scholarly journals Modified perichondrial-periosteal flaps to camouflage nasal dorsum in rhinoplasty

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Gamal Khafagy ◽  
Hesham Abdelaty El-Sersy ◽  
Ahmed Mahmoud Maarouf
Keyword(s):  
Nasal Obstruction ◽  
Lateral Cartilage ◽  
Nasal Dorsum ◽  
Nasal Breathing ◽  
Periosteal Flap ◽  
Nasal Bones ◽  
Upper Lateral Cartilage ◽  
Successful Technique ◽  
Hump Reduction

Abstract Background The smooth and straight nasal dorsum is a goal after nasal hump reduction as dorsal irregularities are unexpectable and inevitable complications. The aim of this study is to evaluate modified perichondrial-periosteal flaps functionally and aesthetically to camouflage nasal dorsal irregularities. A total of 115 patients with nasal humps were enrolled in the study. The perichondrium over the upper lateral cartilages is divided in the midline and dissected forming two laterally based flaps while the periosteum over the nasal bones is dissected superiorly. After completion of all rhinoplasty steps, the flaps were repositioned and sutured as a separate layer. Follow-up for 2 years with an assessment of irregularities of the nasal dorsum, collapse of the upper lateral cartilage, and nasal breathing. Results Aesthetically, no nasal dorsal irregularities were noticed. Also, no patients complained of nasal obstruction. Conclusion The modified perichondrial-periosteal flap is a successful technique, functionally and aesthetically. It avoids the appearance of dorsal irregularities.

Endonasal Triangular Technique for nasal valve rhinoplasty: a ten year review

2018 ◽  
Vol 72 (5) ◽  
pp. 45-50
Author(s):  
Ngalufua'atonga Havea ◽  
Cheryl Tang ◽  
Jason Rockey ◽  
Angelica Lynch
Keyword(s):  
Nasal Obstruction ◽  
Revision Surgery ◽  
Lateral Cartilage ◽  
Endonasal Approach ◽  
Nasal Valve ◽  
Upper Lateral Cartilage ◽  
Main Regulator ◽  
Regional Hospitals ◽  
Subjective Reports

Introduction: The nasal valve is the main regulator of airflow in the nose. Consequently, the collapse of the nasal valve has a significant impact on nasal obstruction and hence quality-of-life of patients. Several nasal valve rhinoplasty techniques are being used, from cartilage grafts to endonasal resection of the upper lateral cartilage. We describe a new endonasal approach to nasal valve rhinoplasty, the Triangular Technique, and assess its efficacy and complication rate over ten years. Materials and Methods: A retrospective study of patients who underwent nasal valve rhinoplasty at three regional hospitals from Jan 2004 to May 2014 was conducted. Subjective reports were used to assess the improvement of nasal obstruction. 24 patients were included. Results: 3 months postoperatively, 19 patients reported improvement in nasal obstruction. 4 patients required revision surgery. 2 of these 4 patients had substantial symptom resolution post revision surgery. 10 patients were followed up for more than 5 years (range: 5.8 to 10.3 years), 9 of who reported continued satisfaction and none or minimal nasal obstruction after nasal valve rhinoplasty compared to before surgery. There were no reported complications. Discussion: The Triangular Technique is a straightforward endonasal technique to address collapsed nasal valves with minimal associated co-morbidities.

scholarly journals Horizontal dorsal resection of a crooked septum in septoplasty

2021 ◽  
Author(s):  
상만 박 ◽  
Hyun Jong Jeon ◽  
Hyun Soo Lee ◽  
Jae Woo Lee ◽  
Eun Jung Lee ◽  
...  
Keyword(s):  
Medical Records ◽  
Suture Technique ◽  
Septal Deviation ◽  
Lateral Cartilage ◽  
Septal Perforation ◽  
Analog Scale ◽  
Anatomic Site ◽  
Subjective Satisfaction ◽  
Upper Lateral Cartilage

Objective: There are several types of septal deviation, including horizontal, vertical, C-shaped, S-shaped, and high deviation. One of the most difficult of these types to correct is the crooked dorsal septum, which attaches to the upper lateral cartilage and causes a high septal deviation. We propose a method for horizontal dorsal resection of a crooked septum using a mucosal through-and-through suture technique for the correction of high septal deviation. Design and setting: The medical records of 30 patients (27 men) who underwent septoplasty by one author of this study from 2019 to 2020 at our institute were reviewed prospectively. The median follow-up was 11 months (range, 4–16 months). All patients underwent a horizontal dorsal septal cartilaginous resection with mucosal through-and-through suture. Data were collected on demographics, symptoms, anatomic site of deviation, and postoperative complications. Patient self-satisfaction scores were subjectively graded using a visual analog scale ranging from 0 (excellent) to 10 (poor). Results: One surgeon performed each septoplasty using the same method; 2 (6.7%) patients underwent additional valvuloplasty. The median scores in subjective satisfaction for the 30 patients were 8.4±1.22 before surgery and 2.07±1.26 after surgery (p<0.05). Furthermore, no patient experienced a saddle deformity, septal hematoma, septal perforation, or loss of nasal tip support during follow-up. Conclusions: After horizontal dorsal resection from the upper lateral cartilage during septoplasty, the patients experienced no stability problems. This suggests that this surgical technique is a safe and effective method for correcting high deviation due to a crooked dorsal septum.

