Manejo del colapso de válvula nasal externa: revisión de la literatura / Management of external nasal valve collapse: literature review

La rinoplastia es una de las cirugías estéticas más realizadas en el mundo y entre las complicaciones más frecuentes está el colapso valvular por la excesiva resección del cartílago alar. La parálisis facial, así como el envejecimiento pueden colapsar la pared lateral en inspiración por disfunción del músculo nasal, al provocar debilitamiento del tejido fibroalveolar de la pared lateral nasal, existiendo también causas genéticas que producen colapso valvular. Actualmente se practican diversas técnicas para mejorar el colapso valvular y ninguna es cien por ciento efectiva, la mayor parte se centran en corregir la propia válvula nasal o el cartílago triangular, lo que indica que se fijan en un solo factor y no en la etiología multifactorial que la produce. Este estudio revisa la evidencia clínica que guía a un diagnóstico correcto y al manejo efectivo de la disfunción de la válvula nasal externa, mediante el uso de diversas técnicas que se emplean actualmente para perfeccionar el colapso valvular nasal.

Rhinoplasty is one of the most frequent cosmetic surgeries in the world and among the most common complications is valve collapse due to excessive resection of the alar cartilage. Facial paralysis, as well as aging, can collapse the lateral wall in inspiration due to dysfunction of the nasal muscle, causing weakening of the fibroalveolar tissue of the nasal lateral wall, and there are also genetic causes that produce valve collapse. Currently, various techniques are practiced to improve valve collapse and none are one hundred percent effective, most of them focus on correcting the nasal valve itself or the triangular cartilage, which indicates that they are fixed on a single factor and not on multifactorial etiology that produces it. This study reviews the clinical evidence that guides a correct diagnosis and effective management of external nasal valve dysfunction, using various techniques that are currently used to improve nasal valve collapse.

Evaluation of postoperative patient satisfaction after covering the nasal dorsum with upper lateral cartilage: "upper lateral closing" / Avaliação da satisfação pós-operatória do paciente após cobertura do dorso nasal com a cartilagem lateral superior: "fechamento lateral superior"

Abstract Introduction: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. Objective: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. Methods: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. Results: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. Conclusion: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.

Resumo Introdução: Após a remoção da giba nasal durante a rinosseptoplastia, a abóbada deve ser reconstruída para evitar problemas funcionais e estéticos. A reconstrução da abóboda entretanto, pode resultar em alargamento dorsal e pode necessitar de um enxerto para camuflar irregularidades dorsais. Objetivo: Avaliar a satisfação dos pacientes com os resultados da reconstrução da abóboda com uma técnica que utiliza a cartilagem lateral superior para recobrir o dorso nasal. Método: Estudo retrospectivo de pacientes submetidos a rinosseptoplastia, que incluiu fechamento do dorso nasal com cartilagem lateral superior, realizado de 1º de dezembro de 2014 a 31 de janeiro de 2016. Foram excluídos aqueles com acompanhamento pós-operatório de menos de 3 meses. O grupo final do estudo incluiu 39 pacientes. O mesmo cirurgião realizou todas as rinosseptoplastias. O dorso foi fechado com uma técnica de "fechamento lateral superior" que aproxima as cartilagens laterais superiores de cada lado sobre o septo. A satisfação pós-operatória dos pacientes foi determinada através de uma escala visual analógica e o questionário Rhinoplasty Outcomes Evaluation. O questionário avalia a satisfação estética e funcional do paciente com o nariz. Escores altos indicam percepção de melhoria estética. Resultados: Não foram observadas irregularidades dorsais na avaliação pós-operatória de seguimento dos pacientes. Em relação à aparência nasal estética, o escore médio da escala visual analógica foi 86% e o escore médio do questionário foi 77,03%. Conclusões: A anatomia natural em forma de domo do dorso nasal foi conseguida através da aproximação das cartilagens laterais superiores entre si. O fechamento do dorso com essa técnica também abrange todas as irregularidades dorsais e resulta em um dorso liso. Os pacientes expressaram satisfação com os aspectos estéticos e funcionais do dorso nasal liso e atraente.

