ABSTRACT
BACKGROUND: This study introduces and assesses the outcomes of a novel rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), employing a combined open and closed approach with tip anatomy conservation and structured tip support. METHODS: The procedure involves a low stairstep columellar sectioning, followed by transmembranous and intercartilaginous incisions without skin dissection in the columella or tip. Elevating the entire mobile nose as a three-layered flap provides extensive access to the entire nasal pyramid and septum. Tip modifications, including retrograde cephalic cartilage resection and supratip skin thinning, are performed based on individual cases. A key columellar strut is frequently used, initially sutured in the interdomal space and then turned down for height adjustment and final fixation. Interdomal sutures, supratip sutures, and alar resection are implemented as needed. RESULTS: One hundred twenty patients participated, with high satisfaction and a low frequency of adverse effects reported using four FACE-Q™ questionnaires. One hundred and two independent raters evaluated pre and postoperative photographs, scoring "overall nose result" as 3.6 out of 5, with minimal or absent nostril deformities (1.84), soft triangle deformities (1.73), and columellar external scar deformity/visibility (1.35) where 1 is the absence of the deformity and 5 is disfigurement. Complications were absent, and revisions were infrequent. CONCLUSIONS: The combined benefits of the wide-open approach, shortened surgery duration, and nasal tip preservation contribute to outcome optimization. TRICK-TIP rhinoplasty is characterized by simplicity, enabling targeted modifications, preventing soft triangle and rim complications, and facilitating essential tip support while maintaining favorable results. Level of Evidence V 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 .
Subject(s)
Esthetics , Patient Satisfaction , Rhinoplasty , Humans , Rhinoplasty/methods , Female , Adult , Male , Young Adult , Middle Aged , Treatment Outcome , Suture Techniques , Nasal Cartilages/surgery , Nasal Septum/surgery , Cohort Studies , Nose/surgery , Surgical Flaps/transplantation , Adolescent , Retrospective StudiesABSTRACT
La cirugía de remodelación o reducción de la base alar, también conocida como aloplastía o alotomía, es un procedimiento orientado a modificar el ancho, la forma de las narinas y la base de la nariz. El objetivo de esta revisión es describir las indicaciones generales de una alotomía, sus consideraciones anatómicas y las técnicas quirúrgicas más frecuentemente utilizadas.
Alar base remodeling or reduction surgery, also known as alloplasty or allotomy, is a procedure aimed at modifying the width and shape of the nostrils and the base of the nose. The objective of this review is to describe the general indications for an allotomy, its anatomical considerations, and the most frequently used surgical techniques.
Subject(s)
Humans , Rhinoplasty/methods , Nose/surgery , Nasal Cartilages/surgerySubject(s)
Rhinoplasty , Humans , Nasal Bone/anatomy & histology , Nose/surgery , Nasal Septum/surgery , Nasal Cartilages/surgeryABSTRACT
Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.
Subject(s)
Orthognathic Surgery , Cephalometry/methods , Female , Humans , Male , Maxilla/surgery , Nasal Cartilages/surgery , Osteotomy, Le Fort/methods , Suture Techniques , SuturesABSTRACT
Resumen El objetivo de este trabajo es discutir la presentación y el manejo de la aplasia congénita unilateral del cartílago alar. En este informe, presentamos el caso de un paciente sometido a rinoseptoplastia abierta primaria que presenta aplasia congénita del cartílago alar izquierdo que se repara con cartílago septal. Se discute el manejo de casos y se revisa la literatura. Las anomalías nasales congénitas son poco frecuentes. La ausencia aislada de cualquier estructura nasal específica es aún más rara. El diagnóstico preoperatorio en una nariz hispana es difícil, pero cuando se encuentra este defecto congénito, puede repararse con cartílago septal u otros tipos de cartílago, dependiendo de la disponibilidad del injerto, con buenos resultados. Se recomienda un enfoque abierto para este tipo de patología. La aplasia unilateral del cartílago alar podría reconstruirse con éxito utilizando el cartílago septal a través de un abordaje abierto.
