Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study

Abstract BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

Thresholds of Identification and Aesthetic Perception of Simulated Alar Base Widening Among Oral and Maxillofacial Surgeons: an Online Questionnaire-Based International Study / Limiares de Identificação e Percepção Estética do Alargamento Simulado da Base Alar Entre Cirurgiões Buco-Maxilo-Faciais: um Levantamento Internacional

This study aimed to compare the thresholds of identification and aesthetic perception of simulated alar base widening among oral and maxillofacial (OMF) surgeons from Brazil and other countries through an online data collection form. Photographs of one male and one female model were digitally manipulated to obtain aesthetically acceptable, symmetrical faces and to gradually widen the alar base to produce six different images from each original photograph. The online questionnaire was sent to OMF surgeons of different nationalities. The results mshowed that the majority of Brazilian (88%) and international (89%) evaluators considered the female faces with 0 to 2 mm of alar base widening as being more pleasant. In turn, Brazilian (93%) and international (94%) respondents agreed that faces with the greatest widening (8 and 10 mm) were less pleasant. As for the male model, Brazilian (93%) and international (85%) OMF surgeons agreed that faces with none or small widening (0 and 2 mm) were more pleasant. The male face with the greatest widening (10 mm) was considered the least attractive by the respondents (93% in both groups). The findings of this study suggest that alar base widening up to the limit of 2 mm did not alter the perception of facial attractiveness. Thus, faces without alar base widening were considered the most attractive, while those with significant alterations were considered less attractive. Most importantly, despite the limitations of this study design, it seems that different cultural and professional contexts have minor influence on aesthetics analysis performed by OMF surgeons. (AU)

Este estudo teve como objetivo comparar os limiares de identificação e percepção estética do alargamento simulado da base alar entre cirurgiões bucomaxilofaciais (BMF) do Brasil e de outros países por meio de um formulário de coleta de dados online. Fotografias de um modelo masculino e de uma modelo feminina foram manipuladas digitalmente para obter faces esteticamente aceitáveis e simétricas e para ampliar gradualmente a base alar produzindo seis imagens diferentes de cada fotografia original. O questionário online foi enviado aos cirurgiões BMF de diferentes nacionalidades. Os resultados mostraram que a maioria dos avaliadores brasileiros (88%) e internacionais (89%) consideraram as faces femininas com 0 a 2 mm de alargamento da base alar como mais agradáveis. Por sua vez, os entrevistados brasileiros (93%) e internacionais (94%) concordaram que os rostos com maior alargamento (8 e 10 mm) foram os menos agradáveis. Quanto ao modelo masculino, os cirurgiões brasileiros (93%) e internacionais (85%) da OMF concordaram que faces com nenhum ou pequeno alargamento (0 e 2 mm) eram mais agradáveis. A face masculina com maior alargamento (10 mm) foi considerada a menos atraente pelos entrevistados (93% em ambos os grupos). Nossos achados sugerem que o alargamento da base alar até o limite de 2 mm não alterou a percepção da atratividade facial. Assim, rostos sem alargamento da base alar foram considerados os mais atraentes, enquanto aqueles com alterações significativas foram considerados menos atraentes. Mais importante ainda, apesar das limitações, parece que diferentes contextos culturais e profissionais têm pouca influência na análise estética realizada pelos cirurgiões da OMF. (AU)

Posicionamento ideal das cartilagens laterais inferiores associado à otimização da válvula nasal externa / Ideal positioning of the lower lateral cartilages associated with the optimization of the external nasal valve

Introdução: O posicionamento das Cartilagens Laterais Inferiores (CLI) está diretamente relacionado à boa funcionalidade nasal. Quando essas cartilagens apresentam um mau posicionamento cefálico, a parede lateral da válvula nasal externa fica sem suporte adequado, podendo levar à insuficiência valvular. O objetivo é definir qual o posicionamento anatômico ideal das CLI associado à otimização da válvula nasal externa. Métodos: Revisão de literatura narrativa nas seguintes bases de dados: SciELO, LILACS e Medline. Os descritores utilizados foram: "cartilagens nasais"; "obstrução nasal" e "rinoplastia", sendo selecionados 15 artigos essenciais para o entendimento do assunto. Revisão de literatura: O posicionamento do ramo lateral das CLI forma o contorno da ponta nasal e dá estabilidade à parede lateral da válvula nasal externa. Constantian definiu que o posicionamento ideal do ramo lateral das CLI à margem da asa nasal deve ser 45° ou menos. Para Toriumi, o ângulo é mensurado a partir do ramo lateral das CLI em relação ao plano sagital mediano e o valor adequado é de aproximadamente 45°. Para Silva, o posicionamento das CLI é mensurado pelo ângulo de divergência entre as CLI e tem como valor apropriado aproximadamente 90°. Conclusão: A válvula nasal externa apresenta melhor funcionamento quando as CLI estão bem posicionadas, a saber: o ângulo formado entre a borda lateral das CLI e a margem alar é próximo de 45° ou menos; o ângulo formado entre as CLI e o plano sagital mediano é próximo de 45°; o ângulo de divergência formado entre as CLI é próximo a 90°.

