Oblique Turnover Flap for Repositioning and Flattening of the Lateral Crura: A Novel Technique to Manage Cephalic Malposition of Lower Lateral Cartilage

2017 ◽  
Vol 33 (05) ◽  
pp. 491-498 ◽  
Author(s):  
Elena Vladykina ◽  
Abdulkadir Goksel
Keyword(s):  
Anatomical Variation ◽  
Senior Author ◽  
Central Axis ◽  
Long Term Results ◽  
P Value ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Satisfaction Scale ◽  
Nasal Tip ◽  
The Mean

AbstractMalposition of the lower lateral cartilage (LLC) is a relatively common anatomical variation, described as any displacement of the lateral crura from the usual parallel direction with the nostril rims. Cephalic malpositioned LLC has the following characteristics: abnormal axes of the lateral crura, bulbous and broad nasal tip, parenthesis deformity, long alar creases, alar wall hollows, nostril deformities, and incompetence of the external valve. Numerous techniques were founded to correct this aesthetic and functional unpleasant variation, although all of them have some limitations. The authors described and evaluated the efficacy of the oblique turnover flap (OTOF) technique in the management of cephalic malposition of LLC (CMLLC). The advantages of this technique are: it does not need any additional grafting; it is quick and safe to perform; it has stable results. In the present study, 24 primary rhinoplasties using OTOF technique were performed between January 2014 and September 2016. There were 21 females (87.5%) and 3 males (12.5%), with age ranging from 23 to 46 years. The mean follow-up period was 12.1 months (range: 8–28 months). All patients were treated by the senior author (A.G.) in the RinoIstanbul Clinic. Three parameters were measured and compared pre- and postoperatively, using a t-test and a p value criteria of 0.05. The difference was found to be statistically significant: the angle between the central axis of the lateral crura and the septum on each side, satisfaction scale rating of the patients' nasal tip appearance and the satisfaction scale rating of patients' nose breathing. The angle of the central axis of lateral cruras to the midline significantly increased, the mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved. OTOF is a quick, useful, efficient technique for repositioning and flattening of the lateral cruras of CMLLC with a good, predictable, and stable long-term results in our hands if used on right candidates.

The Deviated Nasal Tip: A Personal Technique for Correction Using Monolateral Crural Overlay and Monolateral Dome Truncation

2021 ◽  
Author(s):  
Tito M. Marianetti ◽  
Valentino Vellone ◽  
Valerio Ramieri ◽  
Francesca De Angelis
Keyword(s):  
Treatment Strategies ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Self Assessment ◽  
Nasal Tip ◽  
Novel Approach ◽  
High Satisfaction ◽  
Feasible Option ◽  
The Mean

Abstract Background To present a novel approach to correct nasal tip deviation with monolateral crural overlay or monolateral dome truncation, presenting as an isolated deformity or in complex nose deviations. Nasal tip deviation can be congenital or posttraumatic, due to a dislocated septum or cartilaginous septal or lower lateral cartilage malformations. Although some treatment strategies have been introduced, appropriate treatment remains a challenge because of the complexity and variability of such deformities. Methods It had been assumed that in most nasal tip deviations, a lower lateral cartilage was longer than the contralateral one. The authors analyzed 158 patients from January 2015 to October 2019 with nasal tip deviation and corrected the deviated tip by using a monolateral interruptive technique (lateral crural overlay or monolateral dome truncation) on the lower lateral cartilage. Photographic comparison between preoperative and at least 1-year follow-up for nasal axis deviation variable was analyzed and a self-assessment questionnaire was administrated to the patients at 1-year follow-up. Results The mean nasal deviation was 6.59° (±3.1°) preoperatively and 1.56° (±0.26°) postoperatively (p < 0.05). The range of differences between pre and postoperative deviations was 2.7° to 15.1°, and the mean difference was 6.1° (±3.21°). Of the 84 patients, 47 (55.95%) were very satisfied, 33 (39.28%) were satisfied, and 4 (4.76%) were unsatisfied with surgical the results and required revision surgery. Conclusions In authors' hands, monolateral interruptive techniques (lateral crural overlay or monolateral dome truncation) are a viable and feasible option to restore nasal tip symmetry. These techniques achieved high satisfaction rates among patients and resulted in reliable and reproducible symmetry immediately visible after surgery and stable over time (1-year postsurgery controls).

scholarly journals Lateral intercrural suture in the caucasian nose: Decreased domal divergence angle in endonasal rhinoplasty without delivery

2012 ◽  
Vol 16 (02) ◽  
pp. 232-235
Author(s):  
Marcos Mocelin ◽  
Caio Soares ◽  
Rogério Pasinato ◽  
Andreia Frota ◽  
Cezar Berger
Keyword(s):  
Prospective Study ◽  
Divergence Angle ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Lateral Crus ◽  
Basic Technique ◽  
Nasal Tip ◽  
Definition Of

