Isolated congenital lower lateral cartilage (LLC) anomalies are incidental intraoperative findings that challenge surgical planning. Despite their role in external nasal valve (ENV) support, variable clinical presentation suggests the existence of compensatory mechanisms that warrant further investigation. We evaluate the available evidence on isolated congenital LLC deficiency to explore reported preoperative nasal valve dysfunction and surgical outcomes, with the hypothesis that the available evidence demonstrates an association between isolated congenital LLC deficiency and nasal valve dysfunction. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and case series. A systematic search of three databases was undertaken to identify reports of isolated congenital LLC deficiency. Studies without intraoperative confirmation and those involving pediatric populations were excluded. The validated Joanna Briggs Institute (JBI) Critical Appraisal Tools and Case Report Guidelines were used to assess evidence quality. Fifteen studies (n = 18) were eligible, comprising 14 case reports and one case series. Unilateral involvement was most common (n = 16), with the middle crus most frequently affected. Eight patients were asymptomatic. Only three studies were rated as high quality (JBI: 6–7/8). In our case series, the incidence of isolated congenital LLC absence was 0.002, and lateral crus absence was asymptomatic, whereas absence of the medial and middle crura was associated with dynamic ENV collapse. These observations are hypothesis-generating, suggesting a greater functional role for medial crus integrity in nasal valve competence, with lateral crus absence appearing more consistently asymptomatic across the literature. Potential compensatory mechanisms may help preserve nasal valve function despite isolated LLC deficiency, a rare anomaly that underscores the need for intraoperative preparedness and tailored reconstruction when encountered incidentally.

Background/Objectives: This article brings forward a novel methodology for the intra-op approach of forearm amputation stumps to facilitate their subsequent wireless connection to a neural prosthesis. A neural prosthesis offers the amputee more motor functions compared to myoelectric prostheses, but the neural prosthesis must be connected to the patient’s stump nerves. Methods: An experimental animal study was conducted on 15 Wistar rats. Under anesthesia, the sciatic nerve was carefully dissected and preserved using a folding technique to maintain maximum length without tension. Nerves were repositioned with consideration for future use with biocompatible conduits. Morphometric measurements (nerve length, external diameter, fascicle count) were performed, followed by statistical analysis of length–diameter correlations. Results: The techniques show that the length of the nerves in the amputation stump can be preserved and integrated into the muscle masses with appropriate methods and biomaterials, which ensures the transmission of motor impulses to control the movements of a prosthesis. Fibrosis and mechanical injury have a lower risk of occurring with the nerves protected in the muscle mass. Through statistical analysis we find that sciatic nerve length and diameter have a positive correlation (r = 0.71, p = 0.003), supporting anatomic plausibility for human extrapolation of results. Conclusions: The amputation technique preserves much of the nerve length and viability and is simple to perform. Neural electrode implantation can be facilitated by folding the nerve within a large muscle mass and using biomaterial conduits. Better rehabilitation of the patient may occur with the use of a prosthesis equipped with more functions and superior control.

The internal nasal valve (INV) is a key determinant of nasal airflow and is dependent on middle vault integrity. While spreader grafts remain the gold standard for reconstruction, the spreader flap offers a tissue-preserving alternative. This study evaluates outcomes of a modified spreader flap tension suture technique with composite flap elevation in 580 patients, with the hypothesis that this approach yields favorable functional improvements. Retrospective cohort study. Patients who underwent the described procedure were retrospectively identified. Inclusion required a dorsal hump reduction of >3 mm in all cases. Patients were stratified into three groups according to clinical presentation: those undergoing dorsal refinement alone, those with concurrent septal deviation or turbinate hypertrophy, and those with primary INV insufficiency. Prior dorsal rhinoplasty or significant septal deviation were exclusion criteria. Pre- and postoperative (6 months) peak nasal inspiratory flow (PNIF) measurements and visual analog scale (VAS) scores were compared to evaluate objective and subjective functional improvement, respectively. The dorsal refinement group (n = 362) demonstrated stable functional outcomes, with a mean VAS improvement of 2 points. The septal deviation/turbinate hypertrophy group (n = 158) had a mean PNIF increase of 27 L/minute and a 3.5-point VAS improvement, while the INV insufficiency group (n = 60) showed greater gains (PNIF +35 L/minute; VAS +5 points). The modified spreader flap is an effective, cartilage-preserving technique for INV reconstruction, yielding consistent functional and aesthetic outcomes. Further controlled studies are required to assess long-term results.

The resting angle forms between the lateral crus of the lower lateral cartilage (LLC) and the upper lateral cartilage. While conventional nasal valve repair relies on cartilage grafting for reinforcement of these structures, the functional significance of resting angle adjustment remains underexplored. We describe a technique to reposition the LLC, adjusting the resting angle to support the lateral nasal wall and restore external nasal valve (ENV) function without grafts, with the hypothesis that this approach improves functional and aesthetic outcomes. Retrospective cohort study. We retrospectively identified patients with ENV collapse-related nasal obstruction who underwent the described surgery. Pre- and postoperative peak nasal inspiratory flow (PNIF) measurements and FACE-Q scores were compared to evaluate functional and aesthetic improvement, respectively. Thirty patients (22 female, 8 male) were included. Postoperatively, median PNIF increased from 74.0 L/minute (interquartile range [IQR]: 73.0–76.0; 95% confidence interval [CI]: 72.5–75.5) to 96.0 L/minute (IQR: 93.0–97.0; 95% CI: 94.0–97.5), and median FACE-Q Satisfaction with nose scores from 17 (IQR: 16.0–18.0; 95% CI: 16.0–17.5) to 37 (IQR: 35.0–38.0; 95% CI: 36.5–37.5); both improvements were statistically significant (p < 0.001). Resting angle correction may not only improve aesthetics, but also stabilize the lateral nasal wall to prevent or repair ENV collapse.