The Transoral Alar Batten Graft: A Functional Rhinoplasty Technique for the Orthognathic Jaw Surgery Patient.

SUMMARY: Many patients seeking orthognathic jaw surgery also experience nasal obstruction. Current transoral functional rhinoplasty techniques include septoplasty and inferior turbinate reduction, which are performed through the mouth after maxillary downfracture. Although powerful, these interventions do not treat dynamic nasal sidewall collapse. The authors describe a novel transoral alar batten graft. Using the maxillary vestibular approach, septal cartilage is harvested and delivered from the maxillary vestibule into the nasal alar-sidewall junction through a small tunnel. This procedure is simple and versatile, and carries minimal morbidity, enabling the orthognathic jaw surgeon to support the nasal sidewall through a minimal-access approach and improve the patient's nasal function and airway.

Minimally Invasive Mandibular Microsurgery: A Systematic Review and Meta-analysis.

Microsurgical advances have led to minimally invasive approaches for mandibular reconstruction. Currently, no resource compares all minimally invasive microvascular mandibular reconstruction (MIMMR) treatment options. Methods: All known cases of MIMMR were identified following the Preferred Reporting Items for Systematic Reviews, Meta-Analyses guidelines, and our own surgical experience. Patient demographics, MIMMR type [submandibular (SM), modified facelift/retroauricular (MFL/RA), or intraoral (IO)], methodology, and clinical outcomes were analyzed with the Fisher exact and Kruskal-Wallis tests. Results: Forty-seven patients underwent MIMMR. Ameloblastoma was the most common pathology treated using all approaches, and MFL/RA was the only approach used to treat squamous cell carcinoma (P = 0.0103). Reconstruction was reported for large, bilateral defects only via the SM or IO approach (P = 0.0216). The iliac crest or fibula was used as a donor site. The facial artery was the most common recipient vessel using the IO and SM approaches, whereas the superior thyroid and external carotid vessels were the most common in the MFL/RA approach (P < 0.0001). Virtual planning was used in all cases performed via an IO approach, 80.0% of cases using an SM approach, and no MFL/RA cases (P < 0.0001). Good aesthetic and functional outcomes were reported for every patient, and there was no difference in complication rates (P = 0.2880). Conclusions: Minimally invasive approaches are safe and effective treatment options for patients requiring mandibular microsurgery, usually in the setting of benign pathology. The IO and SM approaches usually rely on the facial vessels, whereas the MFL/RA approach permits access to the superior thyroid and external carotid vessels and cervical lymphadenectomy.