Author Affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Correspondence: Dirk J. Menger, MD, Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands (email@example.com).
Collapse of the nasal vestibule during inspiration is a frequently encountered symptom, often caused by weak or medially displaced lateral crura in the lower lateral cartilages. Numerous techniques are available for lateralizing and strengthening the lateral crura using cartilage grafts or suture techniques. In most cases, they involve an external rhinoplasty approach or additional incisions. An elegant endonasal method for widening and strengthening the lateral component of the nasal valve area is described herein. The basis of the procedure is a permanent submucosal spanning suture between the piriform aperture and the distal part of the lower lateral cartilage. The effect of this technique is 2-fold. First, it provides superolateral rotation of the lateral crura, increasing the cross-sectional area, and second, the spanning suture provides additional support for the lateral wall of the nasal vestibule.
Menger DJ. Lateral Crus Pull-upA Method for Collapse of the External Nasal Valve. Arch Facial Plast Surg. 2006;8(5):333-337. doi:10.1001/archfaci.8.5.333