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1.
Rev. argent. cir. plást ; 30(2): 121-129, 20240000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1566971

ABSTRACT

El propósito es presentar una técnica de rinoplastia sin precedentes: la TRICK-TIP (transcolumellar and inter cartilaginous keystoning with tip preservation) usada por 14 años Métodos. La cirugía es indicada en casos estéticos primarios y secundarios y también en reconstructivos como nariz hendida y secuelas de trauma. Una incisión nasal intercartilaginosa se continúa con una vertical en el septum membranoso y se "abre" con una incisión baja en escalera en la parte inferior de la columela, una combinación de elementos de las técnicas abierta y cerrada. La punta nasal se eleva como un colgajo que incluye los alares y la piel vestibular debajo de ellos. El abordaje es muy amplio para realizar todas las maniobras quirúrgicas para septum y dorso, mientras que la punta nasal se preserva anatómicamente y se modifi ca desde abajo por resección cefálica retrógrada de alares, aplicación de poste intercrural fi jado primero arriba y puntos para cierre de espacios muertos en el supra tip, el cierre de las incisiones es sencillo y completo, dos tercios de los casos se realiza resección de alas sin diferimiento. Resultados. Los resultados evaluados por 120 pacientes usando Face Q™, y por 102 evaluadores externos son muy satisfactorios, las complicaciones son bajas y las revisiones infrecuentes. No se presentaron deformidades de triángulos blandos ni de los rebordes de las narinas. De manera subjetiva el autor considera más rápida, barata y fácil esta cirugía mientras que da resultados satisfactorios. Discusión. La TRICK-TIP, una técnica original, convierte la rinoplastia cerrada en una con amplia visibilidad mientras preserva la anatomía de la punta. Su exposición extensa y rapidez permite realizar cambios estructurales complejos en el septum, dorso y vertientes nasales, mientras que maniobras indirectas permiten preservar las uniones interdomales, y proyectar la punta reduciendo espacios muertos. Conclusión. La técnica TRICK-TIP se ha convertido en la preferida del autor debido a su versatilidad y buenos resultados. Ofrece una combinación única de ventajas de los enfoques abiertos y cerrados, con énfasis en la preservación de la punta y la simplifi cación del procedimiento.


The aim is to present an unprecedented rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), which has been used for 14 years. Methods:The Surgery is indicated for primary and secondary aesthetic cases, as well as reconstructive such as cleft nose and post-traumatic sequelae. An intercartilaginous endonasal incision is continued with a vertical incision in the membranous septum. It is "opened" with a stair-step incision in the lower part of the columella, combining elements of both open and closed rhinoplasties. The nasal tip is elevated as a composed fl ap that includes the alar cartilages and the vestibular skin beneath them. The approach is extensive to perform all surgical maneuvers for the septum and dorsum while anatomically preserving and modifying the nasal tip from below by retrograde cephalic resection of the alar cartilages, application of an intercrural strut fi xed fi rst superiorly, and closure points for dead spaces in the supratip. The closure of incisions is simple and complete, with two-thirds of cases undergoing alar resection without deferral. Results: The results evaluated by 120 patients using Face Q™ and by 102 external evaluators are highly satisfactory, with low complications and infrequent revisions. Soft triangle deformities or nasal rim deformities were not observed. Subjectively, the author considers this surgery to be faster, cheaper, and easier, yielding satisfactory results. Discussion: The TRICK-TIP, an original technique, transforms closed rhinoplasty into one with extensive visibility while preserving the anatomy of the nasal tip. Its extensive exposure and reduced surgical time allow for complex structural changes in the septum, dorsum, and nasal sidewalls, while indirect maneuvers preserve interdomal junctions and project the tip, reducing dead spaces. Conclusion: The TRICK-TIP technique has become the author's preferred method due to its versatility and good outcomes. It off ers a unique combination of advantages from both open and closed approaches, emphasizing tip preservation and procedural simplifi cation.