Retalho de cartilagem alar para projeção da ponta nasal / Alar cartilage flap for projection of the nasal tip

Introdução: A ponta nasal é estudada com frequência pelos cirurgiões, visto ser motivo comum de queixa pré e pós-operatória. Dessa forma, a ponta deve ser minuciosamente avaliada para se determinar a melhor técnica a ser utilizada. O objetivo é demonstrar uma técnica original de retalho de cartilagem alar para projeção da ponta nasal, complementar ou não a outros procedimentos de mesmo objetivo. Método: Estudo transversal retrospectivo de 22 pacientes submetidos à rinoplastia aberta com uso do retalho de alar para projetar ponta nasal. Resultados: Foram realizadas 22 rinoplastias abertas, de ponte bulbosa, adiposa e hipoprojetada, sendo todas primárias. Dentre os pacientes do estudo, 90% eram negros e 2% eram brancos, 72,7% apresentaram alto grau de satisfação com a operação, 18,1% consideraram o resultado muito bom e 9,2% acharam regular. Não houve complicações/reoperações. Conclusão: Os retalhos de cartilagens alares para projeção da ponta nasal são um recurso técnico de simples execução e podem ser considerados excelente recurso de projeção adicional da ponta nasal a ser considerado dentre as técnicas para tratamento de narizes negroides.

Introduction: The nasal tip is a frequent object of study by surgeons, since it is a common reason for pre- and postoperative complaints. Thus, the tip should be thoroughly evaluated to determine the best technique to be used. The objective is to demonstrate an original alar cartilage flap technique for projection of the nasal tip, performed alone or in combination with other procedures for the same purpose. Method: A retrospective cross-sectional study of 22 patients submitted to open rhinoplasty with use of the alar flap to project the nasal tip. Results: A total of 22 open rhinoplasties were performed on primary bulbous, fatty, and under-projected tips. Among the patients in the study, 90% were black and 2% were white; 72.7% reported a high degree of satisfaction with the operation, 18.1% considered the result very good, and 9.2% considered the result acceptable. There were no complications/reoperations. Conclusion: The alar cartilage flap for projection of the nasal tip is simple to perform and can be considered an excellent supplemental method for use in treatment of the black nose.

Percepção da redução nasal pela rinoplastia de aumento do radix e da ponta / Perception of nasal reduction by radix and tip augmentation rhinoplasty

Introdução: O dorso reto tem sido sempre um ideal na rinoplastia estética. A simples remoção da giba tem sido o método clássico e mais utilizado, mas pode ter consequências estéticas e funcionais adversas. Ainda existe grande resistência a procedimentos de aumento, porque a maioria dos pacientes solicitam redução e porque os benefícios de melhoria do equilíbrio nasal pelo aumento não são intuitivos. Um nariz aumentado pode parecer menor, o que é um benefício em particular em pacientes com pele espessa ou com o aspecto de terço inferior grande. Por outro lado, a percepção de redução com o aumento do radix e da ponta é muito comum, embora nunca tenha sido medida. Métodos: Esse estudo cria intervenções gráficas e reais para criar um dorso reto por meio do aumento do radix e da ponta e analisa como os pacientes e observadores independentes percebem as modificações. Analisou-se uma amostra de 42 casos consecutivos de rinoplastia. Desses, foram incluídos os que tinham dorso convexo e eram cirurgias primárias, restando 9 casos. Resultados: Houve aumento médio de 6,5% no tamanho do nariz na após a modificação gráfica, enquanto houve percepção de redução do nariz (p = 0,004). Houve aumento médio de 1% após a rinoplastia, enquanto houve percepção de redução. Conclusão: A retificação do dorso nasal pelo aumento do radix e da ponta causa percepção de redução do nariz.

Introduction: A straight bridge has always been the aesthetic ideal. Simple hump removal, the classical and most commonly applied method, can have aesthetic and functional consequences. However, great resistance to augmentation procedures persists because most patients request reduction and the benefits of improving nasal balance are counterintuitive. An augmented nose can look smaller, a particular benefit in patients with thick, inelastic skin or a large lower nose. On the other hand, decreased size perception after raising of the radix and tip is very common but has not been measured to date. Methods: This study created graphic and real interventions to achieve a straight bridge through radix and tip raising and analyzed how patients and independent observers perceive these changes. A sample of 42 sequential rhinoplasty patients was analyzed, including nine cases of primary surgery and dorsal convexity. Results: There was a 6.5% mean augmentation after graphic computing intervention but a perception of size reduction (p = 0.004). There was a 1% mean augmentation after rhinoplasty and an overall size reduction perception. Conclusion: Correction of the nasal dorsum, making a straight bridge through slightly increasing radix and tip, creates the perception of a decreased nose size.

