Effectiveness of anterior cruciate ligament reconstruction with personalized femoral locator based on apex of deep cartilage / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral locator based on the apex of deep cartilage (ADC) combined with patient imaging data.@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with primary ACL rupture were selected and randomly divided into study group (ACL reconstruction assisted by personalized femoral locator based on ADC) and control group (ACL reconstruction assisted by intraoperative fluoroscopy and traditional femoral locator), with 20 cases in each group. There was no significant difference in gender, age, body mass index, affected side, cause of injury, and preoperative International Knee Documentation Committee (IKDC) score, Lyshlom score, and Tegner score between the two groups ( P>0.05). IKDC score, Lyshlom score, and Tegner score were used to evaluate the functional recovery of the affected knee before operation and at 3, 6, and 12 months after operation. CT scan and three-dimensional reconstruction were performed before and after operation to measure the horizontal distance from ADC to the anterior cartilage margin (L) and the horizontal distance from ADC to the center of the femoral canal (I), and the anteroposterior position of the bone canal (R) was calculated by I/L; the distance from the center to the distal cartilage margin (D) was measured on the two-dimensional cross section; the R value and D value were compared between the two groups.@*RESULTS@#The operation time of the study group was significantly less than that of the control group [ MD=-6.90 (-8.78, -5.03), P<0.001]. The incisions of the two groups healed by first intention, and no complication such as intra-articular infection, nerve injury, and deep vein thrombosis of lower limbs occurred. There was no significant difference in the R value and D value between the preoperative simulated positioning and the actual intraoperative positioning in the study group [ MD=0.52 (-2.85, 3.88), P=0.758; MD=0.36 (-0.39, 1.11), P=0.351]. There was no significant difference in the actual intraoperative positioning R value and D value between the study group and the control group [ MD=1.01 (-2.57, 4.58), P=0.573; MD=0.24 (-0.34, 0.82), P=0.411]. The patients in both groups were followed up 12-13 months (mean, 12.4 months). The IKDC score, Lysholm score, and Tegner score of the two groups increased gradually with time, and there were significant differences between pre- and post-operation ( P<0.05). There was no significant difference in the scores between the two groups at each time point after operation ( P>0.05).@*CONCLUSION@#The personalized femoral locator based on ADC can accurately assist the femoral tunnel positioning in ACL reconstruction, which can shorten the operation time when compared with traditional surgical methods, and achieve satisfactory early effectiveness.

Three-dimensional kinematic analysis of knee joint after anterior cruciate ligament reconstruction with personalized femoral positioner based on apex of deep cartilage / 中国修复重建外科杂志

OBJECTIVE@#To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC).@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups ( P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients' data was compared to the data of healthy group.@*RESULTS@#In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant ( P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group ( P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation ( P<0.05), while there was no significant difference in the other indicators at other time points ( P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation ( P<0.05), but there was no significant difference of the indicators between the two groups at other time points ( P>0.05).@*CONCLUSION@#Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.

Paramedian forehead flap combined with hinge flap for nasal tip reconstruction

Abstract The paramedian forehead flap is a great option for restoration of complex nasal defects. For full-thickness defects, it may be used alone or in combination with other methods. We present a patient with a basal cell carcinoma on the distal nose treated by Mohs micrographic surgery, and a resulting full-thickness defect repaired with paramedian forehead flap combined with a hinge flap. For optimal results with the paramedian forehead flap, adequate surgical planning, patient orientation and meticulous surgical technique are imperative.

