Supracrural Ligament Graft in Rhinoplasty

2020 ◽  
Author(s):  
Kirkland N. Lozada ◽  
Garrett D. Locketz ◽  
Daniel G. Becker
Keyword(s):  
Potential Risk ◽  
Fascia Lata ◽  
Nasal Dorsum ◽  
Temporalis Fascia ◽  
Graft Size ◽  
Initial Exposure ◽  
Nasal Tip ◽  
Primary Rhinoplasty ◽  
Thin Skin ◽  
Areas Of Concern

AbstractIrregularities of the nasal dorsum or tip are a potential risk after rhinoplasty. Patients with thin skin are considered to be at a higher risk of these irregularities. Different materials and grafts to address areas that may result in a contour irregularity postoperatively include diced or crushed cartilage, temporalis fascia, fascia lata, and AlloDerm. We describe a new graft, the supracrural ligament graft, which can be used to camouflage or add bulk during primary rhinoplasty. The graft is harvested easily during the initial exposure and does not require additional surgical sites or extra dissection. In this research, we described the use of the supracrural ligament graft in 49 patients. We found the average graft size to be 0.6 × 0.4 cm. The graft was used in the following locations: nasal tip (49%), radix (40%), and nasal dorsum (10%). No complications were seen using the graft in any of the 49 patients. In conclusion, the supracrural ligament graft is a safe, simple, and effective camouflage graft for commonly encountered irregularities in rhinoplasty. Common areas of use include the nasal dorsum and nasal tip. Routine harvest of this graft may obviate the need to use either additional grafting material or an additional surgical site to help camouflage areas of concern in thin skin patients.

scholarly journals Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

2019 ◽  
Vol 8 (5) ◽  
pp. 602 ◽  
Author(s):  
Hyung Joon Seo ◽  
Rafael Denadai ◽  
Lun-Jou Lo
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Normal Subjects ◽  
Width Ratio ◽  
Nasal Dorsum ◽  
Nasal Tip ◽  
Primary Rhinoplasty ◽  
Bilateral Cleft Lip

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.

Tubed Temporalis Fascia for Nasal Dorsal Contouring: A Novel Technique

ORL ◽  
2021 ◽  
pp. 1-7
Author(s):  
Jibril Y. Hudise ◽  
Saud A. Aldhabaan ◽  
Almaha A. Alqabbani ◽  
Raad S. Nassar ◽  
Ahmed M. Alarfaj
Keyword(s):  
Patient Satisfaction ◽  
Predictor Variable ◽  
Outcome Evaluation ◽  
Nasal Dorsum ◽  
Temporalis Fascia ◽  
Graft Size ◽  
Patient Satisfaction Score ◽  
Novel Technique ◽  
Revision Rhinoplasty ◽  
The Mean

<b><i>Introduction:</i></b> Nasal dorsum irregularities may occur after nasal trauma or as a postrhinoplasty complication. Here, we present a novel technique using temporalis fascia (TF) grafting for primary and revision rhinoplasty to repair the nasal dorsum, hide nasal irregularities, and improve nasal contouring. <b><i>Methods:</i></b> This prospective cohort study was conducted from January 2019 to June 2019 and evaluated nasal dorsal contouring using the TF in a tubed form. The outcome variables were patient satisfaction, dorsal irregularity, and contour definition. The predictor variable was the use of tubed TF for dorsal augmentation. Other associated variables were age, sex, indication for surgery, surgery type, and graft size. Patient satisfaction was evaluated using the Rhinoplasty Outcome Evaluation questionnaire. A rhinoplasty specialist other than the surgeon who performed the procedure evaluated the dorsal augmentation outcomes by inspection and palpation of the dorsum. All statistical analyses were performed using the SPSS software. <b><i>Results:</i></b> Seventy-four patients (21.6% men and 78.4% women) were treated with the tubed TF. The mean age was 28.97 years. Thin skin was the most common indication (48.6%) for using TF. The graft size was 2–5 cm; inspection and palpation revealed no irregularities. No reception site complications occurred. One patient had a mild hematoma at the donor site. The mean patient satisfaction score was 10.14 preoperatively and 19.95 postoperatively (<i>p =</i> 0.001). <b><i>Discussion/Conclusions:</i></b> Our novel technique of using the TF graft in a tubed form was easy to perform. Furthermore, the tubed TF covers all irregularities, is good for dorsal augmentation, and improves dorsal contouring and definition.

