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

Application of Trans-Areola Approach for Costal Cartilage Harvest in Asian Rhinoplasty and Comparison with Traditional Approach on Donor-Site Morbidity

2020 ◽  
Vol 40 (8) ◽  
pp. 829-835 ◽  
Author(s):  
Runlei Zhao ◽  
Bailin Pan ◽  
Hengju Lin ◽  
Yan Long ◽  
Yang An ◽  
...  
Keyword(s):  
Traditional Approach ◽  
Costal Cartilage ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Main Concern ◽  
Level Of Evidence ◽  
Traditional Group ◽  
Asian Patients ◽  
Areola Approach

Abstract Background The traditional approach of harvesting costal cartilage through a chest wall incision can result in significant donor-site morbidity and usually causes notable scars in Asian patients. This has become the main concern for Asian females seeking rhinoplasty with autologous costal cartilage. Objectives The aim of this study was to investigate the donor-site morbidity of the trans-areola approach for costal cartilage harvest in Asian rhinoplasty and to compare it with the traditional approach. Methods Patients’ records were reviewed to determine whether their rhinoplasties had been performed with either the trans-areola or the traditional approach to costal cartilage harvest. Donor-site morbidity was evaluated 1 year postoperatively via a visual analog scale and the Modified Vancouver Scar Scale. Long-term complications of the trans-areola group were assessed at least 6 months after surgery. Results There were 26 females in the trans-areola group and 35 females in the traditional group; both groups were of similar age and body mass index range. Compared with the traditional group, the trans-areola group had a significantly longer surgery time and a higher pneumothorax rate (7.7% vs 2.9%) but a significantly better scar quality and a higher overall satisfaction. Long-term outcomes and complications of the trans-areola group included significant scars (2/26, 7.7%), concavity of the breast (1/26, 3.8%), and local chest pain/discomfort (1/26, 3.8%). Conclusions Compared with the traditional approach to harvesting costal cartilage in Asian rhinoplasty, patients who underwent the trans-areola approach had less overall donor-site morbidity and higher overall satisfaction. We recommend this technique to patients who meet the inclusion criteria as well as those seeking a better cosmetic outcome. Level of Evidence: 4

Dorsal Augmentation of Saddle Nose Deformity With Toothpick-Shaped Costal Cartilage Grafts in the Secondary Septorhinoplasty

2017 ◽  
Vol 28 (8) ◽  
pp. 2063-2065 ◽  
Author(s):  
Raşit Cevizci ◽  
Selin Üstün Bezgin ◽  
Burak Ömür Çakir ◽  
Burak Kersin ◽  
Yildirim Ahmet Bayazit
Keyword(s):  
Costal Cartilage ◽  
Saddle Nose ◽  
Cartilage Grafts ◽  
Saddle Nose Deformity ◽  
Nose Deformity

scholarly journals Nasal correction in nasomaxillary hypoplasia (Binder’s syndrome): An optimised classification and treatment

2016 ◽  
Vol 49 (03) ◽  
pp. 314-321 ◽  
Author(s):  
Venkata Ramana Yamani ◽  
Shakuntala Ghosh ◽  
Shreekumar Tirunagari
Keyword(s):  
Costal Cartilage ◽  
Functional Results ◽  
En Bloc ◽  
Cartilage Grafts ◽  
Long Term Stability ◽  
Alar Base ◽  
Rare Congenital Disorder ◽  
Nasal Floor ◽  
The Individual

ABSTRACT Background: Nasomaxillary hypoplasia is a rare congenital disorder involving the central face. It imparts a distinctive appearance to the individual face as the age advances. Severity of the disorder varies, so do the manifestations. Methods: This was a retrospective study conducted on the records and photographic data of 560 rhinoplasty cases performed between 2006 March and 2016 March. About 16 cases of nasomaxillary hypoplasia were selected from the group and they were classified based on the severity of the features. Surgical correction performed in each group was detailed. Results: Three percent of the 560 rhinoplasties performed in our centre turned out to be cases of Binder's syndrome. Nasal correction with locoregional autologous cartilage grafts was sufficient in mild cases. Loco-regional cartilage grafts along with costal cartilage grafts were needed for moderate and severe cases. Anterior nasal floor along with alar base augmentation was performed to achieve a proper aesthetic profile in moderate and severe cases. Post-operative results were excellent in mild and moderate cases and acceptable in severe cases. Discussion: We attempted to correct the deformity only after growth of the nose and maxilla was completed. We used cartilage grafts as a mainstay as cartilage has long-term stability without resorption unlike bone grafts. Instead of following en bloc technique of cartilage assembly, we have reconstructed the nasal dorsum, columella and tip separately as this principle is more functionally acceptable with less warping or stiffness of the nose. Importance was given to proper anchorage of grafts. Conclusion: We have attempted to put together the various features into three categories of mild/moderate/severe based on previous anthropometric studies of nasal anatomical parameters. The second objective of our study was to advise a logical surgical protocol for each group so that future surgeons can follow an easy surgical guideline to attain optimal cosmetic and functional results.

En bloc transurethral resection of bladder tumor: A review of the literature

2021 ◽  
pp. 205141582199373
Author(s):  
Jonathan Kopel ◽  
Pranav Sharma
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Clinical Stage ◽  
Surgical Techniques ◽  
Cancer Recurrence ◽  
En Bloc ◽  
Level Of Evidence ◽  
Alternative Technologies ◽  
Bladder Cancer Recurrence

Bladder cancer remains one of the most common malignancies of the genitourinary tract. Transurethral resection of the bladder tumor (TURBT) via cystoscopy with examination under anesthesia remains the primary method for determining the diagnosis and clinical stage of bladder cancer. Given the substantial cost of treatment and risk of bladder cancer recurrence after TURBT, novel approaches to transurethral resection, such as the en bloc technique, have been developed in an attempt to address these limitations. In this review, we examined the postoperative and oncological outcomes of en bloc TURBT compared to traditional resection techniques. Further prospective clinical studies, however, are still necessary to determine whether these alternative technologies or surgical techniques may improve treatment in bladder cancer patients. Level of evidence: Not applicable.

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

2021 ◽  
pp. 175319342098185
Author(s):  
Xia Fang ◽  
Ping-tak Chan ◽  
Shengbo Zhou ◽  
Xinyi Dai ◽  
Ruiji Guo ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Contralateral Side ◽  
Average Score ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Volar Approach ◽  
Flexion Extension ◽  
Aesthetic Results

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

scholarly journals Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL)

2021 ◽  
Author(s):  
Marwan H Abboud ◽  
Ayush K Kapila ◽  
Svetlana Bogaert ◽  
Nicolas M Abboud
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
Patient Characteristics ◽  
Fat Grafting ◽  
Implant Removal ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Aesthetic Results ◽  
And Migration ◽  
The Aesthetic

Abstract Background An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible. Objectives The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling. Methods A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires. Results Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied. Conclusions The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume. Level of Evidence: 4

scholarly journals Endovascular Stent-Graft Repair of the Ascending Aorta: Assessment of a Specific Novel Stent-Graft Design in Phantom, Cadaveric, and Clinical Application

2021 ◽  
Author(s):  
Sven R. Hauck ◽  
Alexander Kupferthaler ◽  
Marlies Stelzmüller ◽  
Wolf Eilenberg ◽  
Marek Ehrlich ◽  
...  
Keyword(s):  
Clinical Application ◽  
Stent Graft ◽  
Ascending Aorta ◽  
The Novel ◽  
Forward Movement ◽  
Level Of Evidence ◽  
Landing Zone ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Stent Graft Repair

Abstract Purpose To test a stent-graft specifically designed for the ascending aorta in phantom, cadaver, and clinical application, and to measure deployment accuracy to overcome limitations of existing devices. Methods A stent-graft has been designed with support wires to fixate the apices toward the inner curvature, thereby eliminating the forward movement of the proximal end which can happen with circumferential tip capture systems. The device was deployed in three aortic phantoms, and in four cadavers, deployment precision was measured. Subsequently, the device was implanted in a patient to exclude a pseudoaneurysm originating from the distal anastomosis after ascending aortic replacement. Results The stent-grafts were successfully deployed in all phantoms and cadavers. Deployment accuracy of the proximal end of the stent-graft was within 1 mm proximally and 14 mm distally to the intended landing zone on the inner curvature, and 2–8 mm distal to the intended landing zone on the outer curvature. In clinical application, the pseudoaneurysm could be successfully excluded without complications. Conclusion The novel stent-graft design promises accurate placement in the ascending aorta. The differential deployment of the apices at the inner and outer curvatures allows deployment perpendicular to the aortic axis. Level of Evidence No level of evidence.

Cadaveric Costal Cartilage Grafts in Rhinoplasty and Septorhinoplasty

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Miles J. Pfaff ◽  
Anthony A. Bertrand ◽  
Kelsey J. Lipman ◽  
Sri Harshini Malapati ◽  
Daniel H. Kim ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Cartilage Grafts

Mono-Unit Alar Rim Graft Technique for Tip-Alar Margin Support

2020 ◽  
Vol 40 (10) ◽  
pp. NP588-NP596
Author(s):  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Demographic Data ◽  
Costal Cartilage ◽  
Case Series ◽  
Senior Author ◽  
Open Approach ◽  
Level Of Evidence ◽  
Appropriate Treatment ◽  
Patient Demographic Data ◽  
Patient Series ◽  
Alar Rim

Abstract Background The appropriate treatment of alar rim deformities, such as alar pinching or concavity, and soft triangle notching is essential for perfecting nasal aesthetics. Objectives The authors introduced the “mono-unit alar rim graft” technique as a treatment option for these abnormalities. Methods A case series of 29 rhinoplasties conducted by the senior author between May 2017 and June 2019 utilizing the mono-unit alar rim graft technique was retrospectively reviewed. The surgical technique involved an open approach with costal cartilage harvesting. The cortical portion of the harvested costal cartilage was sectioned into a 1-mm-thick strip and soaked with saline for about 15 minutes to let the natural warping occur. The curved cartilage graft was then trimmed, and the midportion was sutured to the tip in an onlay fashion. Both ends of the graft were housed in the vestibular pocket. Patient demographic data and pre- and postoperative facial photos were reviewed. Results Among the 29 cases analyzed, 14 (48.3%) were men and 15 (51.7%) were women. Ten (34.5%) patients had a preoperative parenthesis deformity, but a near-complete correction was achieved in 8 (80.0%) cases. An alar concavity from the basal view was found in 16 patients, 15 (93.8%) of whom had a partial or near-complete correction. Eleven patients had soft triangle notching, 9 (81.8%) of whom had a partial or near-complete correction. There were no technique-related complications in this patient series. Conclusions The mono-unit alar rim graft technique is a viable option for treating various alar rim deformities. Level of Evidence: 4

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