The Combined Auricular Graft: A New Technique for Mestizo Nasal Tip Surgery

2018 ◽  
Vol 39 (12) ◽  
pp. 1297-1308
Author(s):  
Paulo A Escobar ◽  
Simon Zimmermann ◽  
Lukas Lunger
Keyword(s):  
Rotation Angle ◽  
Alar Cartilage ◽  
Cartilage Graft ◽  
Level Of Evidence ◽  
Tip Rotation ◽  
Nasal Tip ◽  
Primary Rhinoplasty ◽  
The Mean ◽  
Mean Differences ◽  
The Aesthetic

Abstract Background Current literature lacks a single cartilage graft to address problems in projection, rotation, and/or definition in mestizo patients that considers the alar cartilage structure, length, and shape characteristics of this population. Objectives The authors sought to describe a novel technique and evaluate the aesthetic outcomes of the combined auricular graft in mestizo patients undergoing primary rhinoplasty. Methods A retrospective cohort study of consecutive patients who underwent primary rhinoplasty using the combined auricular graft between January 2015 and June 2017 was performed. The minimum duration of follow-up was 6 months. Main outcomes were nasal tip projection and tip rotation angle. Results Among the 61 patients (38 women [62.2%] and 23 men [37.8%]; mean age, 29.3 ± 10.8 years), the mean differences in projection were statistically significant between T0 and T1, T0 and T2, and T0 and T3 (1.63, 1.39, and 1.32 mm, respectively). Thus, 80.9% of the increase in projection that had been achieved at T1 was maintained at T3 (P < 0.001). The relapse ratio measured 19.1% (mean difference T1-T3, 0.31 ± 0.10 mm). The mean tip rotation angle at T0 (111.69 ± 3.59°) significantly increased by 2.37 ± 3.13° (T3, 114.06 ± 2.50°, P < 0.001). Conclusions One single auricular cartilage graft can significantly improve projection and/or rotation by simultaneously addressing structure, length, and shape of lower lateral cartilages. Misbalance between the medial and lateral crura is avoided and retraction risks are prevented. Consequently, a more natural, precise, and accurate tip position is obtained. Level of Evidence: 4

Evaluation of a new procedure for nasal alar rim and valve collapse: Nasal alar rim reconstruction

2000 ◽  
Vol 122 (2) ◽  
pp. 204-211 ◽  
Author(s):  
Robert J. Troell ◽  
Nelson B. Powell ◽  
Robert W. Riley ◽  
Kasey K. Li
Keyword(s):  
Retrospective Study ◽  
Medical Center ◽  
Subjective Evaluation ◽  
Alar Cartilage ◽  
Cartilage Graft ◽  
Nasal Valve ◽  
The Mean ◽  
Nasal Valve Collapse ◽  
Alar Rim ◽  
Valve Area

OBJECTIVE A new operative technique to improve nasal valve collapse by placement of cartilage struts along the alar rim was compared with the standard nasal valve cartilage graft (NVG) technique. METHODS AND PATIENTS A retrospective study of consecutive patients with nasal valve collapse was performed at Stanford University Medical Center. Seventy-nine patients with nasal valve collapse underwent reconstruction with either the classic NVG technique or a newly developed nasal alar rim reconstructive (NARR) procedure. The mean age of the NARR group was 50.13 years (SD ± 9.40), with 36 men (92.3%) and 3 women (7.7%). The mean age of the NVG group was 52.14 years (SD ± 10.83), with 36 men (90%) and 4 women (10%). MAIN OUTCOME MEASURES These included functional and subjective evaluation of nasal valve collapse. RESULTS Forty patients (50.6%) underwent the NVG technique, and 39 (49.4%) received the NARR procedure. The NVG technique revealed 0% worsened, 15.0% (6/40) unchanged, 25.0% (10/40) improved, and 60% (24/40) free of obstruction. The NARR procedure revealed 2.6% worsened, 2.6% unchanged, 7.7% improved, and 87.1% free of obstruction. CONCLUSIONS Nasal alar cartilage struts placed along the caudal alar rim offers sufficient support to the alar rim and valve area. This procedure appears to be as effective as currently available reconstructive alternatives, while being technically uncomplicated.

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.

Supero-Septum Pedicle Mammaplasty: A New Modification for Reduction Mammaplasty

2019 ◽  
Vol 40 (10) ◽  
pp. 1080-1095 ◽  
Author(s):  
Mohammadhossein Hesamirostami ◽  
Leila Sarparast ◽  
Hamed Bateni ◽  
Abbas Kazemi Ashtiani
Keyword(s):  
Reduction Mammaplasty ◽  
Wound Dehiscence ◽  
Modified Technique ◽  
Level Of Evidence ◽  
Superior Pedicle ◽  
Aesthetic Result ◽  
Areola Complex ◽  
The Mean ◽  
The Aesthetic ◽  
A Prospective Study

Abstract Background Many techniques have been introduced for reduction mammaplasty and are utilized in diverse frequencies by different surgeons according to patient needs. Each technique is evaluated based on the aesthetic result, longevity, complication rate, and preservation of the nipple-areola complex (NAC) sensation. Objectives The authors sought to introduce the new modified technique of supero-septum pedicle mammaplasty (SSPM) that utilizes both the septum and superior pedicle and is suitable for macromastia and gigantomastia cases. Methods Between 2015 and 2018, 60 women who underwent SSPM were evaluated in a prospective study after undergoing superior pedicle deepithelialization and resection of the inferior, lateral, and medial segments. In the lateral pillar, a tongue of tissue was preserved for fixation to the medial pectoral fascia through a window created in the superior pedicle at the third intercostal space. Finally, septum pedicle was sutured to the fascia and muscle at the upper border of the sixth rib somewhat medially. Patients were followed up for a minimum of 13 months. Results The mean nipple-to-sternal notch (N-SN) distance was 33.05 cm, and the mean NAC elevation was 10.92 cm. Breast reductions varied from 270 to 2800 g per breast. Complications included wound dehiscence (5%), wound infection (2.5%), and partial NAC necrosis (2.5%). At 6 months postoperation, the NAC sensation was significantly better compared with preoperative values (P &lt; 0.005). Conclusions SSPM is a relatively safe method of reduction mammaplasty, even for very large breasts, that leads to good aesthetic form along with preserving circulation and sensation of the NAC. Level of Evidence: 4

Aesthetic and functional outcomes of thinned anterolateral thigh flap in reconstruction of complex wounds of the upper limb

2021 ◽  
pp. 175319342198960
Author(s):  
Mohamed A. Ellabban ◽  
Amr A. Gomaa ◽  
Amr M. Moghazy ◽  
Mohamed A. Elbadawy ◽  
Osama A. Adly
Keyword(s):  
Upper Limb ◽  
Functional Results ◽  
Anterolateral Thigh Flap ◽  
Self Assessment ◽  
Level Of Evidence ◽  
Anterolateral Thigh ◽  
Before And After ◽  
The Mean ◽  
The Aesthetic ◽  
Anterolateral Thigh Flaps

We studied outcomes of reconstruction of complex upper limb wounds using thinned anterolateral thigh flaps. There were 18 patients with a mean age of 27.5 years. The mean thickness of the flap before and after thinning was 23 mm and 5 mm, respectively. Two patients had partial tip necrosis that was treated conservatively. Aesthetic and functional evaluations were performed using a 5-point Likert scale, QuickDASH score, passive range of motion and power grip at 12 months after surgery. The study showed good results in the aesthetic evaluation by a panel of plastic surgeons (mean score: 19.7) and patient self-assessment (mean score: 18.1). There was a significant correlation between the total scores of the panel and the patients. The mean QuickDASH score was 21, with a high percentage in the middle category ‘had a problem but working’. The thinned anterolateral thigh flap is versatile and safe in upper limb reconstruction with good aesthetic and functional results. Level of evidence: IV

scholarly journals Association of Nasal Tip Rotation Outcome Estimation With the New Domes Technique in Primary Rhinoplasty

2018 ◽  
Vol 20 (4) ◽  
pp. 292-299 ◽  
Author(s):  
Fernando Pedroza ◽  
Edgar Eduardo Santos ◽  
Federico Espinosa ◽  
Claudia José Velásquez ◽  
Andrés Fernando Gutiérrez ◽  
...  
Keyword(s):  
Tip Rotation ◽  
Nasal Tip ◽  
Primary Rhinoplasty

scholarly journals Optimising Results of Nasal Tip Rotation Applying Combination of Nasolabial Angle and Lip–Columellar Angle in Tandem in Patients Operated by “Cock-up” Alar Cartilage Flaps Technique

2019 ◽  
Vol 52 (02) ◽  
pp. 183-194
Author(s):  
Uday Bhat ◽  
Amit Ratanlal Peswani ◽  
Snehjeet Wagh ◽  
Rohit Mishra ◽  
Tarush Gupta ◽  
...  
Keyword(s):  
Outcome Evaluation ◽  
Alar Cartilage ◽  
P Value ◽  
Tip Rotation ◽  
Nasal Tip ◽  
Nasolabial Angle ◽  
Digital Measurements ◽  
The Difference ◽  
Long Nose

Abstract Background Setting the angle of tip rotation is of utmost importance in achieving satisfactory results in rhinoplasty. Conventionally the upward rotation of the tip requires shortening of the septum by caudal resection and shortening of the lateral walls by cephalic trim of the alar cartilages. The results are usually assessed subjectively. We describe the use of objective parameters to ensure accuracy of nasal tip rotation in patients operated with “cock-up” alar cartilage flaps, a modification of the cephalic trim. Methods Fifteen patients with a long nose having adequate width of lateral crura, desiring a shorter nose with upward tip rotation, were included in the study. Values of preoperative and desired nasolabial angle (from morphed images), and the derived columellar–labial angle were documented. Nasal tip rotation was set to the derived angle and maintained using cock-up alar cartilage flaps. The outcome was evaluated by digital measurements of the nasolabial angle and patients’ feedback by Rhinoplasty Outcome Evaluation (ROE) score. Results Satisfactory tip rotation and an aesthetic supratip area could be achieved. The difference in preoperative and postoperative nasolabial angles was statistically significant (p value < 0.0001). The difference in desired and the obtained nasolabial angle was not significant (p value 0.085). The results were maintained on subsequent follow-up. Conclusion Application of angles in practice and use of K-wire template helps us achieve accurate and consistent results. Cock-up flap is an effective technique—to obtain an open nasolabial angle and a desirable supratip region by making use of tissues otherwise discarded.

Assessment of Columellar Widening with Columellar Strut Placement

FACE ◽  
2021 ◽  
pp. 273250162110220
Author(s):  
Julia Toman ◽  
Liliya Benchetrit ◽  
Annika Meyer ◽  
James Zachary Porterfield ◽  
Jonathan Y. Lee ◽  
...  
Keyword(s):  
Mount Sinai Hospital ◽  
Nasal Tip ◽  
Columellar Strut ◽  
Primary Rhinoplasty ◽  
Significant Difference ◽  
Tongue In Groove ◽  
The Mean ◽  
Open Versus ◽  
Extension Graft

Objective: The columellar strut is a frequently used technique to provide nasal tip support and projection that is commonly thought to increase columellar width. However, systematic review of the effect has not been reported in the literature. We report a quantitative evaluation of the effect of columellar strut placement on columellar width. Methods: A retrospective cohort study of changes in columellar width in base view photographs for patients who underwent primary rhinoplasty with columellar strut placement (n = 35) and the closely related septal extension graft (n = 9) and tongue-in-groove (n = 5) procedures at Mount Sinai Hospital between 2010 and 2017. The ratio of the columellar width to the intercanthal distance was used to standardize the results among patients. Comparisons were made at follow-up periods of <1 week, 2 to 4 weeks, 1 to 3 months, 3 to 6 months, 6 to 12 months, and >1 year of follow-up. Results: Forty-nine patients (41% female; average age of 43 ± 15 years) were reviewed. The columellar width showed a statistically significant increase for all follow-up date ranges with the exception of 1 week and 3 to 6 months post-operatively. At >1 year of post-operative follow-up, the mean increase in columellar width was 8.6% (95% CI, 2.6%-14.5%, P = .0098). No statistically significant differences were noted between open versus closed procedure for all followup visits after the 1 week followup, and no significant difference if a septocolumellar stitch was placed. Conclusions: A columellar strut was demonstrated to lead to an increase in columellar width. Though the effect was modest at a 8.6% increase, this is a potential cosmetic consideration for the surgeon employing its use to provide nasal tip support and projection.

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