Comparison of 1 Year Nasal Tip Projection Results of Triple Cartilage Combining Suture (Flexible Tongue-in-Groove) and Classical Tongue-in-Groove Techniques.

Objectives: In the present study, we compared patient satisfaction with classical tongue-in-groove (TIG) technique and triple cartilage combining suture (TCCS; flexible tongue-in-groove) techniques applied to the nasal tip in rhinoplasty. Methods: In this retrospective study, 80 patients who underwent rhinoplasty operations with TIG or TCCS techniques applied to the tip region were included. There were 40 patients in both groups. All patients in groups 1 and 2 were evaluated by the criteria written below at preoperative, postoperative first month, and postoperative first year: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. Results: The patients were followed up at 84.32 ± 19.38 months in the TIG group and 87.47 ± 18.01 months in the TCCS group. Our results showed that preoperative, postoperative first-month, and first-year tip projection (P = .013, P = .022, and P = .020, respectively), and nasal dorsum length values (P = .009, P = .020, and P = .020, respectively) of the TCCS group were significantly lower than those in the TIG group. There was a positive correlation between the postoperative first month and postoperative first year ROE scores. Lower preoperative tip projection ratio (Goode) values and higher nasolabial angle values were related to higher ROE scores showing patient satisfaction. Conclusion: For the patient satisfaction after tip rhinoplasty, lower projection ratio (Goode) and higher nasolabial angle values were related to ROE scores. Although there are no significant results, lower tip projection results in the TCCS group may be related to more patient satisfaction due to natural appearance.

Evaluation of the Influence of Nasolabial Angle, Upper Sulcus Depth, and Nasal Tip Protrusion in the Perception of Facial Attractiveness.

Objective: To evaluate the influence of variations in the upper sulcus depth, nasal tip protrusion, and nasolabial angle on the esthetic perception of profiles. Design: A web-based survey study and was conducted in the Department of Orthodontics and Dentofacial Orthopaedics. This survey was conducted for a period of 10 months and included orthodontists practicing in India. Methods: This study included lateral cephalograms of the most esthetic profiles from a set of 30 profiles that were within Holdaways norms; the most esthetic profile was determined by a panel of two orthodontists and two general dentists. The most esthetic profile photograph will be transferred to a computer in Corel software. The outline of the profile will remain the same, with the inner aspect converted into a dark area (black); now, the profile is completely converted into facial silhouettes. This black facial silhouette is presented to avoid any distractions and bias. There will be a total of 27 silhouettes by various combinations of increased, decreased, and normal values for nasolabial angle, upper sulcus depth, and nasal tip protrusions. Results: Both the orthodontist and layman chose the most favored profile as a normal profile having a normal nasal tip, normal nasolabial angle, and normal upper sulcus depth, whereas among dentists, 50% chose the most favored profile in which the nasolabial angle was normal but the nasal tip and upper labial sulcus were decreased. When it comes to the least favored profiles, opinions varied between orthodontists, dentists, and laymen. Conclusion: The perception of facial esthetics has always been and still is varied between the layman, the dentist, and the orthodontists. Profiles with normal to sharp noses with normal and increased nasolabial angles were considered more attractive than the others. Profiles with fuller upper labial sulci were considered least attractive with other parameters changing.

Evaluation of the External Soft Tissue Changes Following the Correction of Class II Skeletal Malocclusion in the Adolescence Period Using Removable and Fixed Functional Appliances: A Systematic Review and Meta-Analysis.

