Autologous costal cartilage for nasal tip surgery: report of 86 cases / 中华医学美学美容杂志

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty,and to report the surgical results and complications in 86 consecutive rhinoplasty cases.Methods All operations were performed by the first author (Liu AT) with open approach,costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty,after removing the previous injection material,L-shaped implant or hypertrophic scar tissue in the tip.Medical charts and operative records were reviewed retrospectively to summary the complications.Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft,sometimes with anterior sheath of rectus abdominis.Patients' subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse,2 no change,3 improved,and 4 much improved).Results From September 2015 to March 2017,86 patients underwent rhinoplasty at our hospital.The postoperative follow-up duration was 6 to 20 months.Overall,functional and aesthetic outcome was satisfactory in most patients,and the mean score by the patients' self-evaluation was 3.3 ± 0.6.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.Conclusions Even with minimal complications and morbidities,autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose,contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested.

Saddle Nose Deformity as a Result of an Aseptic Nasal Abscess Accompanied by Ulcerative Colitis and Pyoderma Gangrenosum

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes granulomatous inflammation in the mucous membrane of the intestinal tract, especially in the colon. Additionally, UC can be accompanied by extraintestinal manifestation (EIM). EIM of UC includes cutaneous lesions such as pyoderma gangrenosum, and rarely, systemically occurring aseptic abscesses (AA) have been reported in a few cases. Nasal involvement of UC as an extraintestinal manifestation of IBD is rare, and few reports of nasal mucosa and septal cartilage involvement have been documented in the literature. However, aseptic nasal abscess involving septal cartilage associated with UC and pyoderma gangrenosum resulting in saddle nose deformity have not been reported. The author presents a case of a 52 year-old woman with UC and pyoderma gangrenosum and an aseptic abscess in the nasal septal cartilage resulting in saddle nose deformity, which was corrected by augmentation rhinoplasty.

The 7th Costal Cartilage Graft for Correcting Saddle Nose Deformity / 昆明医科大学学报

Objective To evaluate the safety and efficacy of the 7th costal cartilage graft for correcting saddle nose deformity.Methods A total of thirty-two patients,10 male and 22 female,were treated from January 2013 to December 2016.The age of the patients ranged from twelve to thirty years with an average of twenty-five years.Fourteen of the thirty-two patients were cases of post traumatic saddle nose deformity,ten were congenital saddle nose deformity,and eight were secondary cleft lip saddle nose deformity.In all of the cases,the 7th costal cartilage was used as an autologous graft for rhinoplasty.The reliability of this method was assessed in term of efficacy and safety including suitability of the graft material,donor site scarring and postoperative results and complications.Results The mean time for harvesting the cartilage was 30 minutes,and the mean length of the harvested 7th costal cartilage was four cm.Postoperatively,there were three cases of nasal deviation,one case of infection and one case where the K-wire exposed.Two patient's hypertrophic scaring on the donor site.All the other cases had positive successful outcomes.Conclusions An autologus 7th costal cartilage can be harvested safely and quickly,and its handling procedure is simple.It is a good option as an autologous graft for rhinoplasty.

Risk Factors of Saddle Nose Deformity after Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgeons operate carefully to prevent nasal deformity during septoplasty, however, rarely unfavorable esthetic outcomes such as saddle nose deformity may occur. This study was designed to investigate patient factors associated with post-septoplasty saddle deformity. SUBJECTS AND METHOD: Of 588 patients who underwent endonasal conservative septoplasty from Jan. 2011 to Dec. 2014, a total of 183 patients were enrolled in this study group after exclusion. Patients were divided into two groups: 12 patients who developed saddle deformity of nasal dorsum after septoplasty belonged to the 'deformity group', and the remaining 171 patients were enrolled in the 'non-deformity group'. We investigated preoperative external nose status, patterns of septal deformity, dorsal septal thickness, the angle of axial and coronal deviation of caudal sepum on CT scan. RESULTS: The postoperative saddle deformity was not found to correlate with the location of the most deviated septum and the thickness of dorsal septum (p>0.05). 50% of patients in the deformity group had saddle nose preoperatively, showing statistical differences between the two groups (p=0.000). 75% of patients in the deformity group had severe deviation at the most deviated site, also showing a significant difference compared with the non-deformity group (p=0.011). The axial and coronal deviation angle of caudal septum in the deformity group were significantly increased compared with the non-deformity group (p<0.01). CONCLUSION: The preoperative saddle nose, severity of deviation, and angle of axial and coronal deviation of caudal septum are all possible risk factors of postoperative saddle deformity. We recommend that the surgeon should check these factors before septoplasty to prevent postoperative saddle nose deformity.