Abstract The objective of this work is discussing the presentation and management of unilateral congenital aplasia of the alar cartilage. In this report, we present the case of a patient undergoing primary open rhinoseptoplasty presenting congenital aplasia of the left alar cartilage that is repaired with septal cartilage. Case management is discussed, and the literature is reviewed. Congenital nasal abnormalities are rare. The isolated absence of any specific nasal structure is even more rare. Preoperative diagnosis in a Hispanic nose is difficult, but when this deformed congenital is found, it can be repaired with septal cartilage or other types of cartilage, depending on the availability of the graft, with good results. An open approach is recommended for this type of pathology. Unilateral alar cartilage aplasia could be successfully reconstructed using septal cartilage through and open approach.
Subject(s)
Humans , Female , Middle Aged , Rhinoplasty/methods , Nasal Cartilages/abnormalities , Nasal Cartilages/surgery , Nose/abnormalities , Nasal Septum/surgeryABSTRACT
The term SPAR (septum pyramidal adjustment and repositioning), aims to conserve the nasal dorsum without detachment of the upper lateral nasal cartilage of the nasal septum, based on the Cotte's principles, unlike classical rhinoplasty. The aim of the study is to describe surgical technique of SPAR with the surgical steps used to reviewing the literature on the surgical treatment of the nasal dorsum. This is a less invasive form of rhinoplasty, but no less effective, not being necessary additional techniques to nasal reconstruction, and preservation of essential nasal structures. It is an evolution of push down and the other conservative surgery, making a more modern technique and may be suitable for most types of cavities. More studies are needed, especially comparative, showing the following late sequelae, complications, and their long-term results.
Subject(s)
Nasal Cartilages , Rhinoplasty , Humans , Nasal Cartilages/surgery , Nasal Septum/surgeryABSTRACT
Introducción: en Cartagena, desde hace aproximadamente una década, se está realizando una nueva técnica de injerto dorsal denominada cartílago en puente (CEP), realizada en rinoplastias cerradas por un solo otorrinolaringólogo. No obstante, no existen estudios que caractericen las complicaciones de esta técnica. Objetivo del estudio: caracterizar las complicaciones posquirúrgicas del manejo del dorso nasal con CEP en pacientes sometidos a una rinoplastia. Metodología: estudio observacional descriptivo, de corte transversal y de carácter retrospectivo, que abarca los registros clínicos de pacientes sometidos a una rinoplastia cerrada con la técnica CEP entre 2013 y 2016. Se midieron variables sociodemográficas, características del procedimiento y se registraron las complicaciones detectadas durante el seguimiento posoperatorio: aparición de infección, extrusión, desplazamiento y reabsorción del injerto Resultados: se identificaron 882 historias clínicas. La mediana de edad fue de 28 años, siendo el 81 % del género femenino. La rinoplastia fue primaria en 80,6 %, el material del injerto dorsal fue solo cartílago en 80,6 %, Gore-Tex® en 1,7 % y una combinación de cartílago y Gore-Tex® en 17,7 %. La mediana de duración de las rinoplastias fue de 78 minutos (rango intercuartílico [RIC]: 72-85), siendo el principal procedimiento adicional la septoplastia en 82,2 %. El 18,2 % de los pacientes presentaron complicaciones. El desplazamiento fue la principal complicación reportada (14,7%), seguida de la reabsorción (4,0 %) e infección (0,1 %). Conclusiones: la técnica CEP mostró como principales complicaciones el desplazamiento y la reabsorción del injerto, con una frecuencia similar a la descrita en otros estudios.
