Pediatric Intranasal Lobular Capillary Hemangioma: A Scoping Review and Multimedia Case Presentation.

STUDY DESIGN: Systematic, scoping literature review and case presentation. OBJECTIVE: The goal of this study is to review current literature on management trends and outcomes of pediatric intranasal lobular capillary hemangioma (ILCH). CASE PRESENTATION: A 14-year-old male patient presented with a 15-month history of unilateral epistaxis, nasal congestion, and mouth breathing. Further workup revealed a pale nasal mass obstructing the right nasal cavity. The patient was successfully treated using a minimally invasive endoscopic endonasal approach for mass resection and nasal floor free mucosal graft for septal reconstruction. METHODS: Independent queries of the PubMed Central, MEDLINE, and Bookshelf databases were performed; articles from 1990 to 2023 were abstracted. All studies that described pediatric ILCH using the Boolean method and relevant search term combinations, including "Intranasal," "Lobular capillary hemangioma," "Pyogenic granuloma," "Pediatric," "Outcome," and "Management," were collected for subsequent analysis. RESULTS: A total of 407 relevant unique articles were identified for analysis. Of these, 19 articles were deemed appropriate for inclusion in this literature review. Twenty-two pediatric ILCH cases were identified with a mean age at diagnosis of 10.5 years. The majority of cases occurred in males and presented with recurrent epistaxis and nasal obstruction. Most lesions originated from the anterior nasal septum and were resected using an endoscopic endonasal approach with no recurrence at last follow-up. CONCLUSIONS: Pediatric ILCH, a benign vascular neoplasm, often presents with unilateral nasal obstruction and severe, refractory epistaxis. This comprehensive review aims to highlight the importance of including this lesion in the differential diagnosis for unilateral nasal obstruction and epistaxis in young children.

Nasal filling guided by high frequency ultrasound: Reducing risks.

BACKGROUND: Given the significant increase in the quantity of cosmetic procedures utilizing hyaluronic acid fillers, including in the nasal region, the initial evaluation of patients using high frequency ultrasound becomes a crucial instrument in evaluating and handling nonsurgical rhinoplasty. AIMS: The aim of this article is to introduce an assessment methodology for nasal filling guided by high frequency ultrasound. PATIENTS/METHODS: A prospective and single-center study was conducted with 12 Latin American patients. The patients underwent nasal filling with hyaluronic acid following high power ultrasound mapping. RESULTS AND CONCLUSIONS: In the evaluation of the GAIS scale, all patients reported improvement with the treatment. No infections, nodules, ischemia, or other relevant adverse effects were noted. Real-time ultrasound-guided filler techniques have been developed to reduce the risk of vascular compromise, confirming the distribution pattern of blood vessels. It's also crucial to visualize the cannula at the same moment as the vessels, even if the previous vascular mapping was performed. Therefore, the utilization of high frequency ultrasound can act as a pivotal tool in augmenting procedure safety.

¡¡¡Ni abierta, ni cerrada!!! Rinoplastia con lo mejor de las dos técnicas. Trick tip rhinoplasty (transcolumellar and inter cartilaginous keystoning with tip preservation) / Trick tip rhinoplasty (transcolumellar and inter cartilaginous keystoning with tip preservation)

