Aplasia congénita unilateral del cartílago alar

Resumen El objetivo de este trabajo es discutir la presentación y el manejo de la aplasia congénita unilateral del cartílago alar. En este informe, presentamos el caso de un paciente sometido a rinoseptoplastia abierta primaria que presenta aplasia congénita del cartílago alar izquierdo que se repara con cartílago septal. Se discute el manejo de casos y se revisa la literatura. Las anomalías nasales congénitas son poco frecuentes. La ausencia aislada de cualquier estructura nasal específica es aún más rara. El diagnóstico preoperatorio en una nariz hispana es difícil, pero cuando se encuentra este defecto congénito, puede repararse con cartílago septal u otros tipos de cartílago, dependiendo de la disponibilidad del injerto, con buenos resultados. Se recomienda un enfoque abierto para este tipo de patología. La aplasia unilateral del cartílago alar podría reconstruirse con éxito utilizando el cartílago septal a través de un abordaje abierto.

Abstract The objective of this work is discussing the presentation and management of unilateral congenital aplasia of the alar cartilage. In this report, we present the case of a patient undergoing primary open rhinoseptoplasty presenting congenital aplasia of the left alar cartilage that is repaired with septal cartilage. Case management is discussed, and the literature is reviewed. Congenital nasal abnormalities are rare. The isolated absence of any specific nasal structure is even more rare. Preoperative diagnosis in a Hispanic nose is difficult, but when this deformed congenital is found, it can be repaired with septal cartilage or other types of cartilage, depending on the availability of the graft, with good results. An open approach is recommended for this type of pathology. Unilateral alar cartilage aplasia could be successfully reconstructed using septal cartilage through and open approach.

Functional results in airflow improvement using a "flip-flap" alar technique: our experience / Resultados funcionais na melhora do fluxo de ar utilizando uma técnica alar em flip-flap: nossa experiência

Abstract Introduction Pinched nasal point can be arising as congenital malformation or as results of unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic problem but also a functional one because can modify the nasal airflow. Several surgical techniques were proposed in literature, we proposed our. Objective The purpose of the study is the evaluation of nose airway flow using our flip-flap technique for correction of pinched nasal tip. Methods This is a retrospective study conducted on twelve patients. Tip cartilages were remodeled by means of autologous alar cartilage grafting. The patients underwent a rhinomanometry pre and post-surgery to evaluate the results, and they performed a self-survey to evaluate their degree of satisfaction in term of airflow sensation improvement. Results Rhinomanometry showed improved nasal air flow (range from 25% to 75%) in all patients. No significant differences were showed between unilateral and bilateral alar malformation (p = 0.49). Patient's satisfaction reached the 87.5%. Conclusion Our analysis on the combined results (rhinomanometry and surveys) showed that this technique leads to improvement of nasal flow in patients affected by pinched nasal tip in all cases.

Resumo Introdução A ponta nasal comprimida pode surgir como malformação congênita ou como o desfecho de uma cirurgia malsucedida. A alteração da válvula nasal devido a esse problema não é apenas um problema estético, mas também funcional, porque pode modificar o fluxo aéreo nasal. Várias técnicas cirúrgicas têm sido propostas na literatura; aqui, propomos a nossa. Objetivo O objetivo do estudo é a avaliação do fluxo das vias aéreas nasais utilizando nossa técnica de flip-flap para correção da ponta nasal comprimida. Métodos Este é um estudo retrospectivo realizado em doze pacientes. As cartilagens da ponta nasal foram remodeladas através de enxerto de cartilagem alar autóloga. Os pacientes foram submetidos à rinomanometria pré e pós-cirúrgica para avaliar os resultados, e realizaram uma auto-avaliação para avaliar seu grau de satisfação em termos de melhora da sensação do fluxo aéreo. Resultados e conclusão Nossa análise dos resultados combinados (rinomanometria e autoavaliação) mostrou que essa técnica melhora o fluxo nasal em pacientes afetados por ponta nasal comprimida em todos os casos. A satisfação do paciente atingiu os 87,5%.

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.

Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on superior border of bilateral nostril / 中华医学美学美容杂志

Objective To introduce the method of lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril.Methods We adopted the method of using the skin cartilaginous tissue flaps on the superior border of bilateral nostril associated with alar cartilages reduction to lengthen the columella in 40 patients with severe secondary bilateral cleft lip nasal deformity.All patients were followed up for 5-28 months,with an average period of 15.3 months.The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results All the 40 patients had achieved satisfactory lengthening of columella and there were no major complications.The questionnaire results showed 36 patients with excellent and 4 patients with good.Conclusions Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril is a relatively simple and safe method with good effect.

Result of Simultaneous Correction of Alar Deformity with Primary Repair of Unilateral Cleft Lip.

