The Caudal Septum Pivot Technique for Short Nose Correction

2021 ◽  
Author(s):  
Tito M. Marianetti ◽  
Valentino Vellone ◽  
Francesca De Angelis ◽  
Valerio Ramieri
Keyword(s):  
Simple Method ◽  
Short Nose ◽  
Tip Projection ◽  
Septal Extension Graft ◽  
Nasolabial Angle ◽  
Revision Rhinoplasty ◽  
Anterior Nasal Spine ◽  
Caudal Portion ◽  
Extension Graft ◽  
Nasal Length

AbstractThe short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22–53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.

Septal Extension Graft in “Closed” Revision Rhinoplasty: A Simplified Technique

2017 ◽  
Vol 31 (4) ◽  
pp. 260-264 ◽  
Author(s):  
Alberto Scattolin ◽  
Pier-Francesco Galzignato ◽  
Fabrizio Longari ◽  
Luca D'Ascanio
Keyword(s):  
Endonasal Approach ◽  
Short Nose ◽  
Tip Projection ◽  
Septal Extension Graft ◽  
Revision Rhinoplasty ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Extension Graft ◽  
Nasal Length ◽  
Preoperative Examination

Background The septal extension graft (SEG) is widely used in secondary rhinoplasty for correction of a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip secondary to an overresection of the caudal septum. Although SEG precise fixation can be relatively easy in the external approach, the difficulties of SEG placement in “closed” rhinoplasty can be discouraging. Objective To describe an easy surgical technique for SEG placement in endonasal revision rhinoplasty and to analyze the aesthetic results of the procedure. Methods Thirty-eight patients were submitted to an endonasal approach revision rhinoplasty with endonasal placement of SEG for the correction of a short nose with a hypoprojected and hyper-rotated nasal tip. Pre- and postoperative nasal length, tip projection, and tip rotation (nasolabial and lobulocolumellar angles) were measured for each patient. Results An increase (mean ± standard deviation) of nasal length by 15.02 ± 3.91% and an augmentation of tip projection by 11.34 ± 2.26% were noticed after surgery with respect to preoperative conditions. A significant (p < 0.001) decrease in the columellar-labial angle was recorded on postoperative (91.23 ± 3.85°) examination with respect to preoperative (99.81 ± 6.49°) conditions. A decrease (p < 0.001) in the columellar-lobular angle was noted on postoperative assessment (34.02 ± 5.28°) with respect to preoperative examination (50.02 ± 0.36°). No relevant postoperative complication was recorded. Conclusion The “endonasal” approach described for SEG placement was an easy and reliable procedure to treat a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip, especially in revision surgery. The advantages of our technique over previously described approaches were reported.

scholarly journals Comparative Analysis and Long-Term Results of Various Septal Extension Graft Types

2020 ◽  
Vol 36 (03) ◽  
pp. 263-267
Author(s):  
M. Brandstetter ◽  
M. Bhatt ◽  
M. Pham ◽  
W. Gubisch ◽  
S. Haack
Keyword(s):  
Long Term Results ◽  
Digital Measurement ◽  
Tip Projection ◽  
Nasolabial Angle ◽  
Significant Difference ◽  
Different Types ◽  
Extension Graft ◽  
Nasal Length

AbstractShape, tip projection, and position can be controlled by the use of septal extension grafts (SEG). A retrospective cohort study of patients undergoing primary and secondary rhinoplasty was reviewed. The purpose of this study was to analyze maintenance of nasal length, dorsal length, and nasolabial angle postoperatively comparing different types of SEG using standardized photography and digital measurement. Two-hundred twenty-one patients undergoing rhinoplasty were included. There was a statistically significant change regarding the nasolabial angle during the time of follow-up decreasing from 97.53 to 95.30 degrees. No changes could be found in dorsal and nasal length. There was no significant difference among the techniques used to fixate the SEG. The nasolabial angle appeared to decrease from the position 2 weeks postoperatively without changes in the dorsal and nasal length. This means that the decrease in the nasolabial angle depends on the swelling effect and not on drooping of the tip confirming the reliability of SEG over time.

scholarly journals New Technique in Nasal Tip Plasty: Sandwich Technique Using Cartilage and Septal Bone Complex