Effectiveness of caudal septal extension graft application in endonasal septoplasty / Eficácia da aplicação de enxerto de extensão septal caudal em septoplastia endonasal

Abstract Introduction Septal deviation is a common disease seen in daily otorhinolaryngology practice and septoplasty is a commonly performed surgical procedure. Caudal septum deviation is also a challenging pathology for ear, nose, and throat specialists. Many techniques are defined for caudal septal deviation. Objective To evaluate the effectiveness of caudal septal extension graft (CSEG) application in patients who underwent endonasal septoplasty for a short and deviated nasal septum. Methods Forty patients with nasal septal deviation, short nasal septum, and weak nasal tip support who underwent endonasal septoplasty with or without CSEG placement between August 2012 and June 2013 were enrolled in this study. Twenty patients underwent endonasal septoplasty with CSEG placement. The rest of the group, who rejected auricular or costal cartilage harvest for CSEG placement, underwent only endonasal septoplasty without any additional intervention. Using the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) questionnaires, pre- and post-operative acoustic rhinometer measurements were evaluated to assess the effect of CESG placement on nasal obstruction. Results In the control group, preoperative and postoperative minimal cross-sectional areas (MCA1) were 0.44 ± 0.10 cm2 and 0.60 ± 0.11 cm2, respectively (p < 0.001). In the study group, pre- and postoperative MCA1 values were 0.45 ± 0.16 cm2 and 0.67 ± 0.16 cm2, respectively (p < 0.01). In the control group, the nasal cavity volume (VOL1) value was 1.71 ± 0.21 mL preoperatively and 1.94 ± 0.17 mL postoperatively (p < 0.001). In the study group, pre- and postoperative VOL1s were 1.72 ± 0.15 mL and 1.97 ± 0.12 mL, respectively (p < 0.001). Statistical analysis of postoperative MCA1 and VOL1 values in the study and the control groups could not detect any significant intergroup difference (p = 0.093 and 0.432, respectively). In the study group, mean nasolabial angles were 78.15 ± 4.26º and 90.70 ± 2.38º, respectively (p < 0.001). Conclusion Endonasal septoplasty with CESG placement is an effective surgical procedure with minimal complication rate for subjects who have a deviated, short nasal septum and weak nasal tip support.

Resumo Introdução Desvio septal é doença comum no cotidiano da prática otorrinolaringológica e a septoplastia é procedimento cirúrgico comum. Desvio caudal do septo nasal é também uma condição desafiadora para os otorrinolaringologistas. São muitas as técnicas definidas para desvio caudal do septo nasal. Objetivo Avaliar a eficácia da aplicação de enxerto de extensão septal caudal (EESC) em pacientes que passaram por septoplastia endonasal devido a septo nasal curto e com desvio. Método Foram recrutados para o estudo 40 pacientes com desvio de septo nasal, septo nasal curto e fraca sustentação da ponta do nariz, tratados com septoplastia endonasal com ou sem a aplicação de EESC, entre agosto de 2012 e junho de 2013. Ao todo, 20 pacientes foram tratados com septoplastia endonasal com aplicação de EESC. O restante do grupo, que rejeitou coleta de cartilagem auricular ou costal para a aplicação de EESC, foi tratado apenas com septoplastia endonasal. Com a aplicação dos questionários Nose (Nasal Obstruction Symptom Evaluation, Avaliação dos Sintomas de Obstrução Nasal) e ROE (Rhinoplasty Outcome Evaluation, Avaliação dos Desfechos da Rinoplastia), as mensurações pré e pós-operatórias com o rinômetro acústico foram obtidas com o objetivo de avaliar o efeito da aplicação de EESC na obstrução nasal. Resultados No grupo controle, as áreas de secção transversal mínima (ASTM1) antes e depois da operação foram 0,44 ± 0,10 cm2 e 0,60 ± 0,11 cm2, respectivamente (p < 0,001). No grupo de estudo, os valores antes e depois da operação para ASTM1 foram 0,45 ± 0,16 cm2 e 0,67 ± 0,16 cm2, respectivamente (p < 0,01). No grupo controle, o valor para os volumes da cavidade nasal (VOL1) foi 1,71 ± 0,21 mL no pré-operatório e 1,94 ± 0,17 mL no pós-operatório (p < 0,001). No grupo de estudo, os VOL1 antes e depois da operação foram 1,72 ± 0,15 mL e 1,97 ± 0,12 mL, respectivamente (p < 0,001). A análise estatística dos valores pós-operatórios para ASTM1 e VOL1 nos grupos de estudo e controle não permitiu a detecção de qualquer diferença intergrupos (p = 0,093 e 0,432, respectivamente). No grupo de estudo e no grupo controle, os ângulos nasolabiais médios foram 78,15 ± 4,26º e 90,70 ± 2,38º, respectivamente (p < 0,001). Conclusão A septoplastia endonasal com aplicação de EESC é um procedimento cirúrgico efetivo, com mínimo percentual de complicações para pacientes que se apresentam com septo nasal curto e com desvio e com fraca sustentação da ponta do nariz.

