled-up nostril rim and nostril collapse, but its effects had not been measured objectively. The authors performed the graft on 16 cadavers and measured before and after.

Sections of note

• 16 human cadavers underwent rhinoplasty with lateral crural strut grafts. Most were young, male and black.
• Variables measured were basilar nasal width, interalar width, columella to tip height, nostril width, and the length and width of the graft itself.
• Measurements were taken with a digital caliper before and after the operation. Nostril cross-sectional area was measured with a computer program.
• All measured values increased.
• Only basilar nasal width, columella to tip height and nostril cross-sectional area increased by a statistically significant amount, p less than 0.05.
• The authors conclude the graft improves the external nasal valve and increases tip projection and basilar nasal width.

What it means for a patient

• The graft widens the base of the nose as well as supporting the nostril, which is a trade-off worth knowing before surgery.
• Enlarging the nostril opening is what improves breathing through the external valve.
• Interalar width and nostril width also rose but not significantly, so the size of those changes is uncertain.
• A cadaver study of 16 specimens with no healing and no follow-up measures the immediate mechanical effect, not the result in a living patient.

Why this paper matters

The graft is in common use on the strength of clinical impression, and this study tests what it actually does to nasal dimensions. Establishing that it widens the nasal base is a practical caution for patients where base width is already a concern. How these measurements translate into results after healing is not addressed.

Terms

• Lateral crus: the outer arm of the tip cartilage, running toward the cheek.
• Lateral crural strut graft: a cartilage strip placed beneath the lateral crus to support and reposition it.
• External nasal valve: the nostril opening and its supporting rim, which can collapse on breathing in.
• Basilar nasal width: the width of the nose at its base, seen from below.
• Interalar width: the distance between the outer edges of the two nostrils.