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 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.

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.

Pipeline embolization device treatment of internal carotid artery terminus aneurysms

2018 ◽  
Vol 11 (5) ◽  
pp. 485-488 ◽  
Author(s):  
Amit Pujari ◽  
Brian Matthew Howard ◽  
Thomas P Madaelil ◽  
Susana Libhaber Skukalek ◽  
Anil K Roy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Maximum Diameter ◽  
Class Iii ◽  
Pipeline Embolization Device ◽  
Proximal Internal Carotid Artery ◽  
The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

Decision analysis of treatment options for vestibular schwannoma

2011 ◽  
Vol 114 (2) ◽  
pp. 400-413 ◽  
Author(s):  
Robert G. Whitmore ◽  
Christopher Urban ◽  
Ephraim Church ◽  
Michael Ruckenstein ◽  
Sherman C. Stein ◽  
...  
Keyword(s):  
English Language ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Complication Rates ◽  
Online Databases ◽  
Decision Analytical Model ◽  
The Mean ◽  
Meta Regression

Object Widespread use of MR imaging has contributed to the more frequent diagnosis of vestibular schwannomas (VSs). These tumors represent 10% of primary adult intracranial neoplasms, and if they are symptomatic, they usually present with hearing loss and tinnitus. Currently, there are 3 treatment options for quality of life (QOL): wait and scan, microsurgery, and radiosurgery. In this paper, the authors' purpose is to determine which treatment modality yields the highest QOL at 5- and 10-year follow-up, considering the likelihood of recurrence and various complications. Methods The MEDLINE, Embase, and Cochrane online databases were searched for English-language articles published between 1990 and June 2008, containing key words relating to VS. Data were pooled to calculate the prevalence of treatment complications, tumor recurrence, and QOL with various complications. For parameters in which incidence varied with time of follow-up, the authors used meta-regression to determine the mean prevalence rates at a specified length of follow-up. A decision-analytical model was constructed to compare 5- and 10-year outcomes for a patient with a unilateral tumor and partially intact hearing. The 3 treatment options, wait and scan, microsurgery, and radiosurgery, were compared. Results After screening more than 2500 abstracts, the authors ultimately included 113 articles in this analysis. Recurrence, complication rates, and onset of complication varied with the treatment chosen. The relative QOL at the 5-year follow-up was 0.898 of normal for wait and scan, 0.953 for microsurgery, and 0.97 for radiosurgery. These differences are significant (p < 0.0052). Data were too scarce at the 10-year follow-up to calculate significant differences between the microsurgery and radiosurgery strategies. Conclusions At 5 years, patients treated with radiosurgery have an overall better QOL than those treated with either microsurgery or those investigated further with serial imaging. The authors found that the complications associated with wait-and-scan and microsurgery treatment strategies negatively impacted patient lives more than the complications from radiosurgery. One limitation of this study is that the 10-year follow-up data were too limited to analyze, and more studies are needed to determine if the authors' results are still consistent at 10 years.

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.

Change, Reliability, and Stability in Self-perceptions in Early Adolescence: A Four-year Follow-up Study

1995 ◽  
Vol 18 (2) ◽  
pp. 351-364 ◽  
Author(s):  
Taru Lintunen ◽  
Esko Leskinen ◽  
Marja Oinonen ◽  
Marjo Salinto ◽  
Paavo Rahkila
Keyword(s):  
Profile Analysis ◽  
Self Esteem ◽  
Time Profile ◽  
Self Concept ◽  
Self Assessment ◽  
Self Perceptions ◽  
Follow Up Study ◽  
The Mean ◽  
Simplex Models

Changes in self-perceptions of fitness, appearance, and self-esteem among adolescents were assessed in a 4-year follow-up study. Both the changes in the mean levels across time (profile analysis), and the changes in the reliability and stability of individual differences (i.e. covariance stability as test-retest correlations) were examined. The subjects (64 boys, 49 girls) were 11 years old at the first annual measurement. Self-esteem was assessed using the Rosenberg Self-Esteem Scale, as well as self-assessment questionnaires specifically designed for this study to assess Perceived Fitness and Perceived Appearance. MANOVA-and Simplex-models were used in the analysis. Our results among the girls were in accordance with the gradual consolidation hypothesis, so that self-perceptions become more fixed with increasing age. The boys showed highly stable self-perceptions throughout the follow-up, which may indicate the early emergence of a fixed self-concept. Self-esteem increased with age but changes in perceived fitness were small over time. The decrease in perceived appearance found among the girls but not among the boys was in accordance with the gender intensification hypothesis.

