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The C2H2 separation from CO2 and C2H4 is of great importance yet highly challenging in the petrochemical industry, owing to their similar physical and chemical properties. Herein, the pore nanospace engineering of cage-like mixed-ligand MFOF-1 has been accomplished via contracting the size of the pyridine- and carboxylic acid-functionalized linkers and introducing a fluoride- and sulfate-bridging cobalt cluster, based on a reticular chemistry strategy. Compared with the prototypical MFOF-1, the constructed FJUT-1 with the same topology presents significantly improved C2H2 adsorption capacity, and selective C2H2 separation performance due to the reduced cage cavity size, functionalized pore surface, and appropriate pore volume. The introduction of fluoride- and sulfate-bridging cubane-type tetranuclear cobalt clusters bestows FJUT-1 with exceptional chemical stability under harsh conditions while providing multiple potential C2H2 binding sites, thus rendering the adequate ability for practical C2H2 separation application as confirmed by the dynamic breakthrough experiments under dry and humid conditions. Additionally, the distinct binding mechanism is suggested by theoretical calculations in which the multiple supramolecular interactions involving C-H···O, C-H···F, and other van der Waals forces play a critical role in the selective C2H2 separation.
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The use of autologous costal cartilage in augmentation rhinoplasty is well-established. However, scenarios where costal cartilage is insufficient or patients are unwilling to undergo additional cartilage harvesting present a challenge. This study introduces a composite dorsal onlay implant, combining silicone and costal cartilage, as an effective solution. Twenty female patients were enrolled in this study. Of these patients, 8 underwent revision surgery who had previous rhinoplasty with costal cartilage graft, and 12 had never previously undergone surgery involving the harvesting of costal cartilage. The implant, created by suturing a silicone base with a costal cartilage overlay, demonstrated low rates of warping and translucency over a mean follow-up of 11.4 months. This method offers a refined nasal appearance, particularly a higher dorsum with reduced translucency for patients with limited costal cartilage availability.
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BACKGROUND: The application of the expanded forehead flap in nasal reconstruction has the advantage of being able to provide a sufficient amount of flap and can provide good aesthetic results. For an expanded forehead flap to survive, there must be adequate arterial supply and venous return. Despite this, limited studies have been conducted on preoperative vascular mapping and the design of the expanded forehead flap for nasal reconstruction. In this article, the authors present a technique of hand-held Doppler detection with light illumination for vascular mapping. PATIENTS AND METHODS: The study included patients who underwent total nasal reconstruction with expanded forehead flaps between May 2016 and April 2021. The design of the flap was based on the result of preoperative vascular detection by hand-held Doppler detection assisted by light illumination. RESULTS: A total of 32 patients underwent total nasal reconstruction with an expanded forehead flap. The distal part of the flap became necrotic 1 week after the surgery in 2 patients. Following dressing changes and the administration of antibiotics, the distal flap in these patients survived well. No complications were reported in the long term. CONCLUSIONS: Hand-held Doppler detection combined with light illumination is a convenient and effective preoperative design method for nasal reconstruction with an expanded forehead flap. All flaps survived well in the long term. LEVEL OF EVIDENCE: Level IV.
