Reconstruction of a Severely Damaged Cartilaginous Septum with a Bypass L-Strut Graft using Costal Cartilage

2021 ◽  
Vol 37 (01) ◽  
pp. 092-097
Author(s):  
Woo Ri Choi ◽  
Yong Ju Jang
Keyword(s):  
Medical Records ◽  
Costal Cartilage ◽  
Nasal Bone ◽  
Septal Cartilage ◽  
Nasal Breathing ◽  
Strut Graft ◽  
Rib Cartilage ◽  
Treatment Information ◽  
Columellar Strut ◽  
Anterior Nasal Spine

Abstract Objective Reconstruction of a weakened septal cartilage is a key procedure for the correction of deformed noses. However, when septal mucoperichondrium dissection is technically challenging, reconstruction of the lower two-thirds of the nose should be performed bypassing the damaged septal cartilage and mucosa. This article summarizes our experience with treating patients with severely damaged septal cartilage with bypass L-strut graft using costal cartilage. Methods We retrospectively reviewed 26 patients who underwent rhinoplasty using bypass L-strut graft. Autologous costal cartilage was used for creating L-strut in two different ways: (1) by fashioning the L-shaped graft as one unit using the sixth rib cartilage and (2) by integrating a dorsal strut with a columellar strut using slices of the seventh rib cartilage. The caudal strut is fixated to the anterior nasal spine; the dorsal L-strut is placed on the nasal dorsum with no fixation to the nasal bone. Medical records were assessed for demographic, clinical, and treatment information. Results One-piece-type L-strut graft was used for 11 patients and integrated-type L-strut graft was used for 15 patients. No statistical differences were found in postoperative aesthetic outcomes between the two groups. The postoperative assessment of surgical outcomes was excellent in 10 patients, good in 10, fair in 6, and poor in none. Functionally, all 26 patients experienced improvements in nasal breathing. Conclusion Bypass L-strut graft using costal cartilage is a useful surgical maneuver of septal reconstruction in particular nasal deformity when the creation of the septal mucoperichondrial pocket is difficult or better to be avoided.

scholarly journals Septoplasty in elderly patients

2020 ◽  
Vol 4 (4) ◽  
pp. 243-246
Author(s):  
S.A. Karpishchenko ◽  
◽  
G.V. Lavrenova ◽  
O.E. Vereshchagina ◽  
P.I. Gas’kova ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Donor Site ◽  
Management Strategies ◽  
Scoring Systems ◽  
Postoperative Management ◽  
Septal Cartilage ◽  
Elderly Persons ◽  
Nasal Breathing ◽  
Deviated Septum ◽  
Age Related

This review article attempts to systematize and summarize the data on the major age-related pathophysiological, biomechanical, and histological processes that contribute to the progression of nasal breathing impairment or the appearance of these symptoms in elderly patients. The specifics of risk assessment of deviated septum surgery using various questionnaires and scoring systems is discussed. The article demonstrates that deviated septum surgery can be performed in these patients and addresses the specificity of donor site selection for a septal graft in elderly patients considering the histological features of various septal cartilage regions. Prior assessment of individual risks is of particular importance since it determines surgical success and favorable postoperative course in these patients. Studies addressing the perspective use of tissue-engineering transplants are unraveled. Management strategies that consider aging biomechanisms potentially affecting treatment efficacy are described. Finally, the article highlights preoperative management, treatment choice, drug dosage regimens, and postoperative management after septoplasty. KEYWORDS: deviated septum, septoplasty, elderly persons, age-related disorders, neuromuscular tone, nasal breathing impairment. FOR CITATION: Karpishchenko S.A., Lavrenova G.V., Vereshchagina O.E., Gas’kova P.I. Septoplasty in elderly patients. Russian Medical Inquiry. 2020;4(4):243–246. DOI: 10.32364/2587-6821-2020-4-4-243-246.

scholarly journals Biomechanical analysis of costochondral graft fracture in temporomandibular joint replacement