scholarly journals Use of Nasal Obstruction Symptom Evaluation Scale in Objective Evaluation of Symptomological Improvement in Post Septoplasty Patients

2017 ◽  
Vol 25 (1) ◽  
pp. 12-18
Author(s):  
Mukulika Saha ◽  
Shoham Banerjee ◽  
Rabi Hembrom ◽  
Indranil Sen
Keyword(s):  
Nasal Obstruction ◽  
Nasal Septum ◽  
Objective Evaluation ◽  
P Value ◽  
Nasal Breathing ◽  
Subjective Satisfaction ◽  
Symptom Evaluation ◽  
Expected Outcome ◽  
Total Failure

Introduction The complaint of nasal obstruction or difficulty in nasal breathing is highly subjective. Benefits of Septoplasty, as perceived by the patient, also varies widely with subjective satisfaction ranging from complete alleviation of symptoms to a total failure. Materials and Methods Fifty three patients above 18 years of age, with anatomical deviation of the nasal septum as the sole cause of obstruction and symptoms persisting for more than 3 months, underwent septoplasty. Nasal endoscopy was done for Mladina typing of the nasal septal deviation. Pre and post operative NOSE (Nasal Obstruction & Symptom Evaluation) score were analysed. Results Mean preoperative NOSE score was 11.98 ±1.23. On the 6th and 12th postoperative week follow up NOSE score was 3.13±1.30 & 1.05±0.87 respectively with p value <0.05.  Conclusion Mladina typing along with NOSE score will help in letting the patient know about his or her expected outcome following septoplasty.

Long-Term Follow-Up after Division of a Pharyngeal Flap for Severe Nasal Obstruction

1992 ◽  
Vol 29 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Louise Caouette-Laberge ◽  
E. Patricia Egerszegi ◽  
Anne-Marie De Remont ◽  
Ilse Ottenseyer
Keyword(s):  
Nasal Obstruction ◽  
Soft Palate ◽  
Nasal Breathing ◽  
Complete Transection ◽  
Velopharyngeal Incompetence ◽  
Complete Section ◽  
Long Term Follow Up ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function

Between 1965 and 1986, nine patients were noticed to have significant nasal airway obstruction following surgery for velopharyngeal incompetence (VPI). All had a superiorly based pharyngeal flap. Division of the flap was recommended to correct the posterior obstruction. A complete section of the flap was done in seven cases and lateral port enlargement was done in the remaining two. The interval between flap elevation and transection ranged from 5 months to 5 years. Three patients required more than one operation to fully correct the obstruction. All the patients were evaluated 2 to 14 years later to assess nasal breathing and speech and to document velopharyngeal function by nasoendoscopy and videofluoroscopy. One patient presented major symptoms of nasal obstruction at follow-up, while others reported snoring and occasional mouth breathing, although their nasal respiration appeared subjectively adequate. Four patients had normal speech, three were mildly hyponasal, one was moderately hyponasal, and the other was severely hyponasal. Intelligibility was good in all cases but one, although three patients had some articulation errors: two with persistent errors related to early VPI and one from dental malocclusion and tongue protrusion. Videofluoroscopy and nasoendoscopy showed that despite complete transection at the base of the flap in eight cases, five still had evidence of residual tethering. In one patient, the obstruction was almost complete and repeat division of the flap was recommended. Seven patients showed increased thickness of the soft palate in the midline where the flap had been anchored. Velopharyngeal closure was adequate in five cases, marginal in three, and obstructed in one. The review of our cases showed that the velopharyngeal opening in these patients is not large and incompetent, but rather is contracted and the flap often reattaches posteriorly after division. We recommend a closure of all raw surfaces to be done when the flap is sectioned, adding Z-plasties when needed to prevent further V-P obstruction. Even in the presence of recurrent obstruction, the resection of the extra tissue contributed by the flap on the soft palate is not felt to be indicated.

scholarly journals Nasal Hump Treatment With Cartilaginous Push-Down and Preservation of the Bony Cap