Prevalence of dentofacial abnormalities in children and adolescents with β-thalassaemia major.

Background: β-thalassaemia major is a hereditary hemolytic anemia and the patients often experience growth retardation, protrusive maxilla, and depressed nasal bride leading to various degrees of malocclusion. Aim: The purpose of this investigation is to find the prevalence of dentofacial abnormalities in β-thalassaemia major patients. Subjects and Methods: Seventy-two patients between 6 and 18 years of age diagnosed with β-thalassaemia major were examined for extraoral abnormalities, malocclusion, oral hygiene, and dental caries. Data obtained were tabulated and statistically analyzed using Chi-square and paired t-test. Results: Thirty-nine (54.2%) were males and 33 (45.8%) were females. Prominent extraoral abnormalities were found in 41 (56.9%) of the individuals. Study population predominantly had class I occlusion (59.7%) followed by class II occlusion (23.6%) and no class III occlusion. Mean oral hygiene index-simplified score was 2.43 ± 1.24, mean decayed missing filled teeth (DMFT) score was 7.10 ± 3.92, and deft was 5.68 ± 3.12. Conclusion: Despite starting regular blood transfusion at an early age, β-thalassaemia major patients showed marked facial abnormalities. When compared with individuals with no systemic disease, oral hygiene status was similar, but the caries experience was higher in β-thalassaemia major patients. Therefore, emphasis to educate these patients in the prevention and control of dental caries and maintenance of good oral hygiene should be considered.

Application of hydroxyapatite-calcium phosphate in nasal augmentation / 中华医学美学美容杂志

ObjectiveTo investigate the practicability and maneuverability of applying partical hydroxylaptite artificial bone to rehabilitate saddle nose as well as removing materials from the malposition of nasal implant.MethodsWe used the incision beside nasal columella and detached atunnel in deep of nasal aponeurosis.Then we put hydroxyapatite into the detached tunnel,at the same time press position of operation from skin to obtain a nice form.At last we sewed up the incision.Results In 15000 cases of nasal implant operations with follow-up within last 18 years,the successful cases were 94 ％,while the failing ones were 6 ％.ConclusionsApplying partical hydroxylaptite artificial bone to saddle nose and nasal implant can obtain a satisfactory,long-tcrm and stable result.It can he an optional surgical method in nasal augmentation.

Correction of Saddle Nose Deformity using Autogenous Cartilage Graft

PURPOSE: Correction of saddle nose remains problematic both in the technique of reconstruction and in the choice of implant material for nasal augmentation. A large variety of graft materials have been used for the reconstruction of the saddle nose deformity. The purpose of this study is to determinate an algorithm for deciding alternative graft materials used in correction of saddle nose deformity. METHODS: Six patients with saddle nose who were corrected using by auricular cartilage and costal cartilage at Chosun university hospital were analyzed. RESULTS: After a mean interval of 12 months, all patients were satisfied with the esthetic and functional result. CONCLUSION: Auricular cartilage is an excellent graft material for esthetic and functional reconstruction of mild to moderate saddle nose deformity.