Subject(s)
Humans , Female , Rhinoplasty/methods , Plastic Surgery Procedures/methods , Nose/anatomy & histology
2.
Rev. argent. cir. plást ; 30(1): 85-89, 20240000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1551535

ABSTRACT

La rinoplastia es una de las intervenciones más comunes en cirugía plástica. Se opera aquí una rinoplastia secundaria por vía abierta injertando los alares y la punta con cartílagos auriculares, mientras el tabique cartilaginoso fue usado para los spreader grafts. Se describe aquí una infección posoperatoria de su punta nasal. Al 9no día de su posoperatorio comienza con la punta nasal congestiva y levemente inflamada. Se medica con una crema con antibióticos, pero el día 14 aparece con la punta nasal muy inflamada y con colección. Cuando en el consultorio el cirujano la ve, como cualquier absceso, decide realizarle drenaje con un trocar 18G, 3 miniincisiones en la piel debajo de la punta nasal, de la que drena un líquido amarronado. Luego con el mismo trocar se realiza un lavado dentro de la cavidad con rifampicina solución. Se medica con trimetoprima-sulfametoxazol (Bactrimforte®) 2 comp/día. Al otro día se observa una notable mejoría. Se continuó con lavado diario durante 4 días con el mismo antibiótico evolucionando rápidamente bien. El Bactrim se lo continúa por 20 días. Al mes la punta nasal está muy bien, deshinchada con cicatrices apenas visibles. A los cuatro meses, la punta está muy blanda, las alas nasales y las narinas normales, la punta con buena proyección igual que el dorso con los spreader graft.


Rhinoplasty is one of the most common interventions in plastic surgery. A secondary open rhinoplasty was carried out grafting the allae and the tip of the nose with conchae cartilage, while the septum was used for spreader grafts. We are here describing this post operatory with a tip of the nose infection.In the control, at the 9th postoperative day, the nasal tip began to be congested and at the 14th post op day the patient showed a clear inflammatory collection. In the office, the surgeon decided to evacuate it with three punctureslike little incisions at the inferior part of the skin tip with a trocar 18G. Through them, drained brownish purulent secretion. With the same trocar, rifampicin solution was injected through these little incisions, like washing the subdermal area. It was medicated with trimethoprim-sulfamethoxazole (Bactrim forte®) 2 tablets/day. The following day, there was a clear improvement in the congestion and erythema of the nose. This procedure of washing was repeated for four days. There was a quick evolution of the inflammatory process and 20 more days, there was no sign of the infection. Four months later, the tip of the nose was soft and the result was considered optimal by the patient and doctors.


Subject(s)
Humans , Female , Adult , Postoperative Complications/therapy , Rhinoplasty/methods , Transplants/surgery , Infections/therapy
3.
Int. j. morphol ; 41(6): 1897-1905, dic. 2023. ilus, tab
Article in English | LILACS | ID: biblio-1528810

ABSTRACT

SUMMARY: Orthognathic surgery and rhinoplasty show synergy in terms of function and aesthetic results. The aim of this research is to analyze variables related to simultaneous orthognathic surgery and rhinoplasty and to discuss the surgical sequence. Male and female subjects between 18 and 45 years old were included in this research. Diagnosis related to nasal morphology (nasal tip bifid, rotate, square and others as well as the alae morphology and columella), facial deformity (sagittal and vertical deformity), type of surgery (rhinoplasty techniques and orthognathic techniques) and complications were included. The minimum follow-up was 12 months; Chi- Square and t test were used to define correlations, considering a value of p<0.05 for statistical significance. Class III facial deformity was observed in 40 % of subjects and class II facial deformity was present in 43 %. For the nasal deformities, the tip and nasal bridge were most prevalent; primary nasal deformity was observed in the 83 % of subjects and was significant more than secondary nasal deformity (p=0.042). Bimaxillary surgery was performed in 31 cases (88 %). In 10 cases a change of the original plan for rhinoplasty due to previous maxillary surgery was realized, mainly in class III facial deformity, with no statistical differences. Revision rhinoplasty was realized in 5 cases (14 %) and was not related to surgical variables; revision for orthognathic surgery was not necessary in this series. Rhinoplasty and orthognathic surgery simultaneously show low complications and predictable results. We can conclude that maxillary mandibular osteotomies and rhinoplasty could be performed safely. However, larger studies are necessary to understand the best choice and variables involved in simultaneous procedures and soft tissue response.