2020 ◽  
Vol 40 (11) ◽  
pp. 1168-1178 ◽  
Author(s):  
Luiz Carlos Ishida ◽  
Jorge Ishida ◽  
Luis Henrique Ishida ◽  
Adriane Tartare ◽  
Rafaela Katerine Fernandes ◽  
...  
Keyword(s):  
Partial Resection ◽  
Nasal Dorsum ◽  
Level Of Evidence ◽  
Nasal Bones ◽  
Push Down ◽  
Hump Reduction

Abstract Background Classic nasal hump reduction based on partial resection of the cartilage and bones in the nose may lead to dorsum deformities such as an inverted-V deformity, irregularities, and an open roof. Techniques that preserve the nasal dorsum (namely the push-down and let-down) avoid these problems, but may not always be indicated for very large, broad, or deviated noses, whereas cartilaginous push-down is also indicated for large and deviated humps. Because only the cartilaginous portion of the hump is preserved in the cartilaginous push-down, a rough area may remain where the bony portion is resected. Objectives The aim of this study was to develop a variation of the cartilaginous push-down technique which includes a bony cap to preserve the smoothness of the keystone area during nasal hump treatment. Methods Forty-eight consecutive patients with indication for nasal hump treatment who underwent cartilaginous push-down procedures with bony cap preservation between August 2018 and October 2019 were studied. Results We observed related complications in 2 patients (4.2%); in 1 patient (2.1%) the bony cap was lost during the rasping of the nasal bones and the surgery was altered to utilize only the cartilaginous push-down. Another patient (2.1%) experienced a mild hump recurrence during the early weeks following the procedure. All of the remaining patients had their nasal humps treated adequately. Conclusions The nasal hump was adequately corrected in most of the study patients (95.8%). Preserving the bony cap while performing the cartilaginous push-down may prevent complications related to the osseous resection of the keystone area. Level of Evidence: 4

The Cottle Push down Operation

1995 ◽  
Vol 12 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Glenn W. Drumheller
Keyword(s):  
Nasal Septum ◽  
Nasal Dorsum ◽  
Nasal Bones ◽  
Nasal Trauma ◽  
Push Down ◽  
Abnormal Anatomy ◽  
Hump Reduction ◽  
Hump Removal ◽  
Operating Surgeon

The “push down” operation was developed by Maurice H. Cottle, M.D., of Chicago. This operation was developed as a more physiologic approach to the management of hump noses. This operation grew out of Dr. Cottle's observation of nasal trauma and his expertise with the handling of nasal septum deformities. He realized that there was a particular degree of support to the nasal dorsum given by the cartilaginous septum. Traditional hump removal, which involves amputation of the roof of the nasal dorsum, has serious physiologic and anatomical sequelae that are avoided using the push down operation. The push down operation not only lowers the dorsum of the nose, but also eliminates prominent bony humps. This effect is due to the flexibility of the chondro-osseous joint between the nasal bones and the cartilaginous vault. This area is known as the “K” area or keystone area. This is where the septum, upper lateral cartilages, and nasal bones join. This junction provides a hinge-like action, allowing for straightening of the dorsum and hump reduction. When performing the push down operation, the operating surgeon must have a thorough knowledge of septum, pyramid, and tip anatomy. The key to the push down operation is the septum, and thorough knowledge of its normal and abnormal anatomy is imperative.

Inferior Turbinectomy in Children

2003 ◽  
Vol 17 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Samuel Segal ◽  
Ephraim Eviatar ◽  
Leonard Berenholz ◽  
Alex Kessler ◽  
Nathan Shlamkovitch ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Postoperative Complications ◽  
Nasal Obstruction ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Older Children ◽  
Nasal Breathing ◽  
History Of ◽  
Nasal Secretions

Background Inferior turbinectomy on patients of all ages is a controversial procedure. Its effect on children has been reported little in the literature and the few studies that are available involved relatively older children, i.e., >10 years old. Nasal obstruction caused by extensive hypertrophy of the inferior turbinates is not an uncommon observation in the pediatric population. The clinical manifestations might present as snoring, noisy breathing, mouth breathing, and, possibly, sleep apnea. Methods In this study, we followed 227 children >10 years of age who underwent inferior turbinectomy (27 children also underwent a revision of an earlier adenoidectomy), of whom 179 children had significant relief of nasal obstruction at the 1-year follow-up. Results Nocturnal breathing was reported to be more regular and otherwise improved in the 36 children with a suspected history of sleep apnea. Forty-two of 47 children who had thick nasal secretions and did not respond to antibiotic therapy before the operation had significant relief postoperatively. Postoperative complications were few and their number did not exceed that of adults. Conclusions A complete inferior turbinectomy should be considered in children >10 years of age who have hypertrophied inferior turbinates that cause major interference with nasal breathing.

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