Avaliação pré e pós-operatória da válvula nasal externa em rinoplastia / Preoperative and postoperative assessment of external nasal valve in rhinoplasty

Introdução: A válvula nasal externa está localizada no rebordo das narinas e é composta por tecidos moles e cartilagem. Caso haja algum desequilíbrio entre estas estruturas, invariavelmente ocorrerá insuficiência desta válvula nasal externa, podendo ser parcial ou total, dependendo do grau das alterações. Avaliou-se a válvula nasal externa no pré e pós-operatório em rinoplastia verificando a eficiência da técnica utilizada. Métodos: Estudo retrospectivo de 34 pacientes operados em hospitais particulares. Foram avaliados o colabamento da asa nasal durante a inspiração profunda e o vetor das cartilagens laterais inferiores. Para estruturação da asa nasal, utilizou-se o enxerto de suporte da cruz lateral e/ou enxerto de contorno alar. Resultados: O vetor não adequado da cartilagem lateral inferior está relacionado com a insuficiência da válvula nasal externa (p = 0,006) e a estruturação da asa nasal, mediante o uso de enxertos, corrigiu esta afecção na maioria dos casos (p = 0,006). Houve diferença na frequência de utilização de enxertos na rinoplastia primária (66%) e secundária (80%). Conclusão: O vetor inadequado das cartilagens laterais inferiores geralmente resultou em uma asa nasal desestruturada, com insuficiência da válvula nasal externa. A estruturação da asa nasal com enxerto de suporte da cruz lateral e/ou enxerto de contorno alar se mostrou eficaz na correção da insuficiência da válvula nasal externa em 90% dos casos, além de conferir proporções e contornos mais belos ao nariz. A frequência de utilização dos enxertos na rinoplastia secundária (80%) foi maior do que na primária (66%) e nos mostrou a necessidade dos enxertos numa cirurgia mais complexa.

Introduction: The external nasal valve is located on the rim of the nostrils and is composed of soft tissues and cartilage. Any imbalance between these structures always leads to external nasal valve insufficiency, which may be partial or total, depending on the degree of alteration. The external nasal valve was evaluated before and after rhinoplasty to assess the efficiency of the technique used. Methods: This is a retrospective study that included 34 patients operated at private hospitals. The collapse of the nasal alae during deep inspiration and the vector of the lower lateral cartilage were evaluated. To provide more structure to the nasal alae, the lateral crural strut graft and/or alar contour graft were used. Results: The inappropriate vector of the lower lateral cartilage is related to the external nasal valve insufficiency (p = 0.006), which was corrected with grafts providing nasal alae remodeling in most of the cases (p = 0.006). A significant difference was observed in the frequency of using grafts in primary (66%) and secondary rhinoplasty (80%). Conclusion: The inappropriate vector of the lower lateral cartilages usually resulted in an unstructured nasal alae, presenting external nasal valve insufficiency. Structuring the nasal alae with a lateral crural strut graft and/or alar contour graft was proven effective to correct external nasal valve insufficiency in 90% of the cases and to provide better aesthetic proportions and nasal contour. The frequency of grafts used in secondary rhinoplasty (80%) was higher than that in primary (66%), which indicates the need for grafts in a more complex surgery.