La cirugía ortognática y la rinoplastia muestran sinergia en términos de resultados funcionales y estéticos. EL objetivo de esta investigación es analizar variables relacionadas con la cirugía ortognática y rinoplastia ejecutada de forma simultanea. Fueron incluidos hombres y mujeres entre 18 y 45 años de edad. EL diagnóstico fue en base a la morfología nasal (punta bífida, rotada, cuadrada u otras así como alteraciones del ala nasal y columela), deformidad facial (deformidad sagital y vertical), tipo de cirugía (técnica de rinoplastia y cirugía ortognática) y complicaciones asociadas. El seguimiento mínimo fue de 12 meses; se utilizo las prueba t test y chi cuadrado para definir relaciones estadísticas considerando un valor de p< 0,05 para obtener diferencias significativas. La deformidad clase III fue observada en el 40 % de los sujetos y la deformidad facial de clase II se presento en el 43 %. Para la deformidad nasal, las alteraciones de a punta nasal y nasal fueron mas prevalentes; la deformidad nasal primaria se presentó en el 83 % de los sujetos y fue significativamente mayor que la deformidad nasal secundaria (p=0,042). La cirugía bimaxilar se realizó en 31 casos (88 %); en 10 casos se realizó el cambio del plan quirúrgico inicial de la rinoplastia debido a cambios generados en la cirugía maxilar previa, mayormente en deformidad facial de clase III, sin presentar diferencias significativas. La rinoplastia de revisión fue realizada en 5 casos (14 %) y no fue relacionada con ninguna variable de tipo quirúrgica; la revisión de cirugía ortognática no fue realizada en ningún caso de esta serie. La rinoplastia y la cirugía ortognática simultanea mostraron bajas complicaciones y resultados predecibles. Se puede concluir que la osteotomía maxilo mandibular y la rinoplastia son seguras; sin embargo, estudios de mayor volumen son necesarios para entender la mejor opción y variables relacionadas con procedimientos simultáneos y la respuesta de tejidos blandos faciales.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Rhinoplasty/methods , Face/surgery , Orthognathic Surgical Procedures/methods , Chi-Square Distribution , Nose Diseases/surgery , Follow-Up Studies , Facial Asymmetry/surgery
4.
Rev. otorrinolaringol. cir. cabeza cuello ; 83(4): 432-439, dic. 2023. ilus
Article in Spanish | LILACS | ID: biblio-1560345

ABSTRACT

La cirugía de remodelación o reducción de la base alar, también conocida como aloplastía o alotomía, es un procedimiento orientado a modificar el ancho, la forma de las narinas y la base de la nariz. El objetivo de esta revisión es describir las indicaciones generales de una alotomía, sus consideraciones anatómicas y las técnicas quirúrgicas más frecuentemente utilizadas.


Alar base remodeling or reduction surgery, also known as alloplasty or allotomy, is a procedure aimed at modifying the width and shape of the nostrils and the base of the nose. The objective of this review is to describe the general indications for an allotomy, its anatomical considerations, and the most frequently used surgical techniques.


Subject(s)
Humans , Rhinoplasty/methods , Nose/surgery , Nasal Cartilages/surgery
5.
Rev. argent. cir. plást ; 29(1): 19-23, 20230000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1428468

ABSTRACT

La estética de la superficie de la nariz y especialmente de la punta nasal se crea mediante ciertas líneas, sombras y reflejos, con proporciones y puntos de ruptura específicos. La evaluación de la estética de la superficie nasal se logra utilizando el concepto de polígonos geométricos como subunidades estéticas, tanto para definir la deformidad existente como los objetivos estéticos. Los principios de los polígonos geométricos permiten al cirujano analizar las deformidades de la nariz, definir un plan operatorio para lograr objetivos específicos y seleccionar la técnica operatoria adecuada


The aesthetics of the surface of the nose and specially of the nasal tip is created through certain lines, shadows and reflections with proportions and specific breaking points. The evaluation of the aesthetics of the nasal surface is achieved using the concept of geometric polygons like aesthetics subunits to define the existing deformity as for the aesthetics objectives. The principles of the geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operating plan to achieve specific objectives and to select the most accurate operating technique


Subject(s)
Humans , Male , Female , Rhinoplasty/methods , Nose/surgery , Esthetics
6.
Article in English | WPRIM | ID: wpr-1007923