Introduction: The Lower Lateral Cartilages (LLC) positioning is directly related to good nasal functionality. When these cartilages have cephalic malpositioning, the lateral wall of the external nasal valve is not adequately supported, which can lead to valvular insufficiency. The objective is to define the ideal anatomical positioning of the LLC associated with optimizing the external nasal valve. Methods: Review narrative literature in the following databases: SciELO, LILACS and Medline. The descriptors used were: "nasal cartilages,"; "nasal obstruction," and "rhinoplasty," being selected 15 essential articles for the understanding of the subject. Literature review: Positioning the lateral crura of the LLC forms the contour of the nasal tip and provides stability to the lateral wall of the external nasal valve. Constantian defined the ideal positioning of the lateral crura of the LLC at the margin of the nasal alae should be 45° or less. For Toriumi, the angle is measured from the lateral crura of the LLC concerning the midsagittal plane, and the appropriate value is approximately 45°. For Silva, the positioning of the LLC is measured by the angle of divergence between the LLCs, and its appropriate value is approximately 90°. Conclusion: The external nasal valve works better when the LLCs are well-positioned, namely: the angle formed between the lateral edge of the LLCs and the alar margin is close to 45° or less; the angle formed between the LLC and the midsagittal plane is close to 45°; the divergence angle formed between the LLC is close to 90°.

Anatomic and histologic analysis of paca larynx (Cuniculus paca, Linnaeus 1766) / [Análise anatômica e histológica da laringe da paca (Cuniculus paca, Linnaeus 1766)]

Paca (Cuniculus paca) has encouraged research as an experimental model both in the human medicine and veterinary, as well as the economic exploitation of its meat cuts, which favored its zootechnical use. There are no anatomical, microscopic descriptions and measurements of the larynx in this rodent. Eight pacas were dissected from the wild animal's sector of the Faculty of Agricultural and Veterinary Sciences of the University of the State of São Paulo. The larynx was observed located in the ventral region of the neck, ventral to the esophagus, connecting the pharynx to the trachea, with cylindrical and irregular shape. Laryngeal cartilages (epiglottic, thyroid, cricoid and arytenoid) are interconnected and have different shapes. Thyroid showed greater length and width, compared to the others. Laryngeal cartilages were submitted to histological processing and stained with hematoxylin-eosin and Masson's trichrome. The epiglottic cartilage was stained with toluidine blue. Laryngeal cartilages thyroid, cricoid and the lower portion of the arytenoids are of hyaline origin and, in contrast, the epiglottis and the upper portion of the arytenoids are elastic. This latter cartilage demonstrated taste buds. The results will be able to auxiliate in veterinary care and as well as the conservation programs for this rodent.(AU)

A paca (Cuniculus paca) tem encorajado inúmeras pesquisas, tornando-a modelo experimental tanto em humanos como na veterinária, além da exploração econômica de seus cortes cárneos, que favoreceu diretamente sua importância zootécnica. Não há descrições anatômicas, microscópicas e mensurações da laringe desse roedor. Foram dissecadas oito laringes de pacas, provenientes do setor de Animais Silvestres da Faculdade de Ciências Agrárias e Veterinárias - Universidade Estadual Paulista. Observou-se que a laringe localiza-se na região ventral do pescoço, ventral ao esôfago, conectando a faringe à traqueia, possuindo formato cilíndrico e irregular. As cartilagens laríngeas (epiglote, tireóide, cricóide e aritenóidea) são interligadas e possuem formatos variados. A cartilagem tireóide demonstrou-se maior em comprimento e largura, comparativamente às demais. As cartilagens laríngeas foram submetidas a processamento histológico e coradas em hematoxilina-eosina e tricrômio de Masson. A cartilagem epiglote foi corada em azul de toluidina. As cartilagens laríngeas tireóide, cricóide e a porção inferior das aritenóides são de origem hialina; em contrapartida, a epiglote e a porção superior das aritenóides, de origem elástica. Esta última cartilagem demonstrou corpúsculos gustativos. Os resultados poderão auxiliar tanto nos atendimentos veterinários quanto nos programas de conservação desse roedor.(AU)

Complicaciones posquirúrgicas del manejo del dorso nasal con la técnica cartílago en puente / Post-surgical complications of the management of the nasal dorsum with the cartilage-bridging technique