The Clinical Analysis of the Nasal Septal Cartilage by Measurement Using Computed Tomography

BACKGROUND: The nasal septal cartilage is often used as a donor graft in rhinoplasty operations but can vary widely in size across the patient population. As such, preoperative estimation of the cartilaginous area is important for patient counseling as well as operating planning. We aim to estimate septal cartilage area by using facial computed tomography (CT) studies. METHODS: The study was performed using facial CT images taken from 200 patients between January 2012 to July 2015. Using the mid-sagittal image, the boundary of cartilaginous septum was delineated from soft tissue using the mean difference in signal intensity (or brightness). The area within this boundary was calculated. The calculated area for septal cartilage was then compared across age groups and sexes. RESULTS: Overall, the mean area of nasal septal cartilage was 8.18 cm² with the maximum of 12.42 cm² and the minimum of 4.89 cm². The cartilage areas were measured to be larger in men than in women (p<0.05). The area decreased with advancing age (p<0.05). CONCLUSION: Measuring the size of septal cartilage using brightness difference is more precise and reliable than previously reported methods. This method can be utilized as the standard for prevention of postoperative complication.

Cartilagem fragmentada para aumento do radix nasal Diced cartilage / Diced cartilage graft to increase the nasal radix

Introdução: A principal queixa dos pacientes que procuram as clínicas de cirurgia plástica para serem submetidos a rinoplastia é o dorso nasal. A utilização de enxerto cartilaginoso em radix nasal é rotineira e suas indicações habituais são para diminuir o ângulo nasofacial inadequado ou para redefinir o ponto de transição do radix, para alongamento ou encurtamento do nariz. Este trabalho tem o intuito de apresentar a enxertia de cartilagem do radix nasal, com cartilagem fragmentada e introduzida até o radix com seringa. Método: Foi analisado o ato cirúrgico e seu resultado através da revisão de prontuários dos pacientes submetidos ao ato cirúrgico no período de 1/maio/2011 a 1/maio/2013, totalizando 37 casos. Resultados: Em todos os casos, conseguiu-se o resultado planejado de aumento do radix nasal com sucesso. Não foi observada absorção clinicamente detectável do enxerto. Conclusão: A utilização do enxerto de cartilagem fragmentada realizada da forma descrita neste trabalho mostrou-se eficaz para a elevação do radix nasal.

Introduction: The main complaint of patients visiting plastic surgery clinics for rhinoplasty is the nasal dorsum. Cartilage grafts are routinely used in the nasal radix to reduce inappropriate nasofacial angles or redefine the transition point of the radix and then lengthen or shorten the nose. The aim of this study is to present cartilage nasal radix grafts prepared with diced cartilage and introduced to the radix with the aid of a syringe. Method: We evaluated the surgical procedure and the results obtained by analyzing the medical records of 37 patients who underwent this surgery between May 1, 2011 and May 1, 2013. Results: In all cases, we achieved the expected result of successfully increasing the nasal radix. No graft absorption was clinically detected. Conclusion: The use of a diced cartilage graft as described in this study effectively increased the nasal radix.

Caudal Septal Extension Graft Using Nasal Septal Osteocartilaginous Graft / 대한이비인후과학회지

The septal extension graft from the septum has become a common method of correcting a small or drooping nose in Korea. It can provide superior tip projection and definition if there is a sufficient amount of cartilage and nasal septal stability. In our case, the caudal type septal extension graft was applied unilaterally using septal osteocartilaginous graft harvested in one piece during septoplasty. It was useful in patients who needed septal extension graft in spite of the insufficient amount of available septal cartilage. For those patients, it could be used to achieve the cephalic rotation of drooping tip and the strengthening of septal support effectively. The nasal septal osteocartilaginous graft may serve as an alternative material for conchal cartilage or costal cartilage for caudal septal extension graft if the stable nasal support is maintained and the harvested graft is applied appropriately.

Analysis of the Development of the Nasal Septum and Measurement of the Harvestable Septal Cartilage in Koreans Using Three-Dimensional Facial Bone Computed Tomography Scanning