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yi Mao ◽  
Xuzhuo Chen ◽  
Shiqi Yu ◽  
Weifeng Xu ◽  
Haiyi Qin ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Mechanical Test ◽  
Costal Cartilage ◽  
Biomechanical Analysis ◽  
Element Analysis ◽  
Rib Cartilage ◽  
Graft Reconstruction ◽  
Costochondral Graft ◽  
Graft Fracture

Abstract This study is the first attempt to explore the reason of costochondral graft fracture after lengthy mandible advancement and bilateral coronoidectomy by combining finite element analysis and mechanical test. Eleven groups of models were established to simulate costochondral graft reconstruction in different degrees of mandible advancement, ranging from 0 to 20 mm, in 2 mm increment. Force and stress distribution in the rib-cartilage area were analyzed by finite element analysis. Mechanical test was used to evaluate the resistance of the rib-cartilage complex. Results showed a sharp increase in horizontal force between 8 and 10 mm mandible advancement, from 26.7 to 196.7 N in the left side, and continue increased after 10 mm, which was beyond bone-cartilage junction resistance according to mechanical test. Therefore, we concluded that bilateral reconstruction with coronoidectomy for lengthy mandible advancement (≥ 10 mm) may lead to prominent increase in shear force and result in a costal-cartilage junction fracture, in this situation, alloplastic prosthesis could be a better choice. We also suggested that coronoidectomy should be carefully considered unless necessary.

A Novel Technique of Asian Tip Plasty: Rein-Shaped Columellar Strut Graft

2018 ◽  
Vol 43 (5) ◽  
pp. 1301-1309
Author(s):  
Hyo In Kim ◽  
Won Jai Lee ◽  
Tai Suk Roh ◽  
Man-Koon Suh
Keyword(s):  
Strut Graft ◽  
Novel Technique ◽  
Columellar Strut ◽  
Columellar Strut Graft ◽  
Tip Plasty

Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction

2015 ◽  
Vol 17 (5) ◽  
pp. 340-345 ◽  
Author(s):  
Henry P. Barham ◽  
Anna Knisely ◽  
Jenna Christensen ◽  
Raymond Sacks ◽  
George N. Marcells ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Strut Graft ◽  
Valve Dysfunction

scholarly journals Optimal Costal Cartilage Graft Selection According to Cartilage Shape: Anatomical Considerations for Rhinoplasty

2017 ◽  
Vol 33 (06) ◽  
pp. 670-674 ◽  
Author(s):  
Adam Bender-Heine ◽  
Michelle Russell ◽  
Allen Rickards ◽  
J. Holmes ◽  
Mark Armeni ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Nasal Dorsum ◽  
En Bloc ◽  
Reconstruction Procedure ◽  
Geometric Morphometric ◽  
Recipient Site ◽  
Columellar Strut ◽  
Columellar Strut Graft ◽  
Geometric Morphometric Analysis ◽  
Cartilage Grafting

AbstractCostal cartilage grafting is a commonly used reconstruction procedure, particularly in rhinoplasty. Although costal cartilage is broadly used in reconstructive surgery, there are differing opinions regarding which costal cartilage levels provide the most ideal grafts. Grafts are typically designed to match the shape of the recipient site. The shapes of costal cartilage grafts have been described as “boat-shaped,” “C-shaped,” “canoe-shaped,” “U-shaped,” “crescent-shaped,” “L-shaped,” “semilunar,” “straight,” and “Y-shaped.” The shapes of costal cartilages are thought to lend themselves to the shapes of certain grafts; however, there has been little study of the shapes of costal cartilages, and most reports have been anecdotal. Therefore, this study is aimed to detail the average shapes of the most commonly grafted cartilages (i.e., the fifth to seventh cartilages). A total of 96 cadaveric costal cartilages were analyzed through geometric morphometric analysis. The fifth costal cartilage was determined to have the straightest shape and would therefore be particularly suitable for nasal dorsum onlay grafting. The lateral portions of the sixth and, particularly, the seventh costal cartilages have the most acute curvature. Therefore, they would lend themselves to the construction of an en bloc “L”-shaped or hockey stick-shaped nasal dorsum-columellar strut graft.

scholarly journals COLUMELLAR STRUT GRAFT IN TIP RHINOPLASTY, IS IT OF BENEFIT?

2019 ◽  
Vol 25 (1) ◽  
pp. 16-21
Author(s):  
Al-Abbasi Ahmed ◽  
Muhanad A Zahra ◽  
Haider Saeed
Keyword(s):  
Strut Graft ◽  
Columellar Strut ◽  
Columellar Strut Graft ◽  
Tip Rhinoplasty

Y-Shaped En-Bloc Mortise-Tenon Rhinoplasty Technique

2019 ◽  
Vol 40 (1) ◽  
pp. NP8-NP20 ◽  
Author(s):  
Zheng Tan ◽  
Wentao Sun ◽  
Wenjing Yang ◽  
Xiaoling Zhu ◽  
Fan Dong ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Septal Cartilage ◽  
The Novel ◽  
En Bloc ◽  
Level Of Evidence ◽  
Cartilage Grafts ◽  
Asian Patients ◽  
Caudal Portion ◽  
Aesthetic Results ◽  
Nose Deformity

AbstractBackgroundNasal tip management is the most important and challenging aspect of rhinoplasty. Costal cartilage can be utilized in septal extension grafting to effectively correct nasal shape deformity.ObjectivesThe authors described their experience with costal cartilage grafting for septal extension utilizing a novel en-bloc mortise-tenon technique to correct primary or secondary nose deformity or to enhance nasal appearance in Asian patients.MethodsFrom July 2015 to December 2017, costal cartilage grafts were applied as septal extension biomaterials utilizing the novel en-bloc mortise-tenon technique in 278 consecutive Asian rhinoplasty patients with primary (n = 95), secondary (n = 173), and tertiary (n = 10) nose deformity or in patients needing nasal reshaping. The age of the patients ranged from 19 to 46 years. In all cases, the mucoperichondria of the nasal septum were dissected bilaterally from the septal cartilage. The prepared en-bloc costal cartilage graft was mounted onto the caudal portion of the septal cartilage and fixed to the septum with 5-0 polydioxanone sutures.ResultsThe follow-up duration ranged from 10 months to 2.5 years. Of the 278 patients treated, 5 were male and 273 were female. External lengthening of the nose from the nasal root to the tip ranged from 3 to 10 mm. All patients except 1 were satisfied with the shape of the nose.ConclusionsThe authors obtained good aesthetic results utilizing the novel en-bloc mortise-tenon method for connecting costal cartilage grafts as septal extension materials in patients with different types of nasal deformity and in patients needing nose reshaping.Level of Evidence: 4

scholarly journals Preliminary Deformational Studies on a Finite Element Model of the Nasal Septum Reveals Key Areas for Septal Realignment and Reconstruction

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Kyrin Liong ◽  
Shu Jin Lee ◽  
Heow Pueh Lee
Keyword(s):  
Nasal Septum ◽  
Preoperative Planning ◽  
Three Dimensional ◽  
Element Model ◽  
Septal Cartilage ◽  
Type I ◽  
Type Ii ◽  
Anterior Nasal Spine ◽  
Force Direction ◽  
Three Dimensional Models

Background. With the current lack of clinically relevant classification methods of septal deviation, computer-generated models are important, as septal cartilage is indistinguishable on current imaging methods, making preoperative planning difficult. Methods. Three-dimensional models of the septum were created from a CT scan, and incremental forces were applied. Results. Regardless of the force direction, with increasing force, the septum first tilts (type I) and then crumples into a C shape (type II) and finally into an S shape (type III). In type I, it is important to address the dislocation in the vomer-ethmoid cartilage junction and vomerine groove, where stress is concentrated. In types II and III, there is intrinsic fracture and shortening of the nasal septum, which may be dislocated off the anterior nasal spine. Surgery aims to relieve the posterior buckling and dislocation, with realignment of the septum to the ANS and possible spreader grafts to buttress the fracture sites. Conclusion. By identifying clinically observable septal deviations and the areas of stress concentration and dislocation, a straighter, more stable septum may be achieved.

Sign in / Sign up

Export Citation Format

Share Document