Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series

2017 ◽  
Vol 33 (03) ◽  
pp. 316-323 ◽  
Author(s):  
Allen Foulad ◽  
Veronika Volgger ◽  
Brian Wong
Keyword(s):  
Nasal Obstruction ◽  
Case Series ◽  
Cosmetic Outcome ◽  
Medical Review ◽  
Nasal Valve ◽  
Nasal Tip ◽  
Technical Details ◽  
External Nasal Valve ◽  
Extension Graft ◽  
Alar Rim

AbstractThe objective of this study was to discuss the technical details and our experiences with lateral crural tensioning (LCT) in both functional and aesthetic rhinoplasties. A retrospective medical review was completed for all patients who underwent rhinoplasty with LCT from the years 2011 to 2014. The indications for LCT included correction of lateral crural convexity, boxy tip geometry, and dynamic collapse of the external nasal valve. The details of the rhinoplasty procedure and complications were evaluated. A total of 114 LCT rhinoplasty cases were included in this series. The most common adjunctive maneuvers included placement of spreader grafts (92% of cases) and alar rim grafts (78% of cases). Conventional classic cephalic trim was not performed in any subjects and conservative paradomal cephalic trim was performed in 48% of cases. As experience with the technique progressed, the use of onlay tip grafts decreased and the use of articulated rim grafts increased. Indications for revision were dissatisfaction with cosmetic outcome (4.4% of cases) and nasal obstruction (0.9% of cases). LCT combines traditional lateral crural steal with the use of a caudal septal extension graft to refine the broad tip and increase stability of the alar lobule. This maneuver is essentially cartilage sparing and does not rely on extensive grafting maneuvers that can reduce airway area.

scholarly journals Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures

2021 ◽  
Author(s):  
Douglas M. Sidle ◽  
Pablo Stolovitzky ◽  
Ellen M. O'Malley ◽  
Randall A. Ow ◽  
Nathan E. Nachlas ◽  
...  
Keyword(s):  
Adverse Events ◽  
Nasal Obstruction ◽  
Large Population ◽  
Inferior Turbinate ◽  
Nasal Valve ◽  
Serious Adverse Events ◽  
Vas Scores ◽  
Nasal Implant ◽  
Nasal Valve Collapse

AbstractThe aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (p < 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on www.clinicaltrials.gov (NCT02952313 and NCT02964312).

scholarly journals Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

2021 ◽  
pp. 014556132098394
Author(s):  
Mohamed A. Taha ◽  
Christian A. Hall ◽  
Harry E. Zylicz ◽  
William T. Barham ◽  
Margaret B. Westbrook ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Primary Group ◽  
Nasal Valve ◽  
Lateral Crus ◽  
Valve Dysfunction ◽  
Score Improvement ◽  
Revision Rhinoplasty ◽  
Final Score ◽  
Sinonasal Outcome Test ◽  
External Nasal Valve

Objective: To evaluate and compare the costal cartilage lateral crural strut graft’s (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. Methods: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. Results: While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort’s preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. Conclusion: The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

scholarly journals Functional and aesthetic outcomes of spreader graft and auto-spreader flap after nasal hump removal

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Maged Baher Naguib ◽  
Mohamed Rifaat Ahmed ◽  
Yasser Taha Madian ◽  
Tarek Mohamady Elnahriry ◽  
Wael Elshahat Eldeeb
Keyword(s):  
Nasal Obstruction ◽  
Operative Time ◽  
Nasal Valve ◽  
Spreader Graft ◽  
Spreader Flap ◽  
The Mean ◽  
The Difference ◽  
A New Technique ◽  
Nasal Valve Collapse ◽  
Duration Of Operation

Abstract Background Following the reduction of the nasal hump to a desired level, spreader grafts are usually positioned to prevent the complication of nasal valve collapse. Auto-spreader flap is a new technique that gained more popularity recently and can be used as an alternative to spreader graft. This RCCT compared between both techniques aesthetically and functionally as well as the operative time. Results Forty patients, 17 males (42.5%) and 23 females (57.5%), were included. The mean duration of operation in auto-spreader flap was 11.8 ± 3.4 min, while it was 19.2 ± 3.2 min in spreader graft. The difference between the two procedures was statistically significant (P < 0.05). Functional assessment of nasal obstruction was done for all patients in both groups preoperative that was (75.6 ± 19.9) which showed marked improvement when re-evaluated 3 moths postoperatively (18.9 ± 14.7), and after 6 months NOSE scale was (29.1 ± 20.2). The overall aesthetic satisfaction was 62.5% (25 of 40) irrespective of the surgery done. Sixteen out of 20 patients in spreader group and 9 out of 20 in auto-spreader flap group. Conclusion Auto-spreader flap and spreader graft are very effective surgical procedure for treatment of nasal obstruction due to internal nasal valve dysfunction, but the auto-spreader flap had shorter operative time. However, spreader graft has a superior aesthetic outcome.