BACKGROUND: The septal cartilage is the most useful donor site for autologous cartilage graft material in rhinoplasty. For successful nasal surgery, it is necessary to understand the developmental process of the nasal septum and to predict the amount of harvestable septal cartilage before surgery. METHODS: One hundred twenty-three Korean patients who underwent three-dimensional (3D) facial bone computed tomography (CT) were selected for evaluation of the midsagittal view of the nasal septum. Multiple parameters such as the area of each component of the nasal septum and the amount of harvestable septal cartilage were measured using Digimizer software. RESULTS: The area of the total nasal septum showed rapid growth until the teenage years, but thereafter no significant change throughout the lifetime. However, the development of the septal cartilage showed a gradual decline due to ossification changes with aging after puberty in spite of a lack of change in the total septal area. The area of harvestable septal cartilage in young adults was 549.84+/-151.26 mm2 and decreased thereafter with age. CONCLUSIONS: A 3D facial bone CT scan can provide valuable information on the septal cartilage graft before rhinoplasty. Considering the developmental process of the septal cartilage identified in this study, septal surgery should not be performed until puberty due to the risk of nasal growth impairment. Furthermore, in elderly patients who show a decreased cartilage area due to ossification changes, septal cartilage harvesting should be performed carefully due to the risk of saddle nose deformity.

Sutura intercrura lateral no nariz caucasiano: Estruturação e diminuição do ângulo de divergência domal na rinoplastia endonasal sem delivery / Lateral intercrural suture in the caucasian nose: Decreased domal divergence angle in endonasal rhinoplasty without delivery

Introdução: Diversas técnicas podem ser realizadas para melhorar a definição da ponta nasal como ressecção cartilaginosa, colocação de enxertos ou suturas. A realização de suturas na ponta nasal proporciona resultados estéticos satisfatórios com menor morbidade1-5. Objetivo: Avaliar a sutura intercrura lateral realizada na cartilagem lateral inferior, através de rinosseptoplastia endonasal por técnica básica sem delivery, para diminuição do ângulo de divergência domal no nariz caucasiano e consequente melhora na definição da ponta nasal. Método: Realizado estudo prospectivo com 64 casos nos quais foi confeccionada sutura no bordo cefálico da cartilagem lateral inferior na junção entre a cúpula e crus lateral, utilizando-se fio P.D.S. (Polydioxanorie®) incolor 4"0" com agulha curva cortante. Resultado: Foram analisadas e comparadas as fotos do pré - operatório e do pós -operatório com 6 meses de evolução. Em todos os casos foi atingida uma melhora na definição da ponta através da sutura intercrura lateral. Conclusão: A sutura intercrura lateral da cartilagem lateral inferior mostrou ser factível para uma melhor definição da ponta no nariz caucasiano podendo ser realizada por rinoplastia endonasal sem delivery...

Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objective: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose...

Cultivo de células de cartílago nasal humano / Culure of human nasal cartilage cells

La producción de cartílago in vitro por bioingeniería de tejidos tienen un enorme potencial terapéutico. Sin embargo, en Venezuela aún no se ha desarrollado esta tecnología, por tanto en nuestro laboratorio se están desarrollando proyectos dirigidos a conocer aspectos involucrados en la biología de los condrocitos, así como también de los tipos de matrices a utilizar como sustrato para su cultivo. En este trabajo se aislaron condrocitos de cartílago nasal humano obtenidos de cirugías estéticas. Las células cultivadas sobre plástico a altas densidades crecen en monocapa, mostrando una morfología poliédrica característica hasta el segundo pasaje; en subcultivos sucesivos estas células muestran cambios morfológicos observándose células fusiformes, indicando un proceso de desdiferenciación. Cuando las células son incluidas en una matriz de colágeno tipo I la mayoría mantiene su morfología esférica típica y sintetizan componentes de matriz característicos como proteoglicanos y colágeno tipo II, marcadores de estabilidad fenotípica, factor importante para el desarrollo de neotejidos

The in vitro production of cartilage bu tissue bioengineered has an enormous therapeutic potential. However, this technology has not been developed in Venezuela, so, in our laboratory several projects related to biological aspects of chondrocytes and the best matrixial support for their culture are under study. In this work we have isolated chondrocytes from human nasal samples obtained from plastic surgery and culture of cells on plastic dishes at high densities. Initially the cells grew up as a monolayer of poliedric cells, and after the second passage this shape was modified, in successive subcultures there cells show spindle cell morphological changes observed, indicating a dedifferentiation process. When cells are embedded in a matrix of collagen type I most keep their spherical morphology typical characteristic matrix components synthesized as proteoglycans and collagen type II markers, phenotypic stability, an important factor for the development of new tissues

Refinamento da ponta nasal: técnica de sutura minimamente invasiva para a ponta nasal larga / Nasal tip narrowing: minimally invasive suture technique for thick nose tip

