Bilateral Alar Cartilage Reduction Rhinoplasty Allows Primary Repair of Alar Defects in the Bulbous Nose

2012 ◽  
Vol 16 (6) ◽  
pp. 424-427 ◽  
Author(s):  
Sammy Al-Benna
Keyword(s):  
Primary Repair ◽  
Alar Cartilage ◽  
Immediate Reconstruction ◽  
Nasal Tip ◽  
Étude Prospective ◽  
Novel Approach ◽  
Satisfaction Des Patients ◽  
Il Y A ◽  
The Aesthetic ◽  
Alar Rim

Background:Plastic surgeons have many reconstructive options for lower nasal skin defects, but given the unique aesthetic features of nasal skin the best source for reconstruction is nasal skin itself, when sufficient quantity exists.Objective:The purpose of this study is to determine the outcome of bilateral alar cartilage reduction rhinoplasty in combination with a nasal flap to facilitate immediate reconstruction of defects of the nasal tip, soft triangle and alar margin.Methods:This prospective study analyzed the aesthetic outcome after reconstruction with bilateral alar cartilage reduction rhinoplasty to reduce the nasal rim and create an excess of skin sufficient to facilitate immediate reconstruction of defects of the nasal tip, soft triangle and alar margin.Results:All wounds healed primarily and patient satisfaction was achieved.Conclusion:Bilateral alar cartilage reduction rhinoplasty allows single-stage reconstruction of defects of the nasal tip, soft triangle, and medial alar rim in the bulbous nose. By placing incisions along the borders of the aesthetic subunits, this novel approach to primary reconstruction of the nasal tip, soft triangle, and medial alar rim provides skin with a superior color and texture match, maintains a satisfactory contour of the nasal rim, and optimizes the likelihood of good scar quality.Contexte:De nombreuses possibilités de reconstruction s'offrent aux chirurgiens plasticiens pour corriger les pertes de substance cutanée de l'extrémité inférieure du nez mais, compte tenu des caractéristiques esthétiques de la peau propres à cet organe, la meilleure source de tissu de remplacement pour la reconstruction est la peau elle-même du nez, s'il y en reste suffisamment.Objectif:L'étude avait pour but do déterminer les résultats de la rhinoplastie de réduction bilatérale du cartilage alaire en association avec la pose d'un lambeau nasal afin de faciliter la reconstruction immédiate de la perte de substance de la pointe du nez, du triangle mou, et de la marge alaire.Méthodes:Il s'agit d'une étude prospective dans laquelle ont été analysés les résultats esthétiques de la rhinoplastie de réduction bilatérale du cartilage alaire visant à diminuer le bord nasal et à créer un surplus suffisant de peau pour faciliter la reconstruction immédiate de la perte de substance de la pointe du nez, du triangle mou, et de la marge alaire.Résultats:Il y a eu cicatrisation par première intention de toutes les plaies, et ce, à la satisfaction des patients.Conclusions:La rhinoplastie de réduction bilatérale du cartilage alaire permet une reconstruction, en un seul temps, de la pointe du nez, du triangle mou, et du bord alaire interne dans le contexte du nez bulbeux. Par les incisions effectuées le long du bord des sous-unités esthétiques, cette nouvelle technique de reconstruction d'emblée de la pointe du nez, du triangle mou, et du bord alaire interne permet de mieux harmoniser la couleur et la texture de la peau, imprime au bord nasal une forme satisfaisante et améliore les chances d'une cicatrisation de qualité.

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

Emotional expectations reported by hospitalized women in southeastern Brazil before being submitted to mastectomy with immediate breast reconstruction: A clinical-qualitative study

2017 ◽  
Vol 41 (S1) ◽  
pp. s507-s507
Author(s):  
G.L. Almeida ◽  
R.M.C. Sena ◽  
V.L.P. Alves ◽  
C. Cardoso-Filho ◽  
E.R. Turato
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
University Hospital ◽  
Southeastern Brazil ◽  
Immediate Reconstruction ◽  
Female Population ◽  
Competing Interest ◽  
Health Assistant ◽  
The Aesthetic

IntroductionBreast cancer is a type that more affects female population in the world. Surgical indication, present in most cases, is a mutilating procedure and mentally traumatic for majority of women subjected. Thus, immediate breast reconstruction, which is the choice to rebuild the breast during the mastectomy surgery, is an alternative to reduce discomforts associated with loss of the breast, in addition to being associated potentially with improved emotional and psychosocial quality of life.ObjectiveTo discuss, from psychological viewpoint, the emotional expectations about surgical results of a planned mastectomy with immediate breast reconstruction, reported by women with breast cancer treated in a university hospital in Campinas, state of São Paulo.MethodQualitative design, particularized in the clinical-qualitative method, adequate to health assistant settings, using the semi-directed interview with open-ended questions in-depth, fully transcribed and after submitted to content clinical-qualitative analysis. Intentional sample closed by criterion of information theoretical saturation with 12 sequential participants.ResultsAmongst the emergent categories from free-floating readings, we have chosen the following to presentation:.–The desire of healing above expectations of the aesthetic aspects;–The perception of the surgical approach predominantly with aesthetic effects;–The desire of a contra-lateral healthy breast withdrawal, too.ConclusionsFace the proposal of mastectomy with immediate reconstruction, days before the surgery, women reported to be well emotionally organized for the procedure, although in different ways. This occurs probably due to emotional meanings built by many experiences from their psychological histories, as well as from values provided by the socio-cultural environments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Novel approach for the dissection of upper pouch during primary repair of esophageal atresia with tracheoesophageal fistula: Technique and results

2020 ◽  
Vol 55 (4) ◽  
pp. 767-771
Author(s):  
Vaibhav Pandey ◽  
Pranay Panigrahi ◽  
Rakesh Kumar ◽  
Arj Deo Upadhyayay ◽  
Shiv P Sharma
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Repair ◽  
Novel Approach

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.

