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\listoverridecount0\ls1}}{\info{\author LIVIJE}{\operator LIVIJE}{\creatim\yr2002\mo9\dy5\hr9\min30}{\revtim\yr2002\mo12\dy23\hr10\min55}{\printim\yr2002\mo12\dy23\hr10\min53}{\version14}{\edmins137}{\nofpages8}{\nofwords1815}{\nofchars10347}
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{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain \s1\sl480\slmult1\keepn\nowidctlpar\outlinelevel0\adjustright Modified alar swing procedure in the saddle nose correction
\par \pard\plain \sl480\slmult1\nowidctlpar\adjustright \f2\fs20 {\f0\fs24 
\par }{\f91\fs24 Livije Kalogjera, PhD; Vlado Bedekovi\'e6, PhD; Tomislav Baudoin, PhD; Mirko Ivki\'e6, BS, MD
\par }{\f0\fs24 
\par 
\par Department of Otorhinolaryngolog/Head and Neck Surgery, University Hospital \ldblquote Sestre milosrdnice\rdblquote , Zagreb, Croatia
\par 
\par 
\par Correspondence to: Prof.dr. Livije Kalogjera, Department of Otorhinolaryngolog/Head and Neck Surgery, University Hospital \ldblquote Sestre milosrdnice\rdblquote , Vinogradska 29, Zagreb, Croatia
\par \page Abstract
\par 
\par Reconstruction of the saddle nose 
involves use of different augmentation materials, from autogenous bone and cartilage to  alloplastic materials. Most important problems considering the choice of reconstructive technique, besides underlying pathology and expected result, include: long-ter
m
 stability, donor morbidity, tendency to infection and extrusion of the implant and its resorption. The use of lateral crura of lower lateral cartilages used as dorsal onlay was reserved for the corrections of minor supratip depressions (flying wing and a
l
ar swing procedure). The authors suggest the use of  pedicled flaps of cephalic portions of lateral crura as dorsal septal strut, which may increase the profile line more than dorsal onlay. Reconstruction is performed using open rhinoplasty approach. Pedi
c
led flaps of the cephalic portions of lateral crura are transfixed in the sagittal plane and, following separation of upper lateral cartilages and medial crura, placed on the dorsum of  nasal septum. Upper laterals are suttured to newly formed cartilagine
ous dorsum, or a new bridge is created using conchal cartilage. Columellar strut may be formed of the septal cartilage. Authors have performed such corrections in 15 patients with good long-term functional and aesthetic results.
\par 
\par Key words: saddle nose, nasal reconstruction, alar swing technique\page Recontouring of the nasal profile in a saddle nose involves the use of }{\f0\fs24\expnd-2\expndtw-12 different augmentation materials used as dorsal implants }{
\f0\fs24\expnd8\expndtw41 (1)}{\f0\fs24\expnd-2\expndtw-12 . Autogenous }{\f0\fs24 cartilage and bone grafts are considered superior to homografts, while alloplastic materials have proven less suitable than autogenous due to }{\f0\fs24\expnd-3\expndtw-17 
more frequent }{\f0\fs24\expnd0\expndtw-2 rejection, }{\f0\fs24\expnd-3\expndtw-17 infection and extrusion }{\f0\fs24\expnd10\expndtw54 (2).}{\f0\fs24 
 The use of bone grafts is preferred by some aesthaetic surgeons, calvarial bone grafts being preferred to illiac bone crest}{\f0\fs24\expnd-2\expndtw-13  }{\f0\fs24\expnd7\expndtw39 (3)}{\f0\fs24\expnd-2\expndtw-13 . Sti
ll, at this time, experience supports the }{\f0\fs24\expnd-2\expndtw-11 concept, that in the }{\f0\fs24\expnd1\expndtw5 nose,}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-11 autogenous cartilage (}{\f0\fs24\expnd0\expndtw-1 nasal, }{\f0\fs24\expnd-3\expndtw-17 
costal or }{\f0\fs24 conchal)}{\f0\fs24\expnd-2\expndtw-11  is the implant of }{\f0\fs24\expnd-2\expndtw-13 choice }{\f0\fs24\expnd9\expndtw47 (4)}{\f0\fs24\expnd-2\expndtw-13 . Cartilage of the lateral crura is recommended for the }{\f0\fs24 
correction of mild to moderate supratip depressions. They can be used as }{\f0\fs24\expnd-2\expndtw-12 free autologous }{\f0\fs24\expnd0\expndtw2 grafts,}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-12 or as pedicled flaps of complete lateral crura, }{