Comparative study of temporalis fascia graft, tragal cartilage graft and fascia lata in tubotympanic type of CSOM

2019 ◽  
Vol 9 (1) ◽  
pp. 37-40
Author(s):  
Sonali Uttamrao Landge ◽  
◽  
Prafful V Jatale ◽  
Vilas Kirdak ◽  
Sambhaji Chintale ◽  
...  
Keyword(s):  
Comparative Study ◽  
Fascia Lata ◽  
Cartilage Graft ◽  
Temporalis Fascia ◽  
Fascia Graft

The role of internal sutures in stabilization of nasal dorsum in primary rhinoplasty

2021 ◽  
Author(s):  
Emrah Kağan Yaşar ◽  
Can İlker Demir ◽  
Buket Dursun ◽  
Murat Şahin Alagöz
Keyword(s):  
Nasal Dorsum ◽  
Primary Rhinoplasty

scholarly journals Comparative study between fascia lata and temporalis fascia in myringoplasty

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Ayman Ali Abdel Fattah ◽  
Abdel Hay Rashad Elasy ◽  
Ahmed Helmy Hoseini ◽  
Tarek Abdel Rahman Abdel Hafez
Keyword(s):  
Tympanic Membrane ◽  
Good Alternative ◽  
Fascia Lata ◽  
The Body ◽  
Temporalis Fascia ◽  
Fascia Graft ◽  
Fascia Lata Graft ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background Repair of a perforated tympanic membrane (myringoplasty) can facilitate normal middle ear function, resist infection, and help re-establish normal hearing. Autogenous graft materials are the most popular graft materials used in myringoplasty because of their easy acceptability by the body. This study is conducted to compare between temporalis fascia graft and fascia lata graft in myringoplasty for patients with tubo-tympanic dry perforation. Results A total of 60 patients with persistent dry tympanic membrane perforation were included in our study during the period from January 2018 to May 2020. Patients underwent myringoplasty with temporalis fascia (30 patients as group A) or fascia lata (30 patients as group B). Patients were scheduled for follow-up visits concerning graft status, ear discharge, and audiograms. The mean postoperative air-bone gap in group A was 17.5 ± 4 after 1 month and 8.6 ± 6.9 after 3 months, while in group B, the mean postoperative air-bone gap was 17.6 ± 4.9 after 1 month and 9.4 ± 7.5 after 3 months. There was 90% success in graft uptake in group A, while there was 80% success in group B. Conclusion Using temporalis fascia is still the best and most trustworthy technique of myringoplasty compared to fascia lata graft. However, fascia lata can be a good alternative to temporalis fascia especially in cases of revision myringoplasty, ears having large perforation, or near-total perforation where the chances of residual perforation are high because of the limited margin of remnant tympanic membrane overlapping the graft.

Rhinoplasty: Aesthetic Augmentation With Improvement of Dorsal Aesthetic Lines

2021 ◽  
Author(s):  
Vitaly Zholtikov ◽  
Vladimir Golovatinskii ◽  
Riadh Ouerghi ◽  
Rollin K Daniel
Keyword(s):  
Single Layer ◽  
Essential Elements ◽  
Rectus Abdominis ◽  
Nasal Dorsum ◽  
Wide Spread ◽  
Temporalis Fascia ◽  
Temporal Fascia ◽  
Layer 2 ◽  
Diced Cartilage

Abstract Background Camouflage of nasal dorsum, aesthetic augmentation and highlighting the dorsal aesthetic lines are essential elements in modern rhinoplasty. Numerous techniques have been utilized including deep temporal fascia, rectus abdominis fascia, and diced cartilage in fascia (DC-F). Despite their wide spread adoption, technical challenges remained, especially when utilized for aesthetic purposes. Objectives The paper details the use of fascia (F) and diced cartilage in fascia grafts (DC-F) for aesthetic dorsal refinement in primary and secondary cases. One of the main goals was to achieve ideal dorsal aesthetic dorsal lines rather than just volume augmentation. Methods We used grafts from the deep temporalis fascia (F) and rectus abdominis fascia (RF) in 4 configurations: 1) single layer, 2) double layer, 3) full length diced cartilage in fascia grafts (DC-F), and 4) partially filled – segmental DC-F grafts. Technical refinements included careful determination of dimensions and meticulously suturing to the dorsum at appropriately 10 points to prevent graft displacement. Results We report our experience: 146 clinical cases over 35 months from January 2017 to December 2019. The patients were divided for 4 groups depending on which type of graft was used. Conclusions Use of autogenous deep temporal fascia, rectus abdominis fascia, and diced cartilage in fascia (DC-F) to camouflage dorsal irregularities, to highlight dorsal aesthetic lines, and to aesthetically augment either the entire nasal dorsum or its individual parts. Optimization of cutting, stitching, filling the graft, careful fixation of these grafts on the nasal dorsum, significantly increases the predictability of these techniques and minimizes problems.

scholarly journals Comparison of conventional temporalis fascia myringoplasty with fascia lata myringoplasty among patients with hearing loss

2019 ◽  
Vol 5 (4) ◽  
pp. 926
Author(s):  
Sumeer Verma ◽  
Anshu Arora ◽  
Ved Prakash Narvey
Keyword(s):  
Postoperative Complications ◽  
Biological Properties ◽  
Fascia Lata ◽  
Graft Material ◽  
Hearing Improvement ◽  
Temporalis Fascia ◽  
Probability Of Survival ◽  
Temporal Fascia ◽  
Tissue Factors ◽  
Tube Function