ABSTRACT

OBJECTIVES@#This study aimed to explore the relationship between alveolar cleft and secondary nasal deformity post unilateral cleft lip repair in adults.@*METHODS@#A total of 27 patients aged 16-30 years old with unilateral secondary nasal deformity and alveolar cleft were included, 13 of whom underwent bone grafting. Spiral CT data of all preoperative and postoperative patients who had alveolar bone grafting were collected. Then, Mimics software was used for three-dimensional reconstruction to evaluate the correlation between the width, height, and volume of the alveolar cleft and those of the nasal deformity. The difference in nasal deformity before and after alveolar bone grafting was also explored.@*RESULTS@#The width of the alveolar cleft was positively correlated with the difference in bilateral nostril floor width (P<0.05). As the effective depth of the alveolar cleft increased, the sub-alare inclination angle largened (P<0.05). However, no significant difference was found in the nasal deformity between before and after alveolar bone grafting.@*CONCLUSIONS@#Alveolar cleft is closely related to secondary nasal deformities post unilateral cleft lip repair, especially nasal floor deformities. Alveolar bone grafting benefits adult patients for the improvement of secondary nasal deformities post unilateral cleft lip repair.


Subject(s)
Humans , Adult , Adolescent , Young Adult , Nose/surgery , Cleft Lip/surgery , Rhinoplasty/methods , Imaging, Three-Dimensional , Treatment Outcome , Cleft Palate/complications
7.
Article in English | WPRIM | ID: wpr-1007939

ABSTRACT

OBJECTIVES@#The long-term effect of muscular force balance reconstruction technique combined with intranasal fixation for correcting secondary nasolabial deformity after unilateral cleft lip was evaluated. The aim was to provide a basis for further improving the surgical treatment effect of secondary nasolabial deformity of acleft lip.@*METHODS@#A total of 40 patients aged 4-28 years with secondary nasal deformity and unilateral cleft lip were selected as research subjects. The two-dimensional photo measurement analysis method was used in comparing the surgical results before and immediately after the operation (7 d) and 1 year after the operation.@*RESULTS@#Columellar angle, nostril height ratio (NHR), alar rim angle, alar rim angle ratio, and nostril shape (NS) increased dimmediately after the operation, whereas alar base width ratio (ABWR) and nostril width ratio decreased (NHR) immediately after the operation (P<0.01). The ABWR, NHR, and NS immediately after the operation were not significantly different from those 1 year after the operation (P>0.05).@*CONCLUSIONS@#Muscular force balance reconstruction technique combined with intranasal fixation is effective in the repair of unilateral secondary nasolabial deformity, and stable results can be obtained 1 year after surgery.


Subject(s)
Humans , Cleft Lip/surgery , Nose/abnormalities , Rhinoplasty/methods , Treatment Outcome
8.
Rev. otorrinolaringol. cir. cabeza cuello ; 83(3): 236-243, 2023. ilus, tab
Article in Spanish | LILACS | ID: biblio-1522099

ABSTRACT

Introducción: El cuidado postoperatorio de la rinoplastia ha evolucionado, paralelamente, al desarrollo de la técnica quirúrgica. Existen varias recomendaciones, sin embargo, hay una gran variabilidad interprofesional de las indicaciones post quirúrgicas. Objetivo: Realizar una revisión sistemática de la literatura científica sobre los cuidados post operatorios de la rinoplastia. Material y Método: Para la realización de este estudio se llevaron a cabo búsquedas en PubMed y en Cochrane Database of Systematic Reviews con los perfiles: ([rhinoplasty] AND [post operative care]) y ([rhinoplasty] AND [post surgical care]). Se seleccionaron los artículos publicados en los últimos 10 años, desde 2013 hasta 2023, ambos inclusive. Resultados: Los documentos analizados recogen la evidencia de los diferentes métodos de cuidados post quirúrgicos en rinoplastia. Estos confirman la utilización de corticoides en el período postoperatorio, así como el reposo en 90° y exponen la variabilidad interprofesional que existe en el protocolo postquirúrgico de esta cirugía. Conclusión: El uso de corticoides y el reposo en 90° disminuyen las complicaciones postquirúrgicas de la rinoplastia. Debe existir una clara información sobre lo que el paciente debe esperar post cirugía. El uso de opioides debe ser restringido y la analgesia debe ser multimodal. Es preciso realizar estudios futuros con mayor nivel de evidencia y tener protocolos uniformes para la práctica clínica.


