Nose and Midface Augmentation by Rib Cartilage Grafts: Methods and Outcome in 32 Cases

Recession of the midface is a relatively common condition that can have a negative impact on facial and nasal aesthetic appearance, and it poses a challenge to plastic surgeons. In cases with generalized maxillary retrusion and/or malocclusion, bone advancement surgery is required, but in localized cases, mostly seen in cleft lip patients, the quest is for an ideal material and a proper technique that would be used to augment the receding area. Throughout a period of seven years, thirty-two patients with nose and midface retrusion were managed by a construct of rib cartilage grafts designed to compensate the deficiency at the maxillary, piriform, and premaxillary areas. Results were satisfactory for most patients in terms of improved fullness of malar area, improved nasal tip projection and rotation, and improvement of upper lip. The presented technique of rib cartilage grafting is a safe and effective method for nose and midface augmentation.

Download Full-text

Prosedur penatalaksanaan celah bibir inkomplit bilateral dan rinoplasti primer dengan modifikasi mulliken

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v49i1.280 ◽

2019 ◽

Vol 49 (1) ◽

pp. 93

Author(s):

Al Hafiz ◽

Debby Apri Grecwin

Keyword(s):

Cleft Lip ◽

Cochrane Library ◽

Upper Lip ◽

Literature Study ◽

Nasal Tip ◽

Tip Projection ◽

Primary Rhinoplasty ◽

Bilateral Cleft Lip ◽

Modification Technique ◽

Nasal Tip Projection

Latar belakang: Celah bibir dengan atau tanpa celah lelangit merupakan abnormalitas perkembangan kraniofasial yang paling sering terjadi. Kelainan ini bisa unilateral atau bilateral, dan mungkin disertai dengan anomali kongenital lain. Celah bibir bilateral berpotensi mengubah struktur dan bentuk wajah serta menyebabkan gangguan dalam perkembangan makan, bicara, gigi geligi, dan kosmetik. Celah bibir selalu disertai dengan deformitas hidung, termasuk pada kasus celah bibir inkomplit. Mulliken adalah pionir yang melakukan perbaikan celah bibir bilateral dan rinoplasti primer dalam satu tahap operasi. Tujuan: Mengetahui keberhasilan operasi celah bibir inkomplit bilateral dan rinoplasti primer dengan teknik modifikasi Mulliken. Laporan kasus: Dilaporkan satu kasus celah bibir inkomplit bilateral pada anak laki-laki usia 7 bulan yang ditatalaksana dengan teknik modifikasi Mulliken. Metode: Telaah literatur berbasis bukti mengenai perbaikan celah bibir inkomplit bilateral dan rinoplasti primer dengan teknik modifikasi Mulliken melalui database Cochrane library, Pubmed Medline, dan hand searching. Hasil: Pertumbuhan nasal tip projection, nasal width, columellar length, upper lip height, cutaneous lip height, dan vermilion-mucosal height mendekati nilai normal. Kesimpulan: Prosedur celah bibir inkomplit bilateral disertai rinoplasti primer dengan teknik modifikasi Mulliken memberikan hasil yang baik. Introduction: Cleft lip with or without cleft palate is the most common disorder of craniofacial development. This disorder could be occurred unilaterally or bilaterally, and sometimes were also accompanied by other type of congenital disorders. Bilateral cleft lip potentially could change the face structure and shape, causing interference in eating, speech, dental development, and aesthetics. Cleft lip always occurred with nasal deformity, even in incomplete cleft lip. Mulliken is a pioneer in performing a repair in bilateral cleft lip and primary rhinoplasty altogether at the same time. Purpose: To find out the result of surgery procedure in bilateral incomplete cleft lip and primary rhinoplasty using Mulliken modification technique. Case report: A bilateral incomplete cleft lip case in a 7 months old boy and managed by Mulliken modification technique. Method: Evidence based literature study of bilateral incomplete cleft lip and primary rhinoplasty with Mulliken modification technique through Cochrane library, Pubmed Medline, and hand searching. Result: The growth of nasal tip projection, nasal width, collumellar length, upper lip height, cutaneus lip height, and vermilion mucous height were close to normal size. Conclusion: Procedure of bilateral incomplete cleft lip and primary rhinoplasty repair using Mulliken modification technique delivered a good outcome.

Download Full-text

Controversies in Cleft Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0040-1701477 ◽

2020 ◽

Vol 36 (01) ◽

pp. 102-111 ◽

Cited By ~ 1

Author(s):

Steven G. Hoshal ◽

Roberto N. Solis ◽

Travis T. Tollefson

Keyword(s):

Cleft Lip ◽

Great Variability ◽

Cartilage Grafts ◽

Aesthetic Appearance ◽

Cleft Lip Palate ◽

Cleft Rhinoplasty ◽

Tailored Approach ◽

Nasoalveolar Molding

AbstractRhinoplasty for cleft lip nasal deformities challenges all cleft surgeons. There is great variability of phenotypical anatomy, but iatrogenic changes and scarring from the previous surgeries add another layer of complexity. Rhinoplasties on a patient with cleft lip–palate are technically and intellectually challenging to master requiring a patient-tailored approach. The shape and structure of the nose are changed to improve both function and aesthetic appearance. In the primary setting, nasoalveolar molding is a form of presurgical infant orthopaedics used for preparation before the cleft lip and nose repair. Intermediate stages should be conservative to minimize scarring, while the definitive cleft rhinoplasty utilizes cartilage grafts from septum, ear, or rib to sculpt the nose. Hereinto, we will outline the controversies, the evidence supporting certain techniques, and our preferences.

Download Full-text

Premaxillary Injection for Perioral Rejuvenation and Lip Enhancement

Aesthetic Surgery Journal ◽

10.1093/asj/sjz108 ◽

2019 ◽

Vol 40 (5) ◽

pp. 560-567 ◽

Cited By ~ 1

Author(s):

Thuy-Van T Ho ◽

Eric W Cerrati ◽

Nimit D Gandhi ◽

Arjun Kalbag ◽

Steven H Dayan

Keyword(s):

Hyaluronic Acid ◽

Statistical Significance ◽

Primary Objective ◽

Upper Lip ◽

Height Ratio ◽

Level Of Evidence ◽

Filler Injection ◽

Nasal Tip ◽

Tip Projection ◽

Nasal Tip Projection

Abstract Background This is the first study to evaluate the effect of premaxillary filler injection on nasal tip projection, upper lip projection, and upper lip vermilion height. Objectives The primary objective of this study was to analyze the change in nasal tip projection (measured by the Goode ratio) and the change in upper lip projection (measured by the Z angle) following premaxillary hyaluronic acid injection. A secondary objective was to measure the change in upper lip vermilion height. We hypothesized that treated subjects will show an increase in nasal tip projection, upper lip projection, and upper lip vermilion height. Methods Twenty volunteer patients with signs of perioral aging or poor upper lip projection were enrolled in this prospective cohort study and underwent premaxillary hyaluronic acid filler injection between November 2017 and June 2018. Nasal tip projection, upper lip projection, and upper lip vermilion height were assessed from baseline and posttreatment photographs based on the Goode ratio, Z angle, and lip vermilion height ratio, respectively. Results No significant change was noted between pre- and posttreatment Goode ratio measurements (P = 0.841). There was a significant decrease in Z angle and therefore significant increase in upper lip projection with treatment (P < 0.001). The lip vermilion height ratio demonstrated a trend of increased upper lip vermilion height but this did not achieve statistical significance (P = 0.561). Conclusions Premaxillary filler treatment resulted in a significant increase in upper lip projection. Premaxillary filler injection when performed in a safe manner is a valuable treatment option for perioral rejuvenation. Level of Evidence: 4

Download Full-text

A Modified Muscle-Activated Maxillary Orthopedic Appliance for Presurgical Nasoalveolar Molding in Infants with Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-141.1 ◽

2004 ◽

Vol 41 (3) ◽

pp. 225-229 ◽

Cited By ~ 32

Author(s):

Sunjay Suri ◽

Bryan D. Tompson

Keyword(s):

Nasal Septum ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Treatment Approach ◽

Normal Position ◽

Tip Projection ◽

Facial Musculature ◽

Nasal Tip Projection ◽

Nasoalveolar Molding ◽

Functional Movements

Objective The purpose of this article is to describe a modified appliance and treatment approach for presurgical nasoalveolar molding in infants with unilateral cleft lip and palate. Methods This approach uses a plate held in with outriggers, which prevents the cleft-widening effect of the tongue, helps with tongue tip placement, and utilizes the functional movements of the facial musculature to guide and relocate the major segment medially to its normal position. Nasal molding is undertaken after most of the lateromedial correction of the alveolar position. Conclusions This technique helps to improve alveolar position, nasal septum alignment, nasal symmetry, and nasal tip projection prior to lip repair.

Download Full-text

Cleft lip scar correction methods

Journal of Face Aesthetics ◽

10.20883/jofa.18 ◽

2019 ◽

Vol 2 (2) ◽

pp. 123-133

Author(s):

Oskar Komisarek ◽

Patrycja Bartkowska ◽

Artur Matthews‑Brzozowski

Keyword(s):

English Language ◽

Cleft Lip ◽

Negative Impact ◽

Upper Lip ◽

Medical Library ◽

Pubmed Database ◽

Control And Prevention ◽

Scar Management ◽

Scar Correction ◽

Postoperative Scar

Introduction. A cleft lip is a congenital malformation that may appear as an independent defect or as one of many syndrome features. Primary cleft lip surgical treatment is the only method of treatment to achieve tissue continuity, however it is associated with the inevitable postoperative scar and the emergence of so‑called secondary disorders, which has got a negative impact on psychosocial patient’s development.Aim. Presentation of possibilities of cleft upper lip scar correction paying attention to facial aesthetics.Material and Methods. The literature search was conducted in the English language via the PubMed database and Main Medical Library. The articles regarding cleft upper lip scar correction and care methods were selected.Results. All the methods of postoperative scar management presented in the results proved to be an effective way of cleft scar correction. These methods concern: surgical procedures, mechanical intervention, laser treatment, and medical therapy with using medicines and are dependent on the type of irregularity. These methods allowed to improvement of the aesthetics of the upper lip area and enabled control and prevention of cleft scar hypertrophy.Conclusions. There is no one procedure regarding the care and correction of cleft scars. Postoperative scar management should be adjusted individually to each patient, analyzing the medical case, to get the best possible aesthetic and functional effect.

Download Full-text

Three-Dimensional Analysis of Definitive Secondary Unilateral Cleft Rhinoplasty Using Cartilage Graft

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211034099 ◽

2021 ◽

pp. 105566562110340

Author(s):

Thinnapat Hantawornchaikit ◽

Raweewan Arayasantiparb ◽

Kumar KC ◽

Kiatanant Boonsiriseth

Keyword(s):

Cleft Lip ◽

Three Dimensional ◽

Nasal Tip ◽

Tip Projection ◽

Alar Base ◽

Cleft Rhinoplasty ◽

Nasal Tip Projection ◽

Base Width ◽

Cleft Lip Nose

Objective Three-dimensional assessment of nasal morphology in patients with unilateral cleft lip nose treated by cartilage graft augmentation. Design Retrospective study. Patients and Intervention Thirteen patients with unilateral cleft lip nose underwent definitive secondary rhinoplasty and postsurgical changes were examined using a three-dimensional (3D) laser scan. Main Outcome Measure Nasal dorsum length, nasal tip, alar width, and alar base width in frontal view; nasion depth, nasal tip projection, nasal dorsal angle, and nasal tip angle in lateral view; nostril width, nostril height, and nasal tip height in basal view were measured at preoperative (T1: within 6 months), short follow-up (T2: 2-10 weeks), and long follow-up (T3: 9-14 months). Results A significant change in alar width, alar base width, nostril width, and nostril height at the cleft side, nasal dorsum length, nasion depth, nasal tip projection, and nasal tip height was observed from T1 to T3 follow-up after rhinoplasty ( P < .05), whereas the nostril height at the noncleft side was also significantly increased at T2 follow-up but the mean change in height relapsed at T3 follow-up. Alar width, alar base width, and nostril width at the noncleft side, and nasal tip angle did not change significantly after surgery at any follow-up period. Conclusions 3D imaging evaluation after secondary cleft rhinoplasty demonstrated improved functional and aesthetic outcomes using a septal or conchal graft.

Download Full-text

Improving Projection of the Nasal Tip in Primary Endonasal Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0041-1736391 ◽

2021 ◽

Author(s):

Norman Pastorek ◽

Patrick Cleveland

Keyword(s):

Structural Integrity ◽

Essential Elements ◽

Senior Author ◽

Nasal Tip ◽

Tip Projection ◽

Cartilage Grafting ◽

Nasal Tip Projection ◽

Beak Deformity ◽

Hump Reduction ◽

And Cartilage

AbstractGaining, improving, and maintaining nasal tip projection is one of the most essential elements of successful endonasal rhinoplasty. For years the hallmark of inadequate nasal tip projection following rhinoplasty has been the Polly beak deformity. Early rhinoplasty technique consisted of intracartilaginous excision of the cephalic margin of the lower lateral cartilages, cartilage and bony hump reduction, and osteotomies. Some of these simple rhinoplasties still look good decades later, however, many are conspicuous in their lack of nasal tip projection. The reason for this inconsistency in rhinoplasty results was the surgeon's inattention to the structural integrity and anatomical position of the LLC. The senior author uses a combination of suture, strut, and cartilage grafting techniques to achieve ideal projection in a manor tailored to each patient's unique anatomic needs.

Download Full-text