The Comprehensive Evaluation of the Pinch Deformity due to Concave Alar Cartilages and Its Management

Abstract

Introduction: Acute angle between dome and ala causes alar concavity/pinch deformity. Breathing problems may accompany pinching. Here, pinch deformities were classified according to their severity and treatment modalities discussed. Materials and Methods: Rhinoplasty patients with pinch deformities were included in study. Pinching without external nasal valve blockage (ENVB) was classified mild, pinching with ENVB was classified moderate, and extreme pinching and ENVB were classified severe deformity. In mild deformity, cephalic resection of ala was performed or cephalic resection was combined with onlay graft over ala. In moderate deformity, cephalic part was bent and sutured over lower ala. In severe deformity, cephalic part was bent, and lateral strut graft was inserted between lower and cephalic ala. In pinch deformities combined with hypertrophic lower lateral cartilage (LLC), medial crural overlay preceded above-mentioned treatment modalities. Results: Thirty-eight patients (22 female, 16 male) with pinch deformities underwent rhinoplasty between January 2017 and December 2022. Mean age was 27 years. Mean follow-up was 32 months. Fifteen patients had mild deformities. Cephalic resection was enough in four patients. Camouflage grafts were settled over ala in eleven patients. Twenty patients had moderate deformities; cephalic ala was bent over lower part and sutured. Two patients had severe deformities; lateral strut graft was settled between lower and bent cephalic alar parts. One patient had LLC hypertrophy/pinch deformity. LLC hypertrophy was corrected by medial crural overlay, and concavity was corrected with cephalic resection. Satisfactory shape, better valve passage obtained in all cases. Conclusion: Pinch deformity could be classified according to its severity and appropriate treatment options could be determined for each class. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .