Correction of deviated nose

Deviated nose deformities have always been a surgical challenge, and it is essential to achieve both functional and esthetic improvements. Various techniques have evolved over time to correct deviated noses but no one method applies in all cases. Successful correction requires a complete understanding of the various surgical techniques and concepts, including the three-dimensional nasal structure and the time-related changes to surgically-treated noses.

Nasal Reconstruction with Chondrocutaneous Preauricular Free Flap and Interpositional Vascular Graft: A Case Report

PURPOSE: Reconstruction of a full thickness defect of the nose is a difficult task for plastic surgeons because the anatomical characteristic, shape, and function of the nose all need to be taken into consideration. Most often, a local flap or a composite graft is used, but for a large defect, reconstruction using free flaps is the most ideal method. In free flap reconstruction, the chondrocutaneous preauricular area can be a suitable donor site. We performed a chondrocutaneous preauricular free flap with an interpositional vascular graft for reconstruction of a nasal ala. METHODS: A 46 year-old male presented to the hospital with a right alar deformity induced by a dog bite. During the surgery, the existing scar tissue was removed and thereby a newly formed full thickness defect was reconstructed using the chondrocutaneous preauricular free flap with an interpositional vascular graft harvested from the descending branch of the lateral femoral circumflex vessel between the facial and superficial temporal vessels of the free flap. RESULTS: The flap survived without flap loss and showed symmetry in its overall shape, contour, texture, and color. The patient was satisfied with the results and the surgery yielded no additional scars at the nasolabial fold area. CONCLUSION: The chondrocutaneous preauricular free flap is a valuable method in reconstruction of full thickness defects of the nose, and using the descending branch of the lateral femoral circumflex vessel as the interpositional vascular graft at the anastomotic site produces reliable results.

Expansion Procedures of the Nasal Envelope in Short Nose Deformity : Release of the Transverse Nasalis Sling and Division of Muscle Confluence in Nasal Hinge Area

Cartilage extension and nasal envelop expansion play a main role incorrecting short or contracted nose. Despite numerous studies for cartilage expansion, there has been no reports of nasal skin elongation methods. We hereby preport a new method for expansion of nasal envelop with a comprehensive understanding of anatomical structures. From April 2009 to September 2010, 6 patients underwent operations to correct short or contracted nose. Two separating procedures were included for nasal envelop elongation; division of muscle(Procerus, Transverse nasali, Levator labii superior alaque nasi: PTL muscles) confluence located at nasal hinge and release of transverse nasalis sling. To estimate the degree of nasal envelop extension, forced skin traction test was performed. Comprehensive research with fresh cadaver was held to study the relationship between nasal SMAS and surrounding structures. Average 3.8mm elongation was documented by forced skin traction testafter the procedure. In the fresh cadaver study, transverse nasalis sling and PTL muscle confluence were firmly attached to the supportive framework. From our clinical experience and cadaver study, we discovered that release of transverse nasalis sling and division of PTL muscle confluence are the main factors for nasal envelop expansion in short or contracted nose.

Surgical Considerations for Effective Correction of Hump Nose in Asians

On the aesthetic surgical point of view, the hump nose characterized by nasal hump, straight or convex dorsal profile, drooping nasal tip and acute nasolabial angle results in strong and older facial image. To improve these hump nose in Asians, classical Joseph's nasal hump reduction or conservative humpectomy followed by nasal tip-plasty and augmentation rhinoplasty were applied according to hump size. However, these methods of hump nose correction are insufficient for satisfactory results due to unfavorable dorsal profile and hump recurrence. Therefore, the author presents systemic and important surgical considerations obtained by surgical experiences from more than 200 cases to produce consistent and complete correction of hump nose without recurrence. From April of 2004 to May of 2008, total 228 patients underwent hump nose correction recognizing surgical considerations presented in this research. Of these patients, 38 patients were secondary cases of hump nose due to unfavorable dorsal profile and hump recurrence. The author obtained aesthetically satisfactory results without recurrence for mean 17 months follow up periods in all patients without any significant surgical complications. Measurement results are as follows: 1.average decrease in nasal length was 3.4mm, 2. average decrease in nasal width was 2.2mm, 3. average increase in nasal tip projection was 4.3mm, 4. average increase of nasolabial angles was 12.2 degree. In conclusion, hump nose correction by recognizing surgical considerations presented in this research is an effective, reliable and valuable method in correcting hump nose without recurrence and improving lateral nasal profile aesthetically.