Introducción: en Cartagena, desde hace aproximadamente una década, se está realizando una nueva técnica de injerto dorsal denominada cartílago en puente (CEP), realizada en rinoplastias cerradas por un solo otorrinolaringólogo. No obstante, no existen estudios que caractericen las complicaciones de esta técnica. Objetivo del estudio: caracterizar las complicaciones posquirúrgicas del manejo del dorso nasal con CEP en pacientes sometidos a una rinoplastia. Metodología: estudio observacional descriptivo, de corte transversal y de carácter retrospectivo, que abarca los registros clínicos de pacientes sometidos a una rinoplastia cerrada con la técnica CEP entre 2013 y 2016. Se midieron variables sociodemográficas, características del procedimiento y se registraron las complicaciones detectadas durante el seguimiento posoperatorio: aparición de infección, extrusión, desplazamiento y reabsorción del injerto Resultados: se identificaron 882 historias clínicas. La mediana de edad fue de 28 años, siendo el 81 % del género femenino. La rinoplastia fue primaria en 80,6 %, el material del injerto dorsal fue solo cartílago en 80,6 %, Gore-Tex® en 1,7 % y una combinación de cartílago y Gore-Tex® en 17,7 %. La mediana de duración de las rinoplastias fue de 78 minutos (rango intercuartílico [RIC]: 72-85), siendo el principal procedimiento adicional la septoplastia en 82,2 %. El 18,2 % de los pacientes presentaron complicaciones. El desplazamiento fue la principal complicación reportada (14,7%), seguida de la reabsorción (4,0 %) e infección (0,1 %). Conclusiones: la técnica CEP mostró como principales complicaciones el desplazamiento y la reabsorción del injerto, con una frecuencia similar a la descrita en otros estudios.

Introduction: In Cartagena, a new dorsal graft technique called Cartilage in Bridge (CEP) has been carried out for approximately a decade, performed in rhinoplasties closed by a single otorhinolaryngologist. However, there are no studies that characterize the complications of this technique. Objective: To characterize postoperative complications of the management of the nasal dorsum with bridge cartilage in patients undergoing rhinoplasty. Methodology: Retrospective, descriptive, observational cross-sectional study, covering clinical records of patients who underwent closed rhinoplasty with the bridge cartilage technique between 2013 and 2016. Sociodemographic variables, characteristics of the procedure, and complications detected during follow-up were recorded postoperative: appearance of infection, extrusion, displacement, and reabsorption of the graft Results: 882 medical records were identified. The median age was 28 years, being 81 % female. Rhinoplasty was primary in 80.6 %, the dorsal graft material was only cartilage in 80.6 %, Gore-Tex® in 1.7 % and combination of cartilage and Gore-Tex® in 17.7 %. The median duration of the rhinoplasties was 78 minutes (ICR: 72-85), with the main additional procedure being septoplasty in 82.2 %. 18.2 % of the patients presented complications. Displacement (14.7 %) was the main complication reported, followed by reabsorption (4.0 %) and infection (0.1 %). Conclusions: The cartilage bridge technique showed graft displacement and reabsorption as main complications, with a frequency similar to that described in other studies.

Aumento da projeção da ponta nasal com "pseudoretalhos" obtidos dos excessos cefálicos laterais das cartilagens alares / Increased projection of the nasal tip with "pseudo-flaps" obtained from lateral cephalic excesses of the alar cartilages

Introdução: O aumento da projeção da ponta nasal às vezes se torna necessário para a obtenção de uma boa proporção entre ela e o dorso. Inúmeras técnicas e táticas são descritas com essa finalidade utilizando enxertos cartilaginosos obtidos do septo nasal, concha auricular e cartilagem costal. Quando esse aumento deve ser discreto é proposto o uso dos excedentes de cartilagens alares laterais em forma de "pseudo-retalhos". Métodos: Em rinoplastias abertas primárias os excedentes das cartilagens alares, geralmente removidas, são utilizados como "pseudo-retalhos", dobrados sobre si mesmos, em forma de "suspensório de soldado francês", sobre o domus das cartilagens alares, tendo como acolchoamento de apoio os tecidos moles delas próprias, e o tecido mole interdomal, geralmente desprezado, que é liberado, e elevado para sobre os domus. Ele é mantido, descolado e deslocado para a ponta nasal, e fica contido pelos "pseudo-retalhos" das cartilagens alares ali suturados ou cobrindo o extremo do enxerto estrutural da columela. Foram operados com essa tática 36 pacientes. Resultados: 35 com bons resultados e um apresentou um abcesso de ponta nasal, provocado pela exposição endonasal de um fio de sutura não absorvível, que foi removido. Houve necessidade de uma segunda intervenção, utilizando novo enxerto auricular, ainda com resultado insatisfatório. O método é relativamente simples para quem opera narizes. Conclusão: A ponta nasal pode ser discretamente mais projetada utilizando os excessos de cartilagens alares, "pediculadas" no domus.

Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.

Aumento da projeção da ponta nasal com "pseudo-retalhos" obtidos dos excessos cefálicos laterais das cartilagens alares / Increased nasal tip projection with "pseudo-flaps" using excess lateral cephalic alar cartilage

Introdução: O aumento da projeção da ponta nasal às vezes se torna necessário para a obtenção de uma boa proporção entre ela e o dorso. Inúmeras técnicas e táticas são descritas com essa finalidade utilizando enxertos cartilaginosos obtidos do septo nasal, concha auricular e cartilagem costal. Quando esse aumento deve ser discreto é proposto o uso dos excedentes de cartilagens alares laterais em forma de "pseudo-retalhos". Métodos: Em rinoplastias abertas primárias os excedentes das cartilagens alares, geralmente removidas, são utilizados como "pseudo-retalhos", dobrados sobre si mesmos, em forma de "suspensório de soldado francês", sobre o domus das cartilagens alares, tendo como acolchoamento de apoio os tecidos moles delas próprias, e o tecido mole interdomal, geralmente desprezado, que é liberado, e elevado para sobre os domus. Ele é mantido, descolado e deslocado para a ponta nasal, e fica contido pelos "pseudo-retalhos" das cartilagens alares ali suturados ou cobrindo o extremo do enxerto estrutural da columela. Foram operados com essa tática 36 pacientes. Resultados: 35 com bons resultados e um apresentou um abcesso de ponta nasal, provocado pela exposição endonasal de um fio de sutura não absorvível, que foi removido. Houve necessidade de uma segunda intervenção, utilizando novo enxerto auricular, ainda com resultado insatisfatório. O método é relativamente simples para quem opera narizes. Conclusão: A ponta nasal pode ser discretamente mais projetada utilizando os excessos de cartilagens alares, "pediculadas" no domus.

Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.

Avaliação da modificação da técnica de reconstrução das cartilagens alares de Max Pereira no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre / Evaluation of Max Pereira alar reconstruction technique modification in the total nasal reconstruction protocol of the Hospital of Clinics of Porto Alegre

Introdução: A reconstrução nasal é a mais antiga das cirurgias plásticas. A anatomia nasal é complexa e necessita de uma associação de técnicas para a restauração da função e estética nasal adequada. Pereira et al. descreveram uma técnica que possibilita a reconstrução nasal total da cartilagem alar, com o uso de um enxerto da cartilagem auricular, com mínima deformidade auricular secundária à retirada do enxerto. O objetivo deste trabalho é apresentar uma modificação da técnica acima descrita, que possibilita reconstruir mais uma região anatômica do nariz, sem aumentar a morbidade, realizada por Collares et al., e a sua inserção no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre. Métodos: Foi realizado um estudo retrospectivo. Avaliou-se a inserção da modificação da técnica em 10 pacientes que realizaram reconstrução nasal total. Resultados: Após a análise dos 10 casos, utilizando a modificação da técnica inserida no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre, encontramos uma melhoria da forma do nariz, a válvula nasal interna com preservação da função e sem sequelas secundárias à retirada do enxerto auricular. Conclusão: Nesta série de casos, a modificação da técnica de Max Pereira resultou em tratamento estético funcional adequado quando implementada no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre, sem aumentar a morbidade na área doadora.

Introduction: Nasal reconstruction is the oldest plastic surgery technique. The nasal anatomy is complex and requires an association of techniques for the restoration of function and adequate nasal esthetics. Pereira et al. described a technique that allows total nasal reconstruction of the alar cartilage through the use of an auricular cartilage graft, with minimal deformity secondary to the donor site. The objective of the present study is to present a modification, by Collares et al., of the technique described above, which allows the reconstruction of another anatomical region of the nose without increasing morbidity, and its insertion into the total nasal reconstruction protocol of Hospital de Clínicas of Porto Alegre. Methods: A retrospective study was conducted. We evaluated technique modification in 10 patients who underwent total nasal reconstructions. Results: After examining the 10 patients who were treated with the modified total nasal reconstruction protocol at the Hospital de Clínicas of Porto Alegre, we observed an improvement in the nose shape and internal nasal valve with preservation of function, without sequelae secondary to auricular graft removal. Conclusion: In this case series, the modification of the Max Pereira technique resulted in adequate aestheticfunctional treatment when implemented in the total nasal reconstruction protocol of the Hospital de Clínicas of Porto Alegre, without increasing the morbidity in the donor area.