\f0\fs24\expnd-2\expndtw-14 such as in the flying wing procedure }{\f0\fs24\expnd11\expndtw56 (5),}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-14 or its cephalic portions, as }{\f0\fs24\expnd-3\expndtw-16 in the butterfly or alar swing procedure }{
\f0\fs24\expnd11\expndtw56 (6,7),}{\f0\fs24  }{\f0\fs24\expnd-3\expndtw-16 leaving the part below }{\f0\fs24\expnd-2\expndtw-12 alar elbow  }{\f0\fs24\expnd0\expndtw2 intact.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-12 When
 the support provided by the  the cartilaginous septum is }{\f0\fs24\expnd1\expndtw7 lost,}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-12 due to septal deformity  or defect  (following septal hematoma or abscess)  or abundant resection of its }{\f0\fs24 
anterior portion, not only saddle nose deformity, but nasal valve }{\f0\fs24\expnd-2\expndtw-11 collapse, loss of tip projection and columellar retraction may }{\f0\fs24\expnd0\expndtw2 occur.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-11 As }{\f0\fs24 
camouflage dorsal grafting does not help solving the problem of nasal }{\f0\fs24\expnd-2\expndtw-13 valve }{\f0\fs24\expnd0\expndtw-1 collapse, }{\f0\fs24\expnd-2\expndtw-13 reimplantation }{\f0\fs24\expnd1\expndtw7 (push}{\f0\fs24  }{
\f0\fs24\expnd-2\expndtw-13 up) of adequately sized flat piece }{\f0\fs24 of septal cartilage harvested from the inferoposterior pa
rt of quadrangular cartilage to the anterior septal region is proposed. This concept can be performed by endonasal approach, but better long term functional and aesthetic results are achieved by open rhinoplasty }{\f0\fs24\expnd-2\expndtw-12 approach }{
\f0\fs24\expnd8\expndtw43 (8)}{\f0\fs24\expnd-2\expndtw-12 . This technique is not indicated for the reconstruction in }{\f0\fs24\expnd-2\expndtw-13 the patients with }{\f0\fs24\expnd1\expndtw7 thin,}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-13 
weak or calcified septal }{\f0\fs24\expnd0\expndtw-3 cartilage, }{\f0\fs24\expnd-2\expndtw-13 septal }{\f0\fs24 perforation, and is not to be performed if an appropriately sized flat piece of cartilage is not expected intraseptally. Dorsal improvement in 
}{\f0\fs24\expnd-2\expndtw-11 such patients is usually achieved by dorsal onlay }{\f0\fs24\expnd0\expndtw1 grafts, combined with collumelar strut, or L-profile graft.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-11 As such }{\f0\fs24 
grafting may not help nasal valve function, the idea of increasing the dorsal projection of cartilaginous septum with intraseptal dorsal strut seemed to off
er better nasal breathing. This paper outlines a method which involves the use of lateral crura in dorsal recontouring. A modification to the flying wing or alar swing procedure is the use of cephalic portion of both lateral crura as a pedicled flap for t
he dorsal }{\f0\fs24\expnd-2\expndtw-11 intraseptal implant placed in the sagittal plain, not the dorsal }{\f0\fs24\expnd0\expndtw3 onlay.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-11 The main functional advantage }{\f0\fs24 
of this technique is that the dorsal strut inserted intraseptally builds }{\f0\fs24\expnd-2\expndtw-13 the profile line increasing the septal dorsal }{\f0\fs24\expnd0\expndtw3 projection,}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-13 imitating the }{
\f0\fs24\expnd-2\expndtw-12 effect achieved by the push-up of the septal }{\f0\fs24\expnd0\expndtw-2 cartilage, }{\f0\fs24\expnd-2\expndtw-12 in order to correct the nasal valve collapse.}{\f0\fs24 
\par }{\f0\fs24\expnd-3\expndtw-15 Technique}{\f0\fs24 
\par The use of this reconstructive technique is indicated when poor nasal valve function is resulting from the loss of support by the anterior porti
on of  quadrangular cartilage in patients with previously overresected cartilaginous septum, patients with minor septal perforations, or patients with poorquality of septal cartilage for the septal push-up technique. The selection of patients for the pres
ented method is restricted to those who have intact and well developed lower lateral cartilages. Combined }{\f0\fs24\expnd-2\expndtw-14 with other procedures }{\f0\fs24\expnd12\expndtw63 (9),}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-14 
