title: Assessment of Nasal Function After Tip Surgery With a Cephalic Hinged Flap of the Lateral Crura: A Randomized Clinical Trial.
abstract: BACKGROUND
  Postrhinoplasty nasal obstruction has been ascribed to either postreductive narrowing of the midvault or dynamic collapse resulting from lateral wall insufficiency. Recently, clinicians have reported on various surgical techniques that maximally preserve alar cartilage integrity, unlike the earlier popular methods of tip reduction surgery.
  
  
  OBJECTIVE
  The authors compared the effects of 2 rhinoplasty techniques: a cephalic trim (CT) of the lateral crura (LC) and a horizontal resection with cephalic hinged flap (HRCH) of the LC of the lower lateral cartilage (LLC).
  
  
  METHODS
  Fifty-two patients who presented with a bulbous nasal tip deformity were randomly assigned to 1 of 2 groups and underwent either CT of the LC or HRCH. Effects of the procedures were evaluated by both acoustic rhinometry (AR; first and second minimal cross-sectional areas [MCA1 and MCA2, respectively]) and by subjective scoring on a global nasal obstruction visual analog scale (VAS). Assessments were made before and after rhinoplasty.
  
  
  RESULTS
  MCA1 and MCA2 were increased after both CT and HRCH. This increase was significant on the right side for both CT (P < .001) and HRCH (P = .001), but the increase on the left side was significant only for HRCH.
  
  
  CONCLUSIONS
  The improvement noted in breathing quality by VAS and AR suggests that a hinged flap may be effective in reconstructing the internal nasal valve.
  
  
  METHODS
  3.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery at Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amin
authors.initials: A
authors.lastname: Amali
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery at Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran asazgar@sina.tums.ac.ir.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Sazgar
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery at Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Jafari
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004954:Esthetics; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery*; D015508:Nasal Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D010781:Photography; D020127:Recovery of Function; D012119:Respiration; D023842:Rhinometry, Acoustic; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: acoustic rhinometry; alar cartilage; cephalic hinged flap; cephalic trim; horizontal resection; lateral crura; nasal valve area; rhinoplasty; tip modification; tip-plasty