Introduction: In Cartagena, a new dorsal graft technique called Cartilage in Bridge (CEP) has been carried out for approximately a decade, performed in rhinoplasties closed by a single otorhinolaryngologist. However, there are no studies that characterize the complications of this technique. Objective: To characterize postoperative complications of the management of the nasal dorsum with bridge cartilage in patients undergoing rhinoplasty. Methodology: Retrospective, descriptive, observational cross-sectional study, covering clinical records of patients who underwent closed rhinoplasty with the bridge cartilage technique between 2013 and 2016. Sociodemographic variables, characteristics of the procedure, and complications detected during follow-up were recorded postoperative: appearance of infection, extrusion, displacement, and reabsorption of the graft Results: 882 medical records were identified. The median age was 28 years, being 81 % female. Rhinoplasty was primary in 80.6 %, the dorsal graft material was only cartilage in 80.6 %, Gore-Tex® in 1.7 % and combination of cartilage and Gore-Tex® in 17.7 %. The median duration of the rhinoplasties was 78 minutes (ICR: 72-85), with the main additional procedure being septoplasty in 82.2 %. 18.2 % of the patients presented complications. Displacement (14.7 %) was the main complication reported, followed by reabsorption (4.0 %) and infection (0.1 %). Conclusions: The cartilage bridge technique showed graft displacement and reabsorption as main complications, with a frequency similar to that described in other studies.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Postoperative Complications/epidemiology , Rhinoplasty/adverse effects , Nasal Cartilages/surgery , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Introdução: O aumento da projeção da ponta nasal às vezes se torna necessário para a obtenção de uma boa proporção entre ela e o dorso. Inúmeras técnicas e táticas são descritas com essa finalidade utilizando enxertos cartilaginosos obtidos do septo nasal, concha auricular e cartilagem costal. Quando esse aumento deve ser discreto é proposto o uso dos excedentes de cartilagens alares laterais em forma de "pseudo-retalhos". Métodos: Em rinoplastias abertas primárias os excedentes das cartilagens alares, geralmente removidas, são utilizados como "pseudo-retalhos", dobrados sobre si mesmos, em forma de "suspensório de soldado francês", sobre o domus das cartilagens alares, tendo como acolchoamento de apoio os tecidos moles delas próprias, e o tecido mole interdomal, geralmente desprezado, que é liberado, e elevado para sobre os domus. Ele é mantido, descolado e deslocado para a ponta nasal, e fica contido pelos "pseudo-retalhos" das cartilagens alares ali suturados ou cobrindo o extremo do enxerto estrutural da columela. Foram operados com essa tática 36 pacientes. Resultados: 35 com bons resultados e um apresentou um abcesso de ponta nasal, provocado pela exposição endonasal de um fio de sutura não absorvível, que foi removido. Houve necessidade de uma segunda intervenção, utilizando novo enxerto auricular, ainda com resultado insatisfatório. O método é relativamente simples para quem opera narizes. Conclusão: A ponta nasal pode ser discretamente mais projetada utilizando os excessos de cartilagens alares, "pediculadas" no domus.
Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.
Subject(s)
Humans , Male , Female , Middle Aged , History, 21st Century , Paranasal Sinuses , Rhinoplasty , Case Reports , Nose , Retrospective Studies , Evaluation Study , Nasal Cartilages , Nasal Mucosa , Paranasal Sinuses/surgery , Rhinoplasty/adverse effects , Rhinoplasty/methods , Nose/surgery , Nasal Cartilages/surgery , Nasal Mucosa/surgeryABSTRACT
Introdução: O aumento da projeção da ponta nasal às vezes se torna necessário para a obtenção de uma boa proporção entre ela e o dorso. Inúmeras técnicas e táticas são descritas com essa finalidade utilizando enxertos cartilaginosos obtidos do septo nasal, concha auricular e cartilagem costal. Quando esse aumento deve ser discreto é proposto o uso dos excedentes de cartilagens alares laterais em forma de "pseudo-retalhos". Métodos: Em rinoplastias abertas primárias os excedentes das cartilagens alares, geralmente removidas, são utilizados como "pseudo-retalhos", dobrados sobre si mesmos, em forma de "suspensório de soldado francês", sobre o domus das cartilagens alares, tendo como acolchoamento de apoio os tecidos moles delas próprias, e o tecido mole interdomal, geralmente desprezado, que é liberado, e elevado para sobre os domus. Ele é mantido, descolado e deslocado para a ponta nasal, e fica contido pelos "pseudo-retalhos" das cartilagens alares ali suturados ou cobrindo o extremo do enxerto estrutural da columela. Foram operados com essa tática 36 pacientes. Resultados: 35 com bons resultados e um apresentou um abcesso de ponta nasal, provocado pela exposição endonasal de um fio de sutura não absorvível, que foi removido. Houve necessidade de uma segunda intervenção, utilizando novo enxerto auricular, ainda com resultado insatisfatório. O método é relativamente simples para quem opera narizes. Conclusão: A ponta nasal pode ser discretamente mais projetada utilizando os excessos de cartilagens alares, "pediculadas" no domus.
Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Rhinoplasty , Nose , Retrospective Studies , Plastic Surgery Procedures , Esthetics , Nasal Cartilages , Nasal Mucosa , Rhinoplasty/methods , Nose/surgery , Plastic Surgery Procedures/methods , Nasal Cartilages/abnormalities , Nasal Cartilages/surgery , Nasal Mucosa/surgeryABSTRACT
Abstract Introduction: In rhinoplasty, the nasal dorsum has important relevance regarding the esthetic and functional aspects of the surgery. Its reduction should be performed with maximum accuracy and controlled resection to prevent or minimize potential complications. The septum pyramidal adjustment and repositioning consists of a conservative surgical technique of the nasal dorsum, which does not require the detachment of the upper lateral cartilages of the nasal septum, allowing the remodeling of the nasal dorsum while maintaining esthetic lines and nasal function, potentially reducing frequent complications in more traditional surgeries. Objective: To describe the septum pyramidal adjustment technique in detail, presenting its advantages and disadvantages in relation to the other surgical approaches, as well as to disclose results of this surgical procedure in patients submitted to primary rhinoplasty in a specific hospital. Methods: The medical records of all patients submitted to surgery from 2011 to 2015 through this surgical technique were evaluated by the same team. Of these cases, certain variables were analyzed such as gender, age, indication for reoperation and surgical complications. Results: 153 patients underwent rhinoplasty through septum pyramidal adjustment. Of these, 13 patients experienced an indication for a second surgery and four had some type of postoperative complication. Conclusion: The septum pyramidal adjustment surgical technique is a simple procedure, as it does not require the reconstruction of the nasal dorsum. It has a low number of complications and preserves the anatomical structures.
Resumo Introdução: Na rinoplastia, o dorso nasal tem importante relevância no quadro estético e funcional. A sua redução deve ser realizada com máxima precisão e ressecção controlada a fim de prevenir ou minimizar complicações potenciais. O termo septum pyramidal adjustment and repositioning consiste em uma técnica cirúrgica conservadora do dorso nasal, que não requer a desinserção das cartilagens laterais superiores do septo nasal, que permite remodelar o dorso nasal, manter as linhas estéticas e a função nasal, reduz potencialmente complicações frequentes nas cirurgias mais tradicionais. Objetivo: Descrever em detalhes o septum pyramidal adjustment, expor suas vantagens e desvantagens em relação às outras abordagens cirúrgicas, bem como apresentar resultados desse procedimento cirúrgico em pacientes submetidos à rinoplastia primária em um hospital específico. Método: Foram avaliados os registros médicos de todos os pacientes operados de 2011 a 2015 por essa técnica cirúrgica, pela mesma equipe. Desses casos, foram analisadas algumas variáveis, como: sexo, idade, indicação de reoperação e complicações cirúrgicas. Resultados: Foram submetidos 153 pacientes à rinoplastia por septum pyramidal adjustment. Desses, 13 tiveram segunda indicação cirúrgica e quatro apresentaram alguma complicação pós-operatória. Conclusão: A técnica cirúrgica septum pyramidal adjustment apresenta-se como um procedimento de fácil realização, pois não exige a reconstrução do dorso nasal. Apresenta baixo número de complicações e preserva as estruturas anatômicas.
Subject(s)
Humans , Male , Female , Adult , Rhinoplasty/methods , Nasal Cartilages/surgery , Nasal Septum/surgery , Postoperative Complications , Rhinoplasty/adverse effects , Reproducibility of Results , Treatment Outcome , Medical IllustrationABSTRACT
Abstract Introduction: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. Objective: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. Methods: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. Results: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. Conclusion: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.
