Use of the Upper Lateral Cartilage Sagittal Rotation Flap in Nasal Dorsum Reduction and Augmentation

Abstract

Medial rotation flaps of the upper lateral cartilages are useful in nasal dorsum reduction surgery because they maintain the separation between the upper lateral cartilages and the septum, and usually avoid the need for spreader grafts. These flaps, however, can be technically challenging. Sagittal rotation flaps of the upper lateral cartilages are more flexible and simpler to apply in nasal dorsum reduction surgery. These flaps can also be utilized in nasal dorsum augmentation surgery. Seventy-one patients underwent dorsal reduction surgery utilizing a posteroinferior sagittal rotation of the upper lateral cartilages. In one-third of patients, in whom there was significant cartilage excess, the sagittal rotation was supplemented with a simplified and incremental medial rotation. Dorsal augmentation with anterosuperior sagittal rotation of the upper lateral cartilages was performed in 11 patients with select caudal dorsal deficiencies. The use of a sagittal rotation simplified the upper lateral cartilage flap procedure in dorsal reductions and significantly reduced the need for medial rotations. The technique was intuitive and could be applied to minor and major dorsal reductions. In select dorsal augmentations, the flap helped avoid the need for potentially visible onlay grafts. Sagittal rotation of the upper lateral cartilages helps preserve the normal anatomy of the upper laterals and the important relationship between the upper laterals and the septum.