Desenvolvimento e aplicação de um protocolo antropométrico para a avaliação de resultados de otoplastia / Development and implementation of an anthropometric protocol to evaluate results of otoplasty

INTRODUÇÃO: A proeminência dos pavilhões auriculares é a forma mais comum de deformidade desta estrutura, afetando em torno de 5% da população. A maioria dos trabalhos acerca da cirurgia de otoplastia apresenta avaliações subjetivas, não permitindo apreciar acuradamente os resultados no pós-operatório, bem como dificultando a comparação entre técnicas. Propõe-se o desenvolvimento e aplicação de protocolo específico para avaliação dos resultados. MÉTODO: Avaliação prospectiva pelo período de um ano de pacientes submetidos à otoplastia bilateral utilizando técnica baseada em modelagem cartilaginosa com suturas, utilizando medidas da distância hélice-mastoide em pontos padronizados. RESULTADOS: Foram operados 23 pacientes com idade média de 17,8 anos. A incidência de reoperação foi de 21,7% dos pacientes ou 10,7% das orelhas. Houve perda de cerca de 45% da correção obtida no ponto superior e 35% nos pontos médio e inferior nos pacientes não reoperados. CONCLUSÕES: O protocolo foi de fácil utilização e permitiu a avaliação objetiva tanto da deformidade no pré-operatório quanto dos resultados cirúrgicos. A técnica utilizada produziu resultados considerados adequados e comparáveis aos da literatura.

INTRODUCTION: Prominence is the most common deformity of the ear, affecting about 5% of the population. Most reports on otoplasty describe subjective evaluations, and do not provide accurate postoperative assessment or a comparison between techniques. We propose the development and implementation of a specific protocol to evaluate results. METHOD: A prospective evaluation for a period of one year in patients who underwent bilateral otoplasty was performed, using a technique based on modeling of the cartilage with sutures, and helix-to-mastoid distance measurements at standardized points. RESULTS: A total of 23 patients with an average age of 17.8 years underwent surgery. Reoperation was performed in 21.7% of the patients or 10.7% of the ears. Nearly 45% of the correction obtained at the upper point and 35% at the middle and lower points were lost in patients who did not undergo reoperation. CONCLUSIONS: The protocol was easily used and allowed objective evaluation of the preoperative deformity and surgical results. This technique produced results considered adequate and comparable to the literature.

Various Applications of Deep Temporal Fascia in Rhinoplasty

PURPOSE: In Asians, nasal dorsal and tip augmentation procedures are usually performed at the same time, and most dorsal augmentations use implants. In this study, dorsal augmentation was given by various types of grafts using deep temporal fascia (DTF) for primary rhinoplasty cases using only autologous tissues to improve the curve of hump noses and depressions. For secondary rhinoplasty cases, DTF was used to improve implant demarcation and transparency. Such effectiveness and utility of DTF is discussed. MATERIALS AND METHODS: Between May 2009 and May 2012, we performed rhinoplasty using DTF in 175 patients, which included 78 secondary surgery patients and 128 female patients. The mean age of the patients was 31.4. DTF was utilized with various types of grafts without implants to improve the curve in dorsal augmentation of hump noses and cases that required curve betterment. DTF was used to improve implant demarcation and transparency for secondary cases. RESULTS: The mean follow-up duration was 1.5 years. Of the 175 patients, 81% were satisfied with the natural correction achieved, whereas 19% complained of undercorrection, which was resolved with additional surgery. No specific complications such as nasal inflammation or contractures were observed. CONCLUSION: DTF can be used with various graft methods for correction of radix, dorsal, and tip irregularities. It can also be used to correct implant contour transparency in secondary rhinoplasty and thus may be considered as a useful supplementary graft material in rhinoplasty for Asians.

Successful Treatment of Infectious Scleritis by Pseudomonas aeruginosa with Autologous Perichondrium Graft of Conchal Cartilage

Infectious scleritis by Pseudomonas aeruginosa is a well-known vision-threatening disease. In particular, scleral trauma following pterygium surgery may increase the risk of sclera inflammation. Surgical debridement and repair is necessary in patients who do not respond to medical treatments, such as topical and intravenous antibiotics. We reports herein the effectiveness of an autologous perichondrium conchal cartilage graft for infectious scleritis caused by Pseudomonas aeruginosa. This procedure was performed on four eyes of four patients with infectious scleritis who had previously undergone pterygium surgery at Gyeongsang National University Hospital (GNUH), Jinju, Korea from December 2011 to May 2012. Pseudomonas aeruginosa was identified in cultures of necrotic scleral lesion before surgery. The conchal cartilage perichondrium graft was transplanted, and a conjunctival flap was created on the scleral lesion. The autologous perichondrium conchal cartilage graft was successful and visual outcome was stable in all patients, with no reports of graft failure or infection recurrence. In conclusion, autologous perichondrium conchal cartilage graft may be effective in surgical management of Pseudomonal infectious scleritis when non-surgical medical treatment is ineffective. Further studies in larger, diverse populations are warranted to establish the effectiveness of the procedure.