Resumo Introdução: Após a remoção da giba nasal durante a rinosseptoplastia, a abóbada deve ser reconstruída para evitar problemas funcionais e estéticos. A reconstrução da abóboda entretanto, pode resultar em alargamento dorsal e pode necessitar de um enxerto para camuflar irregularidades dorsais. Objetivo: Avaliar a satisfação dos pacientes com os resultados da reconstrução da abóboda com uma técnica que utiliza a cartilagem lateral superior para recobrir o dorso nasal. Método: Estudo retrospectivo de pacientes submetidos a rinosseptoplastia, que incluiu fechamento do dorso nasal com cartilagem lateral superior, realizado de 1º de dezembro de 2014 a 31 de janeiro de 2016. Foram excluídos aqueles com acompanhamento pós-operatório de menos de 3 meses. O grupo final do estudo incluiu 39 pacientes. O mesmo cirurgião realizou todas as rinosseptoplastias. O dorso foi fechado com uma técnica de "fechamento lateral superior" que aproxima as cartilagens laterais superiores de cada lado sobre o septo. A satisfação pós-operatória dos pacientes foi determinada através de uma escala visual analógica e o questionário Rhinoplasty Outcomes Evaluation. O questionário avalia a satisfação estética e funcional do paciente com o nariz. Escores altos indicam percepção de melhoria estética. Resultados: Não foram observadas irregularidades dorsais na avaliação pós-operatória de seguimento dos pacientes. Em relação à aparência nasal estética, o escore médio da escala visual analógica foi 86% e o escore médio do questionário foi 77,03%. Conclusões: A anatomia natural em forma de domo do dorso nasal foi conseguida através da aproximação das cartilagens laterais superiores entre si. O fechamento do dorso com essa técnica também abrange todas as irregularidades dorsais e resulta em um dorso liso. Os pacientes expressaram satisfação com os aspectos estéticos e funcionais do dorso nasal liso e atraente.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Rhinoplasty/methods , Patient Satisfaction , Esthetics , Nasal Cartilages/surgery , Nasal Septum/surgery , Postoperative Period , Rhinoplasty/psychology , Surveys and Questionnaires , Reproducibility of Results , Retrospective Studies , Suture Techniques , Treatment Outcome , Statistics, Nonparametric , Visual Analog ScaleABSTRACT
INTRODUCTION: In rhinoplasty, the nasal dorsum has important relevance regarding the esthetic and functional aspects of the surgery. Its reduction should be performed with maximum accuracy and controlled resection to prevent or minimize potential complications. The septum pyramidal adjustment and repositioning consists of a conservative surgical technique of the nasal dorsum, which does not require the detachment of the upper lateral cartilages of the nasal septum, allowing the remodeling of the nasal dorsum while maintaining esthetic lines and nasal function, potentially reducing frequent complications in more traditional surgeries. OBJECTIVE: To describe the septum pyramidal adjustment technique in detail, presenting its advantages and disadvantages in relation to the other surgical approaches, as well as to disclose results of this surgical procedure in patients submitted to primary rhinoplasty in a specific hospital. METHODS: The medical records of all patients submitted to surgery from 2011 to 2015 through this surgical technique were evaluated by the same team. Of these cases, certain variables were analyzed such as gender, age, indication for reoperation and surgical complications. RESULTS: 153 patients underwent rhinoplasty through septum pyramidal adjustment. Of these, 13 patients experienced an indication for a second surgery and four had some type of postoperative complication. CONCLUSION: The septum pyramidal adjustment surgical technique is a simple procedure, as it does not require the reconstruction of the nasal dorsum. It has a low number of complications and preserves the anatomical structures.
Subject(s)
Nasal Cartilages/surgery , Nasal Septum/surgery , Rhinoplasty/methods , Adult , Female , Humans , Male , Medical Illustration , Postoperative Complications , Reproducibility of Results , Rhinoplasty/adverse effects , Treatment OutcomeABSTRACT
INTRODUCTION: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. OBJECTIVE: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. METHODS: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. RESULTS: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. CONCLUSION: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.
Subject(s)
Esthetics , Nasal Cartilages/surgery , Nasal Septum/surgery , Patient Satisfaction , Rhinoplasty/methods , Adult , Female , Humans , Male , Postoperative Period , Reproducibility of Results , Retrospective Studies , Rhinoplasty/psychology , Statistics, Nonparametric , Surveys and Questionnaires , Suture Techniques , Treatment Outcome , Visual Analog Scale , Young AdultABSTRACT
INTRODUCTION: The position of the lower lateral cartilages (LLC) is closely related to the function of the external nasal valve (ENV). When there is a cephalic malposition of these cartilages, the nasal alae have inadequate support, which leads to ENV insufficiency during deep inspiration. METHODS: Retrospective study with 60 patients evaluated: the positioning of the LLC and the occurrence of ENV insufficiency; the effectiveness of structuring the medial and lateral walls of the ENV; and the frequency of the grafts used for structuring it. RESULTS: Of the 60 operated cases, 37 patients (62%) had ENV insufficiency, in 23 cases there was cephalic malposition of the LLC, and in the latter group 17 patients (74%) presented this insufficiency. A structured ENV was effective in the treatment of this insufficiency (p = 0.001). A lateral crural strut graft was performed in 24 cases (40%) of 60 patients operated. The alar contour graft was performed from 2013 to 2015 in 4 patients (22%) of 18 cases operated, and between 2016 and 2018 it was performed in 29 patients (69%) out of 42 cases. The columellar strut was routinely used from 2013 to mid-2016 in 33 cases (100%), and after that period until the present day the tongue-in-groove technique was performed in 11 cases (41%) and in the remaining 16 cases (59%) the caudal septal extension graft was performed. CONCLUSION: Cephalic malposition of the LLC is an important red flag of ENV insufficiency. This insufficiency should be treated by structuring the walls of the ENV. 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 .