Cleft lip and cleft palate has been a recognized congenital malformation from a very early stage in recorded history. The infant born with an orofacial deformity, which leads to develop an unwilling psychosocial problem among the parents and also among the relatives. Successful treatment of cleft is based on overcoming in tissue shortage and repositioning of the tissues in normal anatomical pattern so that it restores both appearance and function. Various modalities of theme, works, observations and involvement of multidisciplinary approaches were tried to achieve better cosmetic, aesthetic and functional aspect in management of cleft face. Poorly performed primary surgery carries a high risk of iatrogenic disturbances of subsequent orofacial growth. Delayed nasal repair in patient with cleft lip did not produce satisfactory aesthetic and functioning result. Aim & objective of the study is to achieve a cosmetically well-accepted face in respect to lip, philtrum and nose of both sides after cleft lip surgery and to reduce the incidence of secondary correction of deformed nose in a patient with cleft lip. In our study total 86 cases are studied according to preformed inclusion and exclusion criteria. Simultaneous correction of alar cartilage deformity at the time of primary repair of cleft lip may lessen the staged operative procedure and markedly reduce the economic burden to the family.

Augmentation rhinoplasty using a reverse alar cartilage flap assisted with implantation of silicon prosthesis / 中华医学美学美容杂志

Objective To investigate a new method which could not only avoid the extrusion of the silicon implant, but also be benefit for the reconstruction of nasal tip and alar during nasal augmen-tation procedure. Methods Folded lower lateral cartilage flap combined with silicon implant was ap-plied for nasal dorsal augmentation and reconstruction of nasal tip and alar with its unique character at the same time. Results 12 cases were all primary healing, without infection, extrusion of implant and other complications. One month after operation, the projection of nasal tip was increased, which had better delicate and definite shape, natural appearing tip adding contour and height to nasal tip, pleas-ant definition. Conclusions Folded lower lateral cartilage flap combined with silicon implant is an ef-fective method to decrease the incidence of extrusion, when we want to have a little over-projected na-sal tip with prosthesis. It is also helpful for reconstructing the nasal tip and alar with its unique char-acter.

Application of Z-form plasty with a nasal mucous membrane and alar cartilage flap to repair severe secondary nasal deformity after cleft lip operation / 中华医学美学美容杂志

Objective To investigate a repair method for unilateral complete cleft lip nasal deformities.Methods Based on the fullness of healthy nasal wing,Z-form plasty was designed with a nasal mucous membrane and alar cartilage flap,to prolong its curtate length of the deformed side through overlapping transposition,and then with suspension of the custom-crafted nasal wing to replace its abnormal structure,subsequently,to recover the normal anatomic structure of the nosewing,and to get the nasal deformity repaired.Results A total of 12 patients with the severe nasal deformity were treated by this method.and all had satisfactory results.Conclusion This technique is a good choice for repairing the severe secondary nasal deformity after single complete cleft lip operation.

Nasal Tip Plasty on the Bulbous Nose Revisited

Correction of bulbous nasal tip in rhinoplasty is a difficult subject, particularly in Asian. Since first published an article on the correction of bulbous nasal tip in 1999, we have accumulated more experiences and improved our result in refining nasal tip. We had 17 patients for the correction of bulbous nasal tip. Age ranged from 20 to 39 years old (Mean age, 26.7 years old) and 6 males and 11 females. We were able to follow up from 1 month to 6 years. We classified our patients into three groups according to the shapes of nasal tip and surgical procedures implicated. Group 1: Simple bulbous nasal tip requiring excision of subdermal soft tissue and rearrangement. Group 2: Bulbous nasal tip with flat dorsum of nose, requiring augmentation of dorsum of nose with silicone implant and augmentation of nasal tip with onlay graft with conchal cartilage. Group 3: Bulbous nasal tip with short columella, requiring nasal tip plasty and lengthening of columella with composite graft using helix of ear. Open rhinoplasty technique was applied in all patients with excising subdermal fibrous tissue from nasal tip, and realignment and fixation of alar cartilage with interdomal sutures. Pressure splint was applied on 7th postoperative days and maintained for a couple of months. Proper preoperative diagnosis, subdermal soft tissue excision, realignment and fixation of alar cartilage, cartilage graft, augmentation of dorsum of nose, columella lengthening, postoperative splint and combinations of these are the key of successful results.

An Anthropometric Study of Medial and Middle Crus of Alar Cartilages

The lack of information germane to alar cartilages in Asians led us to conduct a morphologic and anthropometric study. The purpose of this prospective study was to define the shape of the medial crus of alar cartilage and measure their size. Measurements of 42 medial crura of alar cartilages in 21 Koreans were obtained during 21 consecutive primary open approach rhinoplasties between September of 1999 and February of 2000 in the Korea University Guro Hospital. Eight were male and thirteen were female. Measurements parameters of medial crus included shape, length, width, and thickness. In addition, symmetry of the medial crura and length of the middle crus were also investigated. In the male patients(n = 16), the most common shape was the straight shape(n = 9), followed by the simple flared shape(n = 5), complex flared shape(n = 2). The length of the columellar segment ranged from 8-12 mm, the average being 10.0 mm. That of the footplate segment averaged 7.8 mm, ranging from 6-9 mm. The average width and thickness were 4.3 mm and 0.58 mm. Seven patients showed symmetric shape, but one patient did not. The average length of the middle crus was 4.90 mm. In the female patients(n = 26), the most common shape was the straight shape(n = 12), followed by the simple flared shape (n = 11), complex flared shape(n = 3). The length of the columellar segment ranged from 7-9 mm, the average being 8.0 mm. That of the footplate segment averaged 6.3 mm, ranging from 4-9 mm. The average width and thickness were 4.4 mm and 0.56 mm. Ten patients showed symmetric shape, but three patients did not. The average length of the middle crus was 4.9 mm. In conclusion, the most common shape of the medial crus was straight and the average length of footplate segment was 7.0 mm, which is actually greater than that of Caucasian.