In this systematic review, we aimed to assess the current evidence regarding the effectiveness of functional treatment with both removable and fixed appliances to normalize the external soft tissue for skeletal class II adolescent individuals. We performed a broad electronic search to retrieve relevant studies from nine databases to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated soft tissue changes following functional treatment and evaluated the changes using 2D lateral cephalometric radiographs and 3D-optical surface laser scanning. A total of three RCTs and eight CCTs were included. Ages ranged from 11 to 16 years with the fixed functional appliances, and from eight to 12 years with the removable ones, including 689 skeletal class II patients. Version 2 of Cochran's risk-of-bias (RoB2), and the risk of bias in non-randomized studies of interventions (ROBIN-I) were used to assess the risk of bias for the included papers. Of the 11 eligible studies, three studies were included in the meta-analysis to assess the upper and lower lip position in relation to the E-line (Ricketts's aesthetic line) in addition to the nasolabial angle. The meta-analysis showed that the upper lip retracted after functional treatment with Twin-block in relation to E-line (mean difference (MD) = -1.93; 95% CI: -2.37, -1.50; p < 0.00001; χ² = 5.43; p = 0.07; I2 = 63%), while the lower lip position did not change after functional treatment with Twin-block in relation to E-line (MD = 0.03; 95% CI: -0.56, 0.61; p = 0.92; χ² = 1.74; p = 0.42; I2 = 0%). The nasolabial angle increased after Twin-block treatment (MD = 5.75; 95% CI: 4.57, 6.93; p < 0.00001; χ² = 6.77; p = 0.03; I2 = 70%). The mentolabial angle and Z-angle also increased after functional therapy, where the facial convexity angle decreased, regardless of the functional devices used. On the other hand, using the 3D-optical surface laser scanning showed that the upper lip length and the commissural width did not change following therapy, but the lower lip increased in length, as well as the total face height. More high-quality RCTs are required to obtain accurate evidence in this field.

Reconsidering the role of nasolabial angle in premolar extraction decision-making: A case-series study.

OBJECTIVES: To evaluate the impact of changes in upper incisor inclination and position on the alteration of the nasolabial angle (NLA) in a series of cases involving the extraction of four first premolars. MATERIALS AND METHODS: The study included 41 patients who underwent orthodontic treatment with premolar extractions. The patients were divided into two groups based on their pretreatment NLA values: Group 1 (NLA ≤ 100°) and Group 2 (NLA > 100°). Measurements of NLA, U1.NA and U1-NA were obtained before and after treatment and U1-Ls pretreatment measure was registered. Statistical analyses were performed to compare the differences in NLA, U1.NA and U1-NA between the two groups and to evaluate the influence of these variables added to U1-Ls (T1) on NLA changes. RESULTS: The results showed that Group 1 exhibited significant changes in NLA, while Group 2 did not. However, both groups showed significant changes in U1.NA and U1-NA. In Group 1, 80% of the individuals presented an increase in NLA and 20% no changes. In Group 2, 10% presented a decrease, 57% no changes and 33% an increase in NLA values. Multiple linear regression analysis indicated that the group factor had a statistically significant influence on NLA variation. Additionally, in Group 2, a negative correlation was observed between changes in U1.NA and NLA. CONCLUSIONS: The findings suggest that individuals with higher pretreatment NLA values tend to maintain their NLA values even after the correction of upper incisor inclination.

Using the Novel "3D-Ortho" Concept to Achieve a Beautiful Asian Face.

It has become more common for adult patients to seek conflicting orthodontic results, such as the reduction of the buccal corridors by arch form expansion and achieving esthetic-line (E-line) harmony by moving the anterior teeth backward using the extraction space. Therefore, the author devised and implemented the novel "3D-Ortho" concept to achieve the abovementioned conflicting results and solve the requirement of facial beauty. The patient was a 23-year-old female with mouth protrusion. The author used the 3D-Ortho concept to provide orthodontic treatment. A maxillary skeletal expander appliance and the extraction of the maxillary first premolar were performed, and a multi-bracket device was placed on the buccal aspect to decrease Mx1 to point A-pogonion line (APo) by full class II molar relationship finishing. Postoperatively, the nasolabial angle was increased from 83.4° to 93.1°, the E-line to upper lip distance decreased from 2.6 mm to -1.1 mm, the Mx1 to Apo distance decreased from 13.6 mm to 7.5 mm, the distance between the mesial buccal cusp of the mandibular first molars increased from 41.2 mm to 45.2 mm, the inclination of the mandibular first molar incisor changed from 21° to 11° on the right side and from 21° to 9° on the left side, and the improvement of the buccal corridors was observed; thus, significant improvement was observed in these parameters. Therefore, the novel orthodontic treatment method showed good results in solving problems unique to Asians, incorporating occlusal stability and facial beauty harmony.