The Effect of Closed Septorhinoplasty on Nasal Functions and on External and Internal Nasal Valves: A Prospective Study

2017 ◽  
Vol 31 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Giancarlo Pecorari ◽  
Giuseppe Riva ◽  
Francesca Antonella Bianchi ◽  
Giovanni Cavallo ◽  
Francesca Revello ◽  
...  
Keyword(s):  
Prospective Study ◽  
Nasal Obstruction ◽  
Laser Scanning ◽  
Soft Tissues ◽  
Statistical Significance ◽  
Three Dimensional ◽  
Subjective Assessment ◽  
Nasal Airflow ◽  
Nasal Valve ◽  
Objective Reduction

Background Because nasal function and shape are so closely intertwined, quantitative assessments can better define their relationship and how they are affected by septorhinoplasty. Objective The aim of this prospective study was to perform an analysis of the nasal airflow resistances and a three-dimensional (3D) evaluation of the soft-tissue changes after closed septorhinoplasty. Methods Before surgery (TO) and 6 months after closed septorhinoplasty (Tl), 30 patients underwent symptoms evaluation by means of the Italian version of the Nasal Obstruction Symptom Evaluation scale, endoscopic fiberoptic nasal examination, and visual analog scale for subjective assessment of nasal obstruction. Nasal airflow resistances were investigated with active anterior active rhinomanometry. A 3D laser scanner was used to evaluate facial soft-tissues, with specific nasal points and angles. Results Subjective nasal obstruction decreased. Anterior active rhinomanometry demonstrated a reduction in total inspiratory and expiratory resistances between T0 and T1 but without statistical significance. The significance was still absent after decongestion, excluding turbinate hypertrophy as a cause of failed objective amelioration of nasal resistance. Facial laser scanning showed statistically significant reduction of the superior nasal width and superior alar angle, and a weak negative correlation between the superior alar angle and nasal resistances. Conclusion The absence of objective reduction of nasal airflow resistances could be the result of concurrent surgery on nasal septum and nasal valve. In particular, the ameliorating effect on nasal airflow resistances is counterbalanced by the worsening effect of the narrowing of nasal valve.

The nose and paranasal sinuses

2021 ◽  
pp. 455-496
Author(s):  
Daniel R. van Gijn ◽  
Jonathan Dunne
Keyword(s):  
Paranasal Sinuses ◽  
Nasal Septum ◽  
Side Wall ◽  
Nasal Valve ◽  
Nasal Tip ◽  
Nasal Cartilages ◽  
Nasal Bones ◽  
External Nose ◽  
Nasal Side ◽  
Nose And Paranasal Sinuses

The external nose is pyramidal and consists of a bony cartilaginous framework. The root/radix is continuous with the forehead an inferiorly terminates at the nasal tip. The dorsum of the nose is formed by two lateral surfaces that converge in the midline. The cartilaginous structure of the nose is formed by paired upper (lateral) cartilages that contribute to the internal nasal valve with the nasal bones, and lower lateral cartilages, combined with additional minor nasal cartilages that surround the ala. The nasal septum relies upon anastomoses from five vessels: two from the ophthalmic, two from the maxillary and one from the facial. Collectively, they form Kieselbach’s plexus. The paranasal sinuses are the frontal, sphenoidal, ethmoidal and maxillary – located within the bones of the same name. They are paired structures lined with mucosa that is continuous with the lateral nasal side wall into which they drain, facilitating clearance of mucus by way of the mucociliary escalator.

Mono-Unit Alar Rim Graft Technique for Tip-Alar Margin Support

2020 ◽  
Vol 40 (10) ◽  
pp. NP588-NP596
Author(s):  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Demographic Data ◽  
Costal Cartilage ◽  
Case Series ◽  
Senior Author ◽  
Open Approach ◽  
Level Of Evidence ◽  
Appropriate Treatment ◽  
Patient Demographic Data ◽  
Patient Series ◽  
Alar Rim

Abstract Background The appropriate treatment of alar rim deformities, such as alar pinching or concavity, and soft triangle notching is essential for perfecting nasal aesthetics. Objectives The authors introduced the “mono-unit alar rim graft” technique as a treatment option for these abnormalities. Methods A case series of 29 rhinoplasties conducted by the senior author between May 2017 and June 2019 utilizing the mono-unit alar rim graft technique was retrospectively reviewed. The surgical technique involved an open approach with costal cartilage harvesting. The cortical portion of the harvested costal cartilage was sectioned into a 1-mm-thick strip and soaked with saline for about 15 minutes to let the natural warping occur. The curved cartilage graft was then trimmed, and the midportion was sutured to the tip in an onlay fashion. Both ends of the graft were housed in the vestibular pocket. Patient demographic data and pre- and postoperative facial photos were reviewed. Results Among the 29 cases analyzed, 14 (48.3%) were men and 15 (51.7%) were women. Ten (34.5%) patients had a preoperative parenthesis deformity, but a near-complete correction was achieved in 8 (80.0%) cases. An alar concavity from the basal view was found in 16 patients, 15 (93.8%) of whom had a partial or near-complete correction. Eleven patients had soft triangle notching, 9 (81.8%) of whom had a partial or near-complete correction. There were no technique-related complications in this patient series. Conclusions The mono-unit alar rim graft technique is a viable option for treating various alar rim deformities. Level of Evidence: 4

Modified Z‐plasty of the internal nasal valve—To treat mechanical nasal obstruction: How we do it

2019 ◽  
Vol 44 (6) ◽  
pp. 1203-1204
Author(s):  
Kiran Varadharajan ◽  
Natasha Choudhury ◽  
Hesham A. Saleh
Keyword(s):  
Nasal Obstruction ◽  
Nasal Valve

Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series

2020 ◽  
pp. 000348942097059
Author(s):  
Benjamin G. Hunter
Keyword(s):  
Nasal Obstruction ◽  
Surgical Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
Septal Perforation ◽  
Surgical Success ◽  
Interposition Graft ◽  
Patient Reported ◽  
Septal Perforations ◽  
Porcine Collagen

Objective: Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. Method: The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. Results: Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. Conclusions: This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.

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