Use of Tissue Expander for Contracted Scarred Saddle Deformity Rhinoplasty

2018 ◽  
Vol 35 (01) ◽  
pp. 068-072
Author(s):  
Jared Inman ◽  
Farhad Ardeshirpour ◽  
Erin Ostby
Keyword(s):  
Soft Tissue ◽  
Adverse Outcome ◽  
Case Series ◽  
Tissue Expander ◽  
Saddle Nose ◽  
Nasal Dorsum ◽  
Soft Tissue Envelope ◽  
Skin Breakdown ◽  
Saddle Nose Deformity ◽  
Staged Reconstruction

AbstractThe main purpose of this article is to present an alternative technique for the reconstruction of saddle nose deformity in patients with severely scarred or contracted soft tissue envelopes. In this single surgeon case series, the authors present a two-staged reconstruction performed on four adult patients with saddle nose deformities and contracted soft tissue envelope stemming from a variety of etiologic factors including vasculitis, sarcoidosis, and trauma. Stage one involved placement of a 1 × 4 cm tissue expander along the nasal dorsum through anterior scalp and endonasal incisions. The tissue expander port was positioned under the anterior scalp and injected with saline over 3 weeks in-office. Stage two involved removal of the tissue expander and rhinoplasty using osteocartilaginous rib grafts. All four patients had successful expansion of the contracted soft tissue envelope, creating adequate space for the newly reconstructed nasal framework. One patient developed exposure of the tissue expander through the endonasal incision, which did not lead to any adverse outcome. All patients in this series tolerated expansion well, without complaints of pain or external skin breakdown. The use of soft tissue expanders along the nasal dorsum can successfully expand contracted and scarred soft tissue envelopes prior to reconstructive rhinoplasty. This technique may be an effective alternative to the use of interpolated flaps in treating these patients.

Complications of Polydioxanone Foil Use in Nasal Surgery: A Case Series

2018 ◽  
Vol 34 (03) ◽  
pp. 312-317 ◽  
Author(s):  
Andrew Frankel ◽  
Oren Friedman ◽  
Leo Wang
Keyword(s):  
Case Series ◽  
Septal Cartilage ◽  
Saddle Nose ◽  
Nasal Surgery ◽  
The Past ◽  
Saddle Nose Deformity ◽  
United States Food ◽  
States Food ◽  
Nose Deformity ◽  
Pds Foil

AbstractPolydioxanone (PDS) foil is widely recognized as a septal cartilage replacement during rhinoplasties and is thought to be completely resorbable and biodegradable. Since its United States Food and Drug Administration approval in 2010, PDS foil has drawn significant enthusiasm and many surgeons consider it an ideal implantable biomaterial as reflected in numerous studies highlighting its benefits. However, scant literature exists highlighting relevant complications of PDS plates that may potentially lead to cavalier overuse. This descriptive case series assesses the outcomes of PDS foil usage in three patients seen for septoplasty at two independent institutions over the past 5 years. Our results demonstrate that PDS plate usage can lead to septal cartilage loss and resultant saddle nose deformıty associated with prolonged postoperative edema and inflammation. To our knowledge, this is the largest case series of this reported phenomenon.

scholarly journals Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

2019 ◽  
Vol 40 (1) ◽  
pp. 34-48 ◽  
Author(s):  
Aaron M Kosins ◽  
Rollin K Daniel
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Open Rhinoplasty ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
Primary Rhinoplasty ◽  
Proper Patient Selection ◽  
Total Preservation ◽  
One Year

Abstract Background Preservation rhinoplasty (PR) is a new chapter in rhinoplasty history. The term was coined by Daniel in 2018 and represents a fundamental change in philosophy. Objectives The aim of this study is to discuss a single-surgeon case series utilizing PR techniques. Methods One hundred fifty-three primary rhinoplasty cases were studied retrospectively between December 2016 and August 2017. One hundred cases had at least 1 year of follow-up. Technical details were recorded, including dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and preservation of the dorsum vs traditional reduction. These 100 cases can be categorized as either complete preservation rhinoplasty (PR-C) or partial preservation rhinoplasty (PR-P). Results All patients had open rhinoplasty and the average follow-up time was 13 months. All patients had preservation of the dorsal soft tissue envelope, and in 36 the entire soft tissue envelope and ligaments were preserved. Fifty-four had preservation of the alar cartilages. Thirty-one had dorsal preservation. The combinations include: PR-C (skin, dorsum, and alars): 24; PR-P (skin and dorsum): 2; PR-P (alars and dorsum): 2; and PR-P (skin and alars): 7. Conclusions In most patients, the dorsal soft tissue envelope and nasal ligaments can be preserved. When possible, the lateral crura should be preserved and tensioning chosen over excision. Dorsal preservation is a versatile technique when proper patient selection is undertaken, and long-term issues with the middle vault and keystone area can be avoided. Some patients will benefit from total preservation where nothing is removed/disrupted and underlying structures are reshaped. Level of Evidence: 4

scholarly journals Nasal Dorsum Skin Expansion for Reconstruction of Saddle Nose Due to Gunshot Injury: A Case Report

2005 ◽  
Vol 13 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Serdar Ozturk ◽  
Fatih Zor ◽  
Mustafa Sengezer
Keyword(s):  
Case Report ◽  
Gunshot Injury ◽  
Saddle Nose ◽  
Nasal Dorsum ◽  
Skin Expansion ◽  
Saddle Nose Deformity ◽  
Nose Deformity ◽  
Nasal Implant ◽  
Skin Healing

Saddle nose deformity due to gunshot injury is a challenging problem for the maxillofacial surgeon. Because of the severe damage to the soft and bony tissues, the reconstructive options are very limited. In the present case report, a saddle nose deformity sustained from gunshot injury was reconstructed with a porous polyethylene nasal implant after a successful expansion of the nasal dorsum skin. Healing was uneventful at two-year follow-up, with superior patient satisfaction. Nasal dorsum skin expansion should be considered as an option in the reconstruction of moderately sized soft tissue deficits of the nose.

scholarly journals Radiologic Evaluation of the Influence of Cleft Type on Nasal Dorsum Growth

2019 ◽  
Author(s):  
Lingling Pu ◽  
Renkai Liu ◽  
Bing Shi ◽  
David W Low ◽  
Chenghao Li
Keyword(s):  
Cleft Lip ◽  
Skeletal Maturity ◽  
Nasal Bone ◽  
Morphological Characteristics ◽  
Saddle Nose ◽  
Nasal Dorsum ◽  
Radiologic Evaluation ◽  
Saddle Nose Deformity ◽  
Significant Difference ◽  
Nose Deformity

AbstractPurposeThe study was designed to evaluate whether intrinsic morphological characteristics of the nasal dorsum are affected by cleft type, specifically cleft lip only (CL) and cleft lip with cleft palate(CL/P).Methods576 cleft patients (278 CL only, 298 CL/P), and 333 individuals without orofacial clefts were retrospectively enrolled. Lateral cephalometric radiographs of all individuals were taken to evaluate the nasal length and nasal dorsum height. Dunn’s test was used to analyze the difference (p < 0.001).ResultsIn CL and control, the angulation of the nasal bone and nasal dorsum increase by age similarly (5y-18y, p>0.05). In CL, the total dorsal length is significantly shorter (5y-18y, p<0.001). Although the upper nasal dorsum is similar (except in 5y-6y), the lower nasal dorsum is shorter (5y-18y, p<0.001).In CLP, there is no significant difference in the nasal bone angle compared with controls between 5y-7y. However, it develops insufficiently as children grow (8y-18y, p<0.001). The nasal dorsum angle is notably smaller (5y-18y, p<0.001). Nasal bone length is not significantly different from control at all stages except during ages 11y-13y (p<0.05). Total nasal dorsal length is similar to the control at skeletal maturity (17y-18y, p>0.05), although it is shorter during 8y to 16y (p<0.05). The upper nasal dorsum is overdeveloped (14y-18y, p<0.05), whereas the lower nasal dorsum is underdeveloped (5y-18y, p<0.001).ConclusionCL inhibits the growth of nasal dorsum length, leading to short nose deformity. CL/P patients are prone to saddle-nose deformity because of the diminished nasal height (decreased nasal angle).

Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

2021 ◽  
Author(s):  
Milos Kovacevic ◽  
Aaron M. Kosins ◽  
Abdülkadir Göksel ◽  
Frank Riedel ◽  
Gregor Bran ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Beneficial Effect ◽  
Nasal Dorsum ◽  
Positive Skin ◽  
Platelet Rich Fibrin ◽  
Fat Transfer ◽  
Soft Tissue Envelope ◽  
Mobility Test ◽  
Autologous Whole Blood

AbstractA thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

scholarly journals Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures

2019 ◽  
Vol 33 (02) ◽  
pp. 138-142
Author(s):  
Peter Han ◽  
Yohanan Kim ◽  
Alan Herford ◽  
Jared Inman
Keyword(s):  
Soft Tissue ◽  
Nasal Obstruction ◽  
Facial Asymmetry ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Saddle Nose ◽  
Duct Obstruction ◽  
Saddle Nose Deformity ◽  
Nose Deformity ◽  
And Function

AbstractDelayed or improper repair of nasoorbitoethmoid (NOE) fractures can lead to debilitating outcomes including diplopia, epiphora, nasal obstruction, facial asymmetry, and poor cosmesis. As such, NOE fractures should be repaired promptly and properly to prevent these unwanted sequelae. Treating patients with delayed, untreated, or inadequately reduced NOE fractures is challenging due to scarring and contracture. Saddle nose deformity, telecanthus, enophthalmos, nasolacrimal duct obstruction, and soft-tissue scarring are often encountered in the secondary management of NOE fractures and should be addressed in the overall context of reestablishing facial symmetry and function.

scholarly journals Relapsing Polychondritis pada Anak

Sari Pediatri ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 11
Author(s):  
Budi Setiabudiawan ◽  
Sinta Boesoerie ◽  
Reni Ghrahani DM ◽  
Gartika Sapartini ◽  
Diana Rosifah
Keyword(s):  
Soft Tissue ◽  
Relapsing Polychondritis ◽  
Saddle Nose ◽  
Saddle Nose Deformity ◽  
Nose Deformity

Relapsing polychondritis (RP) adalah penyakit autoimun yang jarang terjadi. Penyakit RP ditandai denganinflamasi jaringan kartilago berulang dan berpotensi untuk terjadi kerusakan progresif pada jaringan tersebut.Terutama menyerang dewasa pada dekade ke-4 atau ke-5 dengan usia rata-rata 51 tahun, hanya sedikit kasusyang dilaporkan pada anak. Patogenesis RP diduga akibat terbentuknya autoantibodi terhadap komponenkartilago terutama kolagen tipe II, sehingga menimbulkan suatu proses inflamasi dan mekanisme selularyang melibatkan pelepasan enzim lisosom dengan hasil akhir berupa penghancuran kartilago. Dilaporkanseorang anak laki-laki, usia 12 tahun dengan keluhan utama sesak napas disertai suara mengorok sejak satubulan sebelum masuk rumah sakit. Pada pemeriksaan didapatkan saddle nose deformity, peningkatan LED(40/125 mm/jam), uji ANA positif dengan pola nuklear, penyempitan kolom udara dalam laring dan faringpada foto soft tissue leher, dan adanya laringotrakeomalasia pada trakeoskopi. Pasien didiagnosis denganrelapsing polychondritis dan mendapat prednison 2 mg/kgBB/hari. Ditambahkan obat imunosupresanmetotreksat karena respons yang kurang baik terhadap steroid. Keadaan klinis pasien membaik setelahmendapat terapi kombinasi.

Risk Factors of Saddle Nose Deformity after Septoplasty

2015 ◽  
Vol 58 (12) ◽  
pp. 859
Author(s):  
Gwan Choi ◽  
Joo Yeon Kim ◽  
Yeong Joon Kim ◽  
Seong Uk Jang ◽  
Joo-Wan Jo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Saddle Nose ◽  
Saddle Nose Deformity ◽  
Nose Deformity

Imaging Features of Primary Tumors of the Hand

2020 ◽  
Vol 16 ◽  
Author(s):  
Filippo Boriani ◽  
Edoardo Raposio ◽  
Costantino Errani
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Epithelioid Sarcoma ◽  
Case Series ◽  
Malignant Neoplasm ◽  
Benign Tumors ◽  
Imaging Features ◽  
Primary Tumors ◽  
Therapeutic Decisions ◽  
Tumors Of The Hand

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

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