El propósito es presentar una técnica de rinoplastia sin precedentes: la TRICK-TIP (transcolumellar and inter cartilaginous keystoning with tip preservation) usada por 14 años Métodos. La cirugía es indicada en casos estéticos primarios y secundarios y también en reconstructivos como nariz hendida y secuelas de trauma. Una incisión nasal intercartilaginosa se continúa con una vertical en el septum membranoso y se "abre" con una incisión baja en escalera en la parte inferior de la columela, una combinación de elementos de las técnicas abierta y cerrada. La punta nasal se eleva como un colgajo que incluye los alares y la piel vestibular debajo de ellos. El abordaje es muy amplio para realizar todas las maniobras quirúrgicas para septum y dorso, mientras que la punta nasal se preserva anatómicamente y se modifi ca desde abajo por resección cefálica retrógrada de alares, aplicación de poste intercrural fi jado primero arriba y puntos para cierre de espacios muertos en el supra tip, el cierre de las incisiones es sencillo y completo, dos tercios de los casos se realiza resección de alas sin diferimiento. Resultados. Los resultados evaluados por 120 pacientes usando Face Q™, y por 102 evaluadores externos son muy satisfactorios, las complicaciones son bajas y las revisiones infrecuentes. No se presentaron deformidades de triángulos blandos ni de los rebordes de las narinas. De manera subjetiva el autor considera más rápida, barata y fácil esta cirugía mientras que da resultados satisfactorios. Discusión. La TRICK-TIP, una técnica original, convierte la rinoplastia cerrada en una con amplia visibilidad mientras preserva la anatomía de la punta. Su exposición extensa y rapidez permite realizar cambios estructurales complejos en el septum, dorso y vertientes nasales, mientras que maniobras indirectas permiten preservar las uniones interdomales, y proyectar la punta reduciendo espacios muertos. Conclusión. La técnica TRICK-TIP se ha convertido en la preferida del autor debido a su versatilidad y buenos resultados. Ofrece una combinación única de ventajas de los enfoques abiertos y cerrados, con énfasis en la preservación de la punta y la simplifi cación del procedimiento.

The aim is to present an unprecedented rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), which has been used for 14 years. Methods:The Surgery is indicated for primary and secondary aesthetic cases, as well as reconstructive such as cleft nose and post-traumatic sequelae. An intercartilaginous endonasal incision is continued with a vertical incision in the membranous septum. It is "opened" with a stair-step incision in the lower part of the columella, combining elements of both open and closed rhinoplasties. The nasal tip is elevated as a composed fl ap that includes the alar cartilages and the vestibular skin beneath them. The approach is extensive to perform all surgical maneuvers for the septum and dorsum while anatomically preserving and modifying the nasal tip from below by retrograde cephalic resection of the alar cartilages, application of an intercrural strut fi xed fi rst superiorly, and closure points for dead spaces in the supratip. The closure of incisions is simple and complete, with two-thirds of cases undergoing alar resection without deferral. Results: The results evaluated by 120 patients using Face Q™ and by 102 external evaluators are highly satisfactory, with low complications and infrequent revisions. Soft triangle deformities or nasal rim deformities were not observed. Subjectively, the author considers this surgery to be faster, cheaper, and easier, yielding satisfactory results. Discussion: The TRICK-TIP, an original technique, transforms closed rhinoplasty into one with extensive visibility while preserving the anatomy of the nasal tip. Its extensive exposure and reduced surgical time allow for complex structural changes in the septum, dorsum, and nasal sidewalls, while indirect maneuvers preserve interdomal junctions and project the tip, reducing dead spaces. Conclusion: The TRICK-TIP technique has become the author's preferred method due to its versatility and good outcomes. It off ers a unique combination of advantages from both open and closed approaches, emphasizing tip preservation and procedural simplifi cation.

Functional and esthetic outcomes of functional rhinoplasty for internal nasal valve dysfunction in Asian patients.

OBJECTIVE: This study aimed to use validated measures to evaluate the functional and esthetic outcomes in patients who underwent functional rhinoplasty for Internal Nasal Valve Dysfunction (INVD) in Korea. METHODS: A retrospective review of consecutive patients who underwent functional rhinoplasty for INVD confirmed by endoscopic findings and the modified Cottle test between 2016 and 2018 was performed. Nasal obstruction was assessed with the Visual Analog Scale (VAS) and nasal obstruction symptom evaluation (NOSE) scale. Acoustic rhinometry was performed pre- and post-operatively. The Minimal Cross-Sectional Area (MCA) of the nose was measured. Objective assessment of the esthetic outcomes was performed with the Objective Rhinoplasty Outcome Score (OROS), which assesses tip rotation, projection, width, dorsal height, width, length, symmetry, and the overall result. RESULTS: Fifty-seven patients (46 men and 11 women; mean age, 30.5 ±â€¯12.3 years) who underwent functional rhinoplasty were included in this study. The VAS and NOSE scores indicated functional improvement in all cases (all p < 0.001). There were no significant between-group differences (VAS score, p = 0.274; NOSE score, p = 0.952). The objective functional outcomes evaluated using MCA on the concave (p = 0.478) and convex (p = 0.631) sides did not differ significantly pre- and post-operatively. The subjective evaluation of esthetic satisfaction revealed no between-group difference. Moreover, 31 out of 44 patients (70.5%) with static INVD and nine out of 14 patients (64.3%) with dynamic or combined INVD showed excellent outcomes. Regarding objective esthetic outcomes, scores for the eight factors were >3, and there was no significant difference between the two groups (all p > 0.05). CONCLUSIONS: Functional rhinoplasty, including extracorporeal septoplasty and spreader grafting, may be a viable option for correcting INVD with functional and esthetic improvement. Dynamic INVD is less prevalent among Asians, and there was no significant difference in the surgical outcomes compared with those of static INVD. LEVEL OF EVIDENCE: Level 4.

Rinoplastia secundaria: infección nasal en el postoperatorio / Secondary rhinoplasty: postoperative nasal infection

La rinoplastia es una de las intervenciones más comunes en cirugía plástica. Se opera aquí una rinoplastia secundaria por vía abierta injertando los alares y la punta con cartílagos auriculares, mientras el tabique cartilaginoso fue usado para los spreader grafts. Se describe aquí una infección posoperatoria de su punta nasal. Al 9no día de su posoperatorio comienza con la punta nasal congestiva y levemente inflamada. Se medica con una crema con antibióticos, pero el día 14 aparece con la punta nasal muy inflamada y con colección. Cuando en el consultorio el cirujano la ve, como cualquier absceso, decide realizarle drenaje con un trocar 18G, 3 miniincisiones en la piel debajo de la punta nasal, de la que drena un líquido amarronado. Luego con el mismo trocar se realiza un lavado dentro de la cavidad con rifampicina solución. Se medica con trimetoprima-sulfametoxazol (Bactrimforte®) 2 comp/día. Al otro día se observa una notable mejoría. Se continuó con lavado diario durante 4 días con el mismo antibiótico evolucionando rápidamente bien. El Bactrim se lo continúa por 20 días. Al mes la punta nasal está muy bien, deshinchada con cicatrices apenas visibles. A los cuatro meses, la punta está muy blanda, las alas nasales y las narinas normales, la punta con buena proyección igual que el dorso con los spreader graft.

Rhinoplasty is one of the most common interventions in plastic surgery. A secondary open rhinoplasty was carried out grafting the allae and the tip of the nose with conchae cartilage, while the septum was used for spreader grafts. We are here describing this post operatory with a tip of the nose infection.In the control, at the 9th postoperative day, the nasal tip began to be congested and at the 14th post op day the patient showed a clear inflammatory collection. In the office, the surgeon decided to evacuate it with three punctureslike little incisions at the inferior part of the skin tip with a trocar 18G. Through them, drained brownish purulent secretion. With the same trocar, rifampicin solution was injected through these little incisions, like washing the subdermal area. It was medicated with trimethoprim-sulfamethoxazole (Bactrim forte®) 2 tablets/day. The following day, there was a clear improvement in the congestion and erythema of the nose. This procedure of washing was repeated for four days. There was a quick evolution of the inflammatory process and 20 more days, there was no sign of the infection. Four months later, the tip of the nose was soft and the result was considered optimal by the patient and doctors.

Modified extracorporeal septoplasty: prospective study.

OBJECTIVES: This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique. METHODS: We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients. RESULTS: Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ±â€¯29.9 and 23.5 ±â€¯26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p <  0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of -29.02; [95% CI -40.5 to -17.5]; p =  0.0001). Residual septal deviation was verified in 2 patients (7.4%). CONCLUSION: Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications. LEVEL OF EVIDENCE: Level 3.

The TRICK-TIP Rhinoplasty: Tip of the Nose Preservation Using the Combined Synergy of Open and Closed Approaches.

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 .

Nasal Tip Vascularization and Its Application for Columellar Reconstruction.

OBJECTIVE: Many studies have been published about the vascular anatomy of the nose and its utility for nasal reconstruction. Anatomic variations of the main arteries and their perforators are well described in the literature. A nasal tip perforator, not well described in the published studies, is analyzed in the present study and its utility for columellar reconstruction. This paper presents an anatomic study of the nasal tip artery and its clinical applications for columellar repair. METHODS: This study investigated the nasal tip perforator artery during nasal tip flap surgery for columellar repair in patients with sequels after nasal continuous positive airway pressure use. A descriptive anatomic study was conducted using intraoperative vascular dissection of patients operated on for nasal columellar defects by the author between 2013 and 2018. An observational study of a group of patients operated on for columellar repair using the axial nasal tip flap is presented here. RESULTS: The nasal tip artery was found in all the intraoperative dissections. Location and trajectory are described. Observed columellar length and width in operated patients have been nonstatistical and significantly different than controls in this study. CONCLUSIONS: The presence and trajectory of the nasal tip artery have been consistent in all the studied cases. The nasal tip flap based on this perforator has been a useful method for columellar repair in the studied group of patients. The presence of this vessel may augment blood supply to the nasal tip skin. By confirming the preservation of this artery, the surgeon may elevate the nasal tip flap safely.

A Dynamic Endonasal Columellar Strut Placement.

The dynamic retrograde intercrural columellar strut graft placement is a novel technique for a columellar strut insertion via a hemi-transfixion incision in patients undergoing endonasal functional or cosmetic surgery. It has a maximally concealed incision and does not disrupt major or minor tip support mechanisms. In our article, we give a detailed description of this unique surgical technique. Laryngoscope, 134:1246-1248, 2024.

Internal suspension sutures in tip rhinoplasty.

BACKGROUND: Achieving an aesthetically pleasant tip rotation is paramount in rhinoplasty, and these results should be long-lasting. However, even powerful structural techniques such as septal extension grafts can lose rotation over time, as most support depends on the attachment of the graft to the septal cartilage. METHODS: We describe a simple suture technique to strengthen tip support in rhinoplasty, by suspending it to the cartilaginous dorsum, providing additional support to the tip against forces, such as gravity, scar contraction and muscle tension. CONCLUSIONS: Combining traditional techniques with suspension sutures can improve intraoperative results and could enhance long-term tip stability.

Analysis of the use of isotretinoin as an adjuvant in rhinoplasty.

BACKGROUND: Isotretinoin has been used in the treatment of acne for decades through the reduction of sebaceous secretion. There are reports in the literature that isotretinoin may be associated with decreased skin thickness, especially in patients with thick nasal skin for whom rhinoplasty can be more challenging. The objective of this study was to quantify, through ultrasonography, the effect of the use of oral isotretinoin in patients undergoing rhinoplasty, pre- and postoperatively. METHODS: Twenty-four patients participated in this randomized, single-blind controlled pilot clinical trial. The intervention group used oral isotretinoin (20 mg/day) for 2 months before rhinoplasty and for 4 months after. Both groups underwent rhinoplasty in the same plastic surgery department and were submitted to high-frequency (22 MHz) ultrasound evaluation of the epidermis and dermis on the nasal dorsum, nasal tip, and left nose wing at the beginning of the study and 6 months after rhinoplasty, with the aim of assessing changes in skin thickness. RESULTS: Six months after rhinoplasty, a statistically significant reduction was observed in the thickness of the epidermis and dermis of the nasal dorsum and left nose wing, as well as of the epidermis of the nasal tip, but only in the intervention group. The results of the satisfaction questionnaire were better after rhinoplasty in both groups, with no statistical difference between them regarding the specific questions; however, the intervention group had significantly higher satisfaction scores than the control group. CONCLUSIONS: Isotretinoin was effective in reducing the thickness of the skin covering the nose of the evaluated sites.

The Fish Bone Technique: An Innovative Approach for the Bony Nasal Pyramid.

Among many contributions to the world of art and science, Renaissance artist Leonardo da Vinci created the technique known as sfumato. In this technique, da Vinci considered that the regions to be highlighted should be lit up, while the regions to be hidden should be darkened. Drawing parallel with the face, we can work on the anatomical structures underlying the skin and create a favorable surface anatomy for the entire face, including the nose. However, to achieve the ideal hourglass shape of the nose, the bones must be shaped, and a variety of osteotomies are described and used to achieve this. The new and innovative Fish Bone technique, described in this article, allows for the bony nasal pyramid to be shaped and adapted to the hourglass shape, resulting in a harmonious contour, with smooth transitions and preservation airway.

Tranexamic Acid in Patients Undergoing Rhinoplasty: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Rhinoplasty is one of the most popular aesthetic plastic surgeries worldwide. The effects of tranexamic acid (TXA) in patients undergoing rhinoplasty are still being studied to guide a better management. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) analyzing the effects of TXA in patients undergoing rhinoplasty. The outcomes evaluated were blood loss, postoperative edema, postoperative ecchymosis, surgery duration and surgeon satisfaction. RESULTS: Eleven studies comprising 841 patients were included. Overall, TXA reduced total blood loss regardless of dose and administration route (MD = - 39.37 mL; 95% CI = - 62.70 to - 16.05 mL; p = 0.0009; I2 = 92%), using intravenous 10 mg/kg of TXA preoperatively (MD = - 16.30 mL; 95% CI = - 29.49 to - 2.57 mL; p = 0.02; I2 = 61%) and using 1 g of oral TXA preoperatively (MD = - 61.70 mL; 95% CI = - 83.02 to - 40.39 mL; p < 0.00001; I2 = 0%). TXA also decreased edema (MD = - 0.78; 95% CI = - 1.28 to - 0.27 points; p = 0.003; I2 = 80%) and ecchymosis (MD = - 1.13; 95% CI = - 1.99 to -0.28; p = 0.01; I2 = 93%) on postoperative day one (POD 1). Surgeon satisfaction was increased (SMD = 1.55; 95% CI = 0.33 to 2.77; p = 0.01; I2 = 95%). However, there was no difference in surgery duration (SMD = - 0.26; 95% CI = - 0.56 to 0.04; p = 0.09; I2 = 36%). CONCLUSION: This study found a significant reduction in blood loss, periorbital edema and periorbital ecchymosis, along with an improvement in surgeon satisfaction. These results hold the potential to optimize the rhinoplasty management by plastic surgeons. LEVEL OF EVIDENCE I: 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 .

Anatomical Conditions in Simultaneous Orthognathic Surgery and Structural Rhinoplasty. A Clinical Series / Condiciones Anatómicas en Cirugía Ortognática y Rinoplastia Estructural Simultanea. Una Seria Clínica

SUMMARY: Orthognathic surgery and rhinoplasty show synergy in terms of function and aesthetic results. The aim of this research is to analyze variables related to simultaneous orthognathic surgery and rhinoplasty and to discuss the surgical sequence. Male and female subjects between 18 and 45 years old were included in this research. Diagnosis related to nasal morphology (nasal tip bifid, rotate, square and others as well as the alae morphology and columella), facial deformity (sagittal and vertical deformity), type of surgery (rhinoplasty techniques and orthognathic techniques) and complications were included. The minimum follow-up was 12 months; Chi- Square and t test were used to define correlations, considering a value of p<0.05 for statistical significance. Class III facial deformity was observed in 40 % of subjects and class II facial deformity was present in 43 %. For the nasal deformities, the tip and nasal bridge were most prevalent; primary nasal deformity was observed in the 83 % of subjects and was significant more than secondary nasal deformity (p=0.042). Bimaxillary surgery was performed in 31 cases (88 %). In 10 cases a change of the original plan for rhinoplasty due to previous maxillary surgery was realized, mainly in class III facial deformity, with no statistical differences. Revision rhinoplasty was realized in 5 cases (14 %) and was not related to surgical variables; revision for orthognathic surgery was not necessary in this series. Rhinoplasty and orthognathic surgery simultaneously show low complications and predictable results. We can conclude that maxillary mandibular osteotomies and rhinoplasty could be performed safely. However, larger studies are necessary to understand the best choice and variables involved in simultaneous procedures and soft tissue response.