Osteochondral grafting of knee joint using mosaicplasty

Focal cartilage defects of articular surface-traumatic and degenerative are difficult to treat, thus a variety of surgical techniques have been developed and reported for treatment of such defects. Procedures such as Priddies perforations, microfracture, abrasion chondroplasty have shown long-term results which are often less than adequate. One of the reasons is that all these techniques lead to the formation of fibrocartilage which has inferior mechanical properties as compared to the native hyaline cartilage. Mosaicplasty is a procedure which aims at replacing the lost articular cartilage with hyaline cartilage including underlying bone support, thus providing adequate stability to the cartilage and better cartilage/bone integration. A young man underwent this procedure for recalcitrant knee pain at our institution. At 2 years follow-up, his knee pain has significantly improved. We hereby present medium term results [2 years] of this first case report in local literature

Tratamento cirúrgico das lesões osteocondrais do joelho com mosaicoplastia / Surgical treatment of osteochondral lesions of the knee with mosaicplasty

OBJETIVO: Avaliação dos resultados funcionais da técnica de mosaicoplastia em joelhos de pacientes com lesão osteocondral. MÉTODOS: No período de agosto de 1999 a março de 2005, 27 pacientes foram submetidos à mosaicoplastia do joelho. Vinte e um eram do sexo masculino e seis, do feminino. A idade variou de 16 a 64 anos (média de 38,1 anos). Dezessete lesões eram do lado direito e 10, do esquerdo. Em relação à localização da lesão, quatro (15 por cento) situaram-se no côndilo femoral lateral, 18 (66,5 por cento) no côndilo femoral medial e 5 (18,5 por cento) na patela. O tamanho das lesões variou de 1 a 8cm² (média de 2,7cm²). Os pacientes operados foram avaliados no pré e pós-operatórios pela escala funcional de Lysholm, com seguimento médio de 2,5 anos. RESULTADOS: O pré-operatório teve uma média de 62,7 pontos e o pós-operatório uma média de 95,4 pontos. Os pacientes submetidos à mosaicoplastia no côndilo femoral lateral apresentaram, no pré-operatório, a média de pontos de 51,5 pontos e, no pós-operatório, média de 100 pontos. No côndilo femoral medial a média no pré-operatório foi de 64,1 pontos e, no pós-operatório, de 95,4 pontos. Com relação à patela, a média do pré-operatório foi de 66,4 pontos e, do pós-operatório, de 92 pontos. CONCLUSÃO: A mosaicoplastia mostrou-se uma boa alternativa no tratamento das lesões osteocondrais do joelho. Entretanto, apresentou melhor evolução nas lesões dos côndilos femorais em relação às localizadas na patela.

OBJECTIVE: To evaluate the functional results of mosaicplasty in knees of patients with osteochondral lesion. METHODS: Between August 1999 and March 2005, twenty-seven patients were submitted to mosaicplasty on the knee. Twenty-one were male and six female. The patients' ages ranged from 16 to 64 years (average 38.1 years). Seventeen lesions were located on the right knee and ten on the left one. The lesion was located on the lateral condyle in 4 patients (15 percent), on the medial condyle in 18 patients (66.5 percent) and on the patella in 5 patients (18.5 percent). The lesion sizes varied from 1 to 8 cm² (average 2.7 cm²). The patients operated on were evaluated before and after surgery by the functional Lysholm scale, with an average follow-up of 2.5 years. RESULTS: In the preoperative evaluation, the average was 62.7 points, evolving to 95.4 points in the postoperative evaluation. The patients submitted to mosaicplasty in the lateral condyle presented an average of 51.5 points before surgery, evolving to 100 points after surgery. The patients submitted to mosaicplasty in the medial condyle had presented average of 64.1 points before surgery, evolving to 95.4 points after surgery. The patients submitted to mosaicplasty on the patella presented average of 66.4 points before surgery, evolving to 92 points in the postoperative evaluation. CONCLUSION: Mosaicplasty proved to be a good alternative for the treatment of chondral and osteochondral lesions of the knee, showing better evolution in lesions located on the femoral condyles than in lesions located on the patella.