Ulnar Shortening for the Treatment of Early Post-Traumatic Osteoarthritis at the Distal Radioulnar Joint

2001 ◽  
Vol 26 (1) ◽  
pp. 41-44 ◽  
Author(s):  
L. R. SCHEKER ◽  
A. SEVERO
Keyword(s):  
Contact Area ◽  
Distal Radioulnar Joint ◽  
Early Osteoarthritis ◽  
Self Assessment ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Relieve Pain ◽  
Post Traumatic ◽  
The Mean

This prospective study describes the outcome of ulnar shortening performed on 32 wrists with early osteoarthritis of the distal radiounlar joint (DRUJ) in an attempt to change the contact area between the ulnar head and the radial sigmoid notch. By changing the contact area, we attempted to relieve pain, while maintaining the function of the DRUJ. The mean age of the patients was 34 years, and the mean follow-up was three years and two months. The wrists were graded by the patients’ self-assessment of satisfaction and by a clinical wrist rating that assessed pain, functional status, range of motion, and grip strength. In terms of self-assessment, 16/32 patients were very satisfied, with complete pain relief. Of the 32 patients, 26 said that they would have surgery again if circumstances were similar. The postoperative wrist ratings were 7/32 excellent, 11/32 good, 9/32 fair, 5/32 poor. The most frequent postoperative complaint was plate irritation.

scholarly journals Absorbable Implant to Treat Nasal Valve Collapse

2017 ◽  
Vol 33 (02) ◽  
pp. 233-240 ◽  
Author(s):  
Marion Nicoló ◽  
Klaus Stelter ◽  
Haneen Sadick ◽  
Murat Bas ◽  
Alexander Berghaus
Keyword(s):  
Lateral Cartilage ◽  
Nasal Valve ◽  
Cosmetic Appearance ◽  
Acid Copolymer ◽  
Symptom Evaluation ◽  
Absorbable Implant ◽  
The Mean ◽  
Nasal Valve Collapse ◽  
Operating Suite

Objective To evaluate the safety and effectiveness of an absorbable implant for lateral cartilage support in subjects with nasal valve collapse (NVC) with 12 months follow-up. Methods Thirty subjects with Nasal Obstruction Symptom Evaluation (NOSE) score ≥ 55 and isolated NVC were treated; 14 cases were performed in an operating suite under general anesthesia and 16 cases were performed in a clinic-based setting under local anesthesia. The implant, a polylactic acid copolymer, was placed with a delivery tool within the nasal wall to provide lateral cartilage support. Subjects were followed up through 12 months postprocedure. Results Fifty-six implants were placed in 30 subjects. The mean preoperative NOSE score was 76.7 ± 14.8, with a range of 55 to 100. At 12 months, the mean score was 35.2 ± 29.2, reflecting an average within-patient reduction of –40.9 ± 31.2 points. The majority (76%) of the subjects were responders defined as having at least one NOSE class improvement or a NOSE score reduction of at least 20%. There were no adverse changes in cosmetic appearance at 12 months postprocedure. Three implants in three subjects required retrieval within 30 days postprocedure and resulted in no clinical sequelae. Conclusion This study demonstrates safety and effectiveness of an absorbable implant for lateral cartilage support in subjects with NVC at 12 months postprocedure.

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 Factors lead to return to sports and recreational activity after total knee replacement

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 11 ◽  
Author(s):  
Jeremy Plassard ◽  
Jean Baptiste Masson ◽  
Matthieu Malatray ◽  
John Swan ◽  
Francesco Luceri ◽  
...  
Keyword(s):  
Case Series ◽  
Activity Level ◽  
Satisfaction Score ◽  
Return To Sports ◽  
Recreational Activity ◽  
High Satisfaction ◽  
Ucla Score ◽  
Total Knee ◽  
The Mean

Introduction: The number of total knee replacements performed (TKR) is increasing and so are patient expectations and functional demands. The mean age at which orthopedic surgeons may indicate TKR is decreasing, and therefore return to sport (RTS) after TKR is often an important expectation for patients. The aim of this study was to analyze the mid-term RTS, recreational activities, satisfaction level, and forgotten joint level after TKR. Methods: Between January 2015 and December 2016, 536 TKR (same implant design, same technique) were performed in our center. The mean age at survey was 69 years with a mean follow-up of 43 months. All patients who did not have a follow-up in the last 6 months were called. Finally, 443 TKR were analyzed. RTS was assessed using the University of California Los Angeles Scale (UCLA), forgotten joint score (FJS), and Satisfaction Score. Results: In this study, 85% of patients had RTS after TKR with a mean UCLA score increasing from 4.48 to 5.92 and a high satisfaction rate. Satisfaction with activity level was 93% (satisfied and very satisfied patients). The RTS is more important for people with a higher preoperative UCLA score and a lower American Society of Anesthesiologist score (ASA). Each point increase in ASA score is associated with reduced probability to RTS by 52%. Discussion: RTS and recreational activity were likely after TKR with a high satisfaction score. Preoperative condition and activity are the two most significant predictive factors for RTS. Level of evidence: Retrospective case series, level IV.

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