this technique can correct the tip projection }{\f0\fs24\expnd-2\expndtw-13 and columellar retraction.}{\f0\fs24 
\par Procedure is performed under general anaesthesia and the operative area }{\f0\fs24\expnd-2\expndtw-11 is exposed as in standard open-rhinoplasty technique. Unfortunately, }{\f0\fs24 
preoperative planning cannot always adequately estimate the condition of nasal cartilages, due to scaring and retra
ction, so the patients are preoperatively informed that a piece of conchal cartilage may be needed for the reconstruction. Columellar incision is V-shaped and followed by the marginal and circumferential incisions. Lower lateral cartilages are fully expos
ed to their posterior and cephalic margin, and with the exposure of }{\f0\fs24\expnd-3\expndtw-16  ULC, which are usually retracted inferiorly, the }{\f0\fs24\expnd-2\expndtw-12 periosteoperichondrial flap is formed }{\f0\fs24\expnd6\expndtw31 (10)}{
\f0\fs24\expnd-2\expndtw-12 . }{\f0\fs24 Medial crura and ULC are carefully separated and the remnant of the septal cartilage and bone is exposed by elevating mucoperichondrial }{\f0\fs24\expnd-2\expndtw-13 flaps on both }{\f0\fs24\expnd0\expndtw-1 
sides. }{\f0\fs24\expnd-2\expndtw-13 At least }{\f0\fs24\expnd6\expndtw30 0,5}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-13 cm of septal dorsum should be exposed }{\f0\fs24\expnd-2\expndtw-12 caudally, to be fixed to the dorsal }{\f0\fs24\expnd0\expndtw4 
strut.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-12 This preparation should be very }{\f0\fs24\expnd0\expndtw-1 careful, }{\f0\fs24\expnd-2\expndtw-12 as it usually goes through a }{\f0\fs24\expnd1\expndtw5 scar.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-12 
The preparation goes to the rhinion cephalad. Incisions of the lateral crura }{\f0\fs24\charscalex91 are carried out from the alar elbow to the dome}{\f0\fs24\expnd-2\expndtw-12  of the lateral crura (Fig 1.).}{\f0\fs24\expnd0\expndtw-1\charscalex91  }{
\f0\fs24\charscalex91 The flaps are carefully elevated from the vestibular skin and following elvation, cephalic strips of the lateral crura are rotated medially (external side }{\f0\fs24\expnd5\expndtw25\charscalex91 in)}{\f0\fs24\charscalex91 
, transfixed together with three to four 4-0 nylon sutures in the sagittal plane and inserted intraseptally. Depending on the flap dimension and the }{\f0\fs24\expnd0\expndtw-1\charscalex91 intraseptal material }{\f0\fs24\expnd4\expndtw23\charscalex91 
left,}{\f0\fs24\charscalex91  }{\f0\fs24\expnd0\expndtw-1\charscalex91 the flap is fixed to the septal remnant. }{\f0\fs24\charscalex91 Following intraseptal reconstruction and positioning of the dorsal }{\f0\fs24\expnd3\expndtw18\charscalex91 flap, }{
\f0\fs24\charscalex91 triangular cartilages are fixed both to the flap and together over the newly formed cartilaginous septal dorsum, if }{\f0\fs24\expnd2\expndtw11\charscalex91 possible.}{\f0\fs24\charscalex91 
 When triangular cartilages are so retracted that this procedure is not }{\f0\fs24\expnd2\expndtw11\charscalex91 possible,}{\f0\fs24\charscalex91 
 a conchal cartilage graft is sutured to the triangular cartilages to make a bridge over the newly formed cartilaginous dorsum, or transfixed over the ULC like in Stucker tech
nique (but not through the skin). Such manouver is helpful in correction of nasal valve colapse.(11) Another cartilage strut is sutured between the medial crura to correct columellar retraction. Medial crura are then transfixed close to the dome with a fe
w
 4-0  Vicryl intracrural and intradomal sutures. Narrowing of the bony pyramid can be achieved with oblique paramedian and lateral osteotomies, and the the bony hump reduction is performed previously, if needed. A 5-0 nylon is used for incisions closure a
nd a light nasal }{\f0\fs24\expnd0\expndtw-3\charscalex91 packing is introduced. Patients receive single dose of }{\f0\fs24\expnd11\expndtw55\charscalex91 iv}{\f0\fs24\charscalex91 
cephalosporine preoperatively, followed by 5 days of oral cephalosporine postoperatively. Packing is left in place for 3 days and the splint for }{\f0\fs24\expnd-1\expndtw-9\charscalex91 5 days.