Asociación entre la inclinación sagital del incisivo central superior y el ángulo nasolabial en ortodoncia / Association between the sagittal inclination of the maxillary central incisor and the nasolabial angle in orthodontics

Objetivo: determinar si existe asociación entre la inclinación del incisivo central superior y el ángulo naso-labial de Legan. Materiales y métodos: se utilizaron las telerradiografías laterales de cráneo de 20 pacientes entre 18 y 39 años, obtenidas al inicio y final de su tratamiento ortodóncico, para un análisis cefalométrico. El total de medidas obtenidas se ordenó en dos tiempos. Tiempo 1 (T1) incluyó la medición del ángulo plano biespinal-eje mayor del incisivo superior (AiT1) y del ángulo naso-labial (AnlT1) en las radiografías tomadas previo al tratamiento y tiempo 2 (T2) incluyó la medición de los mismos ángulos en las radiografías tomadas al finalizar el tratamiento (AiT2 y AnlT2 respectivamente). Los datos obtenidos fueron tabulados y analizados estadísticamente. Resultados: la muestra presentó distribución normal, por lo que se aplicó el test de correlación de Pearson, para determinar si existía asociación entre ambas variables (Ai y Anl) en T1 y T2, obteniendo como resultado un valor de R=0,5. Conclusión: no existe asociación estadística entre la variación en la inclinación del incisivo central superior y el Ángulo naso-labial de Legan.

Aim: to determine if there is an association between the inclination of the upper central incisor and the nasolabial Legan angle. Materials and methods: lateral head radiographs of 20 patients between 18 and 39 years old, obtained at the beginning and end of their orthodontic treatment, were used for a cephalometric analysis. The total of measurements obtained was ordered in two times. Time 1 (T1) included the measurement of the bispinal plane angle-major axis of the upper incisor (AiT1) and the nasolabial angle (AnlT1) in the radiographs taken before treatment and time 2 (T2) included the measurement of the same angles, in the radiographs taken at the end of the treatment (AiT2 and AnlT2 respectively). The data obtained were tabulated and statistically analyzed. Results: the sample presented a normal distribution. So, the Pearson correlation test was applied to determine if there was an association between both variables (Ai and Anl) in T1 and T2, obtaining a value of R=0.5 as a result. Conclusion: there is no statistical association between the variation in the inclination of the upper central incisor and the nasolabial Angle of Legan.

Relationship between Selected Cephalometric Parameters, Nasolabial Angle and Its Components in Adolescent Females.

Nasolabial angle is commonly used to assess the soft tissue profile of the subnasal region. The aim of this retrospective study was to evaluate the relationship between the nasolabial angle, the inclination of the lower border of the nose and upper lip, upper incisor inclination and upper lip thickness. A sample of 142 female adolescents aged 13-18 years was chosen. A modified cephalometric analysis was performed with the nasolabial angle, and its components were traced according to Fitzgerald's method. All analysed parameters showed a statistically significant correlation with the nasolabial angle (NLA). The highest correlation was found for the labial (L/FH) and nasal (N/FH) components of the nasolabial angle, respectively. Upper incisor inclinations (1+:SN, U1FA) and upper lip thickness (ULT) had a stronger correlation with L/FH than NLA, but no correlation was found between these parameters and N/FH. Upper lip thickness did not influence the relationship between incisor inclination and NLA or L/FH. The position of the upper incisors and upper lip thickness influence the nasolabial angle indirectly through its labial component (L/FH). Therefore, it seems purposeful to assess the nasolabial angle as a sum of two independent angles, of which only one (L/FH) can be influenced by orthodontic treatment.

Novel method for correcting cephalic rotation in Asian nasal tip plasty.