INTRODUÇÃO: Técnicas de sutura são métodos indispensáveis para esculpir as cartilagens nasais. Para obter um melhor contorno em pontas nasais largas ou globosas os autores apresentam uma técnica de sutura intercrural controlada e minimamente invasiva e os resultados obtidos em 34 pacientes submetidos a rinoplastia. OBJETIVO: Demonstrar a técnica de sutura intercrural como tratamento para a ponta nasal larga ou globosa em rinoplastia fechada e apresentar os resultados estéticos. MÉTODO: Estudo retrospectivo de documentos clínicos e fotografias de 34 pacientes (5 homens e 29 mulheres), com idade entre 16 e 52 anos, submetidos a rinoplastia com ponta nasal larga ou globosa como elemento anatômico presente no exame físico. Em todos os casos foi utilizada técnica de rinoplastia fechada. Uma sutura inabsorvível é realizada ao longo do processo intermédio. O estudo foi conduzido em 2009 e 2010 no Hospital da Cruz Vermelha Brasileira - Filial do Paraná - Brasil e no Hospital Sugisawa. Os pacientes foram operados pelo autor principal e pelos médicos residentes em treinamento. RESULTADOS: A sutura intercrural controlada proporcionou uma refinamento da ponta nasal e uma melhor forma nos ângulos frontal e lateral da ponta nasal. CONCLUSÃO: A sutura intercrural controlada é um método minimamente invasivo que oferece resultados satisfatórios em refinamento da ponta nasal larga.

INTRODUCTION: Suture techniques are mandatory methods to shape the nasal cartilages. For purposes of achieving a better contour on thick or globose nasal tips, the authors have approached a controlled intercrural and minimally invasive suture technique and the results obtained by submitting 34 patients to rhinoplasty. OBJECTIVE: Illustrate the intercrural suture technique as a treatment for a thick or globose nasal tip under closed rhinoplasty and explain the esthetical results. METHOD: Retrospective study with 34 patients' clinical documents and photographs (5 male and 20 female) aged between 16 and 52, who were submitted to the thick or globose nasal tip rhinoplasty as an anatomic element found in the physical examination. In all the cases, closed rhinoplasty technique was used. A suture that cannot be absorbed is performed throughout the intermediate process. The study was performed at the Brazilian Red Cross Hospital in the State of Paraná and Sugisawa Hospital in 2009 and 2010. Patients were operated on by the main author and the junior doctors under training. RESULTS: The controlled intercrural suture enabled the nasal tip to be narrowed and improved the shape in the frontal and lateral angles of the nasal tip. CONCLUSION: Controlled intercrural suture is a minimally invasive method providing the thick nasal tip narrowing with satisfactory results.

Web Uni-Limb Z-Plasty for Correction of Alar Web Deformity in Unilateral Cleft Lip Nasal Deformities: Photogrammetric Analysis

PURPOSE: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. METHODS: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. RESULTS: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative. CONCLUSION: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

Tripod Framework Rebuilding in Asian Nose: Tip Plasty Using Alar Advancement Technique

In Caucasians, the lateral crural complex is large and long, and the tip plasty is not difficult. In Asians, however, the nasal tissues are insufficient and the nasal tip needs more volume. Therefore, many operators rely on a graft insertion for augmentation effect. Occasionally, if the tip supporting framework is weak, nasal tip drooping is observed by the operators in long period of follow-up. Recently, release and division of tripod structure combined with framework rebuilding has made the correction of various tripod types of tip complexes possible. The main principle of alar advancement technique is that three limbs of the tripod should be properly separated. The nasal tip should be advanced toward upward and forward direction and reinforcement should be done with autologous graft. In other words, scroll ligament, which connects between the alar cartilage and upper lateral cartilage, and nasal hinge complex should be divided freely, inducing the pivot motion and gliding of alar cartilage which leads the V-Y fashioned advancement and projection of alar cartilage. This paper presents an operation method using auricular cartilage after examining the principle of alar advancement in patients who have lack of tip projection, based on my cadaver study and clinical experience.