2019 ◽  
Vol 99 (9) ◽  
pp. 599-604 ◽  
Author(s):  
Tae Hwan Ahn ◽  
Tao Zheng ◽  
Hee Jeong Kang ◽  
Byung Joon Yoo ◽  
Jae Ho Chung ◽  
...  
Keyword(s):  
Septal Cartilage ◽  
P Value ◽  
Ethmoid Bone ◽  
Sandwich Technique ◽  
Nasal Tip ◽  
Tip Projection ◽  
Septal Extension Graft ◽  
Nasolabial Angle ◽  
Nasal Tip Plasty ◽  
Extension Graft

Objectives: It is extremely difficult to obtain ideal tip projection and nose lengthening by septal extension graft using only septal cartilage in Asians, because their nasal septal and alar cartilages are small and weak. Therefore, we introduce a new septal extension graft using a cartilage–bone complex with the vomer and the perpendicular plate of the ethmoid bone as well as cartilage to obtain optimal outcomes. Methods: Participants included 30 patients who underwent surgery by external approach. The septal cartilage, vomer, and perpendicular plate of the ethmoid bone harvested by septoplasty were used. There were 2 layers of cartilage on each side and bone in between to create a strong cartilage–bone complex for projection and lengthening. The bony portion was placed in the tip side, and the double-layered cartilage portion was placed in the inferior portion of the caudal septum of the L-strut to create powerful fixation. Results: There were statistically significant improvements in nasal length (4.71 ± 0.65 vs 5.15 ± 0.53 cm, P value <.0001), tip projection (2.66 ± 0.40 vs 3.18 ± 0.42, P value <.0001), and nasolabial angle (94.0° ± 9.3° vs 107.2° ± 9.6°, P value <.0001) postoperatively. All patients were subjectively satisfied, and 2 different surgeons had excellent or good opinions in 28 (94%) patients. Conclusions: The sandwich technique using cartilage and bone complex results in satisfactory outcomes with stronger tip support, especially in Asians with a weak nasal tip who desire ideal tip projection and dramatic change.

Nasal Tip Surgery in Asians

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P31-P31
Author(s):  
Tae-Bin Won ◽  
Hong-Ryul Jin ◽  
Hyeon-Jong Lee
Keyword(s):  
Surgical Techniques ◽  
Tertiary Hospital ◽  
Initial Diagnosis ◽  
Saddle Nose ◽  
Nasal Tip ◽  
Tip Projection ◽  
Septal Extension Graft ◽  
Low Profile ◽  
Extension Graft ◽  
Onlay Grafts

Objective The authors intended to review our surgical techniques used in Asian tip surgery and to suggest effective techniques, according to the types of the nasal tip that are addressed. Methods 107 patients who had nasal tip surgery from Jan. 2005 to Dec. 2006 in a tertiary hospital were enrolled in the study. Medical records, graphic operation records, and standardized patient photographs were retrospectively reviewed. Initial diagnosis, types of nasal tip surgery, associated operative techniques, surgical results and complications were analyzed. Results Initial diagnosis included deviated nose, hump nose, combine deviated and saddle nose, low profile nose, short nose, and cleft nose deformity, in order of frequency. Nasal tip surgery included augmentation of projection, control of rotation, restoration of symmetry and volume reduction, among which augmentation was used in all cases. External approach was used in 74% and intranasal approach in 26%. For augmentation of the tip projection, onlay grafts (39%), septal extension grafts (25%), and tip modifying suture with onlay grafts (20%) were the most commonly used methods. Infection or extrusion of the grafts was not found. Complications included tip deviation due to the deviation of the septal extension graft in 1 case, visible tip graft in 1 case, and slight upward rotation of the tip in 1 case. Conclusions In Asians, augmentation of the tip projection is the main issue in tip surgery and is best performed with cartilage onlay grafts or septal extension graft rather than suture modification.

Centering a Deviated Nose by Caudal Septal Extension Graft and Unilaterally Extended Spreader Grafts

2019 ◽  
Vol 129 (5) ◽  
pp. 448-455 ◽  
Author(s):  
Yung Yuan Chen ◽  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Postoperative Complications ◽  
Anthropometric Measurements ◽  
Study Patient ◽  
Open Rhinoplasty ◽  
Nasal Tip ◽  
Tip Projection ◽  
Deviated Nose ◽  
Septal Extension Graft ◽  
Nasal Tip Projection ◽  
Extension Graft

Objective: The deviated nose presents a tremendous challenge for rhinoplasty surgeons, especially the correction of the cartilaginous dorsum deviation. In this study, we introduce the surgical techniques of correcting a deviated cartilaginous vault by creating a new center of the lower third using a caudal septal extension graft combined with unilaterally extended spreader grafts. Methods: This retrospective observational study was conducted in a university-based tertiary medical center from December 2014 to January 2018. Thirty-two patients who underwent primary open rhinoplasty for correction of a deviated nose using this method participated in the study. Patient characteristics and surgical records were collected. Anthropometric measurements and analyses were performed based on preoperative and postoperative photographs. The aesthetic outcome consensus of three rhinoplasty surgeons was evaluated specifically for nasal dorsum deviation correction. Postoperative complications were reviewed from the medical records. Results: Among the 32 patients, there were 18 males and 14 females. The mean (SD) age of the patients was 26.7 (8.76) years. Anthropometric measurements showed significant improvements in dorsal deviation angle (a 3.7° change towards midline, P < .001), nasal tip projection (increase of 6.96% measured by Goode’s method, P < .001), and nostril shape (nostril axis inclination decrease of 11.7°, P < .001) after surgery. The nasolabial angle showed no significant change. Aesthetic outcomes were excellent in seven patients (21.9%), good in fourteen patients (43.7%), fair in eight patients (25.0%), and no change in three patients (9.4%). Minor postoperative complications (four patients) were observed during follow-up. Conclusion: Centering the cartilaginous vault using a caudal septal extension graft combined with unilaterally extended spreader grafts is a useful technical option in the correction of a deviated nose, and provides improvement in nasal tip projection and nostril shape.

scholarly journals The T- Graft to Control Nasal Length and Nasal Tip Position

2021 ◽  
Author(s):  
Dirk Jan Menger
Keyword(s):  
Soft Tissue ◽  
Nasal Septum ◽  
Anatomical Features ◽  
Soft Tissue Envelope ◽  
Short Nose ◽  
Nasal Tip ◽  
Tip Projection ◽  
Nasal Tip Projection ◽  
Tip Position ◽  
Nasal Length

The T-graft is a new tool in the armament of structural rhinoplasty. The graft makes it easy to create a well- balanced nasal framework both for beginners and more experienced rhinoplastic surgeons. Due to its multifunctional character the T-graft allows the surgeon to control nasal length as well as nasal tip projection and -rotation. The T-graft is indicated in many anatomical features like in patients with a short nose or heavy soft tissue envelope, but also in patients with under projection of the nasal tip, under- or over-rotation of the nasal tip and deviations of the caudal nasal septum.

Polycaprolactone Mesh for Asian Rhinoplasty: Outcomes and Complications of Composite Septal Extension Graft Compared to Mesh-Only Graft

2021 ◽  
Author(s):  
Seung Hyun ◽  
Seung Woo ◽  
Rong-Min Baek
Keyword(s):  
Asian Population ◽  
Septal Cartilage ◽  
P Value ◽  
Mesh Exposure ◽  
Nasal Tip ◽  
Patients Satisfaction ◽  
Tip Projection ◽  
Septal Extension Graft ◽  
Aesthetic Rhinoplasty ◽  
Extension Graft

AbstractDespite the great demand of aesthetic rhinoplasty in Asian population, it is difficult to obtain the lasting ideal tip projection along with lengthening of the nose due to the small and weak nasal septum. The shortage of available septal cartilage to work with is another major obstacle. A retrospective study was conducted between January 2017 and December 2019 in Seoul, Korea. A total of 774 patients underwent septorhinoplasty using polycaprolactone (PCL) mesh for the cosmetic enhancement of the nasal tip and the projection. Comparisons of aesthetic outcomes, patients' satisfaction surveys, and complications were performed between PCL mesh-only group and composite PCL group. Of all the patients, 97.5% of the patients in composite PCL group were rated more than 3 scores in aesthetic outcomes, whereas 90.4% in mesh-only group (p-value = 0.0002). About 96.7% of the patients with composite PCL rated their satisfaction level as more than satisfied, whereas 94.3% in mesh-only group (p-value = 0.0365). Overall, there were 17 patients in composite PCL group who exhibited complications including decreased tip projection, deviated nasal tip, mesh infection, and mesh exposure. However, there were two patients who had mesh injection in mesh-only group. Septorhinoplasty with septal extension graft using composite PCL graft provides robust support to the aesthetically modified projection and the lengthened nose without obvious complications on the nasal tip. Such technique allows surgeons to overcome the nature of Asian nose that is weak and small, and also provides satisfaction to patients who desire ideal tip projections and dramatic changes.

