Nasal reconstruction with the paramedian forehead flap using the aesthetic subunits principle.

Reconstruction of nasal defects is challenging because it requires covering skin, supporting framework, and lining. Traditionally, the forehead flaps are transferred in 2 stages; however, it can be accomplished in a single stage or in 3 stages. Few published studies are available about the paramedian forehead flap using the intermediate stage (3-stage) and the aesthetic subunits principle. The purpose of this study is to evaluate the use of the paramedian forehead flap in 2 and 3 stages for nasal reconstructions, highlighting the indications, complications, and technical details and evaluating the patient's satisfaction through a questionnaire about the quality of life (Derriford Appearance Scale 24). A retrospective review was performed between 2011 and 2013 for a consecutive series of 11 patients who underwent nasal reconstructions using the paramedian forehead flap in 2 or 3 stages. All preoperative and postoperative data were collected, and outcomes were also assessed through a questionnaire about the patients' postoperative quality of life. The causes of nasal lesions varied among skin cancer, trauma, and infection. Two-stage paramedian forehead flap reconstruction was performed upon 4 patients, whereas the 3-stage reconstruction was performed for 7 patients. Of the 10 survey respondents, 6 were highly satisfied (score of 11-27), and 4 were moderately satisfied (score of 28-44), whereas no one was dissatisfied after his/her surgical nasal reconstruction procedure. Whether the approach is accomplished in 2 or 3 stages, all areas of the reconstructed nose must be firmly supported. Applying the nasal subunits principle seems to contribute to an overall satisfied population in our study, according to the score obtained by the questionnaire about quality of life.

Long-term complication after rhinoplasty using porous polyethylene implant: cutaneous fistula of the forehead.

UNLABELLED: Nasal dorsum augmentation is one of the most frequently performed procedures during rhinoplasty, especially in Asians and reconstructive cases. One can use autogenous cartilage grafts or alloplastic implants for this purpose. However, the potential for permanent damage to the skin and soft tissues as well as complications such as infection and extrusion of the implant make autogenous tissue augmentation preferable to alloplastic implantation. Furthermore, there is scant literature information about long-term outcomes and complications related to these implants. This brief report aimed to describe a unique case of migration of an alloplastic implant from the nose to the forehead, simulating a frontal sinus fistula. LEVEL OF EVIDENCE: IV.

Management of an unusual presentation of Ascher syndrome.

Ascher syndrome is defined by the association between double lip, blepharochalasis, and nontoxic goiter. Because it is a rare disease, it is most often misdiagnosed, despite its implications for quality of life. We report a variation of an incomplete type of Ascher syndrome affecting the upper lip, upper eyelids, and lateral canthi of a young male patient. The surgical management, follow-up, and a brief overview of the syndrome are described. The results presented show an aesthetic and functional improvement of the facial deformities.

Anatomical variations of the upper lateral cartilages and their implications in rhinoplasty.

BACKGROUND: Upper lateral cartilage manipulation is often associated with compromise of the middle-third vault. Although the anatomical details of the upper lateral cartilages are of great importance for the maintenance or even the creation of an aesthetically pleasing dorsum with proper respiratory function, the literature includes few studies related to these themes. Thus, this study aimed to evaluate the total length of the upper lateral cartilages and their extension under the nasal bones and caudally, and examine the anatomical variations of the upper lateral cartilages and their implications in rhinoplasty. METHOD: An anatomical study was performed on 32 upper lateral cartilages of 16 fresh adult cadavers. The upper lateral cartilages were measured for total length, cephalad length (overlapped by the nasal bones), and caudal length (caudally to the nasal bones) using a millimeter ruler. The measurements were recorded and analyzed by BioEstat 5.0 software. The statistical tests were performed at the significance level of 0.05. RESULTS: A total of 13 male specimens and 3 female specimens with ages ranging between 20 and 60 years were analyzed. The length of the upper lateral cartilage portion under the nasal bones on the right side ranged from 3 to 7 mm (4.62 ± 1.20 mm). On the left side, it ranged from 2 to 7 mm (4.56 ± 1.26 mm). The total length of the upper lateral cartilages ranged from 16 to 28 mm (20.44 ± 3.26 mm) on the right side and 17 to 30 mm (20.75 ± 3.71 mm) on the left side. CONCLUSION: Data from this study confirmed the anatomical variations of the upper lateral cartilages, including the portion lying under the nasal bones. This has important surgical implications given the attention required during spreader graft fabrication in order to maintain dorsal aesthetic lines and proper respiratory function.

Assessment of nasal patency after rhinoplasty through the Glatzel mirror.

INTRODUCTION: OBJECTIVE evaluation of nasal function is a constant challenge for plastic surgeons, otolaryngologists, and allergists. The modified Glatzel mirror can evaluate nasal expiratory flow; however, there is little information on this method and its use in the measurement of nasal patency after surgical procedures. OBJECTIVE: To compare, in a prospective study, the functional results before and after cosmetic rhinoplasty and evaluate the use of the Glatzel mirror as an objective method to assess nasal patency. METHODS: To achieve this objective, we analyzed the functional results of surgery through a subjective questionnaire and objective evaluation through a modified Glatzel mirror, and evaluated the correlation between the 2 methods. Twenty patients (14 women and 6 men) underwent aesthetic rhinoplasty using spreader grafts. Pre- and postoperative evaluation (90-120 days) included a respiratory quality score (subjective) and modified Glatzel mirror test (objective). Subsequently, the Spearman test was used to compare the pre- and postoperative subjective and objective data. RESULTS: The subjective evaluation demonstrated a statistical difference between pre- and postoperative scores (8 ± 2 and 9.4 ± 0.7, P ≤ 0.001). There was no statistical difference in mean nasal patency by modified Glatzel mirror. No statistically significant correlation was observed when comparing the modified Glatzel mirror values with the subjective scores reported by patients pre- or postoperatively. CONCLUSION: The Glatzel method lacks sensitivity in detecting patient-reported improvements in breathing following rhinoplasty. This suggests that the method is a poor assessment tool to detect small, post-surgical changes in the nasal airways.

The role of septal cartilage in rhinoplasty: cadaveric analysis and assessment of graft selection.

BACKGROUND: In addition to providing nearly 50% of total airway resistance via the internal valve, the nasal septum provides support for the cartilaginous portion of the nasal dorsum, and it is responsible for determining the projection of the nasal tip. In modern rhinoplasty, septal cartilage plays an important role as a donor graft material. OBJECTIVES: The authors evaluate the anatomy of nasal septal cartilage, identifying variations according to certain regions of the septum and proposing a correlation between the topography and morphology of septal cartilage and graft choice. METHODS: An anatomical study was performed on 14 fresh adult cadavers. The excised septal cartilage was placed on grid paper; digital images were taken; all septal cartilage was divided into nine equivalent quadrants; and quantitative measurements for length, height, and area were calculated and compared. Statistical significance was set at P < .05. RESULTS: The average length of the septum was 35.14 mm, while the average height was 32.5 mm. The average septal area was 933.11 mm(2). The septal thickness mean values were analyzed in nine quadrants, ranging from 1.04 to 1.71 mm. Statistically-significant differences in mean values were found in 13 of the 14 cadavers. Specifically, the central and cranial areas were thickest, and the area corresponding to the L-strut was thinnest. CONCLUSIONS: Anatomical variations of the thickness of septal cartilage excisions were found to be statistically significant, and these differences play an important role in the proper selection of the septal grafts.

Eyebrow composite graft for eyelash reconstruction: a case report and review of the literature.

Reconstructing the eyelash margin is a challenge for plastic surgeons because eyelashes have specific characteristics. There is still no gold standard procedure for this type of reconstruction, which seeks to protect the eyeball and make the eyelid appear natural. The eyebrow composite graft can be a good option for reconstructing the eyelash margin because it is technically simple and safe, and takes advantage of the structural similarity between the eyelashes and eyebrow. The results presented showed the effectiveness of the technique by providing improved occlusion and a good aesthetic result.