Subject(s)
Nasal Cartilages/surgery , Nasal Septum/surgery , Rhinoplasty/methods , Surgical Flaps/transplantation , Adolescent , Adult , Aged , Cohort Studies , Esthetics , Female , Humans , Male , Middle Aged , Nasal Cartilages/abnormalities , Nasal Obstruction/prevention & control , Nasal Septum/abnormalities , Preoperative Care/methods , Retrospective Studies , Risk Assessment , Treatment OutcomeABSTRACT
Introdução: A ponta nasal é estudada com frequência pelos cirurgiões, visto ser motivo comum de queixa pré e pós-operatória. Dessa forma, a ponta deve ser minuciosamente avaliada para se determinar a melhor técnica a ser utilizada. O objetivo é demonstrar uma técnica original de retalho de cartilagem alar para projeção da ponta nasal, complementar ou não a outros procedimentos de mesmo objetivo. Método: Estudo transversal retrospectivo de 22 pacientes submetidos à rinoplastia aberta com uso do retalho de alar para projetar ponta nasal. Resultados: Foram realizadas 22 rinoplastias abertas, de ponte bulbosa, adiposa e hipoprojetada, sendo todas primárias. Dentre os pacientes do estudo, 90% eram negros e 2% eram brancos, 72,7% apresentaram alto grau de satisfação com a operação, 18,1% consideraram o resultado muito bom e 9,2% acharam regular. Não houve complicações/reoperações. Conclusão: Os retalhos de cartilagens alares para projeção da ponta nasal são um recurso técnico de simples execução e podem ser considerados excelente recurso de projeção adicional da ponta nasal a ser considerado dentre as técnicas para tratamento de narizes negroides.
Introduction: The nasal tip is a frequent object of study by surgeons, since it is a common reason for pre- and postoperative complaints. Thus, the tip should be thoroughly evaluated to determine the best technique to be used. The objective is to demonstrate an original alar cartilage flap technique for projection of the nasal tip, performed alone or in combination with other procedures for the same purpose. Method: A retrospective cross-sectional study of 22 patients submitted to open rhinoplasty with use of the alar flap to project the nasal tip. Results: A total of 22 open rhinoplasties were performed on primary bulbous, fatty, and under-projected tips. Among the patients in the study, 90% were black and 2% were white; 72.7% reported a high degree of satisfaction with the operation, 18.1% considered the result very good, and 9.2% considered the result acceptable. There were no complications/reoperations. Conclusion: The alar cartilage flap for projection of the nasal tip is simple to perform and can be considered an excellent supplemental method for use in treatment of the black nose.
Subject(s)
Humans , Male , Female , Rhinoplasty/methods , Surgical Flaps/surgery , Nose/surgery , Plastic Surgery Procedures/methods , Nasal Cartilages/surgery , Postoperative Complications , Projection , Rhinoplasty , Surgery, Plastic , Surgical Flaps , Medical RecordsABSTRACT
Introdução: A reconstrução nasal é a mais antiga das cirurgias plásticas. A anatomia nasal é complexa e necessita de uma associação de técnicas para a restauração da função e estética nasal adequada. Pereira et al. descreveram uma técnica que possibilita a reconstrução nasal total da cartilagem alar, com o uso de um enxerto da cartilagem auricular, com mínima deformidade auricular secundária à retirada do enxerto. O objetivo deste trabalho é apresentar uma modificação da técnica acima descrita, que possibilita reconstruir mais uma região anatômica do nariz, sem aumentar a morbidade, realizada por Collares et al., e a sua inserção no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre. Métodos: Foi realizado um estudo retrospectivo. Avaliou-se a inserção da modificação da técnica em 10 pacientes que realizaram reconstrução nasal total. Resultados: Após a análise dos 10 casos, utilizando a modificação da técnica inserida no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre, encontramos uma melhoria da forma do nariz, a válvula nasal interna com preservação da função e sem sequelas secundárias à retirada do enxerto auricular. Conclusão: Nesta série de casos, a modificação da técnica de Max Pereira resultou em tratamento estético funcional adequado quando implementada no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre, sem aumentar a morbidade na área doadora.