Introduction: The postoperative care of rhinoplasty has evolved along with the development of the surgical technique. There are several recommendations, however there is enormous interprofessional variability of post-surgical indications. Aim: To carry out a systematic review of the scientific literature on rhinoplasty postoperative care. Material and Method: To carry out this study, searches were carried out in PubMed and in the Cochrane Database of Systematic Reviews with the profiles: ([rhinoplasty] AND [post operative care]) and ([rhinoplasty] AND [post surgical care]). Articles published in the last 10 years were selected, from 2013 to 2023, both inclusive. Results: The documents analyzed collect the evidence of the different methods of post-surgical care in rhinoplasty, they confirm the use of corticosteroids in the postoperative period as well as rest at 90° and expose the interprofessional variability that exists in the post-surgical protocol of this surgery. Conclusion: The use of corticosteroids and rest at 90° reduce the post-surgical complications of rhinoplasty. There must be clear information about what the patient should expect post surgery. The use of opioids must be restricted and analgesia must be multimodal. It is necessary to carry out future studies with a higher level of evidence and have uniform protocols for clinical practice.


Subject(s)
Humans , Pain, Postoperative/drug therapy , Rhinoplasty/methods , Arnica , Glucocorticoids/therapeutic use , Postoperative Period , Outcome Assessment, Health Care , Pregabalin/therapeutic use , Analgesics/therapeutic use
9.
Article in Spanish | LILACS | ID: biblio-1522105

ABSTRACT

Las características anatómicas de pacientes con nariz mestiza, generalmente, incluyen una nariz aparentemente grande, un dorso convexo con radix bajo y una base nasal ancha. La longitud de la columela y punta nasal se ve disminuida debido a que los cartílagos alares son cortos, débiles y delgados, proporcionando un soporte estructural insuficiente, mala definición y proyección de la punta nasal. La principal dificultad al manejar este tipo de narices es un marco osteocartilaginoso mal estructurado y débil. En los últimos años se han desarrollado técnicas quirúrgicas para mejorar los resultados estéticos y funcionales de la rinoplastía en estos pacientes. Se realizó una revisión exhaustiva de la literatura describiendo las técnicas quirúrgicas utilizadas en este tipo de nariz.


The anatomical characteristics of patients with mestizo nose usually include an apparently large nose, a convex dorsum with a deep radix, and a wide nasal base. The length of the nasal columella and tip is decreased because the alar cartilages are short, weak and thin, providing insufficient structural support, poor definition and nasal tip projection. The main difficulty in managing this type of noses is a poorly structured and weak osteocartilaginous framework. In recent years, surgical techniques have been developed to improve the aesthetic and functional results of rhinoplasty in these patients. A comprehensive literature review was conducted describing the surgical techniques used in this type of nose.


Subject(s)
Humans , Rhinoplasty/methods , Nose/anatomy & histology , Ethnicity , Suture Techniques
10.
Rev. otorrinolaringol. cir. cabeza cuello ; 82(4): 435-442, dic. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1431932

ABSTRACT

Introducción: La desviación de la punta nasal suele producir alteración estética y funcional nasal. Generalmente, asocia alteraciones morfológicas de los cartílagos alares, además de dismorfia del cartílago septal. Objetivo: Presentar una técnica quirúrgica alternativa para el tratamiento de la laterorrinia en tercio inferior nasal y sus resultados. Material y Método: Se trataron 27 pacientes con una laterorrinia en punta nasal con la técnica del septum bisagra, incluyendo la colocación de uno o dos injertos de expansión. Describimos el protocolo de anamnesis y exploración que seguimos en estos pacientes y la descripción detallada de la técnica quirúrgica. Resultados: En 19 pacientes se utilizó un injerto de expansión unilateral para completar la técnica y en ocho de forma bilateral. Se obtuvo una puntuación media en la escala visual analógica (EVA) de ventilación de 8,3, con una mejoría de seis puntos, y en la EVA de aspecto estético de 8,1, mejorando en 4,6 puntos. Conclusión: la utilización de la técnica del septum bisagra es beneficiosa para el tratamiento de la desviación de la punta nasal, tanto a nivel funcional como estético. Presenta ciertas diferencias frente a otras técnicas descritas. La indicación se debe adecuar a cada paciente de manera individualizada.