Excisão em elipse da cartilagem lateral superior na rinoplastia para correção do terço médio nasal largo / Elliptic excision of the upper lateral cartilage in the rhinoplasty for correction of the large middle third

Introdução: A redução do dorso nasal largo é um passo crítico na rinoplastia porque trabalha na área da válvula nasal com o desafio de um resultado estético favorável sem dano funcional. Método: Foi utilizado um método modificado de redução da cartilagem lateral superior, através de excisão em elipse, com o objetivo de reduzir a largura do terço médio nasal. A estrutura da válvula nasal interna, a relação das cartilagens laterais superiores (CLS) com o septo nasal e o excesso de CLSs são avaliados. O excesso de CLS é marcado para permitir remoção exata em forma de elipse no sentido longitudinal da cartilagem. A largura da elipse é determinada de acordo com a estrutura e o excesso de cartilagem nasal. CLS é exposta e resseca-se a elipse em sentido horizontal seguindo a projeção lateral da cartilagem, à meia distância da sua largura para não interferir na válvula nasal. A avaliação do tamanho da elipse a ser ressecada deve ser feita de forma meticulosa e cuidadosa para evitar estenose da válvula nasal. Os autores operaram 25 casos durante um período de três anos. Resultados: Em todos os casos os resultados foram satisfatórios. Nenhuma revisão foi necessária. Conclusões: Este método é uma boa alternativa às técnicas tradicionais no dorso largo. Em relação ao terço médio nasal largo, a remoção em elipse das CLSs é uma alternativa útil quando bem-indicada. Cuidado deve ser tomado em indivíduos com comprometimento da válvula nasal interna, que pode ser agravado.

Introduction: The reduction of the large nasal dorsum is a critical step for rhinoplasty because it works in the nasal valve area with the challenge of a favorable aesthetic result without functional damage. Method: We used a modified method of reduction of the upper lateral cartilage, through elliptic excision, aiming to reduce the width of the nasal middle third. The inner nasal valve structure, the relationship of the upper lateral cartilages (ULC) with the nasal septum and the excess of ULC are evaluated. The ULC excess is marked to allow the exact removal in form of ellipsis in the longitudinal direction of the cartilage. The ellipsis width is determined according to the structure and the excess of nasal cartilage. ULC is exposed and the ellipsis is dried in the horizontal direction following the lateral projection of the cartilage, at a half distance of its width to prevent from interfering with the nasal valve. The evaluation of the ellipsis size to be dried must be carried out meticulously and carefully in order to avoid stenosis of the nasal valve. The authors operated 25 cases during a period of three years. Results: In all cases the results were satisfactory. No review was needed. Conclusions: This method is a good choice to the traditional techniques in the large dorsum. As for the nasal large middle third, the elliptic removal of the ULCs is a useful option when well indicated. Care must be taken of individuals with the inner nasal valve commitment, which may be aggravated with such maneuver.

Tratamento primário do nariz fissurado bilateral: uma nova abordagem técnica / Primary treatment of the bilateral cleft nose: a new technical approach

