Effect of modified auricle cartilage nasal septum extension stent on rhinoplasty / 中华医学美学美容杂志

Objective:To introduce a modified stent technique of nasal septal extension graft (SEG) with auricle cartilage, and to explore its effect on rhinoplasty.Methods:For 116 patients that underwent rhinoplasty, the cartilage of bilateral auricula was sutured with shell alignment and the dovetail was modified to prepare SEG stent; PTFE or silicone prosthesis was used for nasal dorsal graft. The patients were follow up for 6-18 months after surgery. A number of indicators including length of nose, tip projection, nasal tip and nasolabial angle morphology were used to assess surgical outcomes.Results:The 116 patients obtained satisfactory appearance immediately after operation. Length of nasal extension was 3-6 mm, tip projection was extended by 2-5 mm. Following up for 6-18 months showed stable effect (0.5-1.5 mm retraction) and satisfactory nose tip and nasolabial angle. The skin color was normal. No deformity occured in the ear cartilage donor area existed with no obvious scar.Conclusions:The modified SEG stent of auricle cartilage has good support and stability. It has a good effect on the slight and moderate extension of the short nose. In addition, the elevation of the nasal tip and the severe short nose of the first rhinoplasty and secondary rhinoplasty with mild contracture are also improved.

Application of perpendicular plate of ethmoid bone in short nose plasty in Chinese with insufficient septal cartilage / 中华医学美学美容杂志

Objective To evaluate the applied value of septal cartilage combined with perpendicular plate of ethmoid bone graft in short nose plasty in Chinese people with insufficient septal cartilage.Methods From February 2015 to March 2017,thirty-five women with short noses underwent septal extension grafting in our institute.We used perpendicular plate of ethmoid bone to enhance the L-strut structure.An L-strut,comprising 0.6 cm segments of the caudal and dorsal cartilaginous septum,was left altered to harvest more cartilages for septal extension.The harvested septal cartilage was grafted on one side of the caudal septum.Then the alar cartilage was fixed at the end of the septal cartilage graft.Nasal lengths and nasolabial angles were measured pre-and postoperatively.Results The average nasal lengthening was (3.37±1.87) mm (P＜0.001).There was no infection,cerebral spinal fluid leakage,hemorrhage and other complications postoperatively.The average follow-up was 10 months (6 months to 2 years).After operation,33 patients were satisfied with the nasal contour,1 patient complained of high tip projection whereas one patient complained of low tip projection,and the dissatisfactions were corrected by revision surgeries.Conclusions Combining the septal cartilage with perpendicular plate of ethmoid bone graft presents an adequate nose lengthening and a decreased nostril show,even in patients with very little septal cartilage.With minimum complications,this novel technique provides promising clinical outcomes and high patient satisfaction.

Clinical efficacy of short nose lengthening by using autologous costal cartilage / 中华医学美学美容杂志

Objective To explore the clinical efficacy of applying autologous costal cartilage in lengthening the short nose.Methods Bilateral extended spreader grafts (ESG) and columellar strut grafts were performed by using autologous costal cartilage in 253 patients with short nose,which increased nasal dorsal length and the support force of nasal tip;meanwhile,autologous costal cartilage was used for dorsal augmentation,alar rim retraction,and nasal tip modification.Results A total of 253 patients with short nose were satisfied with postoperative morphology,which presented elongated nasal dorsum,correction of nasal tip topspin,and normal nasal columella-lobular angle.6 months to 17 months follow-up was conducted,and nasal length and morphology showed stable,while 2 cases presented slight nasal tip decreasing,4 cases presented dorsal grafts warping;after revision surgery,the 6 patients had also got satisfactory results.Conclusions Correction of short nose using autologous costal cartilage can result in more stable nasal reconstruction structure,and can be used for the shape correction of other subunits of the nose,achieving at the comprehensive improvement of nasal morphology and functions.

Nasal tip plasty in insufficient-lining cases / 中华医学美学美容杂志

Objective To analyze the plasty of the tip framework and the nasal tip in insufficient-lining cases with auricular and septal cartilage.Methods The tip framework was formed by using septal extension graft (SEG) and columellar strut (CS) to construct the main framework of nasal tip,and then according to the size of the graft the next processes were chosen for supporting structure.When the graft size met the tip position,the caudal margin of the framework could be beyond the maximum stretch position of the lower lateral cartilage and reached or was close to the expected tip position.When the graft size was insufficient,auricular cartilage was used to hold the caudal margin of the framework to extend or to heighten the framework further.Refined plasty of nasal tip was as follows:when the end of framework was higher than or equal to the dome above 3 mm,auricular cartilage strip was used to reconstruct the dome;when less than 3 mm,multilayer onlay grafts were used to heighten the dome.Results From May 2013 to May 2015,42 cases were followed up from 6 months to 18 months.18 cases belonged to the type 1,including 13 cases using ear cartilage to reconstruct dome,5 cases using onlay graft;24 cases belonged to the type 2,including 14 cases using onlay graft and 10 cases using ear cartilage to reconstruct the dome.They all got good results.Conclusions To the insufficient lining cases,the appropriate method can be chosen to form stable tip framework according to the preoperative design and the graft size.Then onlay grafts or dome reconstruction technique is used to form the tip.Most of the insufficient-lining cases can get satisfactory results.