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Iluminação , Rinoplastia , Humanos , Estética Dentária , Retalhos Cirúrgicos/cirurgia , Nariz/cirurgia , Rinoplastia/métodos , Testa/diagnóstico por imagem , Testa/cirurgia , Testa/irrigação sanguíneaRESUMO
In addition to providing extra flap size, the tissue expansion process also brings changes in flap thickness. This study aims to identify the changes in the forehead flap thickness during the tissue expansion period. Patients undergoing forehead expander embedment from September 2021 to September 2022 were included. The thickness of the forehead skin and subcutaneous tissue were measured with ultrasound before and 1, 2, 3, and 4 months after expansion. Twelve patients were included. The average expansion period was 4.6 months, and the mean expansion volume was 657.1 mL. The thickness of skin and subcutaneous tissue in the central forehead changed from 1.09 ± 0.06 to 0.63 ± 0.05 mm and from 2.53 ± 0.25 to 0.71 ± 0.09 mm, respectively. In the left frontotemporal region, skin and subcutaneous tissue thickness changed from 1.03 ± 0.05 to 0.52 ± 0.05 mm and 2.02 ± 0.21 to 0.62 ± 0.08 mm. On the right side, skin and subcutaneous tissue thickness changed from 1.01 ± 0.05 to 0.50 ± 0.04 mm and 2.06 ± 0.21 to 0.50 ± 0.05 mm. This study measured the dynamic changes in the thickness of the forehead flap during expansion. The thickness of the forehead flap decreased the fastest in the first 2 months of expansion, and the changes in skin and subcutaneous thickness slowed down in the third and fourth months and tended to a minimum value. Additionally, the thickness of subcutaneous tissue decreased greater in magnitude than the dermal tissue.
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Testa , Expansão de Tecido , Humanos , Testa/cirurgia , Retalhos Cirúrgicos , Transplante de Pele , Dispositivos para Expansão de TecidosRESUMO
Due to the prevalence of anterior maxilla dysplasia in Asian population, paranasal concavity is a common accompaniment to low nose, but its impact on facial harmonization is often underestimated. A retrospective comparative study was conducted on patients diagnosed as low nose with paranasal concavity between June 2017 and June 2021, with a total of 56 patients followed up successfully. The control and observation groups were established according to whether the paranasal augmentation was performed. Demographic data were collected. Cosmetic enhancement was quantitatively evaluated by sagittal planimetry, establishing related anatomical landmarks and measuring columella base prominence (CBP) and alar base prominence (ABP). Subjective evaluation concluded the patient-reported satisfaction (FACE-Q-Rhinoplasty Module and Facial Appearance Module) and the third-party physician assessment (Global Aesthetic Improvement Scale, GAIS).Significant improvements in CBP and ABP were reported both in the control and the observation group (p < 0.01). In postoperative intergroup comparisons, the observation group was superior to the control group regarding ABP values (2.5 ± 0.75 degrees, p < 0.01), FACE-Q-Facial scores (7.49 ± 3.70, p < 0.05), and GAIS scores (p < 0.05). However, no statistical difference was found in CBP values and FACE-Q-Rhinoplasty scores. Paranasal augmentation-related complications included asymmetry of alar bases (6.9%) and facial or intraoral foreign body sensation (34.5%). This study affirmed that paranasal augmentation using diced costal cartilage in rhinoplasty is a safe procedure effective in remedying paranasal concavity and improving facial satisfaction. LEVEL OF EVIDENCE:: IV.
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BACKGROUND: Because of its unique advantages, frontal expansion has become a common tool for Asian nasal reconstruction, but it has the limitations of prolonging the duration and pain in the expansion area. Based on the fact that the denervation effect of botulinum toxin type A (BTX-A) has been widely used in the reconstruction of superficial organs, we hypothesized that BTX-A would shorten the length of nasal reconstruction sequence and alleviate the discomfort of patients. METHODS: A comparative retrospective study was conducted of consecutive patients underwent sequential treatment of nasal reconstruction between June 2010 and July 2012. Data on demographics, BTX-A injection plan and expansion duration were collected and analyzed. Phased pain intensity outcomes were evaluated by visual analogue scale (VAS). Photographs were collected during the follow-up period. RESULTS: Thirty patients were enrolled in the study; 15 (50%) with and 15 (50%) without BTX-A pre-injection. Demographic data were homogeneous. The duration of the observation group (BTX-A pretreated) (133.87 ± 13.64 days) was significantly shortened versus the control group (164.27 ± 14.08 days, P<0.001). At the initial stage, no significant difference was found in the VAS scores (P=0.64). At the medium stage, the VAS score of the observation group (2.07 ± 0.80) was significantly lower than the control group (3.00 ± 0.53, P<0.01). At the terminal stage, the VAS score of the observation group (1.93 ± 0.59) was significantly lower than the control group (2.73 ± 0.70) but with a narrower disparity. CONCLUSION: Pre-injection of BTX-A is effective in shortening the duration of the expansion phase, as well as relieving the pain associated with expansion. LEVEL OF EVIDENCE IV: The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .
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BACKGROUND: There has been no previous study on the availability of different glucocorticoid varieties used in the multimodal cocktail for harvesting autologous costal cartilage. This randomized controlled trial (RCT) was to compare the significance and complications of betamethasone and triamcinolone acetonide as a component of the cocktail for harvesting costal cartilage in patients. MATERIALS AND METHODS: The patients were randomized to two groups. The group A used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and triamcinolone acetonide; group B used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and betamethasone. The primary outcomes were chest pain after surgery evaluated with a visual analog scale (VAS). The secondary outcomes evaluated the quality of recovery. The tertiary outcomes included rescue analgesic consumption, the first feeding time and the time to the first ambulation, and duration of hospital stay. RESULTS: The VAS scores between the two groups was not considered clinically significant, but the groups achieved a VAS score of 3 or less. However, the time until the first rescue analgesia and the number were significantly longer and smaller for group A. Additionally, there were no significant differences between the two groups in the duration of hospital stay, first feeding time, the quality of recovery, and the first ambulation time. CONCLUSION: Adding corticosteroids into the multimodal cocktails could improve pain relief after costal cartilage harvest. And the efficacy of Triamcinolone acetonide was better than betamethasone. LEVEL OF EVIDENCE II: 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 .
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Cartilagem Costal , Triancinolona Acetonida , Humanos , Betametasona , Ropivacaina , Epinefrina , Dor no Peito , Dor Pós-Operatória , Método Duplo-CegoRESUMO
The development of metal-organic framework (MOF) adsorbents with a potential molecule sieving effect for CO2 capture and separation from flue gas is of critical importance for reducing the CO2 emissions to the atmosphere yet challenging. Herein, a cagelike MOF with a suitable cage window size falling between CO2 and N2 and the cavity has been constructed to evaluate its CO2/N2 separation performance. It is noteworthy that the introduction of coordinated dimethylamine (DMA) and N,N'-dimethylformamide (DMF) molecules not only significantly reduces the cage window size but also enhances the framework-CO2 interaction via C-H···O hydrogen bonds, as proven by molecular modeling, thus leading to an improved CO2 separation performance. Moreover, transient breakthrough experiments corroborate the efficient CO2/N2 separation, revealing that the introduction of DMA and DMF molecules plays a vital role in the separation of a CO2/N2 gas mixture.
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BACKGROUND: Secondary deformities of the cleft lip and nose are mainly caused by the long period of craniofacial development and the secondary scarring. Correction of the secondary cleft lip-nose deformity is a complex process that requires both the correction of the soft tissue and skeletal support. The purpose of this study was to present our experience in correcting the secondary unilateral cleft lip-nose deformities with autologous costal cartilage. METHODS: A retrospective analysis of patients who underwent correction of unilateral cleft nasal deformity with simultaneous rhinoplasty by a senior surgeon from January 2015 to January 2022 was conducted. Preoperative and postoperative measurements of the columellar-labial angle and the inclination of nasal base were conducted to evaluate the surgical outcomes. RESULTS: A total of 54 patients were included in this study according to the inclusion criteria. The mean follow-up period was 4 years (range, 1-7 years). The mean values of the columellar-labial angle were 91.1 ± 9.2 degrees preoperatively and 101.0 ± 5.9 degrees postoperatively. The mean values of the inclination of nasal base were 4.5 ± 1.2 degrees preoperatively and 0.9 ± 0.4 degrees postoperatively. There was a considerable increase in the columellar-labial angle after the surgery (9.9 ± 6.0 degrees; P < 0.01). The inclination of nasal base decreased significantly (3.6 ± 1.1 degrees; P < 0.01). CONCLUSIONS: Our approach on correction the secondary clef lip nose through repositioning the muscles by Z-plasty and application of the block cartilage graft and circular shape alar graft has achieved long-term satisfactory results.