Triangular Resection of the Upper Lateral Cartilage for Middle Vault Deviation

OBJECTIVES: Middle vault deviation has a significant effect on the aesthetic and functional aspects of the nose, and its management continues to be a challenge. Spreader graft and its modification techniques have been focused, but there has been scarce consideration for removing surplus portion and balancing the upper lateral cartilage (ULC). This study aimed to report the newly invented triangular-shaped resection technique (“triangular resection”) of the ULC and to evaluate its efficacy for correcting middle vault deviation. METHODS: A retrospective study included 17 consecutive patients who presented with middle vault deviation and underwent septorhinoplasty by using triangular resection at a tertiary academic hospital from February 2014 and March 2016. Their outcomes were evaluated pre- and postoperatively including medical photographs, acoustic rhinometry and subjective nasal obstruction using a 7-point Likert scale. RESULTS: The immediate outcomes were evaluated around 1 month after surgery, and long-term outcomes were available in 12 patients; the mean follow-up period was 9.1 months. Nasal tip deviation angle was reduced from 5.66° to 2.37° immediately (P < 0.001). Middle vault deviation also improved from 169.50° to 177.24° (P < 0.001). Long-term results were 2.49° (P=0.015) for nasal tip deviation and 178.68° (P=0.002) for middle vault deviation. The aesthetic outcome involved a complete correction in eight patients (47.1%), a minimally visible deviation in seven patients (41.2%) and a remaining residual deviation in two patients (11.8%). Pre- and postoperative minimal cross-sectional areas (summation of the right and left sides) were 0.86 and 1.07, respectively (P=0.021). Fifteen patients answered about their nasal obstruction symptoms and the median symptom score had alleviated from 6.0 to 3.0 (P=0.004). CONCLUSION: Triangular resection of the ULC is a simple and effective method for correcting middle vault deviation and balancing the ULCs without complications as internal nasal valve narrowing.

Alar Rim Composite Graft: A Safe and Simple Way to Correct Alar Retraction

BACKGROUND: The alar rim is a complex structure that ensures the competence of the external valves and the patency of inlets to the nasal airways. Retraction of the alar rim is caused by congenital malpositioning, hypoplasia, or surgical weakening of the lateral crura, with the potential for both functional and aesthetic ramifications. Most previously introduced procedures involved a relatively long operation time and relatively high risks of surgical complications. The purpose of this study is to introduce a novel surgical technique for alar rim connection and to present its results. METHODS: After marking the extent of the correction, the recipient alar bed was created by making an incision through the vestibular skin 2-mm cephalad to the rim. Then, the composite graft was harvested from the cymba concha by removing the cartilage with its adherent anterior skin. According to the degree of retraction, the harvested composite graft was divided into 2 pieces considering the symmetry of both alar rims. The composite grafts were inserted into the defects and primary closure was done at the donor site. RESULTS: Our surgical technique was used to correct 12 retracted alar rims in 6 patients. Caudal advancement of the alar rims was observed and the contour of the ala was corrected in all 6 patients. The mean length of follow-up was 1-year, and there were no postoperative complications, such as graft loss or disruption. CONCLUSIONS: The alar rim composite graft is a safe and simple technique for correction of short nostril and caudal transposition of the retracted alar rim.

Is the diagnosis of calcified laryngeal cartilages on panoramic radiographs possible?

PURPOSE: Detecting laryngeal cartilages (triticeous and thyroid cartilages) on panoramic radiographs is important because they may be confused with carotid artery calcifications in the bifurcation region, which are a risk factor for stroke. This study assessed the efficiency of panoramic radiography in the diagnosis of calcified laryngeal cartilages using cone-beam computed tomography (CBCT) as the reference standard. MATERIALS AND METHODS: A total of 312 regions (142 bilateral, 10 left, 18 right) in 170 patients (140 males, 30 females) were examined. Panoramic radiographs were examined by an oral and maxillofacial radiologist with 11 years of experience. CBCT scans were reviewed by 2 other oral and maxillofacial radiologists. The kappa coefficient (κ) was calculated to determine the level of intra-observer agreement and to determine the level of agreement between the 2 methods. Diagnostic indicators (sensitivity, specificity, accuracy, and false positive and false negative rates) were also calculated. P values < .05 were considered to indicate statistical significance. RESULTS: Eighty-two images were re-examined to determine the intra-observer agreement level, and the kappa coefficient was calculated as 0.709 (P < .05). Statistically significant and acceptable agreement was found between the panoramic and CBCT images (κ=0.684 and P < .05). The sensitivity, specificity, diagnostic accuracy rate, the false positive rate, and the false negative rate of the panoramic radiographs were 85.4%, 83.5%, 84.6%, 16.5%, and 14.6%, respectively. CONCLUSION: In most cases, calcified laryngeal cartilages could be diagnosed on panoramic radiographs. However, due to variation in the calcifications, diagnosis may be difficult.

