Hafezi Farhad, Naghibzadeh Bijan, Kazemi Ashtiani Abbas
Plastic Surgery Department, St. Fatima Hospital, Iran University of Medical Sciences and Burn Research Center, Suit 12, No.33, Asef (Ejazi) St., Zaferanieh, Tehran, Iran.
Loghman Hakim Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran.
Aesthetic Plast Surg. 2018 Jun;42(3):867-876. doi: 10.1007/s00266-018-1136-8. Epub 2018 Apr 11.
Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, "bulbous pinch" LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen.
The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face.
We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups.
There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally.
Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60-70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration.
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如希恩（Sheen）和康斯坦丁（Constantian）所定义，下外侧软骨位置异常表现为下外侧软骨（LLC）穹窿部向前凸出且后方受压。这种解剖变异包括外侧脚的头侧（即向上和向内）旋转，尤其在鼻尖呈球状的患者中。在大多数情况下，“球状受压”的LLC朝向内眦，而非外侧，因此被称为头侧移位。相应地，在大多数观察到这种变异的鼻整形手术病例中，建议将软骨向尾侧移位。
本文的目的是测量面部固定参考点下外侧脚的确切角度。
我们在连续40例鼻整形手术病例中绘制并标记了LLC轮廓以及垂直/水平线。然后将它们分为两组：（1）球状受压组和（2）扁平LLC组。测量并比较左右LLC与中线和水平线的角度，以评估两个亚组之间是否存在显著差异。
在球状和扁平LLC组中，垂直和水平测量的LLC旋转角度之间均无显著差异。
基于我们的研究结果，尽管部分患者可能存在LLC的头侧位置异常，但在大多数情况下，鼻侧壁受压的病因并非外侧脚的头侧移位，而很可能是由于后外侧脚的严重凸出。根据我们的研究结果，头侧位置异常是LLC一种不常见的解剖变异，但在鼻整形手术病例中却有较高的报道频率（60 - 70%）。这一发现可能有助于将这种畸形矫正为正常的解剖结构。
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