Morphological Analysis of Nose in Patients of Tessier No. 0 Cleft With a Bifid Nose in China

Objective: Facial cleft involves complex malformations. No study assessed the facial deformity of Tessier No. 0 cleft with a bifid nose. Thus, we used anthropometric measurements to access the nose in patients.Methods: A total of 24 bifid nose deformities underwent surgery at our institution between 2010 and 2019. Standardized photographs were taken preoperatively and postoperatively. Landmarks were identified on these images; measurements for nasal analysis were performed and compared with the established Chinese norms. Surgical method differences were also analyzed.Results: The median follow-up time was 2.51 years. Postoperatively, there is a significant difference in comparison with preoperative in the nasal index, medial canthus and nose width index, nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. Furthermore, the medial canthus and nose width index, and nasal width and ala length index were significantly larger in ordinary people, while ala length and nasal bridge length index and nasal tip protrusion and nasal width index were smaller. After surgery, most angles and index were standard except the nasolabial angle in the females, and ala length and nasal bridge length index in the males. Moreover, as for the group of costal cartilage transplantation, most index and angles have improved after surgery including nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. However, only nasal tip protrusion and nasal width index, columella length and nasal tip protrusion index, and nasal width and ala length index in the silicone prosthesis group implantation has significance. Costal cartilage transplantation can also better improve ala length and nasal bridge length index than the silicone prosthesis implantation.Conclusion: Most defects can be repaired with surgery, but the outcome has a lack of evaluation. Thus, anthropometric assessment can serve as a material for nasal and reconstructive surgery.

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A Prospective Randomized Trial of N-butyl-cyanoacrylate + Metacryloxysulfolane Adhesive versus Suture Alone for Grafting in Rhinoplasty: 9 year Follow-up

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420943910 ◽

2020 ◽

pp. 000348942094391

Author(s):

Carmine Martino ◽

Francesco Salzano ◽

Diletta Martino ◽

Massimo Ralli ◽

Marco De Vincentiis ◽

...

Keyword(s):

Graft Fixation ◽

Fixation Time ◽

Cyanoacrylate Glue ◽

Post Surgery ◽

Nasolabial Angle ◽

Significant Difference ◽

Long Term Follow Up ◽

Time Required

Objective: Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty. Methods: Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes. Results: All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ: P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time ( P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery. Conclusion: N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.

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Reconstruction Of Noe Fracture With Immediate Diced Costal Cartilage Grafting: A Case Series

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v5i2.258 ◽

2019 ◽

Vol 5 (2) ◽

pp. 220-225

Author(s):

Kristaninta Bangun ◽

Muhammad Iqbal Maulana ◽

Teuku Nanda Putra

Keyword(s):

Demographic Data ◽

Costal Cartilage ◽

Case Series ◽

Cartilage Graft ◽

Nasal Tip ◽

Syringe Needle ◽

Cartilage Grafting ◽

Diced Cartilage ◽

Costal Cartilage Graft

Background : Naso-orbital-ethmoid (NOE) fracture is one of the common injury and the management remains difficult and controversial due to the anatomic complexity. Severe facial deformity and dysfunction are the results from the untreated injury. Moreover, the results from many procedures are not aesthetically satisfying. Meanwhile diced cartilage graft popularity is increasing in order to correct nasal deformity whether post trauma, revision (secondary) rhinoplasty or cleft nose. The procedure is less time consuming, easy to perform and also highly malleable. Methods : This study presents our experience in managing four patients with NOE fracture using costal cartilage graft technique immediately after injury. A columellar V-shaped incision was made, the finely diced cartilage harvested from the eight rib was injected to the glabella, dorsum and nasal tip using one cc syringe needle with cut tip. Demographic data were obtained from the patients’ medical record. Post-operative results were observed. Result: The four surgeries were done, with average 5.75 (range, 2-9) days after injury. During the observation, nasal tip misalignment was observed in only one patient. Diced cartilage were not visible through the skin, although it could be palpable. No cartilage extrusion were occurred. After averange follow up 10.25 mo (range 8-12 mo) All patients were satisfied with their facial appearance. Conclusion: The fracture of NOE can be manage with immediate diced costal cartilage graft, since this treatment can achieve a normal facial function and appearance. The complications are low and manageable, making it as serious contender technique of choice in managing NOE fracture to other techniques. Keywords: NOE fracture, diced costal cartilage graft, facial fracture