BACKGROUND: To correct nasal tip cephalic rotation, SEG made of cartilage or Medpor are often used in rhinoplasty. These techniques require extensive experience for the surgeon, and not all patients can accept this procedure. In this research, we introduce a new method to correct nasal tip cephalic rotation that is relatively simple and rapid. METHODS: Fifty-nine patients who had rhinoplasty using our scaffold were enrolled in the study between January 2020 and January 2021. The authors evaluated the change of nasolabial angel by photogrammetry using standardized clinical photogrammetric techniques. Patients' satisfaction regarding postoperative results was also surveyed. RESULTS: The mean postoperative follow-up duration was 12 months. No complication (infection, extrusion, and displacement) was happened in all patients. Analysis showed our scaffold can correct nasal tip cephalic rotation effectively (98.61±1.21 preoperatively and 89.68±0.99 postoperatively, P<0.0001). And the patient satisfaction rate is 98%. CONCLUSION: We constructed an integrated scaffold by simply folding and suturing a high-density polyethylene sheet (Su-Por) sheet to correct nasal tip cephalic rotation. Using the scaffold we designed, we did not need to alter the structure of the nasal septum, which reduced the operative duration and simplified the surgical procedure.

Characteristics and Dynamics of Smile in Patients With Skeletal Class II Malocclusion Versus Class I Malocclusion Using Still Digital Video Captures: A Three-Group, Cross-Sectional, Comparative Study.

Background Smiling is one of the effective ways for people to express their feelings. It is an integral part of the diagnosis and planning and a key point of the treatment objectives in orthodontic care. Many factors are associated with a pleasant smile, such as correct anatomy, gingival health, and teeth proportion. Therefore, different malocclusion classes can affect the characteristics of smile esthetics. This study aimed to evaluate the effect of skeletal class II malocclusion on the characteristics and dynamics of the smile in the sagittal and frontal planes. Methodology The study sample included 60 patients comprising three groups of malocclusion classes, namely, Class I, Class II division 1, and Class II division 2. A video recording was taken for 5-10 seconds for each patient using a specific camera mounted at a fixed distance from the imaged face. Two facial expressions were captured for each patient, one representing the lips at rest and the second representing the unrestricted natural smile. The facial still images were derived from the streaming video recording, and two images were chosen for each plane (the frontal plane and the sagittal plane) for each patient. In total, 12 variables were assessed on these captured images. One-way analysis of variance (ANOVA) was used to detect significant differences between the three groups. Results There were statistically significant differences in some of the measured variables. The mean values of thickness of the upper lip, commissure height, gum width, maxillary incisor display, and interlabial gap were greater in the Class II division 1 group than in the other two groups. The proclined incisors were evident in the Class II division 1 group, while the retroclined incisors were evident in the Class II division 2 group. Conclusions The skeletal Class II malocclusion influences the characteristics of the smile, either assessed on the anterior or lateral imaging angles, in addition to its influence on the resting position of the lips. Orthodontists should always analyze patients' facial expressions, including those related to the upper and lower lips at rest and when patients smile naturally. Depending on the results of this analysis, treatment planning could be built to improve the characteristics of the natural smile in patients with Class I and Class II malocclusions.

Lip Lifting Efficacy of Hyaluronic Acid Filler Injections: A Quantitative Assessment Using 3-Dimensional Photography.

The study aimed to compare the volume enhancement and the lifting capacity of two different hyaluronic acid gels for lip injection. Thirty-six Korean female patients were randomized into two groups according to the cross-linking degree of the hyaluronic acid filler injected. Using a fixed injection protocol, patients were injected with 1 mL of hyaluronic acid filler in the lips and followed up at four and 12 weeks after injection. Lip volume, lip projection, and columella-labial angle were measured using a 3-dimensional imaging system at each time point. Follow-up values were compared with baseline. Compared with pre-treatment values, there was a statistically significant increase in mean lip volume and lip projection at four and 12 weeks after injection, with no significant differences between the two groups. Lips injected with hyaluronic acid filler of intermediate cross-link density resulted in more acute angles than lips injected with lightly cross-linked hyaluronic acid. The difference was statistically significant at each follow-up time point. No serious complications were observed throughout the study period. Our results imply that in patients who want a prominent upper lip lift, lip injections using hyaluronic acid fillers with intermediate cross-linking density can be a good option due to their lift capacity. The degree of cross-linking may not be a significant determinant of simple lip volume augmentation when other variables are constant.

