Effects of a special shaped tip cartilage support structure on alar rim retraction / 中华医学美学美容杂志

Objective:To investigate the clinical effectiveness and significance of special fixing cartilaginous support structure on nasal tip to prevent and correct alar rim retraction.Methods:Special shaped tip extension support structure was composed of two parts of type Ⅲ of septum extension graft (SEG) and two pieces of wedge graft fixed on either side of the cephalic end near the top of support structure. After the alar cartilage vault was fixed to the nasal tip cartilage support structure, the lower lateral cartilage (LLC) cephalic was fixed to both sides of this nasal tip support structure. The LLC received support from the cartilaginous support structure to counter and correct the lower lateral cartilage cephalic retraction. From January 2017 to January 2020, this surgical procedure was used in 34 patients (aged from 20 to 46 years, with mean 32.6 years) with rhinoplasty who had a nasal tip support structure but still had a space between the LLC and the stent intraoperativly. Preoperativly, 4 cases had normal relation of alar columella and alar rim, 18 cases had mild alar rim retraction, and 12 cases had moderate alar rim retraction. The patients were followed up for 6 to 18 months to observe the correction effect and patient satisfaction.Results:Among the 34 patients, 8 patients received alar edge graft, 2 patients received lateral foot support graft, and 2 patients received alar rim graft combined with lateral foot support graft. All patients were followed up for 6-18 months, 30 patients with alar rim retraction were completely corrected, and 4 patients with normal alar and nasal columella relationship did not have alar rim retraction after surgery. No complications such as infection, necrosis, contracture or respiratory dysfunction were found in all patients. 28 cases (82.4%) were very satisfied; 6 cases (17.6%) were satisfied; the satisfactory rate was 100%.Conclusions:The special shaped nasal tip cartilage support structure combined with type Ⅲ SEG and its cephalic wedge grafts could achieve satisfactory clinical results in the prevention and correction of alar rim retraction.

Diagnosis and Treatment of Alar Rim Deformities / 대한이비인후과학회지

Alar rim deformity is one of the most challenging problems to correct in nasal surgery. It is difficult to correct, recurs easily, and needs delicate handling. The technique to correct a hanging alar includes excision a vestibular skin, direct skin excision, and/or excision of the lateral crus. The technique to correct the minimal-to-mild alar retraction includes scar contracture release, alar rim grafts, V-Y advancement flap and composite grafts. In case of severely retracted alar, several techniques such as lateral crural strut graft, alar spreader graft, inter-cartilaginous graft, and island pedicled advancement flap of the nasal dorsum can help to correct the deformities. Alar rotation flap, septal extension graft, alar base surgery, and derotation graft also have some benefit.

A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry

In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim.

MEASUREMENT OF ALAR RIM & NOSTRIL SILL LENGTH IN CLEFT LIP AND PROPOSAL OF OPERATIVE METHODS

Cleft lip and palate is the most common deformity among the facial congenital anomalies. And although many research and studies of operative methods haute been performed, the actual measurement of length of alar flaring have not been reported in cleft lip and palate. For this, authors chose the length of alas rim and nostril sill, which are an objective parameter, to measure the complete and incomplete cleft lip before the remedy and it was proven by a numerical value that compare to the normal part, the length was elongated. Also we found elongation of the cleft side alar rim in which patients had been operated by triangular flap method. We propose two surgical operative methods of the correction of lengthened alar rim; 1 partial resection of the elongated alar rim. 2. conversion of ala into nostril floor (Millard II operation) We conclude that this study is more accurate correction of the nasal deformity by measuring and understanding the length of alar rim in cleft lip and palate patients.