title: The alar rim flap: a novel technique to manage malpositioned lateral crura.
abstract: BACKGROUND
  Alar cartilage malposition is a common anatomic variation in which the axis of the lateral crus lies cephalically and may be parallel to the cephalic septum. Malposition of the lateral crura may produce inward collapse of the alae that is observable on deep inspiration.
  
  
  OBJECTIVE
  The authors performed the alar rim flap technique to treat patients with alar malposition and assessed functional and aesthetic outcomes.
  
  
  METHODS
  Twelve patients who underwent primary open rhinoplasty with the alar rim flap technique were evaluated in a prospective study. A 2- or 3-mm caudal portion of the lateral crus was elevated from the underlying mucosa, pulled caudally, and extended with a cartilage graft. This extension of the alar rim flap was placed through the pyriform aperture for additional support. Patients completed pre- and postoperative questionnaires addressing nasal obstruction and underwent paranasal computed tomography. Patients received follow-up for an average of 16 months (range, 8-27 months).
  
  
  RESULTS
  Patients with alar cartilage malposition and external valve insufficiency experienced aesthetic and functional improvements after rhinoplasty with the alar rim flap technique. No patients developed alar rim collapse or flap displacement.
  
  
  CONCLUSIONS
  The alar rim flap technique is effective for the correction of malpositioned lateral crura and external valve insufficiency. Because this technique does not damage the scroll area, disruption of the internal valve area is avoided.
  
  
  METHODS
  4 Therapeutic.
authors.affiliation: Dr Kemaloğlu is an Instructor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, Kayseri, Turkey. Dr Altıparmak is an Instructor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Muğla Sıtkı Kocaman University, Muğla, Turkey.
authors.forename: Cemal Alper
authors.initials: CA
authors.lastname: Kemaloğlu
authors.affiliation: Dr Kemaloğlu is an Instructor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, Kayseri, Turkey. Dr Altıparmak is an Instructor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Muğla Sıtkı Kocaman University, Muğla, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Altıparmak
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery*; D015508:Nasal Obstruction / Q000175:diagnosis / Q000601:surgery*; D009666:Nose / Q000503:physiopathology / Q000601:surgery; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult