Use of Auricular Cartilage for Reconstruction of Cartilaginous Defects of the Nose: Emphasis on Reconstruction of the Lower Lateral Cartilage Complex

1994 ◽  
Vol 11 (3) ◽  
pp. 209-216
Author(s):  
John Andrew Bartlett ◽  
Peter A. Hilger
Keyword(s):  
Senior Author ◽  
Congenital Defects ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Fellowship Program ◽  
Previous Surgery ◽  
The Past ◽  
Facial Plastic ◽  
Case Presentations ◽  
Innovative Techniques

During a year of fellowship with Dr. R. C. Webster, a preceptor with the American Academy of Facial Plastic and Reconstructive Surgery Fellowship Program, the senior author was introduced to innovative techniques utilizing conchal cartilage to repair various defects of the nasal tip. In the past 15 years of practice, we have modified his technique slightly but many of his basic concepts and principles remain. We have replaced the entire lower lateral cartilage complex as well as segmental defects of the nose. The presentation will review techniques for reconstruction of the entire lower lateral cartilage complex, as well as segmental defects due to trauma, previous surgery, congenital defects and defects secondary to oncologic resection. Preoperative and postoperative case presentations will highlight salient surgical principles.

The Nasal Hinge

1994 ◽  
Vol 111 (3P1) ◽  
pp. 219-231 ◽  
Author(s):  
Peter A. Adamson ◽  
Todd A. Morrow
Keyword(s):  
Clinical Results ◽  
Plastic Surgeon ◽  
Hinge Region ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Lateral Aspect ◽  
Nasal Tip ◽  
Tip Projection ◽  
Facial Plastic

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, It plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.

Oblique Turnover Flap for Repositioning and Flattening of the Lateral Crura: A Novel Technique to Manage Cephalic Malposition of Lower Lateral Cartilage

2017 ◽  
Vol 33 (05) ◽  
pp. 491-498 ◽  
Author(s):  
Elena Vladykina ◽  
Abdulkadir Goksel
Keyword(s):  
Anatomical Variation ◽  
Senior Author ◽  
Central Axis ◽  
Long Term Results ◽  
P Value ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Satisfaction Scale ◽  
Nasal Tip ◽  
The Mean

AbstractMalposition of the lower lateral cartilage (LLC) is a relatively common anatomical variation, described as any displacement of the lateral crura from the usual parallel direction with the nostril rims. Cephalic malpositioned LLC has the following characteristics: abnormal axes of the lateral crura, bulbous and broad nasal tip, parenthesis deformity, long alar creases, alar wall hollows, nostril deformities, and incompetence of the external valve. Numerous techniques were founded to correct this aesthetic and functional unpleasant variation, although all of them have some limitations. The authors described and evaluated the efficacy of the oblique turnover flap (OTOF) technique in the management of cephalic malposition of LLC (CMLLC). The advantages of this technique are: it does not need any additional grafting; it is quick and safe to perform; it has stable results. In the present study, 24 primary rhinoplasties using OTOF technique were performed between January 2014 and September 2016. There were 21 females (87.5%) and 3 males (12.5%), with age ranging from 23 to 46 years. The mean follow-up period was 12.1 months (range: 8–28 months). All patients were treated by the senior author (A.G.) in the RinoIstanbul Clinic. Three parameters were measured and compared pre- and postoperatively, using a t-test and a p value criteria of 0.05. The difference was found to be statistically significant: the angle between the central axis of the lateral crura and the septum on each side, satisfaction scale rating of the patients' nasal tip appearance and the satisfaction scale rating of patients' nose breathing. The angle of the central axis of lateral cruras to the midline significantly increased, the mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved. OTOF is a quick, useful, efficient technique for repositioning and flattening of the lateral cruras of CMLLC with a good, predictable, and stable long-term results in our hands if used on right candidates.

scholarly journals Hand Surgery in Saudi Arabia

2020 ◽  
Author(s):  
Abdullah E. Kattan ◽  
Mohammad M. Al-Qattan
Keyword(s):  
Saudi Arabia ◽  
Orthopedic Surgery ◽  
Significant Contribution ◽  
Hand Surgery ◽  
Fellowship Program ◽  
Novel Mutations ◽  
Work Related ◽  
The Past ◽  
Aesthetic Results ◽  
Hand Defects

AbstractHand surgery is a unique field that incorporates multiple specialties, aiming to provide the patient with a best possible functional and aesthetic results. Hand surgeons deal with different pathologies that require skills in several aspects of surgery. The field of hand surgery has evolved significantly over the past decades across the globe. This specialty has also been evolving in Saudi Arabia over the past 25 years. Some of the services offered to patients include specialized centers for brachial plexus, peripheral nerve, and pediatric hand surgery as well as centers for work-related hand injuries. There has also been significant contribution to the hand surgery literature from the hand surgeons working in Saudi Arabia, with hundreds of papers published in journals pertaining to hand surgery, orthopedic surgery, and plastic surgery, as well as the publication of several novel mutations causing congenital hand defects in journals concerned with genetics. The recent approval of a hand and microsurgery fellowship program in Saudi Arabia will also help boost this field in the country and the region.

Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results

2021 ◽  
Author(s):  
Juliano de Oliveira Sales ◽  
Wolfgang Gubisch ◽  
Rodrigo Ribeiro Ferreira Duarte ◽  
Aline Souza Costa Teixeira Moreno ◽  
Felipe Marques de Oliveira ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Age Groups ◽  
Functional Results ◽  
First Year ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Alar Retraction ◽  
Outcomes Evaluation ◽  
A New Technique ◽  
Extension Graft

AbstractHere we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from 52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient satisfaction measured by the ROE is present in both sexes and at both age groups but it is better detected in the first year after surgery. Functional improvements analyzed with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months. The caudal extension graft of the LLC technique described herein effectively and safely corrects alar retraction and the collapse of the nasal valve while filling the soft triangle.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (10) ◽  
pp. 391-393
Author(s):  
David M. Tejeda ◽  
Jessica Kaplan ◽  
John S. Andrews ◽  
Catherine DeAngelis ◽  
Neeru Sehgal
Keyword(s):  
Blood Pressure ◽  
Eye Movements ◽  
Early Diagnosis ◽  
Otitis Media ◽  
The Past ◽  
General Pediatrician ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation The parents of a 22-month-old boy complain that he has been increasingly clumsy and cranky for the past 7 days. He initially developed a stumbling gait and now prefers to crawl; he no longer can sit on his own. The child has been afebrile but has had a cough for several weeks. He has been on antibiotics for otitis media (with a presumed labyrinthitis) for 5 days. There have been no other recent illnesses, and he has not been ill in the past. On examination, the child appears irritable and has occasional jerking movements of his extremities. His temperature is 36.3°C, pulse is 128 beats/min, and blood pressure is 84/40 mm Hg. Chaotic, irregular eye movements are present.

Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

2018 ◽  
Vol 34 (03) ◽  
pp. 290-297
Author(s):  
Tsung-yen Hsieh ◽  
Raj Dedhia ◽  
Travis Tollefson
Keyword(s):  
Surgical Procedure ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Nasal Deformity ◽  
Internal Lining ◽  
Cleft Rhinoplasty ◽  
Cartilage Grafting ◽  
Definition Of ◽  
Cleft Nasal Deformity ◽  
Maxillary Deficiency

AbstractRhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (9) ◽  
pp. 369-371
Author(s):  
Linda S. Nield ◽  
David M. Tejeda ◽  
Lynn C. Garfunkel
Keyword(s):  
Clostridium Difficile ◽  
Early Diagnosis ◽  
Medical History ◽  
Middle Ear ◽  
The Past ◽  
Neurologic Impairment ◽  
Middle Ear Infection ◽  
Clostridium Difficile Toxin ◽  
Her 2 ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A mother is concerned because her 2-year-old son is "not as sure on his feet as he used to be." In the past 2 weeks she has noticed that he seems clumsy and is falling more than usual when playing or walking. His babysitter also has noticed this change in abilities, heightening the mother's concern. No other neurologic impairment is noted, and his play does not seem disrupted. The boy's medical history is unremarkable. Recently, he had a persistent middle ear infection that finally resolved after 1 month of treatment with three different antibiotics. He also has been having 6 to 12 loose stools a day. Clostridium difficile toxin has been isolated from his stool.

INDEX OF SUSPICION

1996 ◽  
Vol 17 (6) ◽  
pp. 221-223
Author(s):  
Linda S. Nield ◽  
Jonette E. Keri ◽  
Randall G. Fisher ◽  
Nasha't M. Khanfar
Keyword(s):  
Early Diagnosis ◽  
Late Spring ◽  
The Sun ◽  
Erythematous Rash ◽  
The Past ◽  
General Pediatrician ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 10-year-old boy is brought to your office in late spring because of an erythematous rash on his arms and legs that has been present for 4 days and because he is having joint pains. The rash first appeared after the boy had been playing outdoors for several hours in the sun. He did have a new commercial sunblock lotion applied to his skin before going outdoors. His father is concerned because even though the rash is less pronounced, his son has been experiencing stiff and painful knees and ankles upon awakening for the past 2 days. The joint discomfort improves with movement during the day. The boy has had no other symptoms and has been free of fever.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (12) ◽  
pp. 495-497
Author(s):  
Elliott M. Friedman ◽  
Alexandre T. Rotta ◽  
Vincent J. Menna
Keyword(s):  
Urinary Tract Infection ◽  
Early Diagnosis ◽  
Acute Urinary Retention ◽  
Positive Culture ◽  
Tanner Stage ◽  
Pubic Hair ◽  
The Past ◽  
Hair Development ◽  
Case Presentations ◽  
Similar Episode

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 13-year-old girl comes to you because it is so painful for her to urinate that she has developed acute urinary retention. Over the past 6 months she has had recurrent mild abdominal cramps; exactly 1 month ago she experienced a similar episode of dysuria. At that time she was able to urinate and was diagnosed by positive culture as having a urinary tract infection, for which she was treated. While preparing to catheterize her, you notice that this young woman is Tanner stage 5 in breast and pubic hair development, yet she states that she has never had a menstrual period. Her mother recalls her own menarche at age 11 years. Observations during the procedure allow you to determine the underlying cause of her problems.

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