Lengthening the short nose with bilateral septal spreader graft and columellar strut / 中华医学美学美容杂志

Objective To investigate a safe and effective method of lengthening the short nose.Methods Thirty-nine cases of short nose were corrected by the bilateral septal spreader graft and columellar strut using autologous cartilage,combined with expanded polytetrafluoroethylene (e-PTFE)to reconstruct the supporting structures to improve the forward and upward strength of the nasal tip in order to increase the nasal length and to correct the over rotation of nasal tip.The shield and cap grafts were also used for the patients whose nasal tip were too low with vertical dome division technique.Results All the patients showed preserved nasal length after surgery with well-proportioned nasal features and the nasal lip angles were normal.There was no evidence of postoperative nasal shortening.No operative or postoperative complications were observed by follow-up for 6 months to 1 year,except for 2 cases with graft cartilage being apparent on nasal tip.All the patients were satisfied with the surgical results achieved.Conclusions It is necessary to provide powerful forward and upward strength to lengthen nose and correct the over rotation of nasal tip effectively and safely.The application of bilateral septal spreader graft and columellar strut using autologous cartilage and combined with e-PTFE represents a valuable tool for the short nose and proper cartilage grafts of nasal tip can improve the height of the nasal tip and further correct the over rotation of the nasal tip.

Application of autologous cartilage graft in plastic surgery of aesthetically short nose with low and blunt nasal tip / 中华医学美学美容杂志

Objective To explore more satisfactory results in correcting the aesthetically short nose combined with low and blunt nasal tip by using autologous cartilage grafts.Methods External rhinoplasty approach was preferred.Nasal septal cartilage and auricular cartilage or rib cartilage of patients were adopted,as necessary,various shapes of grafts were carved,such as septal extention graft,columella strut and shift graft.Then we used these autologous cartilage grafts with suture and removal techniques to correct the aesthetically short nose combined with low and blunt nasal tip.The length of the nose (n-prn) and the projection of nasal tip (sn-prn) were measured before and after the operation.Paired t-test was adopted to evaluate the results.Results Thirty-one patients accepted the nasal tip rhinoplasty with autologous cartilage whose nasal tip was over rotation,blunt and low.All the patients were followed up for 3 months.Thirty patients satisfied with the results,accounting for 96.7 ％ of the total.()ne (3.3 ％) patient dissatisfied with the result because of postoperative asymmetry nostrils.Nose length before and after surgery was significantly different (P＜0.05).Nasal tip projection before and after surgery was also significantly improved (P＜0.05).Conclusions It is an effective method to use autologous cartilage graft for correcting the aesthetically short nose combined with low and blunt na sal tip,with low complications.

Correction of short and upwardly rotated nose by transplanting autogenous rib cartilage / 中华医学美学美容杂志

Objective To discuss the effect of transplanting autogenous rib cartilage in correction of short and upwardly rotated nose.Methods A piece of autogenous rib cartilage was transplanted into the front of nasal septa to lengthen it,leading to the nasal tip moving forwards and correcting the short and upwardly rotated nose.For low nose cases,simultaneous implants was used into the nasal back.Results The nasal tips were prolonged 0.75 cm on average after operation in 56 patients with short and upturned noses.The nasolabial angle and extent of nostril exposure were normal after operation.The operational consequences were fine in 54 patients,while 2 case were not satisfactory.Efficacy was stable during one year follow-up.Conclusions This method is reliable,and it can be recommended in rhinoplasty of patients with short and upwardly rotated nose.

Elongating Asian nose with autologous septal cartilage / 中华医学美学美容杂志

Objective To employ autologous septal cartilage grafting as a new method of elongating the nose and adjusting the nasolabial angle in order to correct the deformities of short nose and bulbous tip.Methods A set of techniques,including,yet not limited to,releasing and sculpturing of the alar cartilages,harvesting of septal cartilages and carving them into L shape and cap-like shape for transplant,moulding the soft tissue envelop with buried through and through sutures etc.were used to lengthen the nose and modify the tip.Results From 2004 to now,the new technique had been applied to 345 patients with short nose and bulbous tip.Follow-up ranged from 6- 48 months,satisfactory outcomes were obtained.Conclusions The new technique adopted by the author in which autologous septal cartilages are settled to the anterior angle of the nasal septum and between the domes of alar cartilages has been proved to be a viable and reliable way to lengthen the nose.Further advantages of this technique include the easiness of harvesting grafts,minimal injury,rare complications of infection and rejection etc.