Summary Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objctive: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose.

scholarly journals Cephalic lateral crural advancement flap

2021 ◽  
Vol 48 (2) ◽  
pp. 158-164
Author(s):  
Fuat Bulut
Keyword(s):  
Analogue Scale ◽  
Advancement Flap ◽  
Open Rhinoplasty ◽  
Nasal Patency ◽  
Lower Lateral Cartilage ◽  
Lateral Crus ◽  
Tip Rotation ◽  
Nasal Tip ◽  
The Mean

Background In lower lateral cartilage (LLC) surgery, cephalic trimming poses risks for the collapse of the internal and external nasal valves, pinched nose, and drooping deformity. The cephalic lateral crural advancement (CLCA) technique presented herein was aimed at using a flap to increase nasal tip rotation and support the lateral crus, in addition to the internal and external nasal valves, by avoiding grafts without performing excision.<br/>Methods This study included 32 patients (18 female and 14 male) and the follow-up period for patients having undergone primer open rhinoplasty was 12 months. The LLC was elevated from the vestibular skin using the CLCA flap. A cephalic incision was performed without cephalic trimming. Two independent flaps were formed while preserving the scroll ligament complex. The CLCA flap was advanced onto the lower lateral crus while leaving the scroll area intact. The obtained data were analyzed retrospectively.<br/>Results The mean age of the patients was 31.6 years (range, 20–51 years). The Rhinoplasty Outcome Examination scores after 12 months varied from 90 to100 points, and 93% of patients reported perfect satisfaction. At a 1-year follow-up, the patients’ nasal patency (visual analogue scale) rose from 4.56±1.53 (out of 10) to 9.0±0.65 (P<0.001).<br/>Conclusions The CLCA flap led to better nasal tip definition by protecting the scroll area, increasing tip rotation, and supporting the internal and external nasal valves without cephalic excision.

scholarly journals Job Satisfaction among Hemodialysis and Labour Ward Nurses: A Comparative Descriptive Study

2021 ◽  
pp. 48-56
Author(s):  
Monisayo Olayemi Komolafe
Keyword(s):  
Job Satisfaction ◽  
Work Environment ◽  
Statistical Significance ◽  
Descriptive Study ◽  
P Value ◽  
Satisfaction Scale ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
The Mean ◽  
Labour Ward

Introduction: Increasing CKD cases means higher demands for haemodialysis nurses. Haemodialysis nurses are required to fulfil many demanding roles such as advocate, caregiver, educator, mentor and technician while patients attend a dialysis unit. The complexities of the role that are performed by these nurses along with organization factors within the work environment have led to haemodialysis nurses experiencing high levels of burnout thus impacting on satisfaction derived from job done. Objectives: To compare job satisfaction among haemodialysis nurses with that of labour ward nurses and determine if the type of patient managed affects job satisfaction of nurses. Methodology: The multidimensional Job satisfaction scale designed and validated by Murat Ozpehlivan and Zafer Acar was used to determine job satisfaction among sixty-six hemodialysis nurses and sixty-four labour ward nurses in a cross sectional comparative descriptive study. Statistical significance difference between the two group of nurses attributed to events with a p-value lower than 5% (p < 0.05). Results: The overall mean job satisfaction score was higher among the labour ward nurses 67.95 ± 13.39 compared to the mean score among renal nurses 65.07 ± 14.24 (T= 1.81, p = 0.240). The mean score of labour ward nurses regarding satisfaction based on patient managed 74.51 ± 14.96 is higher than the mean score among renal participants of 71.21 ± 14.70 (T= 1.27, p = 0.201). Conclusion: Hemodialysis nurses in Nigeria are satisfied with the job they do and this is comparable to that of nurses in labour ward.

The Nasal Hinge

1994 ◽  
Vol 111 (3P1) ◽  
pp. 219-231 ◽  
Author(s):  
Peter A. Adamson ◽  
Todd A. Morrow
Keyword(s):  
Clinical Results ◽  
Plastic Surgeon ◽  
Hinge Region ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Lateral Aspect ◽  
Nasal Tip ◽  
Tip Projection ◽  
Facial Plastic

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, It plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.

scholarly journals Long-term results of endonasal dacryocystorhinostomy with and without stenting

2013 ◽  
Vol 95 (3) ◽  
pp. 196-199 ◽  
Author(s):  
SH Mohamad ◽  
I Khan ◽  
M Shakeel ◽  
V Nandapalan
Keyword(s):  
Success Rate ◽  
Statistical Significance ◽  
Case Series ◽  
Senior Author ◽  
Long Term Results ◽  
P Value ◽  
Stent Group ◽  
Chi Squared

