Prevention and treatment strategy for deviation of costal cartilage dorsal onlay graft in rhinoplasty / 中华医学美学美容杂志

Objective:To investigate the prevention and treatment for deviation of costal cartilage dorsal onlay grafts in rhinoplasty.Methods:From January 2010 to October 2020, a total of 588 patients (83 male cases, 505 female cases, age range from 25 years to 55 years, 32±4 years in average) accepted costal cartilage rhinoplasty in Shenzhen Mylike Medical Plastic Aesthetic Hospital. During the operation, various methods were used in the process of catilage selection, water bath, sculpture, treatment of nasal dorsal, graft fixation and fascial modification to prevent and treat the deformation and displacement of the costal cartilage dorsal onlay grafts.Results:The immediate postoperative photograph of 588 cases showed that costal cartilage dorsal onlay graft was put on the middle of dorsum. After a follow-up period of 396 cases from 6 to 60 months, the average follow-up period was 12.1 months, there were 44 cases happened with the deviation of dorsal onlay grafts, and deviation was managed after the second rhinoplasty surgery. There was no prolonged function sequela such as ventilation dysfunction, abnormal sensation, or hyposmia occured. 362 cases were satisfied with the aesthetic effect.Conclusions:It is particularly important to grasp the principles of managing costal cartilage in rhinoplasty and to learn how to prevent and treat postoperative complications of costal cartilage dorsal onlay graft.

Application of thin-ribbed cartilage with the perichondrium in correction of secondary cleft lip nasal deformity as lateral crural onlay graft / 中国修复重建外科杂志

Objective: To explore the application and effectiveness of thin-ribbed cartilage with the perichondrium in the correction of secondary cleft lip nasal deformity as the lateral crural onlay graft. Methods: A retrospective study was performed based on the data of 28 patients with secondary nasal deformity of cleft lip between October 2015 and April 2017. There were 16 males and 12 females with an average age of 24 years (range, 18-31 years). There were 11 cases with secondary nasal deformities on the left side, 13 cases on the right side, and 4 cases on both sides. Three-dimensional stereotaxy of the nasolabial muscles was used to correct the deformity. The costal cartilage as the support was used to perform nasal columella and nasal dorsum while the thin-ribbed cartilage with the perichondrium was used as wing cartilage support. The photography of nasal position was taken before operation and at 6-8 months after operation. The midpoint of the junction between the nasal columella and the upper lip was marked point O; the lateral horizontal line passing through the point O was marked as X-line, and the longitudinal line (the midline) as Y-line. The distance of the highest point of the affected nostril to the X-line, the distance of the nostril's outermost point to the Y-line, the symmetries of both the most lateral and the highest point of the bilateral nostrils, and the distance of the highest point of the nasal tip to the X-line were measured. Results: All incisions healed by first intention. All patients were followed up 6 to 24 months with an average of 12 months. The size and shape of the noses were stable, and no compli cation, such as cartilage exposure, hematoma, or infection occurred during the postoperative follow-up. There were 4 cases with obvious incision scars, 3 cases with nostril and alar asymmetry, and 1 case of lateral side of the nose without well positioned. The symmetry of the highest points of bilateral nostrils was 57.643%±27.491% before operation and 90.246%±18.769% after operation. The symmetry of the most lateral points of the bilateral nostrils was 77.391%±30.628% before operation and 92.373%±21.662% after operation. And there were significant differences between pre- and post-operation ( P<0.05). There were also significant differences in the distance of highest point of the affected nostril to the X-line, the distance of the nostril's outermost point to the Y-line, and the distance of the highest point of the nasal tip to the X-line ( P<0.05). No thoracic contour change occurred at the costal cartilage donor site. Conclusion: The thin-ribbed cartilage with the perichondrium has good support and long-term stability, and it can be used as one of the ideal materials for nasal alar cartilage transplantation for nasal deformity secondary to cleft lip.

Effects of Block Bone Substitutes Loaded with Escherichia Coli-Produced Recombinant Human Bone Morphogenetic Protein-2 on Space Maintenance and Bone Formation in Rat Calvarial Onlay Model

We aimed to evaluate the effects of onlay-type grafted human freeze-dried corticocancellous bone block (FDBB) and deproteinized bovine bone with collagen (DBBC) loaded with Escherichia coli-produced recombinant human bone morphogenetic protein-2 (ErhBMP-2) on space maintenance and new bone formation in rat calvaria. Collagen sponge (CS), FDBB, or DBBC disks (8×4 mm) with ErhBMP-2 (2.5 µg) were implanted onto the calvaria of male Sprague-Dawley rats, whereas CS with buffer was implanted onto the calvaria as controls (n=20/carrier). Rats were killed at 2 or 8 weeks post-surgery for histologic and histomorphometric analyses; total augmented area, new bone area, and bone density were evaluated. At both time-points, all ErhBMP-2 groups showed significantly higher new bone area and bone density than the control group (p<0.05). ErhBMP-2/FDBB and ErhBMP-2/DBBC groups showed significantly higher total augmented area than ErhBMP-2/CS group (8 weeks), and ErhBMP-2/FDBB group showed significantly higher new bone area and bone density than ErhBMP-2/DBBC group (p<0.05). ErhBMP-2/CS group showed the highest bone density (p<0.05). Combining ErhBMP-2 with FDBB or DBBC could significantly improve onlay graft outcomes, by new bone formation and bone density increase. Moreover, onlay-grafted FDBB and DBBC with ErhBMP-2 could be an alternative to autogenous block onlay bone graft.