Introduction: Nasal reconstruction is the oldest plastic surgery technique. The nasal anatomy is complex and requires an association of techniques for the restoration of function and adequate nasal esthetics. Pereira et al. described a technique that allows total nasal reconstruction of the alar cartilage through the use of an auricular cartilage graft, with minimal deformity secondary to the donor site. The objective of the present study is to present a modification, by Collares et al., of the technique described above, which allows the reconstruction of another anatomical region of the nose without increasing morbidity, and its insertion into the total nasal reconstruction protocol of Hospital de Clínicas of Porto Alegre. Methods: A retrospective study was conducted. We evaluated technique modification in 10 patients who underwent total nasal reconstructions. Results: After examining the 10 patients who were treated with the modified total nasal reconstruction protocol at the Hospital de Clínicas of Porto Alegre, we observed an improvement in the nose shape and internal nasal valve with preservation of function, without sequelae secondary to auricular graft removal. Conclusion: In this case series, the modification of the Max Pereira technique resulted in adequate aestheticfunctional treatment when implemented in the total nasal reconstruction protocol of the Hospital de Clínicas of Porto Alegre, without increasing the morbidity in the donor area.
Subject(s)
Humans , Adult , History, 21st Century , Nose , Nose Deformities, Acquired , Nose Neoplasms , Retrospective Studies , Nasal Cartilages , Nasal Surgical Procedures , Nose/anatomy & histology , Nose/surgery , Nose Deformities, Acquired/surgery , Nose Deformities, Acquired/rehabilitation , Nose Neoplasms/surgery , Nose Neoplasms/rehabilitation , Plastic Surgery Procedures , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Nasal Cartilages/anatomy & histology , Nasal Cartilages/surgery , Nasal Surgical Procedures/methods , Nasal Surgical Procedures/rehabilitationABSTRACT
Este trabajo está enfocado en pacientes que presentan una rinodeformidad mínima, en quienes creo, como cirujanos plásticos, que podemos realizar una intervención quirúrgica mínimamente invasiva mediante una rinomodelación simple con hilo (vicril - mononylon). Para casos de mayor rinodeformidad (giba ósea y cartilaginosa de cualquier tipo) podemos realizar una rinomodelación combinada (resección de giba) con hilo. Existen varias técnicas descriptas de rinomodelación. Esta técnica se basa en la esqueletización de los cartílagos alares con transección lateral, disección limitada del dorso, miotomía del musculo depresor, preservando el ligamento suspensor de la punta a través de incisiones mínimas colocando un hilo, que actúa como tutor y no tensor, desde la columela al rádix nasal, por lo que se obtiene un refi namiento de la punta nasal proyectando la misma y acortando la longitud nasal. También indicada en casos de resección de giba ósea y cartilaginosa realizando una rinomodelación combinada.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Rhinoplasty/methods , Bone Wires , Nasal Cartilages/surgery , Myotomy , DissectionABSTRACT
Abstract Introduction Pinched nasal point can be arising as congenital malformation or as results of unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic problem but also a functional one because can modify the nasal airflow. Several surgical techniques were proposed in literature, we proposed our. Objective The purpose of the study is the evaluation of nose airway flow using our flip-flap technique for correction of pinched nasal tip. Methods This is a retrospective study conducted on twelve patients. Tip cartilages were remodeled by means of autologous alar cartilage grafting. The patients underwent a rhinomanometry pre and post-surgery to evaluate the results, and they performed a self-survey to evaluate their degree of satisfaction in term of airflow sensation improvement. Results Rhinomanometry showed improved nasal air flow (range from 25% to 75%) in all patients. No significant differences were showed between unilateral and bilateral alar malformation (p = 0.49). Patient's satisfaction reached the 87.5%. Conclusion Our analysis on the combined results (rhinomanometry and surveys) showed that this technique leads to improvement of nasal flow in patients affected by pinched nasal tip in all cases.