Use of Postmastectomy Radiation in Patients Treated for Invasive Breast Cancer with Mastectomy and Immediate Reconstruction

2019 ◽  
Vol 85 (11) ◽  
pp. 1299-1303
Author(s):  
Genevieve Hayek ◽  
Mary Winslow ◽  
Morgan Maier ◽  
Ralph Corsetti ◽  
Amy Rivere ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Psychological Impact ◽  
Tumor Stage ◽  
Immediate Reconstruction ◽  
Aesthetic Result ◽  
Postmastectomy Radiation ◽  
Postmastectomy Radiation Therapy ◽  
The Aesthetic ◽  
To Receive

Immediate reconstruction after mastectomy helps women manage the psychological impact of deforming surgery. Postmastectomy radiation therapy (PMRT) can negatively impact the aesthetic result after breast reconstruction. We performed this study to achieve a better understanding of how PMRT is used after reconstruction in our institution. We conducted a retrospective review of a pro-spectively maintained database of all women who underwent mastectomy for invasive breast cancer followed by immediate reconstruction from 2006 to 2017. Patients were divided into two groups depending on whether PMRT was included in their treatment, and we compared clinical and pathologic characteristics to determine which factors were likely to lead to PMRT. A total of 315 women treated with mastectomy and immediate reconstruction were identified. A total of 96 were treated with PMRT; 219 had mastectomy and immediate reconstruction without radiotherapy. Tumor characteristics, tumor stage, demographics, and comorbidities did not predict the use of PMRT. Neoadjuvant chemotherapy (NAC) was the most powerful predictor for using PMRT. In 47 of 81 (58%) patients treated with NAC, PMRT was used. Whereas 49 of 234 (21%) patients who did not receive NAC were treated with PMRT ( P = 0.0001, risk ratio 2.77, 95 per cent confidence interval 2.03–3.77). In our institution, patients treated with NAC followed by mastectomy and immediate reconstruction are significantly more likely to receive PMRT. The increased use of PMRTafter NAC should be factored into the preoperative discussion with patients choosing mastectomy and immediate reconstruction.

A New Classification System for Unilateral Cleft Lip and Palate Infants to assist Presurgical Infant Orthopedics

2015 ◽  
Vol 39 (3) ◽  
pp. 231-234 ◽  
Author(s):  
PS Daigavane ◽  
PV Hazarey ◽  
P Niranjane ◽  
SD Vasudevan ◽  
BR Thombare ◽  
...  
Keyword(s):  
Classification System ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Anatomical Variations ◽  
Scar Formation ◽  
Alar Cartilage ◽  
New Classification ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Infant Orthopedics

The proposed advantages of pre-surgical naso-alveolar moulding (PNAM) are easy primary lip repair which heals under minimum tension reducing the scar formation and improving the aesthetic results in addition to reshaping of alar cartilage and improvement of nasal symmetry.However, the anatomy and alveolar morphology varies for each cleft child; the procedure for PNAM differs accordingly. In an attempt to categorize unilateral cleft lip and palate cases as per anatomical variations, a new classification system has been proposed. This classification aims to give an insight in unilateral cleft morphology based on which modification in PNAM procedure could be done.

Presurgical Nasal Molding With a Nasal Spring in Patients With Mild-to-Moderate Nasal Deformity With Incomplete Unilateral Cleft Lip With or Without Cleft Palate

2018 ◽  
Vol 56 (2) ◽  
pp. 280-284
Author(s):  
Supakit Peanchitlertkajorn
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Primary Repair ◽  
Alar Cartilage ◽  
Nasal Deformity ◽  
Steep Learning Curve ◽  
Oral Plate ◽  
Cleft Nasal Deformity ◽  
Nasoalveolar Molding ◽  
Design Construction

Objective: Traditional nasoalveolar molding (NAM) requires steep learning curve for clinicians and significant compliance from parents. Nasal springs have been developed by the author to simplify presurgical nasal molding. This article presents the design, construction, and application of the spring. The treatment goal is to improve nasal deformity prior to primary repair in infants born with incomplete unilateral cleft lip with or without cleft palate. Method: The design, fabrication, and utility of the nasal spring are described. The spring has a simpler design and construction compared to a traditional NAM appliance. Participants: Two patients with incomplete unilateral cleft lip with and without cleft palate are presented. Interventions: The spring is constructed and delivered. The active arm of the spring can be 3-dimensionally (3-D) adjusted to mold the alar cartilage of the affected nostril. The spring does not require an oral plate for adherence as a traditional NAM appliance does, hence an oral impression is not needed. The spring is easy for clinicians to adjust. It also requires less compliance by parents. Main Outcome Measures/Results: The presurgical molding achieved by the use of a nasal spring improved surgical nasolabial aesthetic outcomes. Conclusion: The nasal springs are effective in reducing the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with incomplete unilateral cleft lip with or without cleft palate.

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