La cirugía ortognática y la rinoplastia muestran sinergia en términos de resultados funcionales y estéticos. EL objetivo de esta investigación es analizar variables relacionadas con la cirugía ortognática y rinoplastia ejecutada de forma simultanea. Fueron incluidos hombres y mujeres entre 18 y 45 años de edad. EL diagnóstico fue en base a la morfología nasal (punta bífida, rotada, cuadrada u otras así como alteraciones del ala nasal y columela), deformidad facial (deformidad sagital y vertical), tipo de cirugía (técnica de rinoplastia y cirugía ortognática) y complicaciones asociadas. El seguimiento mínimo fue de 12 meses; se utilizo las prueba t test y chi cuadrado para definir relaciones estadísticas considerando un valor de p< 0,05 para obtener diferencias significativas. La deformidad clase III fue observada en el 40 % de los sujetos y la deformidad facial de clase II se presento en el 43 %. Para la deformidad nasal, las alteraciones de a punta nasal y nasal fueron mas prevalentes; la deformidad nasal primaria se presentó en el 83 % de los sujetos y fue significativamente mayor que la deformidad nasal secundaria (p=0,042). La cirugía bimaxilar se realizó en 31 casos (88 %); en 10 casos se realizó el cambio del plan quirúrgico inicial de la rinoplastia debido a cambios generados en la cirugía maxilar previa, mayormente en deformidad facial de clase III, sin presentar diferencias significativas. La rinoplastia de revisión fue realizada en 5 casos (14 %) y no fue relacionada con ninguna variable de tipo quirúrgica; la revisión de cirugía ortognática no fue realizada en ningún caso de esta serie. La rinoplastia y la cirugía ortognática simultanea mostraron bajas complicaciones y resultados predecibles. Se puede concluir que la osteotomía maxilo mandibular y la rinoplastia son seguras; sin embargo, estudios de mayor volumen son necesarios para entender la mejor opción y variables relacionadas con procedimientos simultáneos y la respuesta de tejidos blandos faciales.

Cirugía de reducción de base alar: aspectos fundamentales y técnica quirúrgica / Alar base reduction surgery: fundamental aspects and surgical technique

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.

Daño nasal por abuso de cocaína. Reporte de caso clínico / Nasal damage cocaine abuse. Case report

La cocaína proviene de la hoja de coca, es una sustancia que cuando se consume por la vía inhalatoria puede producir lesiones graves a nivel nasal, con lesiones que se inician a nivel de la mucosa, perforación septal, con pérdida del soporte a nivel de la punta nasal, retracción alar, compromiso de y retracción de ambas alas, planos de cobertura y piso de fosas nasales. La reconstrucción es un desafío para el cirujano plástico. Abarcando un arsenal terapéutico que va desde solo confeccionar un marco cartilaginoso para soporte de la columela y dorso nasal con costilla, hasta cobertura interna y externa con colgajos más sofisticados. Creemos que estos pacientes para su tratamiento deben presentar conocimiento de que es un camino largo que requiere muchos tiempos quirúrgicos y que en estadios avanzados la cobertura de mucosa es el mayor desafío.

Cocaine comes from the coca leaf, it is a substance that when consumed by inhalation can cause serious injuries to the nose. With lesions that start at the level of the mucosa, septal perforation, with loss of support at the level of the nasal tip, alar retraction, compromise and retraction of both wings, coverage planes, and floor of the nostrils. Reconstruction is a challenge for the plastic surgeon. A therapeutic arsenal that goes from just making a cartilaginous framework to support the columella and nasal dorsum with rib, to internal and external coverage with more sophisticated flaps. We believe that in order to treat these patients, they must be aware that it is a long road that requires many surgical times and that in advanced stages mucosal coverage is the greatest challenge

Evaluación clínica para el aumento del mentón en pacientes sometidos a rinoplastia / Clinical evaluation for chin augmentation in patients undergoing rhinoplasty