Correction of Saddle Nose Deformity using Autogenous Cartilage Graft

PURPOSE: Correction of saddle nose remains problematic both in the technique of reconstruction and in the choice of implant material for nasal augmentation. A large variety of graft materials have been used for the reconstruction of the saddle nose deformity. The purpose of this study is to determinate an algorithm for deciding alternative graft materials used in correction of saddle nose deformity. METHODS: Six patients with saddle nose who were corrected using by auricular cartilage and costal cartilage at Chosun university hospital were analyzed. RESULTS: After a mean interval of 12 months, all patients were satisfied with the esthetic and functional result. CONCLUSION: Auricular cartilage is an excellent graft material for esthetic and functional reconstruction of mild to moderate saddle nose deformity.

The Usefulness of Costochondral Cantilever Graft for Correction of Saddle Nose

PURPOSE: Saddle nose deformity results from lack of support to the nasal dorsum. The integrity of both the cartilaginous or bony portion of the nose is compromised. Cantilever bone graft is the mainstay for correction of saddle nose deformity, but the problems of bone graft are stiffness of the nasal tip and resorption. Thus the authors propose a costochondral cantilever graft, with the bony and cartilaginous portion harvested as one block, using cartilaginous portion as support to the nasal tip. METHODS: Between October of 1996 and July of 2005, 8 cases of saddle nose deformity were treated by the same surgeon. All patients had undergone costochondral cantilever graft. Postoperative evaluation included the depression of the nasal dorsum and tip. Comparisons of preoperative and postoperative photographs was done if possible. RESULTS: The mean follow-up period was 5.9 years. The results were excellent aesthetically and there was no complication. Conclusion: The authors' method maximize the benefits of each bone and cartilage graft while minimizing their inherent limitations.

Saddle Nose & Septal Perforation Associated with Chemotherapy in Patients with Acute Leukemia / 대한이비인후과학회지

To date, no cases of nasal septal perforation during or after chemotherapy in patients with acute leukemia have been reported. In this study, we report three acute leukemia patients that had septal perforation and saddle nose deformity after chemotherapy and the results of our attempts to determine the causes of this phenomenon. We investigated retrospectively the types of chemotherapeutic agents involved and the duration of chemotherapy until the development of the nasal septal perforation. In addition, we also studied whether there were any remaining malignant cells by biopsy from the septal perforation margin. We found that Ara-C was the only drug that was used in all 3 patients. Nasal septal perforation and saddle nose developed approximately 4~7 weeks after the chemotherapy. A biopsy revealed inflammatory cells but no malignant cell infiltration. In cases of saddle nose associated with septal perforation after the chemotherapy for acute leukemia, one may consider the possibility of side effects of Ara-C. Furthermore, more active diagnosis and treatment are required when patients with acute leukemia complain of epistaxis or nasal obstruction during or after chemotherapy.

Augmentation Rhinoplasty Using Calvarial Bone Graft / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Multiple autogenous and alloplastic implants have been used in nasal reconstruction. Autogenous implants include auricular and septal cartilage as well as rib and iliac crest bone grafts. Alloplastic materials include acrylic, supramid mesh, Gortex, and silicone rubber. Autogenous grafts have been shown to provide excellent long-term reliable results in nasal reconstruction. our study was designed to demonstrate the usablility of calvarial bone as primary choice of graft material in nasal dorsum reconstruction. MATERIAL AND METHODS: Eleven patients with saddle nose underwent augmentation rhinoplasty using a calvarial bone graft from Jan. 1993 to Dec. 1996. We observed for any complications in the donor and/or recipient sites, stability of grafted bone, and final results including volume loss through medical records and photographs taken during follow-up periods. RESULTS: Hematoma in the scalp was the only complication. CSF leakage, or infection have been observed. Grafts were well fixed without screws or K wires. Displacement of grafted bone were not seen. External nasal contour was well achieved in all cases. CONCLUSION: In augmentation rhinoplasty, split calvarial bone is recommended as a good material.