Nasal sill augmentation: an overlooked concept in rhinoplasty-a technical note and review of the literatures.

BACKGROUND: Nasal sill is one of the components of the alar ring, affecting the esthetic outcomes of rhinoplasty; accordingly, we developed a novel technique to adjust defects in this area and compared it with the available techniques. METHODS: Our technique was based on creating a tunnel access to the nasal sill area through an incision made in the lower third of the columella using the open approach or through a nostril base incision in patients, who underwent alar base reduction, followed by insertion of a cartilaginous graft into the marked defect area. RESULTS: A total number of 54 patients with a defect in the nasal sill area were included in this study. Thirty-one patients underwent open rhinoplasty with the sill approach from the lower third of the columella, while 23 patients underwent rhinoplasty with a nostril base approach for nasal sill augmentation procedure. There were no reports of patient dissatisfaction, infection, bleeding, sensory dysfunction, or remaining asymmetry of the sill area. CONCLUSION: Based on the findings of the present study, this technique can be successfully used in reconstructing the nasal sill area with minimal complications and morbidity.

Concomitant Dorsal Preservation Rhinoplasty and Orthognathic Surgery: A Technical Note.

PURPOSE: In the present report, we have introduced a novel technique for concomitant Le Fort I surgery and dorsal preservation rhinoplasty and reviewed the reported data. PATIENTS AND METHODS: Concurrent surgery could be considered a suitable option for patients requiring both upper jaw orthognathic surgery and rhinoplasty or those who are willing to undergo single-stage concomitant rhinoplasty and orthognathic surgery. In the present technical note, we have introduced a dorsal preservation rhinoplasty technique combined with Le Fort I surgery through an intraoral approach. The advantages of this technique include its conservative design, avoidance of a second surgery and anesthetic, the ability to correct possible nasal defects caused by the Le Fort I osteotomy, keeping the keystone area intact, and, most importantly, the possibility of concomitant surgery. However, recurrence of the hump and nasal pyramid lateralization are among the problems that could be associated with this technique. These disadvantages might necessitate revision surgery. RESULTS: A total of 48 patients (23 females and 15 males) had undergone concomitant rhinoplasty and Le Fort I surgery using a modified dorsal preservation technique. No patient reported dissatisfaction with the results of surgery regarding the nasal and facial esthetics. No evidence of severe complications, such as saddle nose, severe deviation, airway compromise, or severe asymmetry, was observed postoperatively. CONCLUSIONS: Based on our experience with patients and after at least 1 year of follow-up, the results of the present study suggest that this technique is straightforward and produces excellent results.

Intraosseous neurofibroma and concurrent involvement of the mandible, maxilla and orbit: report of a case.

Neurofibroma is an autosomal dominant disorder which has major criteria such as hyperpigmentation (cafe-au lait spots), cutaneous and subcutaneous tumors and bone deformities. In this report, a case of multifocal intraosseous neurofibroma in a 16-year-old male with right facial asymmetry, multiple unerupted maxillary posterior teeth and a previous history of infratemporal and orbital neurofibroma is presented. The majority of reported cases occurred in the posterior portion of the mandible and a limited number in the maxilla. Cone beam CT (CBCT) was performed for better evaluation of the extension and form of the maxillary and mandibular lesions. This report presents a rare situation of simultaneous peripheral neurofibromatosis (NF) and multifocal intraosseous NF in the mandible, maxilla and orbits and also focuses on advanced imaging findings of bony and soft tissue neurofibroma.