Inaccuracy of Standard 2D Photography for the Diagnosis of Cephalic Malposition of Lateral Crural Cartilages

2021 ◽  
Author(s):  
Shahin Bastaninejad ◽  
Ardavan Tajdini ◽  
Yasaman Rezaie
Keyword(s):  
Surgical Techniques ◽  
Accurate Diagnosis ◽  
Alar Cartilage ◽  
Nasal Valve ◽  
Strut Graft ◽  
Primary Rhinoplasty ◽  
The Face ◽  
Medical Photography ◽  
And Function ◽  
External Nasal Valve

AbstractLateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contributes to functional disturbances of the external nasal valve. Accurate diagnosis of this deformity helps surgeons plan for better outcomes. A total of 176 candidate patients for primary rhinoplasty underwent standard 2D medical photography of the face. Senior authors analyzed photography results and differentiated the patients with LCCM. In addition, we measured the angle between the dorsal septum and lateral end of the long axis of the alar cartilage in the operation room. Ninety-five patients were diagnosed with LCCM on photography. As much as 31.3% (55) of all the patients had LCCM in intraoperative measurements. The sensitivity and specificity of 2D photography for diagnosing LCCM were 0.7924 and 0.5391, respectively. The main surgical techniques for correction of LCCM were alar repositioning (34.3% in total, 56% in LCCM patients) and lateral crural strut graft (43.8% in total, 69% in LCCM patients). LCCM is overdiagnosed via 2D photography, and this method lacks sensitivity. The overall frequency of LCCM seems to be lower than the previously reported frequency. For optimal results in rhinoplasty, surgeons must focus on the best contouring and function rather than solely correcting angles and rotations.

Improvement of Alar Concavity With Scroll Ligament Preservation: Sandwich Technique

2020 ◽  
Vol 40 (10) ◽  
pp. 1064-1075 ◽  
Author(s):  
Güncel Öztürk
Keyword(s):  
Outcome Evaluation ◽  
Nasal Valve ◽  
Level Of Evidence ◽  
Easy Method ◽  
Transposition Flap ◽  
Sandwich Technique ◽  
Novel Technique ◽  
Primary Rhinoplasty ◽  
External Nasal Valve

Abstract Background Excessive concavity of the lower lateral crura can cause significant aesthetic problems for the nasal tip and can be associated with significant functional problems, such as insufficiencies in the external nasal valve. Objectives The aim of this study was to develop a novel technique for the improvement of several alar concavities that preserve the scroll area. Methods In this retrospective study, 51 primary rhinoplasty patients with unoperated alar concavity deformities were assessed. Alar concavities were repaired with alar strut grafts and a superior transposition flap or superior-based sliding flap, which were designed with the “sandwich” technique. Additionally, the scroll ligament was completely preserved in the 2 variants of the technique. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation (ROE) questionnaire before surgery and at their 1-year follow-up appointment. Results The median age of patients was 29.2 years (range, 19-49 years). The ROE scores ranged between 90 and 100 points after 1 year. The median score was 91.2 points, and this was significantly increased at the 1-year follow-up appointment (P = 0.002). Patient satisfaction was found to be excellent in 92% of the included patients. Patients were also evaluated in terms of functionality. The patients’ patency scores increased to 9.4 from 6.1 (out of 10) after a 12-month follow-up (P = 0.003). Conclusions This “sandwich” technique involves a combination of superior transposition flaps, superior-based sliding flaps, and alar strut grafts. Thus, patients who receive this treatment may also benefit from new flap techniques and vertical and longitudinal scroll ligament preservation. This new technique presents a novel and easy method for the reconstruction of severe alar concavities. Level of Evidence: 4

scholarly journals Management of Rhinophyma

2016 ◽  
Vol 7 (3) ◽  
pp. 188-191
Author(s):  
Timothy S Lian ◽  
Richard W Thompson
Keyword(s):  
Surgical Techniques ◽  
Surgical Excision ◽  
Definitive Treatment ◽  
Nasal Valve ◽  
Sebaceous Glands ◽  
Tumescent Anesthesia ◽  
Sharp Dissection ◽  
Argon Beam Coagulation ◽  
External Nasal Valve ◽  
Head Neck

ABSTRACT Rhinophyma is a condition that can cause significant disfigurement as well as functional impairment of the nose. It results from hypertrophy and hyperplasia of the sebaceous glands and can be a manifestation of advanced staged rosacea. If left untreated, not only can it cause disfigurement, rhinophyma can also result in nasal airway obstruction by marked ptosis and collapse of the external nasal valve. Surgical excision is the definitive treatment as rhinophyma does not spontaneously regress. Though various surgical techniques are available for the treatment of rhinophyma, a specific technique using tumescent anesthesia, sharp dissection, and argon beam coagulation has been found to be most efficacious. This technique and its advantages are described. How to cite this article Lian TS, Thompson RW. Management of Rhinophyma. Int J Head Neck Surg 2016;7(3):188-191.

The Anchor of the Nasal Ala in Cleft Lip-Nose Patients: A Morphological Description and a New Surgical Approach

2000 ◽  
Vol 37 (2) ◽  
pp. 130-136
Author(s):  
Paolo G. Morselli
Keyword(s):  
Surgical Technique ◽  
Cleft Lip ◽  
Normal Growth ◽  
Alar Cartilage ◽  
Morphological Description ◽  
Triangular Flap ◽  
Primary Rhinoplasty ◽  
The Face ◽  
Cleft Lip Nose ◽  
New Surgical Technique

Objective The purpose of this article is to describe a morphological condition that is readily seen in both primary and secondary deformed noses of cleft patients and to present a new surgical technique to correct this specific deformity that afflicts the alar dome. This anomaly resembles a taut cord-like tissue that runs vertically from the pyriform aperture and is anchored onto the alar cartilage, thus impeding the cartilage's normal growth process. This new surgical technique releases the anchor and corrects the deformity of the nasal rim by using a triangular flap V-Y advancement technique. Results From 1994 to 1997, 88 cleft lip-nose cases were operated on by the author using the triangular flap V-Y advancement technique for releasing the anchor. Forty-two cases were primary repairs and 46 were secondary repairs. Conclusions By studying the normal and pathological anatomy of the nose and its proportions, the surgeon can obtain ideas for new surgical corrective techniques that can be used to restore anatomical balance and harmony between the nose and the face. Only in the last 15 to 20 years has the plastic surgeon begun to be interested in primary rhinoplasty in cleft lip-nose patients. Within this time, many different techniques have been proposed. All primary and secondary cases that have undergone this specific technique for release of the anchor have shown good results for restoring the height of the alar dome's affected side to that of the noninvolved side, thus establishing a more anatomically balanced nose.

Management of External Nasal Valve Collapse: Literature Review

2020 ◽  
pp. 47-54
Author(s):  
Libia Avila Campoverde ◽  
Deniss Calderón Alemán ◽  
Doris Calderón Alemán ◽  
Mónica Tello Larriva ◽  
Mayra Montecinos Rivera
Keyword(s):  
Clinical Evidence ◽  
Correct Diagnosis ◽  
Lateral Wall ◽  
Alar Cartilage ◽  
Effective Management ◽  
Nasal Valve ◽  
Valve Dysfunction ◽  
The World ◽  
Nasal Valve Collapse ◽  
External Nasal Valve

Rhinoplasty is one of the most frequent cosmetic surgeries in the world and among the most common complications is valve collapse due to excessive resection of the alar cartilage. Facial paralysis, as well as aging, can collapse the lateral wall in inspiration due to dysfunction of the nasal muscle, causing weakening of the fibroalveolar tissue of the nasal lateral wall, and there are also genetic causes that produce valve collapse. Currently, various techniques are practiced to improve valve collapse and none are one hundred percent effective, most of them focus on correcting the nasal valve itself or the triangular cartilage, which indicates that they are fixed on a single factor and not on multifactorial etiology that produces it. This study reviews the clinical evidence that guides a correct diagnosis and effective management of external nasal valve dysfunction, using various techniques that are currently used to improve nasal valve collapse.

scholarly journals The Effectiveness of Modified Cottle Maneuver in Predicting Outcomes in Functional Rhinoplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Elaine Fung ◽  
Paul Hong ◽  
Corey Moore ◽  
S. Mark Taylor
Keyword(s):  
Surgical Techniques ◽  
Rank Correlation ◽  
Nasal Airflow ◽  
Nasal Valve ◽  
Spearman Rank Correlation ◽  
Nasal Breathing ◽  
Analog Scale ◽  
Outcomes Evaluation ◽  
Postoperative Symptoms ◽  
External Nasal Valve

Objective. To assess the outcomes of functional rhinoplasty for nasal valve incompetence and to evaluate an in-office test used to select appropriate surgical techniques. Methods. Patients with nasal obstruction due to nasal valve incompetence were enrolled. The modified Cottle maneuver was used to assess the internal and external nasal valves to help select the appropriate surgical method. The rhinoplasty outcomes evaluation (ROE) form and a 10-point visual analog scale (VAS) of nasal breathing were used to compare preoperative and postoperative symptoms. Results. Forty-nine patients underwent functional rhinoplasty evaluation. Of those, 35 isolated batten or spreader grafts were inserted without additional procedures. Overall mean ROE score increased significantly (P<0.0001) from 41.9 ± 2.4 to 81.7 ± 2.5 after surgery. Subjective improvement in nasal breathing was also observed with the VAS (mean improvement of 4.5 (95% CI 3.8–5.2) from baseline (P=0.000)). Spearman rank correlation between predicted outcomes using the modified Cottle maneuver and postoperative outcomes was strong for the internal nasal valve (Rho = 0.80; P=0.0029) and moderate for the external nasal valve (Rho = 0.50; P=0.013). Conclusion. Functional rhinoplasty improved subjective nasal airflow in our population. The modified Cottle maneuver was effective in predicting positive surgical outcomes.