Report on 220 cases of endoscopic septoplasty with submucous resection / 药物分析学报

Objective To explore the efficiency of endoscopic septoplasty with submucous resection for the treatment of 220 patients with deviated nasal septum and report our experience in this field. Methods From May 2006 to May 2010, 220 patients with deviated nasal septum were treated by endoscopic septoplasty with submucous resection to decompress the stress points, resect the deviated parts and implant the reshaped bone of nasal septum, while retaining the normal structure of nasal septum with minimally invasive technique. Results Satisfactory effects were achieved in all the 220 patients, showing centered septal structure and disappeared symptoms such as nasal obstruction, headache and nasal hemorrhage, but no complications including perforation of nasal septum, depressed nasal bridge and septal chalasia and flaring. Conclusion Rhino-endoscopic septoplasty with submucous resection can substantially retain the original structure of nasal septum and thus is proven to be a desirable operation with multiple advantages including minimal invasiveness, quicker healing and fewer complications.

Report on 220 cases of endoscopic septoplasty with submucous resection / 西安交通大学学报·英文版

Objective: To explore the efficiency of endoscopic septoplasty with submucous resection for the treatment of 220 patients with deviated nasal septum and report our experience in this field. Methods: From May 2006 to May 2010, 220 patients with deviated nasal septum were treated by endoscopic septoplasty with submucous resection to decompress the stress points, resect the deviated parts and implant the reshaped bone of nasal septum, while retaining the normal structure of nasal septum with minimally invasive technique. Results: Satisfactory effects were achieved in all the 220 patients, showing centered septal structure and disappeared symptoms such as nasal obstruction, headache and nasal hemorrhage, but no complications including perforation of nasal septum, depressed nasal bridge and septal chalasia and flaring. Conclusion: Rhino-endoscopic septoplasty with submucous resection can substantially retain the original structure of nasal septum and thus is proven to be a desirable operation with multiple advantages including minimal invasiveness, quicker healing and fewer complications.

Morphologic Analysis of the Deviated Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The nasal septum, centrally located in the nasal cavity, has dynamic relations with other craniofacial structures and is also influenced by them during development. Moreover, the mosaic structure of the septum is constituted through ossification. The purpose of this study was to evaluate the anatomical characteristics of the deviated nasal septum with preoperative computed tomography (CT) and calculations during surgery. SUBJECTS AND METHOD: We studied 62 patients with nasal septal deviation on one side, who underwent septoplasty between July 2008 and February 2009. The area of the septal cartilage, vomer, and perpendicular plate of the ethmoid bone was calculated with sagittal imaging using preoperative CT. The angle of deviation was also measured with coronal imaging. The length between the anterior nasal spine and sphenoidal sinus and that of the sphenoidal process was measured during surgery. RESULTS: The deviation angle increased significantly with the length of the sphenoidal process (p<0.01). The area of the septal cartilage decreased with age due to the progression of ossification. CONCLUSION: Nasal septal deviation without a history of trauma is influenced by the progression of nasal septal ossification.

Complete Septal Extension Graft using Porous High-Density Polyethylene Sheet or Septal Cartilage in Unilateral Cleft Lip Nasal Deformities: Photogrammetric Analysis

PURPOSE: Complete septal extension grafts have been widely used in rhinoplasty for effective projection of the short retruded columella in Asian patients. Autologous septal cartilages and porous high-density polyethylene sheets are frequently used as septal extension grafts. This study was conducted to compare the postoperative results of porous polyethylene sheets and septal cartilages used for correction of unilateral cleft lip nasal deformities by using photogrammetric analysis. METHODS: This study investigated a total of 49 patients with cleft lip nasal deformities who underwent corrective surgery, and were followed up for at least 6 months. Septal cartilages were used in 39 patients, and porous polyethylene sheets were used in 10 patients. In all patients, through the open rhinoplasty, complete septal extension grafts were sutured to the caudal margin of the septal cartilage, and the alar cartilage was sutured with suspension. The cleft side alar cartilage was overcorrected by approximately 3 - 5 mm. Postoperative outcomes were evaluated by using photogrammetric analysis. Five indices and 4 angles were measured on their photographs taken before and after the surgery. In patients with unilateral cleft lip nasal deformities, symmetry was also evaluated by means of columellar length index. RESULTS: The postoperative values obtained in photogrammetric analysis showed improvements in comparison with the preoperative ones. The polyethylene group produced more improved outcomes than the septal cartilage group but also resulted in more complications at the same time. CONCLUSION: The results of this study indicates that complete septal extension grafts are efficient for the correction of unilateral cleft lip nasal deformities. However, since postoperative complications occur more frequently in the polyethylene group than in the septal cartilage group, caution is advised in using porous high-density polyethylene sheets in patients with cleft lip nasal deformities.