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

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.

Folded Cymba Concha: Is It Large and Stable Enough for Caudal Septal Extension Graft in Asian Rhinoplasty?

2021 ◽  
Author(s):  
Sik Namgoong ◽  
Soobyn Kim ◽  
Hyung-Rok Kim ◽  
Seong-Ho Jeong ◽  
Seung-Kyu Han ◽  
...  
Keyword(s):  
Septal Cartilage ◽  
Men And Women ◽  
Nasal Tip ◽  
Tip Projection ◽  
Tongue In Groove ◽  
Physical Validity ◽  
The Mean ◽  
Nasal Tip Projection ◽  
Extension Graft

Abstract Background Septal extension grafting (SEG) is used for nasal tip projection and positioning. Often, insufficient quadrangular cartilage is available for grafting in Asians and in most secondary cases, the septum is already harvested. We utilized the folded cymba concha as an alternative for caudal SEG (CSEG) by modifying a tongue-in-groove technique. Objectives To evaluate the physical validity of the cymba concha for CSEG and compare its outcomes with those of septal quadrangular cartilage. Methods The mean length and width of 311 harvested consecutive folded cymba conchae were measured from intraoperative photographs. Data from 220 patients with >12 months of follow-up were retrospectively reviewed for clinical outcomes. Clinical demography was determined based on the need for additional spreader grafts. For clinical reliability, anthropometric photographs of patients in whom folded cymba conchae were used were compared with those in whom quadrangular cartilage was used. Results Mean lengths and widths of the folded cymba conchae in men and women were 24.2 ± 3.9 and 22.4 ± 3.7 mm, and 7.8 ± 1.9 and 7.2 ± 1.9 mm, respectively. Using the folded cymba concha graft significantly increased nasal tip projection by 28.9% and columellar-labial angle by 9.7%, improving both aspects postoperatively. Anthropometric comparison revealed no significant differences between folded cymba conchae and septal cartilage in terms of nasal tip projection (p = 0.264) and postoperative columellar-labial angle (p = 0.182). Conclusions Folded cymba conchal cartilage can be a primary option for CSEG in Asian septorhinoplasty cases or for individuals with insufficient septal cartilage remnants.

Assessment of Columellar Widening with Columellar Strut Placement

FACE ◽  
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.

scholarly journals The effect of the tongue in groove technique on the nasolabial angle and nasal tip projection

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Fatemeh Khabir ◽  
Mehdi Sezavar ◽  
Behnam Bohluli ◽  
Vahid Mesgarzadeh ◽  
Hamidreza Tavakoli
Keyword(s):  
Nasal Tip ◽  
Tip Projection ◽  
Nasolabial Angle ◽  
Tongue In Groove ◽  
Nasal Tip Projection

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

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

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

2021 ◽  
Vol 9 ◽  
Author(s):  
Xin Wang ◽  
Huan Wang ◽  
Jianjun You ◽  
Ruobing Zheng ◽  
Yihao Xu ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Medial Canthus ◽  
Cartilage Transplantation ◽  
Nasal Bridge ◽  
Nasal Tip ◽  
Silicone Prosthesis ◽  
Nasolabial Angle ◽  
Significant Difference ◽  
Bridge Length

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.

Centering a Deviated Nose by Caudal Septal Extension Graft and Unilaterally Extended Spreader Grafts

2019 ◽  
Vol 129 (5) ◽  
pp. 448-455 ◽  
Author(s):  
Yung Yuan Chen ◽  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Postoperative Complications ◽  
Anthropometric Measurements ◽  
Study Patient ◽  
Open Rhinoplasty ◽  
Nasal Tip ◽  
Tip Projection ◽  
Deviated Nose ◽  
Septal Extension Graft ◽  
Nasal Tip Projection ◽  
Extension Graft

Objective: The deviated nose presents a tremendous challenge for rhinoplasty surgeons, especially the correction of the cartilaginous dorsum deviation. In this study, we introduce the surgical techniques of correcting a deviated cartilaginous vault by creating a new center of the lower third using a caudal septal extension graft combined with unilaterally extended spreader grafts. Methods: This retrospective observational study was conducted in a university-based tertiary medical center from December 2014 to January 2018. Thirty-two patients who underwent primary open rhinoplasty for correction of a deviated nose using this method participated in the study. Patient characteristics and surgical records were collected. Anthropometric measurements and analyses were performed based on preoperative and postoperative photographs. The aesthetic outcome consensus of three rhinoplasty surgeons was evaluated specifically for nasal dorsum deviation correction. Postoperative complications were reviewed from the medical records. Results: Among the 32 patients, there were 18 males and 14 females. The mean (SD) age of the patients was 26.7 (8.76) years. Anthropometric measurements showed significant improvements in dorsal deviation angle (a 3.7° change towards midline, P < .001), nasal tip projection (increase of 6.96% measured by Goode’s method, P < .001), and nostril shape (nostril axis inclination decrease of 11.7°, P < .001) after surgery. The nasolabial angle showed no significant change. Aesthetic outcomes were excellent in seven patients (21.9%), good in fourteen patients (43.7%), fair in eight patients (25.0%), and no change in three patients (9.4%). Minor postoperative complications (four patients) were observed during follow-up. Conclusion: Centering the cartilaginous vault using a caudal septal extension graft combined with unilaterally extended spreader grafts is a useful technical option in the correction of a deviated nose, and provides improvement in nasal tip projection and nostril shape.

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

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.

scholarly journals The Horn Technique for Nasal Tip Support in Rhinoplasty

2020 ◽  
Author(s):  
Luiz Carlos de Melo Barboza ◽  
Maíra Garcia Martins ◽  
Carlos Alberto Caropreso ◽  
José Luiz Teixeira Rodrigues ◽  
André Baraldo Rodrigues
Keyword(s):  
Retrospective Review ◽  
Aesthetic Surgery ◽  
Nasal Dorsum ◽  
Effective Technique ◽  
Nasal Tip ◽  
Small Loss ◽  
Tip Projection ◽  
Tongue In Groove ◽  
Nasal Tip Projection ◽  
New Surgery

Abstract Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients

2018 ◽  
Vol 35 (01) ◽  
pp. 058-064 ◽  
Author(s):  
Tsutomu Mizuno
Keyword(s):  
Costal Cartilage ◽  
Graft Material ◽  
Anthropometric Parameters ◽  
Augmentation Rhinoplasty ◽  
Recipient Site ◽  
Nasal Tip ◽  
Asian Patients ◽  
A New Technique ◽  
Nasal Tip Projection ◽  
Materials Used

AbstractAugmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18–43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.

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