0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Surgical Technique |

Barrel Roll Technique for the Correction of Long and Concave Lateral Crura

Armando Boccieri, MD; Tito M. Marianetti, MD
Arch Facial Plast Surg. 2010;12(6):415-421. doi:10.1001/archfacial.2010.90.
Text Size: A A A
Published online

Objective  To describe the barrel roll technique that is capable of concurrently correcting 2 associated deformities—overprojection and ptosis of the nasal tip.

Methods  Thirty-two patients with concavity of the upper section of 1 or both lateral crura combined with a droopy tip were treated from January 1, 2005, through December 31, 2007. In all cases, the barrel roll technique was used, which involves rotating the lateral crus by 180° on its major axis so that the concavity is transformed into convexity, and carrying out lateral crural overlay to correct the overprojection concurrently.

Results  All the patients displayed functional and aesthetic improvement by correcting the droopy tip and concavity of the lateral crura. Revision was necessary in 1 case of monolateral concavity. The comparison of preoperative and postoperative rhinomanometric data showed significant improvement of nasal airway resistance.

Conclusions  A combination of the overlay technique and rotation of a portion of the lateral crus on its axis is capable of concurrently correcting serious functional problems and aesthetic defects of the nasal tip. The open approach is essential for perfect positioning of the mobilized cartilaginous segments and ensuring stable results over time.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.

General practitioner questionnaire.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Patient questionnaire.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Basal (A) and frontal (B) views of the external nasal valve deformity and asymmetry are due to concavity of the upper section of the left lateral crus.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Complete detachment of the vestibular skin below the concave lateral crus.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Sectioning and removal of the deformed portion of the left lateral crus.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.

Extracorporeal reshaping of the lateral crus with trimming of the cephalic portion.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 7.

Sectioning of the right lateral crus for application of the overlay technique.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 8.

Repositioning and suturing of the left lateral crus after rotation of 180° on its major axis and overlay.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 9.

End result with pure overlay technique from the right side and barrel roll technique from the left side.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 10.

Schematic illustration of the barrel roll technique. Shown in red is the segment of lateral crus rotated by 180° on its major axis and overlapped.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 11.

Patient with monolateral concavity of the lateral crus associated with overprojection of the tip. Frontal preoperative view (A) and 1-year postoperative results (B). Three-quarters preoperative view (C) and 1-year postoperative results (D). Basal preoperative view (E) and 1-year postoperative results (F).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 12.

Patient with bilateral concavity of the lateral crus associated with overprojection of the tip. Frontal preoperative view (A) and 4-year postoperative results (B). Three-quarters preoperative view (C) and 4-year postoperative results (D). Lateral preoperative view (E) and 4-year postoperative results (F). Note the correction of the tip ptosis allowed by the barrel roll technique.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 13.

Preoperative and postoperative rhinomanometric data of nasal airflow at rest (A) and during forced inspiration (B).

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

128 Views
3 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();