Columellar strut grafts versus septal extension grafts during rhinoplasty for airway function, patient satisfaction and tip support.

IMPORTANCE: Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice. OBJECTIVE: Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs. MAIN OUTCOMES AND MEASURES: Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon's ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability. RESULTS: A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ "obstructed" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG. CONCLUSION AND RELEVANCE: While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance.

Relationship of Nasolabial Angle with Maxillary Incisor Proclination and Upper Lip Thickness in North Indian Population.

Aim: The aim of the study was to evaluate the relationship between nasolabial angle (NLA) with maxillary incisor proclination (U1-NA) and upper lip thickness (ULT). Materials and methods: Pretreatment lateral cephalometric radiographs of 120 patients were taken, and NLA, U1-NA, and basic ULT measurements were obtained for each patient. Descriptive statistics were calculated for all the variables involved in the study. The correlation was found using the Pearson correlation coefficient (r) test. p < 0.01 was considered statistically significant. Results: The mean values of NLA, upper incisor proclination, and ULT were found to be 91.38° ± 7.10°, 34.21° + 5.17°, and 15.38 ± 1.76 mm, respectively. r (r = -0.583) was found between NLA and upper incisor proclination and (r = -0.040) for NLA and ULT. Conclusion: There is a statistically significant relationship between NLA and U1-NA. How to cite this article: Garg H, Khundrakpam D, Saini V, et al. Relationship of Nasolabial Angle with Maxillary Incisor Proclination and Upper Lip Thickness in North Indian Population. Int J Clin Pediatr Dent 2022;15(5):489-492.

The Nasal Tip Rotation After Primary Rhinoplasty Using Columellar Strut Graft.

OBJECTIVE:  In this study, we aimed to investigate the degree of nasal tip rotation three months after rhinoplasty using columellar strut graft. METHODS:  Using photographs of 25 patients who underwent rhinoplasty, we prospectively analyzed nasal tip rotation before, during, and after three months of the surgery. Columellar strut graft was used for all patients for tip support. Standardized left profile images were taken. For evaluation of tip rotation, the nasolabial angle was measured. The results were statistically compared, and a p value less than 0.05 was considered statistically significant. RESULTS:  The mean preoperative nasolabial angle (NLA) for the entire group was 91.44°, and the directly postoperative angle measured 108.84°. The mean of postoperative nasolabial angles measured at three-month follow-up was 97.2°. The preoperative, directly postoperative, and three-month postoperative nasolabial angles were all recorded. CONCLUSION:  Considering the results of this study, a postoperative nasolabial angle is increased compared to preoperative angle. However, an occasional dropping of the angle might be seen in following months, which can be linked to several factors.

A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty.

INTRODUCTION: Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended columellar strut graft, tongue in groove, columellar strut graft, and tip rotation sutures. This study aimed to evaluate changes in nasal tip support after modified tongue-in-groove technique (auto-septal projection graft). MATERIALS AND METHODS: Forty-two patients who underwent a primary open approach septorhinoplasty using the modified tongue-in-groove technique between June 2017 and March 2019 were retrospectively analyzed. Postoperative and preoperative photographs were analyzed, and nasolabial angle and the nasal tip projection ratio were recorded and compared before and average of 17.3 months after the surgery. RESULTS: Forty-two patients (33 female and 9 male) were included the study. The mean nasolabial angle was 85.7° preoperatively and 99.3° postoperatively. The nasal tip projection ratio was 0.60 preoperatively and 0.64 postoperatively. Both the tip rotation and the tip projection increased significantly after the modified tongue in groove (p<0.05). CONCLUSION: It seems that modified tongue-in-groove method (auto-septal projection graft) is an effective technique in maintaining tip projection and rotation in rhinoplasty and safe method to correct droopy nasal tip in selected cases. 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 www.springer.com/00266 .