Introduction: Deviation of nasal tip usually produces aesthetic disturbance and nasal ventilation decrease. It is usually associated with alar cartilages morphologic disturbances and dysmorphia of the septal cartilage. Aim: To present an alternative surgical technique for treating laterorrhinia in the nasal inferior third and its outcomes. Material and Method: 27 patients with nasal tip laterorrhinia were treated with the hinge septum technique, including the placement of one or two spreader grafts. We describe the anamnesis and exploration protocol that we carried out in these patients and a detailed description of the surgical procedure. Results: Unilateral spreader graft was used in 19 patients to complete the technique, and bilateral spreader graft was used in eight. The average score in visual analogue scale (VAS) related to nasal flow was 8.3, which means an improvement of six points, and in VAS related to aesthetic appearance the score was 8.1, improving 4.6 points. Conclusion: The use of the hinge septum technique is useful to treat the deviation of the nasal tip in a functional and aesthetic way. There are several differences compared to other described techniques. The indication has to be suitable for each patient individually.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Rhinoplasty/methods , Nose/surgery , Nasal Septum/surgery , Nasal Obstruction , Nose/abnormalities , Retrospective Studies , Nasal Septum/abnormalities
11.
Rev. cuba. cir ; 61(3)sept. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1441509

ABSTRACT

Introducción: La deformidad nasal asociada con el labio leporino ha sido vista como uno de los problemas reconstructivos más desafiantes en la rinoplastia, hasta el momento no se ha acordado ningún método único para cuantificar el éxito del tratamiento. En el año 2006 se aprobó oficialmente el protocolo para el tratamiento de las deformidades nasales complejas del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", que están incluidas, las deformidades nasales congénitas secundarias en el adulto, no se recogen antecedentes de resultados en este grupo de pacientes basados en mediciones objetivas. Objetivo: Evaluar los resultados estéticos de la rinoplastia secundaria en pacientes con fisura labiopalatina. Métodos: Se realizó un estudio analítico a través de mediciones nasales angulares y de áreas, comparadas en fotografías estandarizadas entre el pre y posoperatorio y se determinó el índice de asimetría según la fórmula de Nakamura. Un panel de expertos usó la escala de Asher McDade y realizó la evaluación subjetiva de las imágenes, que permitió calcular el índice estético antes y después del tratamiento. Resultados: Se obtuvo una reducción marcada de todos los índices de asimetría nasal entre el pre y posoperatorio, así como una mejoría del índice estético posoperatorio pasándose de una apariencia pobre a muy buena apariencia. Conclusiones: Con la aplicación del protocolo para el tratamiento de las deformidades nasales del paciente fisurado adulto del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" se obtienen buenos resultados estéticos(AU)


Introduction: Nasal deformity associated with cleft lip has been seen as one of the most challenging reconstructive problems in rhinoplasty; up to date, no single method has been agreed upon to quantify management success. In 2006, the protocol for managing complex nasal deformities was officially approved by Hermanos Ameijeiras Clinical Surgical Hospital, which includes secondary congenital nasal deformities in adults; however, there is no history of outcomes in this group of patients based on objective measurements. Objective: To assess the aesthetic outcomes of secondary rhinoplasty in patients with cleft lip and palate. Methods: An analytical study was carried out through linear and angular nasal measurements, compared in standardized photographs between the pre- and postoperative period; while the asymmetry index was determined according to Nakamura's formula. A panel of experts used the Asher McDade scale and performed the subjective assessment of the images, which allowed calculation of the esthetic index before and after the procedure. Results: A marked reduction was obtained in all nasal asymmetry indexes between the pre- and postoperative periods; as well as an improvement in the postoperative aesthetic index, from a poor appearance to a very good appearance. Conclusions: With the application of the protocol for managing nasal deformities of the adult cleft patient of Hermanos Ameijeiras Clinical Surgical Hospital, good esthetic outcomes are obtained(AU)


Subject(s)
Humans , Rhinoplasty/methods , Nose/abnormalities , Cleft Lip , Plastic Surgery Procedures/methods
12.
Rev. cuba. cir ; 61(2)jun. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1408243