Introdução: O nariz do fissurado bilateral se caracteriza pela presença de columela curta e larga, ponta nasal bífida e mal posicionada, narinas pendentes e pregas vestibulares anormais. No passado, acreditava-se que a columela seria curta pela deficiência de crescimento, porém atualmente se aceita que o encurtamento columelar se deva ao mau posicionamento das alares. O tratamento padrão é alongamento columelar por meio de técnicas com retalhos do lábio ou do nariz, sendo as mais usadas e conhecidas as técnicas de Cronin em V-Y e os retalhos em forquilhas descrito por Millard, o que se mostrou pouco satisfatório a longo prazo, pela presença de narinas muito alargadas, pontas nasais bulbosas e um ângulo nasolabial deficientes, além de cicatrizes na região doadora dos retalhos. Enquanto no nariz unilateral a conduta atual mais aceita é a do reposicionamento das cartilagens alares, primariamente através do descolamento do heminariz fissurado, no nariz bilateral a abordagem primária do nariz é muito discutida, enquanto autores com Mülliken, Trott e Cutting abordam o nariz primariamente no tempo do lábio, outros autores o fazem secundariamente, com ou sem alongamento de columela. Método: Apresentamos uma série de dez pacientes com fissura bilateral, operados em nosso serviço, nos últimos três anos. Os pacientes não tiveram tratamento ortopédico pré-operatório. Resultados: Apresentamos fotos pré e pós-operatórias que mostram a melhora estético-funcional, com o visível melhor posicionamento das cartilagens alares com o crescimento (tempo de acompanhamento médio de dois anos). Nenhum paciente apresentou complicação pós-operatória como infecção ou deiscência. Conclusão: Acreditamos que a melhor conduta para evitar o tratamento da seqüela nasal do fissurado bilateral seja a intervenção cirúrgica precoce, com reposicionamento das cartilagens alares no mesmo tempo do reparo labial.

Introduction: The bilateral cleft noses have some problems that are short and large columela, bifid tip with large nostril and vestibular skin excess. In the pass, believed that the columela was short because of the nasal tip crowing, but now believe that short columela is because of the alar position. The treatment for the short columela is lengthening the columela with flaps from the lip or nose as described for Millard and Cronin, but these techniques always let scars in the donate area and the nostril and the tip still have the same problems. While in the unilateral cleft nose the reposition of the alar cartilage in totally accepted, the bilateral nose repair is not a consensus, while some authors treat the bilateral nose with the lip, like Mülliken, Trott and Cutting others treat it in a second time with columela lengthening. Method: We present our series consisting of ten patients with bilateral cleft lip operated in our service in the last three. Patients had no orthopaedic preoperative treatment. Results: No patients had postoperative complications. Conclusion: In our view, the best way to avoid the bilateral nose defects in to treat the nose in the same time of the lip.

Avaliação do peso de cartilagem desidratada e hidratada / Weight assessment of dehydrated and hydrated cartilage

A cartilagem de banco pode ser utilizada para tratamento cirúrgico do lagoftalmia, reconstrução nasal e auricular, reconstrução do assoalho da órbita e cirurgia do mento. Este trabalho tem como objetivo avaliar o peso da cartilagem desidratada e hidratada e a variação do peso após a implantação de ambas as cartilagens em dorso de ratos. Foram utilizados 10 ratos Norvergicus submetidos a dois implantes de cartilagens conservadas em álcool etílico a 70, obtidas de cadá- veres. Uma cartilagem a ser implantada permaneceu em solução com a álcool 70 e outra, em solução fisiológica (NaCl 0,9), por 24 h antes do procedimento cirúrgico. O peso médio inicial era de 0,5 g e após a hidratação passou a pesar 1,2 g em média. As cartilagens foram então implantadas no dorso dos ratos e após 8 dias retiradas e pesadas novamente para avaliação estatística do ganho de peso.

The cartilage bank can be used for lagoftalmia surgical treatment, nose and ear reconstruction and low jaw surgery. This study has the objective of evaluating the weight of hydrated and dehydrate cartilage and the variation of weight after the implementation of both cartilages on the back of mice. Ten Norvergicus mice were submitted to the implanting of cartilages obtained from corpses and that were kept in alcohol etilic 70. One of the cartilage to be implanted was kept in a solution with alcohol 70 and the other one in SF (NaCl 0,9) for 24h before the surgery procedure. The medium initial weight was 0.5g and after the hydratation it medium weighted 1.2g. The cartilages were then implanted on the back of mice and taken out 8 days later and weighted again for statistic evaluation on weight increase.