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ABSTRACT: Costal cartilage harvesting (CCH) is a fundamental skill for plastic surgery residents to master. Understanding the learning process is essential for optimizing training programs and ensuring patient safety. Previous research on learning curves has been limited. A retrospective study was conducted on patients who underwent CCH between January 2018 and December 2022. The learning process of 14 inexperienced residents was analyzed using the curve-fitting method, with operative time (OT) and complication rates as outcome measured. Data were compared with 4 attending surgeons who also performed CCH. Resident OTs decreased as experience grew, with the bi-exponential model fitting best. After 10 to 20 cases, the average OT decreased to around 40 minutes. By extrapolation, novice residents require ~50 cases to achieve a plateau of OT similar to the attending surgeons, around 27 minutes. Most complications of the resident group occurred within the first 10 to 20 cases, and the complication rate of attending surgeons was <1%. Harvesting on the left side and a higher body mass index resulted in longer OTs for residents. Harvesting the seventh rib required significantly more time for both residents and attending surgeons. The learning curve for CCH shows that 10 to 20 cases are necessary for residents to perform safely and efficiently. Training should progress gradually, starting with longer incisions and leaner patients, then moving to smaller incisions and more challenging cases. LEVEL OF EVIDENCE: Level IV.
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Cartilagem Costal , Internato e Residência , Cirurgia Plástica , Humanos , Estudos Retrospectivos , Curva de Aprendizado , Competência ClínicaRESUMO
BACKGROUND: The costal cartilage is widely used in rhinoplasty. Although different surgical methods of costal cartilage harvest have been developed, few studies have reported the method of costal cartilage harvest for patients after breast augmentation. This study aims to provide our experience of costal cartilage harvest through a small incision approach. METHODS: A retrospective review was performed for patients undergoing esthetic rhinoplasty with costal cartilage after breast augmentation between May 2019 and May 2021. Postoperative pain was evaluated with the Visual Analog Scale, and the scars at the donor site were assessed 1 year postoperatively with the Modified Vancouver Scar Scale. RESULTS: A total of 23 female patients were included. The average follow-up time was 21.4 months. No complications of massive bleeding, pleural injury, or breast implant injury during the surgery, wound dehiscence, or wound infection in the harvested site were observed. No patients complained of changes in breast morphology or breast asymmetry after costal cartilage harvest. Results of Visual Analog Scale for donor-site pain indicated pain in donor-site peaked at 12 hours after surgery and gradually decreased. All patients were satisfied with the scarring of the donor sites after surgery. CONCLUSION: The better scar performance, low complication rates, and high satisfaction among patients suggest that this is a safe technique to harvest costal cartilage with a small incision in rhinoplasty for patients after breast augmentation.
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Cartilagem Costal , Mamoplastia , Rinoplastia , Ferida Cirúrgica , Humanos , Feminino , Cartilagem Costal/cirurgia , Rinoplastia/métodos , Cicatriz/cirurgia , Estética Dentária , Dor Pós-Operatória , Estudos Retrospectivos , Ferida Cirúrgica/cirurgiaRESUMO
BACKGROUND: Despite the different approaches for detection of perforators, methods of vascular mapping of the expanded forehead flap for nasal reconstruction are rarely described. This article aimed to present our experience in the preoperative design of the expanded forehead flap for nasal reconstruction and to compare the clinical practice of hand-held Doppler and indocyanine green angiography (ICGA) in vascular mapping for nasal reconstruction with the expanded forehead flap. METHODS: From October 2019 to April 2022, 26 patients underwent nasal reconstruction using expanded forehead flap. The authors performed preoperative vascular mapping on 16 patients by hand-held Doppler alone, and on 10 patients by hand-held Doppler and ICGA primary outcomes considered were the visualization of the main vascular course of the flap obtained by hand-held Doppler or ICGA, intraoperative observation of the flap, and its postoperative complications. RESULTS: Indocyanine green angiography provides a better detection in distal flap and the branches of the supratrochlear artery. Vein detection by ICGA generally corresponds to the results obtained by the combination of hand-held Doppler and transillumination test. In the group that only used hand-held Doppler, 2 patients presented hemodynamic complications in the margin of the flap and 1 patient presented partial necrosis postoperatively. No complication was found in the group that used ICGA. CONCLUSIONS: It is recommended to use the ICGA for preoperative planning, as it yields highly accurate vascular courses. As an alternative to other methods, hand-held Doppler is also an effective tool. LEVEL OF EVIDENCE: IV.