Changes to the Cleft Nose Esthetic After Le Fort I Advancement: A 3-Dimensional Analysis

FACE ◽  
2021 ◽  
pp. 273250162110469
Author(s):  
Fady P. Marji ◽  
Madeleine K. Bruce ◽  
Erin E. Anstadt ◽  
Irene T. Ma ◽  
Jonathan Y. Lee ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Le Fort ◽  
3 Dimensional ◽  
Tip Projection ◽  
Alar Base ◽  
Nasolabial Angle ◽  
Le Fort I ◽  
Nasal Length ◽  
Nasal Changes

Background and Purpose: The study of nasal changes in cleft lip and palate (CLP) orthognathics is limited. This study aimed to determine differences in 3-dimensional (3D) nasal changes for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients after Le Fort I advancement. Methods: This study was a retrospective cohort evaluation of 18 subjects (9 male, 9 female) treated at a single institution over a 5-year period who had class III skeletal and dentoalveolar malocclusion related to non-syndromic cleft lip and/or palate and underwent surgical correction via Le Fort I osteotomy. Patients underwent pre- and postoperative cephalometric measurements and 3D volumetric assessment for comparison to analyze nasal changes. Statistical analysis was performed to determine changes in nasal parameters using student’s t-test and multivariate analysis. Differences were considered significant for P-values ≤.05. Results: All nasal parameters except for nasolabial angle and nasal length changed significantly postoperatively in the entire cohort. Alar base and flare width both increased significantly (2.1 mm, P = .0002, 1.4 mm, P = .0005), while both relative and total tip projection decreased (−3.4 mm, P = .000004, −2.2 mm, P = .0008). An advancement of the entire nasal complex was seen postoperatively (1.0 mm, P = .0005). UCLP patients had a significantly larger decrease in total nasal tip projection following surgery relative to BCLP patients (−3.5 ± 1.2 mm, −0.8 ± 2.1 mm, P = .008). BCLP morphology increases the degree of 3D nasal surface area advancement relative to UCLP (1.2 mm ± 0.3, 0.8 mm ± 0.6, P = .028). Alar cinch stitch decreases nasolabial angle ( P = .024) but increases nasal length ( P = .004). Conclusion: Discrepancies exist in nasal changes after Le Fort I advancement between UCLP and BCLP patients. Increased understanding of outcomes for cleft patients undergoing Le Fort I can help improve the predictability of nasal esthetic changes in this patient population.

The Performance of Secondary Nasal Alar Base Revision for Unilateral Cleft Lip by Single YV-Plasty (the Importance of Overcorrection During Surgery)

2021 ◽  
pp. 105566562110106
Author(s):  
Yoshitaka Matsuura ◽  
Hideaki Kishimoto
Keyword(s):  
Cleft Lip ◽  
Minimum Degree ◽  
Nasal Deformity ◽  
Simple Method ◽  
Primary Surgery ◽  
Base Revision ◽  
Alar Base ◽  
Anterior Nasal Spine ◽  
Nasal Floor ◽  
Case Basis

Although primary surgery for cleft lip has improved over time, the degree of secondary cleft or nasal deformity reportedly varies from a minimum degree to a remarkable degree. Patients with cleft often worry about residual nose deformity, such as a displaced columella, a broad nasal floor, and a deviation of the alar base on the cleft side. Some of the factors that occur in association with secondary cleft or nasal deformity include a deviation of the anterior nasal spine, a deflected septum, a deficiency of the orbicularis muscle, and a lack of bone underlying the nose. Secondary cleft and nasal deformity can result from incomplete muscle repair at the primary cleft operation. Therefore, surgeons should manage patients individually and deal with various deformities by performing appropriate surgery on a case-by-case basis. In this report, we applied the simple method of single VY-plasty on the nasal floor to a patient with unilateral cleft to revise the alar base on the cleft side. We adopted this approach to achieve overcorrection on the cleft side during surgery, which helped maintain the appropriate position of the alar base and ultimately balanced the nose foramen at 13 months after the operation. It was also possible to complement the height of the nasal floor without a bone graft. We believe that this approach will prove useful for managing cases with a broad and low nasal floor, thereby enabling the reconstruction of a well-balanced nose.

Sign in / Sign up

Export Citation Format

Share Document