\par 
\par }{\f0\fs24\expnd-1\expndtw-7 Discussion}{\f0\fs24 
\par We have operated 15 patients (11 male, 4 female) with this method in 11 }{\f0\fs24\expnd-1\expndtw-5 years }{\f0\fs24\expnd2\expndtw10 period.}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-5 Twelve of the patients were previously operated, two had }{\f0\fs24 
a septal abscess in the childhood and one had recent septal abscess. Our longest follow-up is longer than five years }{\f0\fs24\expnd-1\expndtw-5 in 5 }{\f0\fs24\expnd1\expndtw6 patients.}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-5 
They had a stable reconstruction, good profile line }{\f0\fs24 and significantly improved respiratory function. Most of the patients were lost after 6 months to 2 years follow-up. They had no complaints of nasal obstruction and their profile was im
proved while observed. Some patients complained of feeling tension in the tip area for first 12 weeks.The problem }{\f0\fs24\expnd-1\expndtw-5 we have noticed was relatively overprojected tip in 2 }{\f0\fs24\expnd1\expndtw8 patients,}{\f0\fs24  }{
\f0\fs24\expnd-1\expndtw-5 and }{\f0\fs24\expnd-1\expndtw-6 transitional dorsal swelling in one }{\f0\fs24\expnd1\expndtw8 patient,}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-6 who had a conchal implant }{\f0\fs24\expnd-1\expndtw-5 over the ULC}{
\f0\fs24\expnd1\expndtw5 .}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-5 The method presented, following a }{\f0\fs24 proper patients' selection, offers better nasal breathing, dorsal improvement, increased tip projection and correction of retracted }{
\f0\fs24\expnd-1\expndtw-6 columella. The advantage over the existing techniques is less donor morbidity (calvaria, crista illiaca or rib), no danger of displacement (L-profile of rib cartilage) and no tendency of  infection and extrusion (allografts). }{
\f0\fs24\expnd1\expndtw8 Still,}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-6 it does not build a strong }{\f0\fs24\expnd1\expndtw5 profile,}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-6 and it can be used }{\f0\fs24\expnd-1\expndtw-5 
for the correction of mild to moderate supratip depressions. }{\f0\fs24 
Problems following dorsal recontouring with camouflage grafting depend on the positioning and fixing the implant, its partial resorption or displacement. Conchal cartilage onlays may be helpful in correcting nasal valve colapse (11), but the 
supratip correction is minor than with our technique, but is helpful when both procedures are combined. Advancing of L-profile dorsocolumellar strut from posterior septal region is the best solution from the functional standpoint, if adequate material is 
available. As limits of the septal push-up technique are often present in candidates for the revision }{\f0\fs24\expnd-1\expndtw-5 septoplasty after abundant septal }{\f0\fs24\expnd1\expndtw5 resection,}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-5 
the technique presented has }{\f0\fs24 overcome some functional problems following augmentation with dorsal implants. Our technique was created to improve nasal respiratory function, and sometimes, in minor corrections, it is used without any }{
\f0\fs24\expnd-1\expndtw-6 other }{\f0\fs24\expnd1\expndtw8 grafting,}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-6 even in patients with very little cartilage left }{\f0\fs24 intraseptally. The resection of cephalic flap of the lateral crura in }{
\f0\fs24\expnd-1\expndtw-5 our patients has created not only the dorsal }{\f0\fs24\expnd2\expndtw11 flap,}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-5 but has helped in narrowing and rotation of the }{\f0\fs24\expnd3\expndtw16 