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Testa , Verde de Indocianina , Humanos , Testa/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos/irrigação sanguínea , Angiografia/métodosRESUMO
BACKGROUND: Extended Spreader Grafts (ESGs) are widely used for both esthetic and functional purpose in rhinoplasty. This study aims to examine the effects of drilling on ESGs in rhinoplasty and their clinical benefits, as well as to analyze their histologic characteristics. METHODS: We conducted a retrospective review of patients undergoing esthetic rhinoplasty using drilled ESGs with autologous costal cartilage by a senior surgeon from January 2018 to April 2022. RESULTS: A total of 80 patients were included, with a mean follow-up period of 26 months. Revision operations were performed on 4 patients. The phenomenon of tissue ingrowth from the septum mucoperichondrium to the septal cartilage through the holes of the drilled ESGs was observed in all 4 patients. Specimens of the ingrown tissue were taken from 3 patients during their revision surgeries. Vascular structures and connective tissue were observed in the specimens after fixation, paraffin embedding, and staining with hematoxylin-eosin. No other complications were observed except for 2 cases presenting cartilage warping after surgery. CONCLUSION: Application of the drilled ESGs is a simple but effective approach, which has 3 significant advantages in rhinoplasty: enhancing the stability of the cartilaginous framework through connective tissue ingrowth, preserving the septal cartilage, and providing septum vitality by allowing the formation of vascular structures between the perichondrium and the septal cartilage; reducing the probability of warping in early stages through release the tension force of the cartilage itself. LEVEL OF EVIDENCE: Level IV.
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BACKGROUND: A variety of techniques for alar base modification have been described in the literature. Limitations of these techniques include scars, recurrence, asymmetry, etc. An incorrect excision of the lateral alar wall can result in a tear-drop or Q-shaped deformity. OBJECTIVES: In this study, a modified V-Y advancement flap will be introduced that will avoid the complications discussed above as well as adjust the positional relationship between the nasal alar and the columella using this technique. In addition, this method is reversible; once the nostril is narrow due to excessive advancement of the flap, the reverse V-Y advancement method can be used to enlarge the nostril. METHODS: In this study, a retrospective review of wide nasal bases in the past 3 years was conducted. A blind analysis of anthropometric points was conducted. There were 3 outcome variables: the width of the alar base, the width of the flare, and the distance between the alar base and columellar base. RESULTS: The alar base was reduced with a modified V-Y advancement flap on 65 female patients ranging from 18 to 45 years of age. In 10 cases, an "Inclined Y-arm flap" was used to narrow alar bases and adjust columella-alar positions. In the remaining cases, a "Horizontal Y-arm flap" was performed to narrow the simple nasal alar width. In all cases, the nasal base was reduced without distortion. In the postoperative period, all the effects were seen to persist for a long time, and patients were generally satisfied with the results of the procedure. CONCLUSION: By using this modified V-Y advancement flap technique, the incision can be concealed as thoroughly as possible, thereby avoiding "tear-drop" or "Q" deformities as well as narrowing the nasal alar effectively. Furthermore, this method, in combination with rhinoplasty surgery, will greatly enhance the nasal appearance.