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Optimising Results of Nasal Tip Rotation Applying Combination of Nasolabial Angle and Lip–Columellar Angle in Tandem in Patients Operated by “Cock-up” Alar Cartilage Flaps Technique

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1695804 ◽

2019 ◽

Vol 52 (02) ◽

pp. 183-194

Author(s):

Uday Bhat ◽

Amit Ratanlal Peswani ◽

Snehjeet Wagh ◽

Rohit Mishra ◽

Tarush Gupta ◽

...

Keyword(s):

Outcome Evaluation ◽

Alar Cartilage ◽

P Value ◽

Tip Rotation ◽

Nasal Tip ◽

Nasolabial Angle ◽

Digital Measurements ◽

The Difference ◽

Long Nose

Abstract Background Setting the angle of tip rotation is of utmost importance in achieving satisfactory results in rhinoplasty. Conventionally the upward rotation of the tip requires shortening of the septum by caudal resection and shortening of the lateral walls by cephalic trim of the alar cartilages. The results are usually assessed subjectively. We describe the use of objective parameters to ensure accuracy of nasal tip rotation in patients operated with “cock-up” alar cartilage flaps, a modification of the cephalic trim. Methods Fifteen patients with a long nose having adequate width of lateral crura, desiring a shorter nose with upward tip rotation, were included in the study. Values of preoperative and desired nasolabial angle (from morphed images), and the derived columellar–labial angle were documented. Nasal tip rotation was set to the derived angle and maintained using cock-up alar cartilage flaps. The outcome was evaluated by digital measurements of the nasolabial angle and patients’ feedback by Rhinoplasty Outcome Evaluation (ROE) score. Results Satisfactory tip rotation and an aesthetic supratip area could be achieved. The difference in preoperative and postoperative nasolabial angles was statistically significant (p value < 0.0001). The difference in desired and the obtained nasolabial angle was not significant (p value 0.085). The results were maintained on subsequent follow-up. Conclusion Application of angles in practice and use of K-wire template helps us achieve accurate and consistent results. Cock-up flap is an effective technique—to obtain an open nasolabial angle and a desirable supratip region by making use of tissues otherwise discarded.

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Evaluation of nasal morphology in predicting vertical and sagittal maxillary skeletal discrepancies’

European Journal of Dentistry ◽

10.4103/1305-7456.130600 ◽

2014 ◽

Vol 08 (02) ◽

pp. 197-204 ◽

Cited By ~ 1

Author(s):

Mandava Prasad ◽

Nellore Chaitanya ◽

Karnati Praveen Kumar Reddy ◽

Ashok Kumar Talapaneni ◽

Vijaya Bhaskar Myla ◽

...

Keyword(s):

Soft Tissue ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Nasal Tip ◽

Nasolabial Angle ◽

South Indian ◽

Significant Difference ◽

Skeletal Pattern ◽

Pre Treatment ◽

Nasal Length

ABSTRACT Objective: The purpose of this prospective observational study was to evaluate the relationship between nasal morphology and maxillary skeletal pattern. The clinical significance was to emphasize the importance of role of nasal pattern in diagnosis and treatment planning. Materials and Methods: The sample included the pre-treatment lateral cephalometric radiographs of 180 South Indian adults (94 women, 86 men), aged 18 to 28 years. Six maxillary and six nasal soft tissue parameters were measured. Pearson correlation coefficients and Analysis of variance were used for statistical analyses. Results: There were significant correlations between maxillary vertical and sagittal, skeletal and soft tissue parameters. The Mean and standard deviations were correlated between low insignificant range to high significant levels with nasal length, nasal depth and columella convexity. Nasal length also showed significant correlation with inclination of palatal plane. Significant influence of gender was seen on nasal length, nasal depth, columella convexity and nasal tip angle. A statistically significant difference was seen regarding nasal length between males and females, with nasal length being more in males (50.26 ± 4.18) than in females (48.86 ± 3.45), nasal depth being more in males (18.64 ± 2.56) than in females (16.63 ± 2.16), columella convexity being greater in males (4.31 ± 1.26) than in females (3.41 ± 1.13), nasolabial angle decreased in males (87.26° ±13.79°) than in females (89.38° ±15.72°) and nasal tip angle being more in females (80.18° ±9.44°) than in males (73.60° ±10.24°). There was no statistically significant difference in nasal hump between males (-2.01 ± 1.76) and females (-2.02 ± 1.62). Conclusion: Long nose with increased nasal prominence were seen with increase in the anteroposterior length and vertical height of maxilla. Male and female genders had a varied amount of nasal length, nasal depth and columella convexity along with nasal tip angle.