Efeitos da ressecçäo parcial da cartilagem do septo nasal no desenvolvimento dos ossos da face de coelhos em crescimento / The effects of partial resections on the nasal septum cartilage in the development of cranial bones in growing rabbits

O presente experimento teve como objetivo estudar os efeitos da ressecção parcial da cartilagem do septo nasal de coelhos em crescimento. Dez coelhos foram submetidos ao trauma operatório, grupo experimento( E ), no 28º dia de idade e a eutanásia ocorreu no 140º dia de idade. Como grupo controle ( C ) foram utilizados 10 coelhos sem trauma no septo nasal. Na avaliação comparou-se as medidas obtidas nos ossos entre os referidos grupos. A análise estatística mostrou haver diferenças estatisticamente significantes quando comparados os grupos E e C.

Plastia Nasal primaria en fisura labio-palatina unilateral / Primary nasal correction in unilateral cleft lip and cleft palate

Las fisuras labio-palatinas unilaterales se presentan siempre asociadas a defectos nasales bien definidos. La plastia nasal primaria, en el momento que se realiza la quiloplastia, se justifica plenamente. No afecta el crecimiento facial, con frecuencia se evita una segunda cirugía y se anula el estigma que marca a estos pacientes

Perfuraçöes X abrasäo do osso subcondral no tratamento das lesöes condrais do joelho por via artroscópica / Perforations X abrasion of subchondral bone in the treatment of chondral lesions of the knee by arthroscopic way

Estudo prospectivo e comparativo entre as técnicas de perfuraçäo do osso subcondral e artroplastia por abrasäo das lesöes condrais do joelho foi realizado de forma aleatória em dois grupos de dez pacientes cada um. Ambas as técnicas foram realizadas por via videoartroscópica, sendo que em sete pacientes o resultado do tratamento inicial foi reavaliado aos seis meses de pós-operatório através de uma segunda artroscopia. O resultado comparativo baseou-se na resposta clínica ao tratamento estabelecido, sendo que o número de resultados insatisfatórios foi igual em ambos os grupos, sem que se pudesse verificar a supremacia de uma técnica sobre a outra

Modified treatment of the alar cartilages in primary rhinoplasty

Traditionally, the treatment of the alar cartilages in primary rhinoplasty consists of resection of the cranial portions of the lateral crura, leaving about 5 mm wide caudal remnants untouched. This approach is very effective and time proven, but in selected patients, in whom tip of the nose needs little (if any) cranial rotation, but must be narrowed, agressive resection of superomedial portions of the lateral crura seems unnecessary. In order to optimize the procedure, the authors suggest a modified treatment of the alar cartilages with conservation of greater portions of the superomedial lateral crura.

Nueva técnica de mioplastia con utilización de musculo temporal y cartilago / A new myoplasty technique using temporal muscle and cartilage

Se analizaron los resultados obtenidos en operaciones realizadas a 2 cadáveres humanos, 14 animales de experimentación y finalmente a una paciente afectada de hemiatrofia facial progresiva. Se determinó que es posible corregir los defectos faciales, especialmente el Síndrome de Parry Romber, utilizando la técnica quirúrgica de la mioplastia temporal combinada con injerto autógeno de cartílago costal, cubierto con pericondrio

Nasal lobule surgery: a simple maneuver for precise resection of part(s) of the lower lateral cartilages through intercartilaginous approach

The bases of the maneuver described are: (a) to draw on the external skin of the nasal lobule the limits of the Lower Lateral Cartilages (LLCs) resections to be done, in order to have at the end symmetrical and enough LLCs for both a good functional and cosmetic result: (b) after convenient exposure of each LLC - by eversion through intercartilaginous approach and elevation of most of the attached vestibular skin - to transfer the landmarks traced on the lobule skin to the vestibular aspest of the cartilage by using a forceps, with the tips 6 mm wide and provided with teeth for grasping together both the external skin of the lobule and the LLC. With these so transferred landmarks the precise resections of part(s) of the LLCs - according to each specific case and the surgeon's choice - will be easy and quickly performed