An Anthropometric Study of Lateral Crus of Alar Cartilages in Koreans

The lack of information about alar cartilages in Orientals led us to conduct a morphologic and anthropometric study. Measurements of 52 lateral crura of alar cartilages in 26 Koreans were obtained during the 26 consecutive primary open approach rhinoplasties between September 1999 and February 2000 in the Korea University Guro Hospital. Ten were male and sixteen were female patients. Measurement parameters of lateral crus included shape, length, width, thickness, and distance of caudal border from nostril rim. In addition, symmetry of the cartilages and length of the middle crus were also investigated. In case of male patients (n=20), the most common shape was the concave shape (40%), followed by the concave-convex shape (30%). The average length, width, and thickness were 19.7, 10.5 and 0.54 mm. The distance from the nostril rim was 5.7 mm anteriorly, 7.3 mm middle, and 12.3 mm posteriorly. Eight patients showed symmetric shape. The length of the middle crus was 5.0 mm. In the female patients(n=32), the most common shape was the concave shape(50%), followed by the convex(25%) and convex-concave shape(25%). The average length, width, and thickness were 16.8, 9.8 and 0.54 mm. The distance from the nostril rim was 5.8 mm anteriorly, 6.5 mm middle, and 11.5 mm posteriorly. All 16 patients showed symmetric shape and the length of the middle crus was 4.9 mm. In conclusion, we could find that the lateral crus of alar cartilage in Koreans, contrary to popular myth, may not be significantly smaller than that of Caucasian.

Correction of Alar Cartilage Malposition

The alar cartilage malposition is defined as any displacement of lateral crura from the usual parallel alignment with nostril rims. It has several characteristics including parentheses deformity, notches in alar rims, flat nasal tip, square basal perimeter. It tends to be misdiagnosed as cartilaginous hump or bulbous tip because of its longitudinally prominent lobule. But, exact diagnosis can be easily attained with careful examination and recognition in the clinical diagnosis of bulbous or ambiguous tips. It is confirmed by the resistless collapse of lateral alar rim when light compression is applied by cotton stick. Its incorrect diagnosis can bring about inappropriate tip graft, soft tissue resection, rasping, humpectomy and secondary nasal deformity may develope as a result. Authors performed open approach followed by meticulous dissection of displaced alar cartilages. Each medial portion, corresponding to the cephalic portion of normal lateral crus, was resected. Then, each lateral crus was symmetrically rotated in the infero-lateral direction along the axis of the medial crura. If needed, autocartilage on-lay graft and dorsal augmentation were done for optimal aesthetic result. We believe accurate evaluation of the anatomical variation should be checked out preoperatively and recommend out method for the effective correction of unusual bulbous or broad tips.

Total En Bloc Reconstruction of Alar Cartilage with Conchal Cartilage in Seconday Cleft Lip Nasal Deformity

The cleft lip nasal deformity includes not only distorted lower lateral cartilage but generally also an abnormal deficient maxillary bony platform as well as distorted anterior nasal spine and deviated nasal septum. The main defect in the nose is in the position and shape of lower lateral cartilage. There were many literatures for modification of alar cartilage for nasal symmetry in the past several decades, that is, relocation, suture fixation and graft augmentation with deformed alar cartilage itself. But the various corrective techniques were unsatisfactory for both surgeons and patients. The purpose of this article is to present new concepts and surgical techniques. Author's basic concept is total replacement of deformed alar cartilage with new sources of contoured alar cartilage. The grafts were taken from conchal cartilage en bloc. The medial crus, dome, and lateral crus were replaced by the lamina tragi, isthmus and cavum conchae, respectively. The unilateral secondary cleft lip and nose deformity patients were reviewed with charts and photographs from 1991 to 1998. The surgical procedures were open rhinoplasty incision technique with reversed U-incision of nostril web and wide undermining of cartilaginous vault. The total en bloc reconstruction technique has been performed for 125 patients, aged from 5 to 40 years, and they were followed up for 6 months to 8 years. There were no surgical complications and donor site morbidities. There were no relapse and growth disturbance over time. The postoperative results showed symmetry of alar unit, alar dome projection, tip-defining points and nostrils. CONCLUSION: A new technique is described for sensational improvement of the nasal esthetics in secondary cleft lip nasal deformity by using an en bloc autogenous conchal cartilage graft. But further observation is needed for evaluating its effect on the long-term growth potentials.