In the progressive development of modern rhinoplasty, advances in corrective surgery of the nasal tip have been highly important, based chiefly on modeling of the lateral crura. The significance of the mesial crura in repair of the nasal tip has not been emphasized. This paper discusses the anatomy and surgery of these structures to show how not only to attain but to maintain the tip in this new cephalic position without the aid of implants.
An undesirable "surgical" appearance is the unduly pointed nasal tip. This may be formed because of (1) imperfect trimming of the mesial crura, (2) type of reconstructive method which reassembles the elements already present and holds them in place by a columellar batten or strut, or (3) insertion of a cartilaginous button in the apex of the lobule for purposes of projection. The behavior of grafts is unpredictable; some cartilaginous or bony struts or buttons
GOLDMAN IB. The Importance of the Mesial Crura in Nasal-Tip Reconstruction. AMA Arch Otolaryngol. 1957;65(2):143–147. doi:10.1001/archotol.1957.03830200039005
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