scholarly journals Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

2012 ◽  
Vol 5 (4) ◽  
pp. 243-252 ◽  
Author(s):  
Pamela R. Brown Baer ◽  
Joseph C. Wenke ◽  
Steven J. Thomas ◽  
Colonel Robert G. Hale
Keyword(s):  
Surgical Techniques ◽  
Case Series ◽  
Wound Dehiscence ◽  
Service Members ◽  
Natural Form ◽  
Form And Function ◽  
The Face ◽  
Surgical Options ◽  
And Function ◽  
Battle Injuries

This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function.

scholarly journals Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

2021 ◽  
pp. 014556132098394
Author(s):  
Mohamed A. Taha ◽  
Christian A. Hall ◽  
Harry E. Zylicz ◽  
William T. Barham ◽  
Margaret B. Westbrook ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Primary Group ◽  
Nasal Valve ◽  
Lateral Crus ◽  
Valve Dysfunction ◽  
Score Improvement ◽  
Revision Rhinoplasty ◽  
Final Score ◽  
Sinonasal Outcome Test ◽  
External Nasal Valve

Objective: To evaluate and compare the costal cartilage lateral crural strut graft’s (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. Methods: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. Results: While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort’s preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. Conclusion: The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

Upper Lateral Strut Graft: A Technique to Improve the Internal Nasal Valve

2014 ◽  
Vol 28 (1) ◽  
pp. 65-69 ◽  
Author(s):  
John Craig ◽  
Parul Goyal ◽  
Amar Suryadevara
Keyword(s):  
Nasal Valve ◽  
Strut Graft

scholarly journals Management of the Crooked Nose

2016 ◽  
Vol 7 (3) ◽  
pp. 168-172
Author(s):  
Jessica W Scordino ◽  
Frederick J Stucker
Keyword(s):  
Surgical Techniques ◽  
Successful Outcome ◽  
Open Approach ◽  
Form And Function ◽  
Crooked Nose ◽  
Self Image ◽  
Level Of Satisfaction ◽  
High Level ◽  
And Function ◽  
Nasal Function

ABSTRACT Aim: To describe an approach for the diagnosis and management of patients presenting with crooked nose. Background Patients with crooked nose suffer from functional ailments, most significant nasal obstruction, as well as esthetic concerns which may impact their self-image as well as others’ perception of them. As such, management of the crooked nose is an especially challenging task in that it demands careful attention to both nasal function and appearance. There are a plethora of surgical techniques which may be utilized, and the surgeon's approach must be tailored to each individual patient's presentation. Technique Accurate diagnosis is imperative for a successful outcome and relies on a thorough history and careful physical examination. Surgical intervention may be addressed by either an endonasal or open approach based on the location and severity of the deformity. It is helpful to break down the nose in vertical thirds when planning your surgical approach. Different techniques are used to address the upper third comprising the nasal bones, middle third composed of the upper lateral cartilages and septum, and the lower third composed of the lower lateral cartilages and caudal septum. Conclusion Management of the crooked nose is a technically challenging endeavor that highlights the need to address both form and function for a successful outcome. Effective treatment can significantly improve a patient's quality of life leading to a high level of satisfaction for both the patient and the surgeon. How to cite this article Scordino JW, Stucker FJ. Management of the Crooked Nose. Int J Head Neck Surg 2016;7(3):168-172.

scholarly journals Neural contributors to trauma resilience: a review of longitudinal neuroimaging studies

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alyssa R. Roeckner ◽  
Katelyn I. Oliver ◽  
Lauren A. M. Lebois ◽  
Sanne J. H. van Rooij ◽  
Jennifer S. Stevens
Keyword(s):  
Individual Differences ◽  
Neural Circuit ◽  
Major Life ◽  
Stress Resilience ◽  
Control Networks ◽  
The Face ◽  
Sensory Cortices ◽  
Life Stressor ◽  
Threat Cues ◽  
And Function

AbstractResilience in the face of major life stressors is changeable over time and with experience. Accordingly, differing sets of neurobiological factors may contribute to an adaptive stress response before, during, and after the stressor. Longitudinal studies are therefore particularly effective in answering questions about the determinants of resilience. Here we provide an overview of the rapidly-growing body of longitudinal neuroimaging research on stress resilience. Despite lingering gaps and limitations, these studies are beginning to reveal individual differences in neural circuit structure and function that appear protective against the emergence of future psychopathology following a major life stressor. Here we outline a neural circuit model of resilience to trauma. Specifically, pre-trauma biomarkers of resilience show that an ability to modulate activity within threat and salience networks predicts fewer stress-related symptoms. In contrast, early post-trauma biomarkers of subsequent resilience or recovery show a more complex pattern, spanning a number of major circuits including attention and cognitive control networks as well as primary sensory cortices. This novel synthesis suggests stress resilience may be scaffolded by stable individual differences in the processing of threat cues, and further buttressed by post-trauma adaptations to the stressor that encompass multiple mechanisms and circuits. More attention and resources supporting this work will inform the targets and timing of mechanistic resilience-boosting interventions.

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