Various Surgical Procedures in the Scale of Upturned Nose

We should better not confuse "short nose" with "the nose that the tip of it turned upward regardless of its length". If we simply diagnose "the nose that the tip of it turned upward" as "short nose", we might have the risk of focusing on lengthening the whole nose instead of correcting the angle of the tip of the nose. We, therefore, started to call "the nose that the tip of it turned upward" differently from "short nose" in the cases of Asian patients who have relatively short and small noses. We then decided to classify "the nose that the tip of it turned upward" as "upturned nose". And, in revision cases, we have to be careful about changes of anatomical structures, and the usage of the amount of shared cartilages, we have to be fully aware of various operation procedures to correct upturned nose. Furthermore, we have to consider many other different ways of corrections that possibly need various types of grafts and suture techniques combined or modified from the usual procedures. We achieved satisfactory results by using this new paradigm of "upturned nose" and concepts of procedures to have the better result of reforming the "short nose".

Effects of Release of Tip Supporting Fibrous Tissues for Short Nose Correction

A short nose is one that extends less than one third of the vertical height of the face or whose distance from nasion to tip-defining point is short. Lengthening short noses has been regarded as one of the most challenging and at times vexing tasks in secondary nasal surgery. For correction of short nose, nasal tip supporting tissues from alar cartilages are released and nasal tip is positioned and fixed again. There are five important nasal tip supporting tissues, fibrous connection between upper lateral cartilage and lower lateral cartilage, hinge region(fibrous connection between lateral border of lateral crus and pyriform aperture), interdormal attachment to anterior septal angle (fibrous tissue between anterior septal angle and middle crus), fibrous connection between septum and foot plate of medial crus and dermocartilaginous ligament. This study is to find out which one of the five nasal tip supporting tissues is the most important in short nose correction except dermocartilaginous ligament which has to be released during rhinoplasty. We dissected ten noses from ten fresh cadavers. Five were male and five were female with an average age of sixty three for all ten. We measured the distance between anterior septal angle and tip-defining point in every step of soft tissue dissection releasing the alar cartilage and mucosa, that are often released in short nose corrections and caudally pulling them to the direction of tip-defining point. First, distances were measured in resting and in pulling of alar cartilage. Further, changed distance were measured after releasing nasal tip supporting tissues beginning from the dissection of soft tissues between lateral crus and upper lateral cartilage to that of mucoperichondrium underneath upper lateral cartilage and septal mucoperichondrium. In each process, we found the average and standard variation, confirmed effects of those values to the lengthening of short noses. Dissecting upper lateral cartilage and lateral crus of alar cartilage was most effective in short nose correction. We also found it effective to release the hinge area and dissect the mucoperichondrium under upper lateral cartilage in lengthening the short noses.

Lengthening of Short Noses

BACKGROUND AND OBJECTIVES: Lengthening of short noses is one of the therapeutic dilemmas in facial plastic surgery. Aesthetically, short noses are characterized by a decreased distance from the root of the nose to the tip-defining point, and this extends less than one third the vertical height of the face. Also, concavity of the dorsum, a low and deep nasion, an overprojected tip, and an obtuse nasolabial angle of the nose will give a shortened appearance. Considering aesthetical and facial analytic factors, we discuss three techniques for the correction of this problem and propose useful procedure for the desired effect of lengthening in this study. MATERIALS AND METHODS: We have experienced eleven cases of lengthening of the short nose during the last 2 years. We categorized these patients into three groups according to nasolabial angle and tip projection which make a distribution in selecting procedure. On-lay graft on the caudal margin of the lower lateral cartilage is used to the patients with mild overrotated tip and proper nasal projection. Cartilage graft between the caudal septum and the lower lateral cartilge combined with on-lay graft on the caudal margin of the lower lateral cartilage is used to the patients with moderately overrotated tip. Full-length dorsal augmentation is applied to the patients with severely overroatated tip and problematic tip projection. RESULTS: We used three techniques aimed at the correction of the short nose. These techniques treated short nose patients and we obtained effective substantial lengthening results in this study. CONCLUSION: Aesthetical and facial analytic factors must be considered in properly selecting a procedure to lengthen the short nose.

Nasal deformities and their treatments in the leprosy patients (I) / 나학회지

Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.