Reducción de base nasal con disección subperióstica de tercio medio en rinoplastia primaria / Nasal base reduction with extended midface subperiosteal dissection in primary rhinoplasty

Introducción y objetivo: Las técnicas de reducción de base nasal son usadas frecuentemente en rinoplastias primarias y de revisión cuando la distancia interalar excede la distancia intercantal. La reducción de base nasal mas común es la resección directa de los alares. Los métodos alternativos incluyen aumentar la proyección del dorso nasal y las técnicas de medialización de bases alares. Investigamos en una población de nariz mestiza si la reducción de la base alar percutánea es una técnica útil para disminuir el ancho de la base alar y si el resultado perdura. Material y método: Estudio prospectivo sobre 20 pacientes evaluando la media de medidas de base nasal en el postoperatorio inmediato, a las 2 semanas, 6 meses, 1 año y 2 años, así como también investigando el nivel de satisfacción con este procedimiento. Resultados: De los 20 pacientes del estudio, el 80% (16 pacientes) fueron mujeres y 20% (4 pacientes) hombres. La media de medidas de base nasal en el postquirúrgico inmediato fueron: inmediato=32.15 mm (+/−2.25, SD); 2 semanas = 33.95 mm (+/−2.97, SD); 6 meses = 36.1' mm (+/−2.80, SD); 1 año = 36.42 mm (+/−2.86, SD); y 2 años = 36.42mm (+/−2.86, SD). Nuestro estudio muestra una reducción inmediata de base nasal de 10.8 mm, y una reducción final de 6.52 mm, correspondiendo a una perdida de reducción de 4.27 mm en el período de estudio. Las comparaciones realizadas entre los períodos de tiempo como a las 2 semanas y a los 6 meses y de 6 meses frente a 1 año muestran una diferencia significativa entre los grupos. Después de 1 año no hubo diferencia significativa hasta los 2 años, sugiriendo que el resultado final se obtiene aproximadamente al año de seguimiento. Conclusiones: De la experiencia de nuestro estudio podemos deducir que la reducción alar nasal percutánea es una herramienta útil para reducción de base nasal en pacientes con base alar ancha. Los resultados quirúrgicos se mantuvieron estables después de 1 año postoperatorio. (AU)

Background and objective: Nasal base reduction techniques are frequently used in primary and revision rhinoplasties when interalar distance exceeds the intercanthal distance. The most common nasal base reduction technique is direct alar resection. Alternative methods include increasing dorsal nasal projection and nasal base medialization techniques. We investigate in a mixed-nosed population whether percutaneous alar base reduction is a useful technique to decrease the width of the alar base and whether the result lasts Methods: Prospective study including 20 patients measuring nasal base medial widths at immediate postoperative period, 2 weeks, 6 months, 1 year and 2 years; also investigate the level of patient satisfaction with this procedure. Results: Twenty patients in the study, 80% (16 patients) were women and 20% (4 patients) were men. Mean nasal base widths measured at the respective postoperative period were as follows: immediate = 32.15 mm (±2.25, SD); 2-weeks = 33.95 mm (±2.97, SD); 6 months = 36.10 mm (±2.80, SD); 1-year = 36.42 mm (±2.86, SD); and 2-year = 36.42 mm (±2.86, SD). Our study showed an immediate mean reduction of nasal base width of 10.8 mm, and a final mean reduction of 6.52 mm, corresponding to a 4.27 mm loss in reduction over the study period. comparisons made between subsequent consecutive time points, such as 2-week versus 6-months, and 6-months versus 1-year, continued to demonstrate a significant difference between groups. After 1 year, there was no statistical significance of the measurements relative to 2 years, suggesting that the final result was achieved after approximately 1-year of follow-up. Conclusions: Our study experience showed that percutaneous nasal reduction is a useful tool for nasal base reduction in patients with broad alar base. The surgical outcome remained stable after 1-year postoperatively. (AU)

Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management.

BACKGROUND: Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies. The aim of this work is to evaluate the prevalence of upper extremity malformations in patients with Moebius syndrome, clarify its various clinical presentations, and present treatment strategies for their management. METHODS: This is a retrospective, cross-sectional study including patients with Moebius syndrome and upper extremity malformations between 2012 and 2019. Data include demographic characteristics, Moebius syndrome subtype, type of malformation, affected extremity, and surgical procedures underwent. Quantitative data were recorded as mean (standard deviation [SD]), and qualitative data were expressed in terms of totals and percentages. Statistical association between Moebius syndrome subtype and development of upper extremity anomalies was evaluated using binary logistic regression. RESULTS: Twenty-five out of 153 patients (16.3%) presented upper extremity malformations (48% male). Mean age of presentation was 9.08 ± 9.43 years. Sixty-eight percent of the malformations were unilateral. The most common presentations included Poland syndrome and simple syndactyly with 8 cases each (32%), followed by 5 cases of brachysyndactyly (20%), 3 cases of amniotic band syndrome (12%), and 1 case of cleft hand (4%). No statistical association was found between Moebius syndrome subtype and odds ratio for development of upper extremity anomalies. Thirteen patients (52%) underwent reconstructive procedures. CONCLUSION: Poland syndrome and syndactyly are the most common anomalies in patients with Moebius syndrome. Patients may present with a wide range of hand malformations, each patient should be carefully evaluated in order to determine whether surgical treatment is needed and to optimize rehabilitation protocols.