Introduction This study aimed to evaluate the short and long-term results of endoscopic dacryocystorhinostomy (DCR) with and without silicone stenting in chronic dacrocystorhinitis due to postsaccal blockage. Methods The study involved a case series of consecutive 89 patients (128 eyes) who underwent endoscopic DCR. All patients were operated on by the senior author. The stent group comprised 63 eyes (44 patients), for which the DCR was performed between September 2002 and September 2005. The non-stent group with 65 eyes (45 patients) underwent the DCR between October 2005 and December 2006. The follow-up duration was up to 33 months after surgery. The statistical significance (p-value) was calculated using the chi-squared test. Results The short-term success rate at six months’ follow-up was 70% in the stent group and 97% in the non-stent group (p=0.0005) while the long-term success rate at 33 months was only 57% in stent group compared with 89% in the non-stent group (p=0.0003). Conclusions In this study, the non-stent group showed a higher success rate than the stent group on both short and longterm follow-up. Our study suggests that postoperative stents are not necessary for primary DCR and may be associated with a worse outcome.

Use of Auricular Cartilage for Reconstruction of Cartilaginous Defects of the Nose: Emphasis on Reconstruction of the Lower Lateral Cartilage Complex

1994 ◽  
Vol 11 (3) ◽  
pp. 209-216
Author(s):  
John Andrew Bartlett ◽  
Peter A. Hilger
Keyword(s):  
Senior Author ◽  
Congenital Defects ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Fellowship Program ◽  
Previous Surgery ◽  
The Past ◽  
Facial Plastic ◽  
Case Presentations ◽  
Innovative Techniques

During a year of fellowship with Dr. R. C. Webster, a preceptor with the American Academy of Facial Plastic and Reconstructive Surgery Fellowship Program, the senior author was introduced to innovative techniques utilizing conchal cartilage to repair various defects of the nasal tip. In the past 15 years of practice, we have modified his technique slightly but many of his basic concepts and principles remain. We have replaced the entire lower lateral cartilage complex as well as segmental defects of the nose. The presentation will review techniques for reconstruction of the entire lower lateral cartilage complex, as well as segmental defects due to trauma, previous surgery, congenital defects and defects secondary to oncologic resection. Preoperative and postoperative case presentations will highlight salient surgical principles.

Endoscopic Lateral Cartilage Graft Tympanoplasty

2017 ◽  
Vol 157 (4) ◽  
pp. 683-689 ◽  
Author(s):  
Cameron C. Wick ◽  
Demetri Arnaoutakis ◽  
Vivian F. Kaul ◽  
Brandon Isaacson
Keyword(s):  
Tympanic Membrane ◽  
Tertiary Care ◽  
Case Series ◽  
University Hospital ◽  
Long Term Results ◽  
Lateral Cartilage ◽  
Cartilage Graft ◽  
Closure Rate ◽  
Tympanic Membrane Perforations ◽  
The Mean

Objective To describe a novel technique for lateral graft tympanoplasty. Study Design Case series with chart review. Setting Tertiary care university hospital. Subjects and Methods Pediatric and adult patients with tympanic membrane perforations deemed unfavorable for a medial graft technique due to the perforation characteristics or myringitis. Results Between 2014 and 2016, 34 ears from 31 patients underwent a transcanal endoscopic lateral cartilage graft tympanoplasty. The mean age was 24.4 years (range, 6-71 years), and 22 patients (65%) were younger than 18 years. All patients had tympanic membrane perforations. Eighteen patients (53%) had total or near-total perforations, leaving a minimal anterior remnant, and 16 patients (47%) had extensive myringitis. A bisected tragal cartilage-perichondrium shield graft was used in 33 patients (97%). The mean (SD) follow-up length was 9.8 (5.7) months. Initial perforation closure rate was 88.2% (30/34). Three of the persistent perforations underwent a revision endoscopic medial graft tympanoplasty with successful closure, leaving a final closure rate of 97.1% (33/34). Five patients (15%) required topical therapy for postoperative myringitis. Mean (SD) pure-tone average and air-bone gap significantly improved by 11.5 (10.7) dB ( P < .001) and 11.4 (10.6) dB ( P < .001), respectively. Twenty-seven patients (79%) closed their air-bone gap within 20 dB. Conclusion Transcanal endoscopic lateral cartilage graft tympanoplasty is feasible, and initial data support favorable outcomes. Further data are necessary for evaluation of long-term results and efficacy comparisons.

Median Horizontal Split Tip

1985 ◽  
Vol 93 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Frank M. Kamer ◽  
Alfred Cohen
Keyword(s):  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Horizontal Strip ◽  
Tip Rotation ◽  
Nasal Tip ◽  
Tip Projection ◽  
Innovative Technique ◽  
Central Strip ◽  
Nasal Tip Projection

One of the most difficult problems encountered in rhinoplasty is lack of nasal tip projection. An innovative technique is described that utilizes the removal of a median horizontal strip of lower lateral cartilage to enhance projection, while maintaining a natural highlight and tip support without the use of grafts. The indications are limited to noses that have a widened dome requiring removal of a central strip, and tip rotation. Alternate techniques are discussed; cases and results are discussed.

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