Meta-analysis dataset comparing orthodontic mini-implants and conventional anchorage reinforcement for maximum orthodontic anchorage.

The present article describes data from systematic review and meta-analysis investigating the efficacy and safety outcomes comparing mini-implants (MIs) and conventional anchorage reinforcement in patients with maximum dentoalveolar protrusion. All relevant RCTs and non-RCTs published up to 2018 were collected from PubMed, Embase and Cochrane database. Thirteen studies assessing the effect of mini-implants were included, of which 4 were randomized controlled trials (RCTs) and 9 observational studies. The efficacy parameters include mesiodistal movements of molars and incisors and vertical movements of molars and incisors. Whereas, the safety parameters were angular and linear measurement of soft tissue change. Subgroup analysis data was provided in terms of patients average age (<18 years and ≥18 years) at the initiation of treatment. This dataset is suitable for research purpose in the field of orthodontics and also helps dental doctors to determine their treatment preferences in the choice of anchorage reinforcement.

The effect of the tongue in groove technique on the nasolabial angle and nasal tip projection.

BACKGROUND: The tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society. METHODS: This is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation. RESULTS: Fifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant (P = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant (P < 0.01). CONCLUSION: The study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation.

"Modified tongue-in-groove": a new tip-plasty technique and comparison of its effect on correction of the nasolabial angle with the columellar strut technique.

Ptosis of the nasal tip is one of the most challenging aspects of rhinoplasty, and the tongue-in-groove (TIG) and the columellar strut (CST) techniques are the two most common procedures used to improve it. The purpose of this study was to introduce a new modification of TIG, to evaluate the long term results of the modified TIG, and to compare its effect on correction of the nasolabial angle with that of the CST. Eighty patients with droopy nasal tips (all female, aged <40 years) were divided into two groups of 40 each according to the technique used for correction (modified TIG or CST). The nasolabial angle was recorded preoperatively, immediately postoperatively, and after one year. The mean was 90.80° in the modified TIG group and 94.87° in the CST preoperatively, which did not differ significantly (p=0.056). Immediately postoperatively, it was significantly higher in the CST group (116.92° compared with 107.10°, p=0.01), but at the one-year follow-up, the droop was similar in both groups (-7.35° in the modified TIG, and -7.48° in the CST group, respectively, p=0.942). Both techniques significantly increased the nasolabial angle postoperatively (p<0.001 in both cases). This study showed that the modified TIG is a reliable and effective technique for reconstructing and correcting a droopy nasal tip, and its long-term efficacy is comparable with that of CST.

Open rhinoplasty using a columellar strut: effects of the graft on nasal tip projection and rotation.

BACKGROUND: Despite the discordance in the literature concerning the effect of columellar strut grafts on nasal tip rotation, this method is often used when an increase in nasolabial angle or nasal tip projection is desired. OBJECTIVES: We aimed to elucidate the change in nasolabial angles and nasal tip projections after exclusive columellar strut graft implantations and in addition to other surgical steps. Furthermore, differences in these parameters between patients with conchal and septal columellar strut grafts were investigated. METHODS: A monocentric retrospective cohort study of 173 open septorhinoplasties with columellar strut graft technique, between 2006 and 2016, was conducted. The pre- and postoperative nasal tip projection, nasolabial and nasofrontal angle and interalar distance were determined and the Goode-ratio was calculated. RESULTS: In cases where uprotation was not specifically desired, neither nasolabial angles nor tip projections changed significantly, irrespective of whether a columellar strut graft was used alone or with additional surgical steps. If an uprotation through surgery was desired, a significant mean increase in nasolabial angle of 4.4° was achieved. Furthermore, conchal instead of septal columellar strut grafts showed significantly better results. CONCLUSION: In our study, a columellar strut graft-without any additional surgical step-does only have an improving impact on nasal tip rotations and projections, if specifically intended to by the surgeon. In other words, if the strut graft was not chosen for an uprotational intention, it did not relevantly impact on the nasolabial angle or nasal tip projection. However, in patients where an uprotation is desired, the columellar strut graft still represents a meaningful tool. Since conchal instead of septal columellar strut grafts showed better results, we suggest using them for these patients. LEVEL OF EVIDENCE: 2b.