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Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib

Facial Plastic Surgery ◽

10.1055/s-0039-1677718 ◽

2019 ◽

Vol 35 (01) ◽

pp. 103-108 ◽

Cited By ~ 3

Author(s):

Jennifer Fuller ◽

Patricia Levesque ◽

Robin Lindsay ◽

Natalie Justicz

Keyword(s):

Costal Cartilage ◽

Septal Cartilage ◽

Informed Consent Process ◽

Nasal Airway ◽

Postoperative Infections ◽

Time Points ◽

Nose Scale ◽

Symptom Evaluation ◽

Significant Difference

AbstractIn functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.

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Assessment of Columellar Widening with Columellar Strut Placement

FACE ◽

10.1177/27325016211022004 ◽

2021 ◽

pp. 273250162110220

Author(s):

Julia Toman ◽

Liliya Benchetrit ◽

Annika Meyer ◽

James Zachary Porterfield ◽

Jonathan Y. Lee ◽

...

Keyword(s):

Mount Sinai Hospital ◽

Nasal Tip ◽

Columellar Strut ◽

Primary Rhinoplasty ◽

Significant Difference ◽

Tongue In Groove ◽

The Mean ◽

Open Versus ◽

Extension Graft

Objective: The columellar strut is a frequently used technique to provide nasal tip support and projection that is commonly thought to increase columellar width. However, systematic review of the effect has not been reported in the literature. We report a quantitative evaluation of the effect of columellar strut placement on columellar width. Methods: A retrospective cohort study of changes in columellar width in base view photographs for patients who underwent primary rhinoplasty with columellar strut placement (n = 35) and the closely related septal extension graft (n = 9) and tongue-in-groove (n = 5) procedures at Mount Sinai Hospital between 2010 and 2017. The ratio of the columellar width to the intercanthal distance was used to standardize the results among patients. Comparisons were made at follow-up periods of <1 week, 2 to 4 weeks, 1 to 3 months, 3 to 6 months, 6 to 12 months, and >1 year of follow-up. Results: Forty-nine patients (41% female; average age of 43 ± 15 years) were reviewed. The columellar width showed a statistically significant increase for all follow-up date ranges with the exception of 1 week and 3 to 6 months post-operatively. At >1 year of post-operative follow-up, the mean increase in columellar width was 8.6% (95% CI, 2.6%-14.5%, P = .0098). No statistically significant differences were noted between open versus closed procedure for all followup visits after the 1 week followup, and no significant difference if a septocolumellar stitch was placed. Conclusions: A columellar strut was demonstrated to lead to an increase in columellar width. Though the effect was modest at a 8.6% increase, this is a potential cosmetic consideration for the surgeon employing its use to provide nasal tip support and projection.