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Fenda Labial , Doenças Nasais , Rinoplastia , Humanos , Feminino , Nariz/cirurgia , Retalhos Cirúrgicos/cirurgia , Rinoplastia/métodos , Septo Nasal/cirurgia , Doenças Nasais/cirurgia , Estudos Retrospectivos , Fenda Labial/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Flaps contract immediately after harvest, which added difficulty to flap design. This study aims to investigate the immediate contraction rate of the expanded forehead flap used in nasal reconstruction. METHODS: Patients undergoing nasal reconstruction with expanded forehead flaps from September 2021 to January 2023 were included. Objective measurements of the pedicle width, maximum width, maximum length, and flap size of the expanded forehead flap before and after harvest were conducted. RESULTS: Fourteen patients, including 9 males and 5 females, were included. The average expansion period was 4.6 months, and the mean injection volume was 658.6 ml. The average retraction rate of pedicle width, maximum width, maximum length, and size of the flap after harvest were 16.15%, 30.26%, 26.86%, and 50.89%, respectively. CONCLUSION: This study presents the contraction rate of the expanded forehead flap used for nasal reconstruction. The data from the measurement will help surgeons to design the expanded forehead flap. LEVEL OF EVIDENCE: Level-Level IV.
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BACKGROUND: The camouflage of the nasal dorsum is very important for thin-skinned patients. In this study, the authors presented an improved method for these patients and evaluated the safety and efficacy of this method in augmentation rhinoplasty. METHODS: Fifty-two thin-skinned nose Chinese patients, ranging in age from 18 to 42 years, who underwent open augmentation rhinoplasty with modified perichondrium on dorsal onlay graft were included in the study. Among these patients, 24 of them were primary cases, and the other cases were secondary. The Rhinoplasty Outcomes Evaluation (ROE) scale and Visual aid scoring (VAS) questionnaire were used to evaluate aesthetic outcomes. RESULTS: During the long-term follow-up (ranging from 6 to 20 months), the ROE scores of each item before and after surgery were statistically significant in our study. The total scores of the preoperative and postoperative ROE scale of the study were 9.77 ± 3.18 and 20.65 ± 1.88, respectively, which indicated reasonably high satisfaction. According to the VAS questionnaire, patients' own evaluations of the nasal dorsal improvement rendered a high satisfaction rate. One case of fat liquefaction at the donor site and two cases of warping occurred and no other major complications were encountered. CONCLUSION: Covering the two edges of the graft with perichondrium on the onlay dorsal graft seems a convenient and effective method for thin-skinned augmentation rhinoplasty, which was the best choice for camouflage of the nasal dorsum in our department. LEVEL OF EVIDENCE: IV 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 ."
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Cartilagem Costal , Rinoplastia , Humanos , Adolescente , Adulto Jovem , Adulto , Rinoplastia/métodos , Cartilagem Costal/transplante , Seguimentos , Resultado do Tratamento , Nariz/cirurgia , Estudos Retrospectivos , EstéticaRESUMO
INTRODUCTION: Rhinoplasty for caudal septal cartilage defects is a challenge due to the difficulty of fixation of the grafts. OBJECTIVES: This study presents an approach for correcting defects in caudal septal cartilage with the costal cartilaginous framework using a mortise-tenon technique. METHODS: From May 2019 through May 2022, a retrospective analysis of patients with caudal septal cartilage defects underwent rhinoplasty using a mortise-tenon cartilaginous framework by a senior surgeon was performed. The surgical outcomes were evaluated both preoperatively and postoperatively. RESULTS: This study involved 17 patients, ranging in age from 27 to 58 years. There were 22.4 months of follow-up on average. There was no long-term or short-term complication observed. The aesthetic outcome of all cases was satisfactory. The mean score for the patients of the perceptions of improvement in their noses was 8.11. CONCLUSION: Correction of caudal septal cartilage defects with this costal cartilaginous framework using the mortise-tenon technique is feasible and effective. LEVEL OF EVIDENCE IV: 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 .