Histomorphometric Evaluation of Onlay Freeze-Dried Block Bone and Deproteinized Bovine Bone with Collagen in Rat

The aim of this study was to evaluate the effect of human freeze-dried bone block (FDBB) and deproteinized bovine bone with collagen (DBBC) on bone formation when applied as an onlay graft in rat calvariums. Thirty male Sprague-Dawley rats received collagen sponge (control), FDBB, or DBBC onlay grafts trimmed into 8-mm disks measuring 4-mm height. Each graft was secured onto the calvarium surface using horizontal mattress sutures. Rats in each group were killed at 2 (n=5) or 8 (n=5) weeks postoperatively for histologic and histomorphometric analysis. The total augmented area (mm²), new bone area (mm²), and bone density (%) were measured. The FDBB and DBBC groups showed significantly more new bone formation and bone density than the control group at 2 and 8 weeks. The increased new bone area was significantly greater in the FDBB group than in the DBBC group (p<0.05). The total augmented area was significantly higher in the FDBB and DBBC groups at 2 and 8 weeks than in the control group (p<0.05), and at 8 weeks, the area was significantly decreased in the DBBC group compared to that in the FDBB group and the area at 2 weeks (p<0.05). Within the limitations of the present study, we concluded that onlay FDBB and DBBC grafts caused new bone formation through an osteoconductive mechanism. In addition, compared to FDBB, DBBC had less capacity to form new bone and maintain the space.

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

PURPOSE: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the long-term outcome of this grafted gingiva. METHODS: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. RESULTS: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. CONCLUSIONS: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.

Full mouth implant rehabilitation of a patient with ectodermal dysplasia after orthognathic surgery, sinus and ridge augmentation: a clinical report

An 18-year-old male presented severe hypodontia due to hypohidrotic ectodermal dysplasia was treated with Le Fort I maxillary osteotomy with simultaneous sinus floor augmentation using the mixture of cortical autogenous bone graft harvested from iliac crest and organic Bio-Oss to position the maxilla in a right occlusal plane with respect to the mandible, and to construct adequate bone volume at posterior maxilla allowing proper implant placement. Due to the poor bone quality at other sites, ridge augmentation with onlay graft was done to construct adequate bone volume allowing proper implant placement, using tissue harvested from the iliac bone. Seven implants were placed in the maxilla and 7 implants were inserted in the mandible and screw-retained metal ceramic FPDs were fabricated. The two year follow up data showed that dental implants should be considered as a good treatment modality for patients with ectodermal dysplasia.

Técnica modificada de injerto de tejido conectivo interposicionado y sobrepuesto en implantología y rehabilitación oral: reporte de dos casos clínicos / Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective yissue graft and gingival sculping

Se describen dos reportes de casos clínicos mostrando posibilidades quirúrgicas de corrección o reconstrucción para rebordes usando tejido conectivo y posterior modelado gingival.

Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping.

Multilayer Onlay Cartilage Graft with Perichondrium: Comparing Growth Rate and Strength in a Rabbit Model

Multilayered cartilage graft has been clinically used at tip plasty, total ear reconstruction, and cleft lip nasal deformities. Perichondrial flap or a free perichondrium has been also commonly used for induction of neocartilage. However, the influence of perichondrium on multilayered cartilage graft to strength and growth rate is still unknown. The purpose of this study was to compare the strength and growth rate of different multilayered cartilage graft and to present the most ideal model of multilayered cartilage graft. Twenty New- zealand white rabbit were used. Triple layers of cartilage grafts with various perichondrium were inserted into six separate pockets in paravertebral region of rabbits. The grafts were grossly and microscopically observed on 8 and 16 weeks after grafting. On gross observation, the grafts showed marked enlargement of three layers of cartilage grafts with perichondrium compare with three layers of cartilage grafts without perichondrium In histologic examination, the number of PCNA-labelled cells were significantly high on three layers of cartilage grafts with perichondrium. In conclusion, this study suggested that triple-layer graft of cartilage grafts with perichondrium on the outside of triple-layer graft has strength and an effect on chondrogenetic induction by the perichondrium.

Anatomical Nasal Tip Plasty with Autogenous Cartilage Graft

Augmentaion rhinoplasty is one of the most common aesthetic surgery in Korea. Plastic surgeons have been more interested in not only simple augmentation of nasal dorsum, but making more beautiful and natural nasal tip. In the people who has depressed nasal bridge with round and blunted tip, simple augmentation of the nasal dorsum with silicone or Gore-Tex implants could aggravate the tip's disfigurement, so the need for tip plasty has been more emphasized in those persons. There have been used two traditional techniques in endonasal autogenous cartilage tip graft for increasing tip projection, Sheen's shield graft and Peck's onlay graft. But these techniques have several disadvantages such as displacement, visibility of graft margin and flattening of infralobule. The most criticizable problem is that these grafts have limitation in producing the natural and anatomical tip contour.We have done 45 consecutive nasal tip plasties using anatomically-shaped cartilage grafts which was developed from the idea of combination of Sheen's shield and Peck's onlay graft. We followed up the patients from 2 to 14 months. Most patients have been very satisfied with the results and no serious complications were noted. Author's graft was designed to minimize displacement by stable placement on both alar domal and lobular segments, minimize graft visibility by increasing graft contact to nasal tip skin, manipulate the cephalo-caudal length by modification of onlay thickness, and most of all, reproduce the anatomical tip projection and contour.