Soft Tissue Changes in Patients With Dentoalveolar Protrusion Treated With Maximum Anchorage: A Systematic Review and Meta-analysis.

OBJECTIVE: This meta-analysis aimed at comparing the angular and linear changes of soft tissue profile using conventional anchorage techniques and mini-implant (MI)-based space closure in patients with dentoalveolar protrusion. MATERIALS AND METHODS: Electronic databases, viz. PubMed, Embase, and Cochrane Central Register of Controlled Trials, were searched for relevant literature from their inception to December 2017 according to the specific inclusion and exclusion criteria. The following Medical Subject Heading terms were used for searching: "skeletal anchorage", "temporary anchorage devices", "miniscrew implant", "mini-implant", "micro-implant". Selected randomized control trials (RCTs) were assessed for their quality using Cochrane's Risk of Bias Tool, whereas the Newcastle-Ottawa scale was used for non-RCTs. Standardized mean difference (SMD) and 95% confidence interval (CI) were obtained with either fixed- or random-effects models based on the heterogeneity of the included studies. RESULTS: A total of 5 articles (2 RCTs with moderate risk of bias and 3 high-quality non-RCT studies) were included in the final analysis. The nasolabial angle had significantly greater changes in the MI group than in the conventional anchorage group (SMD = 0.68, 95% CI = 0.39 to 0.97, P < .0001). Significantly higher retraction of the upper lip was seen in the MI group than in the conventional group (SMD = -0.51, 95% CI = -0.84 to -0.18; P = .002). No significant difference was seen in the facial convexity (SMD = -0.34, 95% CI = -0.76 to 0.07, P = .106) and lower lip retraction (SMD = 0.28, 95% CI = -1.72 to 2.28, P = .784) between the groups. CONCLUSION: It was seen that MIs facilitated favorable soft tissue profile than the conventional anchorage devices. However, more high-quality studies are warranted to confirm the clinical effectiveness of MIs.

Optimising Results of Nasal Tip Rotation Applying Combination of Nasolabial Angle and Lip-Columellar Angle in Tandem in Patients Operated by "Cock-up" Alar Cartilage Flaps Technique.

Background Setting the angle of tip rotation is of utmost importance in achieving satisfactory results in rhinoplasty. Conventionally the upward rotation of the tip requires shortening of the septum by caudal resection and shortening of the lateral walls by cephalic trim of the alar cartilages. The results are usually assessed subjectively. We describe the use of objective parameters to ensure accuracy of nasal tip rotation in patients operated with "cock-up" alar cartilage flaps, a modification of the cephalic trim. Methods Fifteen patients with a long nose having adequate width of lateral crura, desiring a shorter nose with upward tip rotation, were included in the study. Values of preoperative and desired nasolabial angle (from morphed images), and the derived columellar-labial angle were documented. Nasal tip rotation was set to the derived angle and maintained using cock-up alar cartilage flaps. The outcome was evaluated by digital measurements of the nasolabial angle and patients' feedback by Rhinoplasty Outcome Evaluation (ROE) score. Results Satisfactory tip rotation and an aesthetic supratip area could be achieved. The difference in preoperative and postoperative nasolabial angles was statistically significant (p value < 0.0001). The difference in desired and the obtained nasolabial angle was not significant (p value 0.085). The results were maintained on subsequent follow-up. Conclusion Application of angles in practice and use of K-wire template helps us achieve accurate and consistent results. Cock-up flap is an effective technique-to obtain an open nasolabial angle and a desirable supratip region by making use of tissues otherwise discarded.