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Compulsory auricular cartilage use: Modified septal extension graft application in revision rhinoplasty

Praxis of Otorhinolaryngology ◽

10.5606/kbbu.2021.69772 ◽

2021 ◽

Vol 9 (3) ◽

pp. 104-110

Author(s):

Ali Seyed Resuli

Keyword(s):

Costal Cartilage ◽

Auricular Cartilage ◽

Caudal Part ◽

Nasal Tip ◽

Revision Rhinoplasty ◽

Aesthetic Appearance ◽

Tongue In Groove ◽

Nasal Tip Projection ◽

Extension Graft

OBJECTIVE: This study aimed to demonstrate how to perform a tongue-in-groove graft with the method we developed using auricular cartilage to provide adequate nasal tip support in 17 revision rhinoplasty cases. METHODS: This retrospective study was conducted on 17 patients (17 females; mean age: 23.9+3.7 years; range, 19 to 30 years) who underwent revision rhinoplasty (RR) operations for a low nasal tip between February 2019 and September 2020. After auricular cartilage was removed with a standard posterior auricular intervention, it was folded in two to increase its resistance and fixed to the caudal part of the nasal septum as a tongue-in-groove graft. RESULTS: Solid nasal tip support and satisfactory nasal tip projection and rotation were achieved in all patients. One (6%) patient developed auricular hematoma as a complication on the third postoperative day, and three (17%) of our patients complained of nasal obstruction in their postoperative follow-up. CONCLUSION: When the use of costal cartilage is limited due to social and cultural reasons in RR cases performed due to a low nasal tip, auricular cartilage can be used as a modified tongue-in-groove graft and provides a satisfactory aesthetic appearance.

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Surgical Treatment of Costal Cartilage Fractures With Titanium Plate Internal Fixation

10.21203/rs.3.rs-416529/v2 ◽

2021 ◽

Author(s):

Yang Li ◽

Yonghong Zhao ◽

Yi Yang ◽

Weiming Wu ◽

Xiang Guo ◽

...

Keyword(s):

Internal Fixation ◽

Costal Cartilage ◽

Good Prognosis ◽

Hospital Length ◽

Pain Severity ◽

Hospital Length Of Stay ◽

Titanium Plate ◽

Severity Scores ◽

Significant Difference

Abstract Background: This study aim to evaluate surgical procedures for titanium plate internal fixation of costal cartilage fractures with displacement or nonunion. Methods: From January 2019 to October 2020, 13 patients with costal cartilage fractures were treated with titanium plate internal fixation in the thoracic surgery department of the Shanghai Sixth People’s Hospital. Pain severity scale scores and respiratory function were evaluated preoperatively and postoperatively. All the patients had a 6-month follow-up for treatment evaluation. Results: The mean hospital length of stay was 10.7 days. A statistically significant difference (P < 0.05) was found between preoperative and postoperative pain severity scores( 7.69 vs. 5.00). VC (24.6% vs. 44.5%) and FEV1 (25.3% vs. 44.0%) were also significantly different before operation and after operation (P<0.05). At follow-up, healing of the nonunion or fracture was confirmed in all the cases. Conclusion: The rigid titanium plate application ensured a safe and easy management of costal cartilage fractures and nonunion with a good prognosis as compared with other methods.

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Comparative Analysis and Long-Term Results of Various Septal Extension Graft Types

Facial Plastic Surgery ◽

10.1055/s-0040-1712468 ◽

2020 ◽

Vol 36 (03) ◽

pp. 263-267

Author(s):

M. Brandstetter ◽

M. Bhatt ◽

M. Pham ◽

W. Gubisch ◽

S. Haack

Keyword(s):

Long Term Results ◽

Digital Measurement ◽

Tip Projection ◽

Nasolabial Angle ◽

Significant Difference ◽

Different Types ◽

Extension Graft ◽

Nasal Length

AbstractShape, tip projection, and position can be controlled by the use of septal extension grafts (SEG). A retrospective cohort study of patients undergoing primary and secondary rhinoplasty was reviewed. The purpose of this study was to analyze maintenance of nasal length, dorsal length, and nasolabial angle postoperatively comparing different types of SEG using standardized photography and digital measurement. Two-hundred twenty-one patients undergoing rhinoplasty were included. There was a statistically significant change regarding the nasolabial angle during the time of follow-up decreasing from 97.53 to 95.30 degrees. No changes could be found in dorsal and nasal length. There was no significant difference among the techniques used to fixate the SEG. The nasolabial angle appeared to decrease from the position 2 weeks postoperatively without changes in the dorsal and nasal length. This means that the decrease in the nasolabial angle depends on the swelling effect and not on drooping of the tip confirming the reliability of SEG over time.

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