Resumo Introdução A ponta nasal comprimida pode surgir como malformação congênita ou como o desfecho de uma cirurgia malsucedida. A alteração da válvula nasal devido a esse problema não é apenas um problema estético, mas também funcional, porque pode modificar o fluxo aéreo nasal. Várias técnicas cirúrgicas têm sido propostas na literatura; aqui, propomos a nossa. Objetivo O objetivo do estudo é a avaliação do fluxo das vias aéreas nasais utilizando nossa técnica de flip-flap para correção da ponta nasal comprimida. Métodos Este é um estudo retrospectivo realizado em doze pacientes. As cartilagens da ponta nasal foram remodeladas através de enxerto de cartilagem alar autóloga. Os pacientes foram submetidos à rinomanometria pré e pós-cirúrgica para avaliar os resultados, e realizaram uma auto-avaliação para avaliar seu grau de satisfação em termos de melhora da sensação do fluxo aéreo. Resultados e conclusão Nossa análise dos resultados combinados (rinomanometria e autoavaliação) mostrou que essa técnica melhora o fluxo nasal em pacientes afetados por ponta nasal comprimida em todos os casos. A satisfação do paciente atingiu os 87,5%.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rhinoplasty/methods , Surgical Flaps , Nasal Obstruction/surgery , Nasal Cartilages/surgery , Nose/anatomy & histology , Nose/surgery , Retrospective Studies , Patient Satisfaction , Rhinomanometry , Nasal Cartilages/anatomy & histologyABSTRACT
Introdução: O dorso reto tem sido sempre um ideal na rinoplastia estética. A simples remoção da giba tem sido o método clássico e mais utilizado, mas pode ter consequências estéticas e funcionais adversas. Ainda existe grande resistência a procedimentos de aumento, porque a maioria dos pacientes solicitam redução e porque os benefícios de melhoria do equilíbrio nasal pelo aumento não são intuitivos. Um nariz aumentado pode parecer menor, o que é um benefício em particular em pacientes com pele espessa ou com o aspecto de terço inferior grande. Por outro lado, a percepção de redução com o aumento do radix e da ponta é muito comum, embora nunca tenha sido medida. Métodos: Esse estudo cria intervenções gráficas e reais para criar um dorso reto por meio do aumento do radix e da ponta e analisa como os pacientes e observadores independentes percebem as modificações. Analisou-se uma amostra de 42 casos consecutivos de rinoplastia. Desses, foram incluídos os que tinham dorso convexo e eram cirurgias primárias, restando 9 casos. Resultados: Houve aumento médio de 6,5% no tamanho do nariz na após a modificação gráfica, enquanto houve percepção de redução do nariz (p = 0,004). Houve aumento médio de 1% após a rinoplastia, enquanto houve percepção de redução. Conclusão: A retificação do dorso nasal pelo aumento do radix e da ponta causa percepção de redução do nariz.
Introduction: A straight bridge has always been the aesthetic ideal. Simple hump removal, the classical and most commonly applied method, can have aesthetic and functional consequences. However, great resistance to augmentation procedures persists because most patients request reduction and the benefits of improving nasal balance are counterintuitive. An augmented nose can look smaller, a particular benefit in patients with thick, inelastic skin or a large lower nose. On the other hand, decreased size perception after raising of the radix and tip is very common but has not been measured to date. Methods: This study created graphic and real interventions to achieve a straight bridge through radix and tip raising and analyzed how patients and independent observers perceive these changes. A sample of 42 sequential rhinoplasty patients was analyzed, including nine cases of primary surgery and dorsal convexity. Results: There was a 6.5% mean augmentation after graphic computing intervention but a perception of size reduction (p = 0.004). There was a 1% mean augmentation after rhinoplasty and an overall size reduction perception. Conclusion: Correction of the nasal dorsum, making a straight bridge through slightly increasing radix and tip, creates the perception of a decreased nose size.