Manejo de la punta nasal mediante la técnica los domos inteligentes / Handling the nasal tip through the smart domes technique

"El propósito de este artículo es describir paso a paso mi técnica personal al trabajar la punta nasal en cualquier tipo de rinoplastia, técnica que he llamado "LOS DOMOS INTELIGENTES". Considero es una versátil poderosa herramienta a la hora de resolver los detalles más importante relativos a rotación, proyección, definición y soporte de la punta nasal. El manejo de esta técnica por medio de rinoplastia abierta, nos permite trabajar en forma cómoda, todas las subregiones de la punta nasal, y corregir la gran mayoría de deformidades y patologías asociadas a las narices que se operan en nuestro medio, tales como columela colgante, nariz sobreproyectada, punta ptósica, nariz con poca definición de punta, etc. Este artículo será de mucha utilidad para los colegas otorrinolaringólogos y cirujanos plásticos interesados en el tema, pues se trata de una técnica de fácil reproducibilidad y los resultados que se obtienen son bastante satisfactorios y constantes con el pasar del tiempo."

The purpose of this article is to describe step by step my own technique to work nasal tip in any type of rhinoplasty, technique I have called "THE SMART DOMES". I think is a versatile and powerful tool to solve the most important details of rotation, projection, definition and support of the nasal tip. This technique through open rhinoplasty, allows to work comfortably all sub-regions of the nasal tip, and correct the most deformities and pathologies associated with noses that are operated in our environment, such as hanging columella, overprojected nose, ptotic tip, nose tip with little definition, etc. This article will be very useful for ENT and plastic surgeons interested in the subject, as it is an easily reproducible technique and the results obtained are quite satisfactory and consistent through time.

Correção do dorso nasal baixo ou em sela com enxerto composto de cartilagem conchal fragmentada fixa ao pericôndrio envolvidos à fáscia da mastóide / Correction of low or saddle nasal dorsum with a composite graft of fragmented conchal cartilage fixed to the perichondrium wrapped in mastoid fascia

Introdução: A rinoplastia de aumento em muitos casos torna-se mais difícil que a rinoplastia de redução. Enxertos dorsais sólidos realizados com cartilagem costal têm sido muito utilizados para aumento dorsal, porém estão associados com altos índices de revisão, por isso, muitos autores passaram a utilizar cartilagem em cubos envoltos por fáscia. A fáscia da mastoide, conectada ao pericôndrio da cartilagem conchal auricular, pode formar um enxerto composto para o aumento do dorso nasal, sendo também uma opção de tratamento. O objetivo é demonstrar a possibilidade do uso de cartilagem da concha auricular fragmentada fixa ao seu pericôndrio, e envoltos na fáscia da mastoide, formando um enxerto composto para aumento do dorso nasal. Métodos: Tratase de um estudo retrospectivo de 9 pacientes operados entre 2012 e 2016 no Hospital de Base da Faculdade de Medicina de São José do Rio Preto, em que foi realizado aumento do dorso nasal com cartilagem conchal fragmentada fixa ao seu pericôndrio e envolto à fáscia da mastoide. Resultados: Os pacientes foram acompanhados de 6 a 48 meses. Foram questionados quanto à satisfação do procedimento nasal e sensibilidade auricular, com avaliação positiva dos pacientes e cirurgiões. Conclusão: A cartilagem conchal parece ser uma alternativa de grande valia para procedimentos de aumento de dorso nasal. Esta cartilagem envolta com fáscia da mastoide parece ser uma alternativa vantajosa em comparação ao uso de outras fáscias, com baixa morbidade e taxa de complicações, podendo ser uma grande opção para tratamento do nariz em sela.

Introduction: In many cases, augmentation rhinoplasty is more difficult than reduction rhinoplasty. Solid dorsal grafts performed with costal cartilage have been widely used for dorsal augmentation; however, they are associated with high rates of revision. Thus, many authors began to use cartilage cut into cubes wrapped in fascia. The mastoid fascia, connected to the perichondrium of the auricular conchal cartilage can form a composite graft to augment the nasal dorsum, which is also a treatment option. The objective is to demonstrate the possibility of using fragmented auricular conchal cartilage fixed to its perichondrium and wrapped in mastoid fascia to form a composite graft for augmentation of the nasal dorsum. Methods: This is a retrospective study of 9 patients who underwent operation between 2012 and 2016 at the Base Hospital of the Faculty of Medicine of São José do Rio Preto, in which the nasal dorsum was augmented with fragmented conchal cartilage fixed to its perichondrium and wrapped in the mastoid fascia. Results: The patients were followed up for up 6 to 48 months. They were questioned about their satisfaction with the nasal procedure and hearing sensitivity, and provided a positive evaluation of the surgeons. Conclusion: The conchal cartilage seems a highly valuable alternative graft for nasal dorsum augmentation procedures. The technique of using cartilage wrapped in mastoid fascia seems to be an advantageous alternative when compared with those using cartilage wrapped in other fasciae: it has low morbidity and complications rates and can be a great option for saddle nose treatment.