Introducción: el análisis detallado de las proporciones nasofaciales desempeña un papel fundamental para lograr la armonía facial e identificar desequilibrios; asi se dirige el tratamiento quirúrgico para lograr mejores resultados postoperatorios. El objetivo de este estudio fue determinar la prevalencia de pacientes sometidos a rinoplastia que requerían, además, un aumento del mentón. Materiales y métodos: se seleccionaron 100 pacientes voluntarios sometidos a rinoplastia entre los 17 y 55 años y se les realizó un estudio fotográfico preoperatorio. Se realizó un análisis facial del tercio inferior de la cara mediante tres métodos: González-Ulloa, Goode y Silver, y se hizo un análisis univariado y bivariado. Resultados: 100 pacientes voluntarios ingresaron al estudio; de estos, 7 fueron excluidos y quedaron 73 mujeres y 20 hombres; la edad mínima fue de 17 años y la máxima de 55 años, con un promedio de 28,4 años. La edad media de los hombres fue de 30,9 años y de las mujeres de 28,2 años. Del total de pacientes, 96,7 % de los pacientes cumplían con 2 o 3 métodos para aumento del mentón; de estos, 78,8 % eran mujeres y 21,1 % eran hombres. Conclusión: un análisis adecuado de las proporciones nasofaciales es fundamental para determinar los procedimientos necesarios para lograr un buen resultado quirúrgico y una mayor satisfacción del paciente. Estos métodos no sustituyen el juicio estético del cirujano; sin embargo, proporcionan un estándar objetivo para el diagnóstico de los desequilibrios faciales.

Introduction: Detailed analysis of nasofacial proportions plays a fundamental role in achieving facial harmony and identifying imbalances; thus, surgical treatment is directed to achieve better postoperative outcomes. The aim of this study was to determine the prevalence of patients undergoing rhinoplasty who also required chin augmentation. Materials and methods: 100 volunteer rhinoplasty patients between 17 and 55 years of age were selected and a preoperative photographic study was performed. Facial analysis of the lower third of the face was performed by three methods: Gonzalez-Ulloa, Goode and Silver, univariate and bivariate analysis was performed. Results: 100 voluntary patients entered the study, 7 of these were excluded, leaving 73 women and 20 men, the minimum age was 17 years and the maximum 55 years, with an average of 28.4 years. The mean age of the men was 30.9 years and of the women 28.2 years. Of the total number of patients, 96.7% of the patients com- plied with 2 or 3 methods for chin augmentation, of these 78.8% were women and 21.1% men. Conclusions: Adequate analysis of nasofacial proportions is essential to determine the procedures necessary to achieve a good surgical outcome and greater patient satisfaction. These methods do not replace the surgeon's aesthetic judgment; however, they provide an objective standard for the diagnosis of facial imbalances.

Polígonos de la punta nasal / Nasal tip polygons

La estética de la superficie de la nariz y especialmente de la punta nasal se crea mediante ciertas líneas, sombras y reflejos, con proporciones y puntos de ruptura específicos. La evaluación de la estética de la superficie nasal se logra utilizando el concepto de polígonos geométricos como subunidades estéticas, tanto para definir la deformidad existente como los objetivos estéticos. Los principios de los polígonos geométricos permiten al cirujano analizar las deformidades de la nariz, definir un plan operatorio para lograr objetivos específicos y seleccionar la técnica operatoria adecuada

The aesthetics of the surface of the nose and specially of the nasal tip is created through certain lines, shadows and reflections with proportions and specific breaking points. The evaluation of the aesthetics of the nasal surface is achieved using the concept of geometric polygons like aesthetics subunits to define the existing deformity as for the aesthetics objectives. The principles of the geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operating plan to achieve specific objectives and to select the most accurate operating technique

Postoperative Nasal Conformers in Cleft Rhinoplasty: Are They Efficacious?

BACKGROUND: Lip and nose symmetry the goal of repair of unilateral cleft lip and different preoperative and postoperative treatments have been developed with this purpose. The objective of this study was to compare 2 techniques used for primary cleft lip nose repair. MATERIALS AND METHODS: This is an retrospective study between 2 groups of patients with unilateral cleft lip and palate who underwent primary nasolabial repair either with or without postoperative nasal conformers. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements under general anesthesia during primary cleft palate repair. RESULTS: Our comparative study did not find a statistically significant difference regarding percentile indexes of nasal asymmetry between the 2 groups. Major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 3.84% of nasal conformer group and 4.65% of the group without nasal conformers. CONCLUSIONS: The results obtained from this study provides showed that placement of postoperative nasal conformers did not improve nasal symmetry in patients with unilateral cleft lip and palate. Based on these findings and available scientific evidence, definitive conclusions about the effectiveness of these devices on nasal symmetry after unilateral cleft lip nose repair cannot be drawn.