<p class="abstract"><strong>Background:</strong> In selection of a graft tissue factors considered include its biological properties, probability of survival, its adequacy in size and ease of procurement<strong> </strong>The present study aims to preoperatively predict hearing improvement by paper patch test and compare with postoperative hearing improvement i.e. pre and post operatively hearing assessment.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on 25 cases undergoing myringoplasty with Fascia lata and Temporalis fascia as a graft material among the patients fulfilling the standard criteria for myringoplasty i.e. pars tensa perforation, good cochlear reserve, dry ear and normal eustachian tube function were considered for surgery. Myringoplasty was done from post aural route for harvesting fascia temporalis graft &amp; from upper 1/3rd of thigh laterally to harvest fascia lata. Each case was followed up post operatively monthly for 3 months.  </p><p class="abstract"><strong>Results:</strong> Factors which influence graft take up are the size of perforation and lack of infection at the time of surgery and postoperative. Large perforations were difficult to repair as it took more time to heal. Surgery performed postaurally underlay technique using temporal fascia was associated with less morbidity, better uptake and lesser postoperative complications but permeatal route also serve similar purpose and does not affect the result of study significantly.</p><p class="abstract"><strong>Conclusions:</strong> This study compared both temporal fascia and fascia lata as graft materials for myringoplasty and proved that myringoplasty done by postaural underlay technique using temporal fascia holds best as per graft uptake, hearing improvement and postoperative complications when compared to fascia lata myringoplasty.</p>

Auricular Sandwich Graft for Caudal Septal Augmentation

1986 ◽  
Vol 3 (4) ◽  
pp. 27-31
Author(s):  
Julius Newman ◽  
Abram Nguyen ◽  
Roger Anderson
Keyword(s):  
Surgical Procedure ◽  
Donor Site ◽  
Obtuse Angle ◽  
Nasal Reconstruction ◽  
Nasal Dorsum ◽  
Cartilage Graft ◽  
Nasal Tip ◽  
Aesthetic Results ◽  
Conchal Cartilage Graft ◽  
Primary Phenomenon

Retraction of columella and collapse of nasal tip may be a primary phenomenon or secondary to poor results of rhinoplasty. This may be due to excessive resection of dorsocaudal septum or inappropriate removal of the nasal spine. Reconstruction of the columella is a difficult surgical procedure and many techniques have been described. This report describes a technique of interposition of a composite skin-conchal cartilage graft between the caudal septum and columella. The graft will restore the projection of the nasal tip and correct a retracted columella by increasing its base. The newly positioned columella forms an aesthetically acceptable obtuse angle with the lip and is 2–3 mm lower than the alar rims. The cartilage from the concha of the ear is an excellent grafting material for nasal reconstruction. It has been used for augmentation of the nasal dorsum, tip grafting, and correction of vestibular atresia. The graft is harvested utilizing a technique that allows for minimal postoperative auricular deformity at the donor site. Aesthetic results have been satisfactory, with very low morbidity following this method.

The Nasal Width and Boxiness Index: Introduction and Pilot Study on Reliability and Validity of Sonographic Morphometry

2018 ◽  
Vol 34 (04) ◽  
pp. 373-380
Author(s):  
Ralph Litschel ◽  
Abel-Jan Tasman
Keyword(s):  
Pilot Study ◽  
Cross Section ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Skin Surface ◽  
Likert Scale ◽  
Nasal Dorsum ◽  
Limits Of Agreement ◽  
Nasal Tip ◽  
Lay Persons

AbstractBoth intended and unintended surgical modifications of nasal width and shape of the nasal tip continue to be of interest to the rhinoplasty surgeon. As validated instruments for quantifying width and boxiness are lacking, the objective of this study was to introduce a width index and a boxiness index for the nasal dorsum and the nasal tip. A width index and a boxiness index were defined within the methodological limits of noncontact sonography. The reliability of both indices was studied by comparing the measurements of two examiners on the noses of five volunteers. The validity of the indices was studied by correlating the sonographic width and boxiness with the 5-point Likert scale ratings of photographs of 5 noses by 21 lay persons. Nasal width was defined as the diameter at a distance of 5 mm from the skin surface on a sonographic cross-section perpendicular to the skin surface. Boxiness was defined as the quotient of width at a depth of 1 and 5 mm. Bland–Altmann analysis revealed negligible bias between both examiners and 95% of limits of agreement of 13, 7, and 13% for width at 1 mm, width at 5 mm, and boxiness, respectively. Corresponding Pearson's correlation coefficients were r = 0.93, r = 0.93, and r = 0.71. The correlation between the cumulative lay persons' scores and sonographic width and boxiness were r = 0.97, r = 0.66, and r = 0.81 for nasal tip width, dorsal width, and boxiness, respectively. Both the width at a depth of 5 mm as measured with sonography and the boxiness index that is defined as width at a depth of 1 mm divided by the width at a depth of 5 mm may prove to be acceptable surrogate parameters for width and boxiness of the nose in comparative morphometric studies.

Sign in / Sign up

Export Citation Format

Share Document