Reconstrucción de defectos totales del ala nasal utilizando el colgajo frontal / Reconstruction of total ala nasi defects using forehead flap

El ala nasal es considerada una unidad estética cuya reparación quirúrgica constituye un desafío. La creciente incidencia del cáncer de piel, no melanoma, ha motivado la consulta frecuente de pacientes portadores de carcinomas en localizaciones fotoexpuestas, como el ala nasal. El método clásico para la reconstrucción del ala nasal es el colgajo nasogeniano, pero cuando la zona está afectada por cicatrices o intervenciones anteriores, hay que acudir a otro tipo de reconstrucción, como por ejemplo, el colgajo frontal. En esta presentación se muestran dos casos con defecto total de ala nasal reconstruidos con colgajo frontal doblado sobre sí mismo, sin utilizar cartílago. El objetivo de esta presentación es mostrar los resultados de la cirugía reconstructiva utilizando colgajo frontal en pacientes con defectos totales de ala nasal.

Ala nasi is considered an esthetics unit whose surgical reconstruction constitutes a challenge. The increasing incidence of skin cancer, non-melanoma, has led to frequent consultation of patients with carcinomas in photo-exposed locations, as ala nasi. The classical method for ala nasi reconstruction is nasogenian flap. But when the area is affected by scars or previous interventions, it is necessary to use another type of reconstruction, as forehead flap. In this presentation two cases with total defect on ala nasi reconstructed with forehead flap are presented, folded over itself, without using cartilage. The objective of this presentation is to show the results of reconstructive surgery using forehead flap in patients with nasal total defects.

Immediate ear reconstruction by superficial temporal fascia flap combined with avulsion auricular tissue / 中华整形外科杂志

Objective@#To explore the application and effect of superficial temporal fascia flap combined with avulsion auricular tissue in emergency auricular restoration.@*Methods@#From June 2015 to December 2015, 6 patients with auricular large area complete avulsion were underwent treatment in Department of Plastic Surgery of General Hospital of Shenyang Military. After thorough debridement, the auricular cartilage scaffold of the avlusion ear and skin was completely stripped. The auricular cartilage was repositioned on its anatomical site and subsequently covered by superficial temporal fascia flap. The free skin was stripped as full-thickness graft to cover the surface of reconstructed ear.@*Results@#All 6 patients with auricle large area complete avulsion achieved immediate repair under emergency condition. The operations were successfully completed and the ears were healed primarily. The patients were followed-up for one year. Five patients with partial auricular avulsion achieved obvious reconstructed auricle profile. The color of reconstructed ear was close to the surrounding skin and the cranioauricular angle was nearly normal. Patients and their families were very satisfied. One patient of total auricular reconstruction had auricular contracture. The auricle profile was not obvious with small size, morphological changes and external auditory canal stenosis.@*Conclusions@#Avulsion auricle and temporal superficial fascia flap can be used to repair partial auricle defects as a first-stage repair with ideal results. It is the best choice for large auricle defects in emergency cases.

Injertos de Recubrimiento en Rinoplastia Una nueva propuesta / Nasal autologus grafts in Rinoplasty A new propousal

El objetivo de este artículo es exponer nuestra experiencia en el uso de injertos de recubrimiento para la punta y el dorso nasal. Se mostrará detalladamente la técnica quirúrgica por medio de un abordaje abierto y una serie de 59 pacientes en quienes se colocaron injertos de recubrimiento obtenidos del SMAS (sistema músculo aponeurótico superficial) y su seguimiento. Esta técnica no descrita previamente se presenta como una alternativa que podría ser de utilidad para los otorrinolaringólogos y cirujanos plásticos faciales. La principal ventaja que ofrece esta técnica, es la prevención de retracciones y favorecer el camuflaje de los injertos nasales, especialmente postes y escudos bajo pieles delgadas, con el fin de obtener resultados más naturales y consistentes a largo plazo.

The aim of this article is to present our experience in the use of coverage grafts for the tip and dorsum of the nose. A detailed description of the technique is shown, via an open rhinoplasty approach. Selected cases, in which a graft harvested from the SMAS (nasal superficial musculoaponeurotic system) was used, are depicted for pre and postoperative comparison. This technique is suggested as a useful surgical alternative for otolaryngologists and facial plastic surgeons. The main advantages of this technique is the prevention of retractions and an appropriate camouflage of nasal grafts, especially struts and shields underlying thin nasal skin, in order to achieve more natural and aesthetic results, consistent in the long term.

