Lateral Crural Strut Grafts

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.

Lateral crural strut grafts are a rhinoplasty technique used to address problems of the lower lateral cartilages — the paired cartilages that form and support the nasal tip and alar sidewalls. They are used for both functional and structural purposes and are among the most versatile grafts in rhinoplasty surgery.

What Are the Lateral Crura?

The lower lateral cartilages consist of two portions — the medial crura, which form the columella and central tip support, and the lateral crura, which extend outward to form the alar rims and provide structural support to the nasal sidewalls and external nasal valve. The shape, position, and orientation of the lateral crura have a significant influence on both the appearance of the nasal tip and the function of the external nasal valve.

When the lateral crura are curved, malpositioned, or insufficiently strong, the result can be external nasal valve collapse during inspiration, a bulbous or poorly supported tip appearance, or both.

Lateral crura — nasal tip anatomy

What Do Lateral Crural Strut Grafts Do?

Treat external valve collapse

By stiffening and supporting the lateral crura, the graft prevents the alar sidewall from collapsing inward during inspiration. This is the primary functional indication.

Correct internal recurvature

Where the lower lateral cartilages curve inward into the nasal airway — a condition called internal recurvature — the strut graft straightens and repositions the cartilage, restoring the external nasal valve and improving airflow.

Flatten and reposition the lateral crura

Curved lateral crura produce a poorly defined or wide-appearing tip. The strut graft — sutured to the undersurface of the lateral crura — flattens and straightens them, which can improve both tip definition and alar contour.

Provide structural support after reduction

Where the lateral crura have been weakened by a cephalic trim (removal of the upper portion of the cartilage to refine the tip), strut grafts restore adequate structural support to prevent long-term alar retraction or valve collapse.

What Are the Grafts Made From?

Lateral crural strut grafts are made from a straight, relatively firm piece of cartilage — typically septal cartilage (first preference) or rib cartilage. The graft is carved into a rectangular strip of appropriate length and width and sutured to the undersurface of the lateral crus in a precise pocket.

Lateral crural strut graft position — frontal and profile views

Dr Roth’s Clinical Perspective

Lateral crural strut grafts are one of the techniques that has been partially superseded in my practice by lateral crural tensioning for bulbous and boxy tip correction — LCT achieves the repositioning and stiffening of the lateral crura without adding graft bulk to the nasal sidewall. That said, lateral crural strut grafts remain an important technique where there is genuine structural deficiency in the lateral wall — in revision cases where lateral crural cartilage has been over-resected, or where the wall is too weak to support tensioning alone. Understanding which approach is appropriate for a given anatomy is the decision that determines the outcome.

— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS

Dr Jason Roth — Specialist Otolaryngologist Sydney

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Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.

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Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.

Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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