tip and offers stability due to its integration into the nasal tripod structure.}{\f0\fs24 
\par Literature:
\par }{\i\f0\fs24\expnd-2\expndtw-14 1. }{\f0\fs24\expnd-2\expndtw-14 Soss }{\f0\fs24\expnd2\expndtw13 TL.}{\f0\fs24\expnd-2\expndtw-14 Saddle }{\f0\fs24\expnd1\expndtw5 nose.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-14 Arch Otolaryngol }{
\f0\fs24\expnd2\expndtw11 1973;98:391-2}{\f0\fs24 
\par }{\f0\fs24\expnd-1\expndtw-7 2. Tardy }{\f0\fs24\expnd5\expndtw29 ME.}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-7 Rhinoplasty. }{\f0\fs24\expnd4\expndtw21 in:}{\f0\fs24\expnd-1\expndtw-7 Operative challenges in Otolaryngology and }{\f0\fs24\expnd-1\expndtw-5 
Head/Neck }{\f0\fs24\expnd1\expndtw6 Surgery.}{\f0\fs24  }{\f0\fs24\expnd-1\expndtw-5 HC Pillsbury, Goldsmith MM. Yearbook Medical }{\f0\fs24\expnd-3\expndtw-15 Publisher }{\f0\fs24\expnd5\expndtw29 Inc,}{\f0\fs24  }{\f0\fs24\expnd-3\expndtw-15 Chicago, }
{\f0\fs24\expnd4\expndtw22 1990,}{\f0\fs24  }{\f0\fs24\expnd-3\expndtw-15 540-552
\par 3. Thomassin JM, Paris J, Richard-Vitton T, Management and aestehtic results of support grafts in saddle nose surgery. Aesthetic Plast Surg 2001;25(5):332-7
\par }{\f0\fs24\expnd-1\expndtw-9 4. Bateman N, Jones NS. Retrospective review of augmentation rhinoplasties using autologous cartilage grafts. J Laryngol Otol 2000;114(7):514-8}{\f0\fs24 \sect }\sectd 
\margrsxn1781\linex0\headery709\footery709\colsx60\sectdefaultcl \pard\plain \sl480\slmult1\nowidctlpar\adjustright \f2\fs20 {\f0\fs24\expnd-2\expndtw-12 5. Kazanjian VH, Converse JM. Deformities of the }{\f0\fs24\expnd0\expndtw4 nose.}{\f0\fs24  }{
\f0\fs24\expnd3\expndtw16 In:}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-12 The surgical }{\f0\fs24\expnd-2\expndtw-14 treatment of facial }{\f0\fs24\expnd0\expndtw1 injuries.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-14 The Williams & Wilkins Company, }{
\f0\fs24\expnd0\expndtw-3 Baltimore, }{\f0\fs24\expnd3\expndtw17\charscalex77 1949.}{\f0\fs24 
\par }{\f0\fs24\charscalex90 6. Dingman RO. Corrections of nasal deformities due to defects of the }{\f0\fs24\expnd-2\expndtw-11\charscalex90 septum. Plast Rec Surg }{\f0\fs24\expnd6\expndtw30\charscalex90 1956;}{\f0\fs24\expnd4\expndtw20\charscalex90 
18:291-295}{\f0\fs24\expnd6\expndtw30\charscalex90 .}{\f0\fs24 
\par }{\f0\fs24\charscalex90 7. Earley MJ, Lendrum J. The alar swing technique in the correction of }{\f0\fs24\expnd-1\expndtw-6\charscalex90 the saddle nose deformity. Br J Plast }{\f0\fs24\expnd1\expndtw8\charscalex90 Surg.}{
\f0\fs24\expnd4\expndtw22\charscalex90  1984;37:307-12,}{\f0\fs24 
\par }{\f0\fs24\charscalex90 8. Toriumi DM. Subtotal reconstruction of the nasal septum: a preliminary }{\f0\fs24\expnd0\expndtw1\charscalex90 report.}{\f0\fs24\charscalex90  Laryngoscope }{\f0\fs24\expnd6\expndtw32\charscalex90 1994.}{\f0\fs24\charscalex90  }
{\f0\fs24\expnd4\expndtw24\charscalex90 104:906-913,}{\f0\fs24 
\par }{\f0\fs24\expnd0\expndtw-3\charscalex90 9. Hewell }{\f0\fs24\expnd5\expndtw25\charscalex90 TS,}{\f0\fs24\charscalex90  }{\f0\fs24\expnd0\expndtw-3\charscalex90 Tardy }{\f0\fs24\expnd6\expndtw30\charscalex90 ME.}{\f0\fs24\charscalex90  }{
\f0\fs24\expnd0\expndtw-3\charscalex90 Nasal tip refinement. Fac Plast Surg }{\f0\fs24\expnd2\expndtw11\charscalex90 1984;}{\f0\fs24\expnd0\expndtw-3\charscalex90  }{\f0\fs24\expnd4\expndtw23\charscalex90 1:87-124}{\f0\fs24\expnd2\expndtw11\charscalex90 .