Eficácia das técnicas estruturada e convencional na abordagem estética e reparadora do nariz / Efficacy of structured and conventional techniques on aesthetic and corrective rhinoplasty

Introdução: A rinoplastia, como outras subespecialidades da Cirurgia Plástica, apresentou evolução muito grande nas últimas décadas, tanto em termos de técnica operatória quanto em diagnóstico das alterações a serem tratadas. O objetivo deste trabalho é avaliar a eficácia das técnicas Estruturada e Convencional na abordagem estética e reparadora do nariz. Métodos: Foram estudados de forma retrospectiva 49 pacientes operados pelo autor do trabalho, que foram submetidos a uma das duas técnicas operatórias. A eficácia das técnicas foi avaliada a partir da crítica dos pacientes e do cirurgião com relação aos resultados e à capacidade de se chegar ao objetivo do pré-operatório. Resultados: Ambas as técnicas se mostraram eficazes para alcançar o objetivo final da cirurgia. A satisfação dos pacientes e do cirurgião foram semelhantes nos dois casos, e não houve complicações maiores em nenhum dos grupos. Conclusão: O trabalho mostrou que tanto a técnica Estruturada quanto a Convencional são eficazes para o tratamento das alterações nasais, sendo o mais importante o correto diagnóstico pré-operatório das alterações para a escolha da melhor abordagem em cada caso.

Introduction: Rhinoplasty, like other plastic surgery subspecialties, has greatly evolved in recent decades, as both a surgical technique and a diagnosis of the alterations that need to be performed. The objective of the current study was to evaluate the efficacy of the structured and conventional surgical techniques on nasal aesthetic and corrective approaches. Methods: A total of 49 patients, who underwent surgical operation by the author of this work, were retrospectively studied. The patient generally underwent one of the two surgical techniques. The efficacy of each technique was evaluated by means of the critique provided by the patients and the surgeon regarding the results, and the ability to reach the pre-operative goals. Results: Both techniques were efficient in attaining the final objective of the surgery. Patient and surgeon satisfaction were similar in both cases, and there were no major complications in any of the groups. Conclusion: The present work showed that both the structured and the conventional techniques were efficient in the treatment of nasal alterations. The most important factor for selecting the best approach in each case was the correct pre-operative diagnosis of the required alterations.

Application of laser scanning 3D technology in rhinoplastic prothesis / 中华医学美学美容杂志

Objective To investigate the effect of application of 3D printing technology in the rhinoplastic prothesis with the help of the laser scanning 3D technology.Methods Before the rhinoplastic prothesis,we got the whole facial morphology of patients by laser scanning technology,and printed out the facial model which was 1:1 with the real and then discussed with patients to confirm the ideal nose three-dimensional effect.In the process of operation,doctors were guided by the data for the procedure.Results Among 33 patients who were followed up postoperatively,only one patient's nosal tip dropped,then were repaired with her ear cartilage,both of us found satisfactory effect after repair,and without postoperative complications.The rest 32 patients were satisfied with their nose.Conclusions The laser scanning 3D technology is worth trying and using in plastic surgery.

Failed septal extension graft in a patient with a history of radiotherapy / 대한악안면성형재건외과학회지

BACKGROUND: This report describes the authors’ experience of “melting” septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. METHODS: Electronic medical records were used to obtain details of the patient's clinical history. RESULTS: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). CONCLUSIONS: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

Nasal morphology - harmony and proportion applied to rhinoplasty / Morfologia nasal - harmonia e proporção aplicadas à rinoplastia

The study of nasal morphology is of fundamental importance for a better understanding and planning of rhinoplasty. The objective of this study is to analyze the basic shape of the nose seen as an isolated structure, and especially in equilibrium with the patient's face. The existing patterns to do so are quite subjective, since the concept of beauty depends on several factors. The classic proportion measurements assist the surgeon with the conception and aesthetic view. When combined with an understanding of the anatomy and surgical technique they determine the final outcome of rhinoplasty. Thus, the concept of "optimal" nose must be applied on an individual basis, respecting classical anthropometry patterns, gender, ethnicracial, cultural and psychosocial factors. Morphology is not limited only to the static aspect of the nose, but is directly related to personal dynamics, mimicry and personality of the patient.

O estudo da morfologia nasal é de fundamental importância para um melhor entendimento e planificação das rinoplastias. O objetivo deste trabalho é analisar a forma básica do nariz visto como estrutura isolada, e principalmente em equilíbrio com a face do paciente. Os padrões determinados são bastante subjetivos, pois o conceito de beleza depende de vários fatores. As medidas clássicas de proporção auxiliam na concepção e visão estética do cirurgião. E quando associadas ao conhecimento da anatomia e técnica cirúrgica irão determinar o resultado final da rinoplastia. Logo, o conceito do nariz "ideal" deve ser aplicado para cada um, respeitando os padrões clássicos da antropometria, o sexo, grupo étnico-racial, fatores culturais e psicossociais. A morfologia não se restringe apenas ao aspecto estático do nariz, mas relaciona-se diretamente com a dinâmica pessoal, a mímica e a personalidade.