Comparative study of the effectiveness of the surgical technique with and without preservation of the conchal cartilage in otoplasty through the measure of the cephalo-auricular and scapho-conchal angles

Abstract Objectives Prominent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. Methods The two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student's t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann-Whitney were used in the statistical analyses. Results A significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p < 0.001). However, no significant difference was found between them (p = 0.887). Conclusion The two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. Level I Evidence obtained from at least one properly designed randomized controlled trial.

Evaluating the effectiveness of the lateral intercrural suture to decrease the interdomal distance to improve the definition of the nasal tip in primary rhinoplasty

Introduction: Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS). Techniques for measuring these structures are not yet standardized. Objectives: Assess the efficacy of LIS using polydioxanone 4–0 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition. Materials and Methods: This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements. Results: LIS was efficient on reducing interdomal distances. Conclusion: LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip...

Sutura intercrura lateral no nariz caucasiano: Estruturação e diminuição do ângulo de divergência domal na rinoplastia endonasal sem delivery / Lateral intercrural suture in the caucasian nose: Decreased domal divergence angle in endonasal rhinoplasty without delivery

Introdução: Diversas técnicas podem ser realizadas para melhorar a definição da ponta nasal como ressecção cartilaginosa, colocação de enxertos ou suturas. A realização de suturas na ponta nasal proporciona resultados estéticos satisfatórios com menor morbidade1-5. Objetivo: Avaliar a sutura intercrura lateral realizada na cartilagem lateral inferior, através de rinosseptoplastia endonasal por técnica básica sem delivery, para diminuição do ângulo de divergência domal no nariz caucasiano e consequente melhora na definição da ponta nasal. Método: Realizado estudo prospectivo com 64 casos nos quais foi confeccionada sutura no bordo cefálico da cartilagem lateral inferior na junção entre a cúpula e crus lateral, utilizando-se fio P.D.S. (Polydioxanorie®) incolor 4"0" com agulha curva cortante. Resultado: Foram analisadas e comparadas as fotos do pré - operatório e do pós -operatório com 6 meses de evolução. Em todos os casos foi atingida uma melhora na definição da ponta através da sutura intercrura lateral. Conclusão: A sutura intercrura lateral da cartilagem lateral inferior mostrou ser factível para uma melhor definição da ponta no nariz caucasiano podendo ser realizada por rinoplastia endonasal sem delivery...

Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objective: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose...

Estreitamento da base nasal no nariz caucasiano através da técnica de cerclagem / Nasal base narrowing of the caucasian nose through the cerclage technique

Introdução: Diversas técnicas podem ser realizadas para diminuir a base nasal (estreitamento), como ressecção de pele vestibular, ressecção de pele columelar, ressecção de pele em elipse do bordo narinário, descolamentos e avançamentos de pele (técnica V-Y de Berstein) e o uso de suturas na cerclagem da base nasal. Objetivo: Avaliar a técnica de cerclagem realizada na base nasal, através de rinosseptoplastia endonasal por técnica básica sem delivery, no nariz caucasiano, diminuindo a distância inter-alar e corrigindo o alar flare com consequente melhora da harmonia nasal no conjunto facial. Método: Realizado estudo retrospectivo através da análise das fotos e documentos clínicos de 43 pacientes, nos quais foi confeccionada a cerclagem da base nasal, através da ressecção de pele em elipse da região do vestíbulo e base nasal (técnica de Weir modificada), utilizando-se fio mononylon® incolor 4"0" com agulha reta cortante. O estudo foi realizado nos anos de 2008 e 2009 no Hospital Instituto Paranaense de Otorrinolaringologia - IPO em Curitiba-Paraná, Brasil. Os pacientes tiveram um follow up que variou de 7 a 12 meses. Resultados: Em 100% dos casos foi atingida uma melhora na harmonia nasal, através da diminuição da distância inter-alar. Conclusão: A cerclagem associada a ressecção mínima de pele vestibular e da base nasal é um método eficaz para o estreitamento da base nasal no nariz caucasiano, com resultados previsíveis e de fácil realização.

Introduction: Several techniques can be performed to reduce the nasal base (narrowing), as skin resection vestibular columellar skin resection, resection of skin in elliptical lip narinary, sloughing of skin and advancements (VY technique of Bernstein) and the use of cerclage sutures in the nasal base. Objective: To evaluate the technique of cerclage performed in the nasal base, through endonasal rhinoplasty without delivery of basic technique, in the Caucasian nose, reducing the distance inter-alar flare and correcting the wing with consequent improvement in nasal harmony in the whole face. Methods: A retrospective analysis by analysis of clinical documents and photos of 43 patients in whom cerclage was made of the nasal base by resecting skin ellipse in the region of the vestibule and the nasal base (modified technique of Weir) using colorless mononylon® 4 "0" with a straight cutting needle. The study was conducted in 2008 and 2009 at Hospital of Paraná Institute of Otolaryngology - IPO in Curitiba, Parana - Brazil. Patients had a follow up ranging 7-12 months. Results: In 100% of cases was achieved an improvement in nasal harmony, by decreasing the inter-alar distance. Conclusion: The encircling with minimal resection of vestibular skin and the nasal base is an effective method for the narrowing of the nasal base in the Caucasian nose, with predictable results and easy to perform.