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BACKGROUND: It is undeniable that costal cartilage is an excellent source of grafts, however it has some potential disadvantages, including a tendency to warp. There are very few studies that have examined how to resolve preexisting cartilage warping during secondary revisional surgery. OBJECTIVES: The aim of this study was to explore causes of cartilage warping other than the cartilage itself and ways to correct cartilage warping during revisional surgery. METHODS: In the present study, cases of cartilage warping in the past 5 years were retrospectively reviewed, and external factors of cartilage warping were evaluated to help design new cartilage grafts that could be employed to repair cartilage deformities. RESULTS: A total of 29 females and 3 males between the ages of 18 and 60 years participated in the study (average age, 32.5 years). In all cases, embed-in grafts were utilized to correct warping. All patients were satisfied with the results. As a result of our research, we found that another external cause of cartilage warping was the hump that was not removed completely during the initial surgery. CONCLUSIONS: Incomplete removal of the hump is a major contributing external factor to cartilage warping, particularly in the sagittal plane. This embed-in graft is not intended as a routine graft in normal circumstances, but rather as an immediate means of solving an unexpected situation. The graft is primarily for management of severely warped cartilage.
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Cartilagem Costal , Rinoplastia , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cartilagem Costal/transplante , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Estudos Retrospectivos , Cartilagem/transplante , Transplante AutólogoRESUMO
BACKGROUND: An enduringly stable tip graft is the key to achieving successful rhinoplasty. However, the intrinsic tendency of rib grafts to warp renders the long-term outcome of cartilage-based rhinoplasty highly unpredictable. OBJECTIVES: The aim of this study was to detail and validate the utilization of a tip graft that is characterized by a circumferential split on the tip graft, which creates a shape similar to the letter X. METHODS: The counterrotating force applied intraoperatively and the complications that arose were examined retrospectively. Three-dimensional stereophotogrammetric evaluations of patients was performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, tip rotation, and the nasion-pronasale angulation. RESULTS: Forty-five female patients, ranging in age from 18 to 41 years (average, 28.5 years) completed the study. In all cases, the X graft was applied as an essential element for enhancing tip projection. Postoperative analysis showed excellent maintenance of tip position over time, evidenced by insignificant changes in nasion-pronasale angulation. Other postoperative evaluations, including tip projection, nasal length, and nasolabial angle, showed significant improvement. The differences were not statistically different between short- and long-term follow-up. CONCLUSIONS: The X graft effectively mitigates the negative impact of graft warping. It is the ultimate form for tip support and for elongating short noses. It has the merits of versatility and flexibility when used to create a strong and sustainable tip support in East Asian rhinoplasty.
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Rinoplastia , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Septo Nasal/cirurgia , Estudos Retrospectivos , Nariz/cirurgia , Cartilagem/transplante , Costelas , Resultado do TratamentoRESUMO
BACKGROUND: Insufficient support of the nasal septum due to congenital or secondary deficiency leads to severe saddle nose deformity, which presents an unpleasant appearance. OBJECTIVES: The purpose of this study is to present our approach to constructing a costal cartilaginous framework with autologous costal cartilage for correction of severe saddle nose deformities. METHODS: A retrospective analysis was conducted of patients who underwent correction of severe saddle nose deformity (type 2 to type 4) by a senior surgeon from January 2018 to January 2022. Preoperative and postoperative measurements were conducted to evaluate the surgical outcomes. RESULTS: A total of 41 patients ages 15 to 50 years completed the study. The average follow-up time was 20.6 months. No short-term complications were observed. Revisional operations were performed on 3 patients. All patients were satisfied with the aesthetic results. Analysis of objective measurements showed that the nasofrontal angle, columellar-labial angle, and tip projection improved significantly in type 2 cases, the nasofrontal angle and tip projection improved significantly in type 3 cases, and tip projection improved significantly in type 4 cases. CONCLUSIONS: Application of this modified costal cartilaginous framework, which consists of a fairly stable foundation layer and an aesthetic contour layer of block costal cartilage, has achieved satisfactory results over the long term.