}{\f0\fs24 
\par }{\f0\fs24\expnd5\expndtw28\charscalex90 10.}{\f0\fs24\charscalex90  }{\f0\fs24\expnd0\expndtw-3\charscalex90 Padovan I. External approach in rhinoplasty }{\f0\fs24\expnd2\expndtw12\charscalex90 (Decortication)}{\f0\fs24\expnd0\expndtw-3\charscalex90 . }{
\f0\fs24\expnd5\expndtw25\charscalex90 In:}{\f0\fs24 
\par }{\f0\fs24\expnd0\expndtw-3\charscalex90 Conley, JT Dickinson }{\f0\fs24\expnd11\expndtw57\charscalex90 (eds.):}{\f0\fs24\charscalex90  }{\f0\fs24\expnd0\expndtw-3\charscalex90 Plastic and reconstructive surgery of the}{\f0\fs24 
\par }{\f0\fs24\expnd-2\expndtw-13 Face and Neck, }{\f0\fs24\expnd1\expndtw8 vol.}{\f0\fs24  }{\f0\fs24\expnd-2\expndtw-13 1, Aesthetic surgery, G. Thieme Verlag, }{\f0\fs24\expnd0\expndtw-3 Stuttgart,}{\f0\fs24 
\par }{\f0\fs24\expnd0\expndtw4 1972,}{\f0\fs24  }{\f0\fs24\expnd0\expndtw4 pp.}{\f0\fs24  }{\f0\fs24\expnd-5\expndtw-25 143-146
\par }{\f0\fs24 11. Stucker FJ, Hoasjoe DK.}{\b\f0\fs24  }{\f0\fs24 Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse. Arch Otolaryngol Head Neck Surg 1994;120(6):653-8
\par \page FIGURE LEGENDS
\par 
\par Fig. 1.
\par {\pntext\pard\plain\hich\af0\dbch\af0\loch\f0 A.\tab}}\pard \fi-360\li360\sl480\slmult1\nowidctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pnucltr\pnstart1\pnindent360\pnhang{\pntxta .}}\ls1\adjustright {\f0\fs24 
Incision on the lateral crus of lower lateral cartilage is carried out from the dome to the alar elbow
\par {\pntext\pard\plain\hich\af0\dbch\af0\loch\f0 B.\tab}}\pard \fi-360\li360\sl480\slmult1\nowidctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pnucltr\pnstart1\pnindent360\pnhang{\pntxta .}}\ls1\adjustright {\f0\fs24 After rotatio
n of the flaps of cephalic portions of the lateral crura, the flaps are transfixed together and fixed to the septal remnant
\par {\pntext\pard\plain\hich\af0\dbch\af0\loch\f0 C.\tab}}\pard \fi-360\li360\sl480\slmult1\nowidctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pnucltr\pnstart1\pnindent360\pnhang{\pntxta .}}\ls1\adjustright {\f0\fs24 
Upper lateral cartilages are sutured over the newly formed septal dorsum
\par }\pard \sl480\slmult1\nowidctlpar\adjustright {\f0\fs24 
\par Fig. 2.,3.,4, and 5
\par Figures show profile before (fig 2.) and 3 months after the surgery (fig.3), and inferior view before (fig. 4.) and 3 months after the surgery (fig.5)\line 
\par }}