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Surgical Technique |

The Lateral Crural Stairstep Technique A Modification of the Kridel Lateral Crural Overlay Technique

Armando Boccieri, MD; Giuseppe Raimondi, MD
Arch Facial Plast Surg. 2008;10(1):56-64. doi:10.1001/archfacial.2007.7.
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The Kridel lateral crural overlay technique has proved capable of resolving overprojection with severe ptosis of the tip and can be used along with a medial crural overlay to reduce marked overprojection of the tip with no significant rotation. In the technique described herein, the section of the lateral crus involved in the lateral crural overlay is step-shaped rather than vertical and the cartilage is completely detached from the skin beneath as far as the domus. The anterior segment is moved downward and is overlapped with the posterior segment on both sides to resolve “parenthesis deformities” of the nasal tip that are caused by malposition of the lateral crura. This procedure can also be combined when necessary with both posterior and anterior sliding of the lateral crus to correct most deformities of the nasal tip. Within the framework of surgery on the nasal tip, attention has focused primarily on techniques that were designed to modify the projection and rotation of the nasal tip. It is only recently that a new parameter with important aesthetic and functional implications has emerged, namely cephalocaudal positioning in the space of the lateral crura.1

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Figure 1.

Intraoperative view of malpositioning of lateral crura. A, Cephalically positioned lateral crura. B, Caudal margin of lateral crura placed below cephalic margin.

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Figure 2.

Lateral crural stairstep technique. A, Schematic drawing of stairstep incision. B, Intraoperative view of incision.

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Figure 3.

Detachment of anterior segments of lateral crura from skin of nasal vestibule beneath as far as the domus.

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Figure 4.

Surgical options of the lateral crural stairstep technique. A, Correction of a pure parenthesis deformity. B, Correction of malposition of lateral crura combined with overprojection and ptosis of tip. C, Correction of malposition of lateral crura combined with marked overprojection of tip. D, Correction of overprojection and overrotation of tip with no malposition of lateral crura.

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Figure 5.

Suturing of cartilage segments with 6.0 nylon.

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Figure 6.

The caudal margin of the domus is slightly higher than the cephalic margin.

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Figure 7.

Removal of protruding cartilage from the lower margin of lateral crura.

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Figure 8.

Patient who underwent a previous rhinoplasty with nasal wings pinched. Correction was performed via the lateral crural stairstep technique without removal of the lower margin of the lateral crura (fifth surgical option of the technique]). A and C, Preoperative views; B and D, postoperative views after 13 months.

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Figure 9.

Patient who presented with dorsal hump, crooked nose, and cephalic malposition of lateral crura with overprojection and ptosis of the tip. Correction was performed via hump excision, septal crossbar graft technique, and lateral crural stairstep technique. Anterior segments of lateral crura were moved down and back to overlap with posterior segments. A and C, Preoperative views; B and D, postoperative views after 1 year.

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Figure 10.

Patient who presented with malposition of the lateral crura with overprojection and ptosis of the tip (correction performed with surgical option in Figure 4B). A and C, Preoperative views; B and D, postoperative views.

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Figure 11.

Patient who presented with malposition of the lateral crura with overprojection of the tip (correction performed with surgical option in Figure 4C). A and C, Preoperative views; B and D, postoperative views.

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Figure 12.

Patient who underwent a previous rhinoplasty with overprojection and overrotation of the tip (correction performed with surgical option in Figure 4D). A and C, Preoperative views; B and D, postoperative views.

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