ABSTRACT

Introducción: La reducción del ancho y definición de la punta nasal es uno de los objetivos principales de la rinoplastia estética. La vía endonasal, con incisión transcartilaginosa, se emplea principalmente cuando no hay alteraciones significativas en la estructura cartilaginosa de la punta nasal. Objetivo: Determinar los cambios morfológicos que se producen en la punta nasal, posterior a la rinoplastia transcartilaginosa. Métodos: Se realizó un estudio descriptivo, prospectivo, longitudinal en 15 pacientes con deformidad estética de la punta nasal, operados por rinoplastia transcartilaginosa en el Hospital "Hermanos Ameijeiras", entre el 2016 y el 2020. Las variables estudiadas fueron: ángulo nasolabial, ancho de la punta nasal, porciento de reducción del ancho de la punta nasal, relación longitud nasal-proyección de la punta nasal y estado de satisfacción de los pacientes. Resultados: Se produjo un estrechamiento de la punta nasal, de una media del ancho preoperatorio de 64,8 por ciento con relación a la base nasal, a una media del 60,1 por ciento para el posoperatorio, para una media del porciento de reducción del ancho de la punta nasal posoperatoria de 7,3 por ciento. En el resto de las variables estudiadas, aun cuando existieron cambios individuales, como grupo no hubo variación respecto al predominio de las categorías ideales. Conclusiones: Se produjeron modificaciones posoperatorias que tributaron en un refinamiento de la punta nasal, con un alto grado de satisfacción de los pacientes operados. Palabras clave: rinoplastia endonasal; modificación de la punta nasal; mediciones antropométricas(AU)


Introduction: The reduction of the width and definition of the nasal tip is one of the main objectives of aesthetic rhinoplasty. The endonasal route, with a transcartilaginous incision, is mainly used when there are no significant alterations in the cartilaginous structure of the nasal tip. Objective: To determine the morphological changes that occur in the nasal tip after transcartilaginous rhinoplasty. Methods: A descriptive, prospective, longitudinal study was carried out in 15 patients with aesthetic deformity of the nasal tip, who were operated by transcartilaginous rhinoplasty at Hermanos Ameijeiras Hospital, from 2016 to 2020. The variables studied were nasolabial angle, width of the nasal tip, percentage of reduction in the width of the nasal tip, relationship between the nasal length and the projection of the nasal tip, and the patients' satisfaction status. Results: There was a narrowing of the nasal tip, starting from a preoperative mean width of 64.8 percent in relation to the nasal base, to a postoperative mean of 60.1 percent, resulting in a mean percentage reduction in width of the postoperative nasal tip of 7.3 percent. No variation was observed regarding the predominance of the ideal categories in the rest of the variables studied, even when there were individual changes, as a group. Conclusions: Postoperative modifications were produced that contributed to a refinement of the nasal tip, with a high degree of satisfaction of the operated patients(AU)


Subject(s)
Humans , Rhinoplasty/methods , Congenital Abnormalities , Personal Satisfaction , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
13.
Rev. otorrinolaringol. cir. cabeza cuello ; 82(1): 33-40, mar. 2022. ilus, graf
Article in Spanish | LILACS | ID: biblio-1389827

ABSTRACT

Resumen Introducción: La rinoplastia de preservación dorsal es una técnica innovadora en rinoplastias de reducción primaria, logrando una adecuada ventilación nasal y resultados estéticos naturales. Objetivo: Describir los resultados estéticos y funcionales en pacientes sometidos a rinoplastias de preservación dorsal. Material y Método: Se realiza un estudio de intervención no aleatorio "antes-después", donde se evaluaron las variables estética y funcional previo a la cirugía y luego a los seis meses. La variable estética se evaluó mediante el cuestionario de Utrecht (CU), escala visual análoga de apariencia nasal (EVA) y set de fotos clínicas. La variable funcional mediante el cuestionario de NOSE (Nasal Obstruction Symptoms Evaluation). Resultados: Un total de 15 pacientes fueron sometidos a rinoplastia de preservación dorsal. No hubo complicaciones tanto intra como posoperatorias. Ningún paciente intervenido presentó irregularidades dorsales, asimetrías, ni deformidades en "V" invertidas. Se observó una mejoría estadísticamente significativa (p < 0,01) en los resultados del CU, EVA y NOSE. Conclusión: La rinoplastia de preservación dorsal ofrece como resultado una nariz funcional, con líneas dorsales posoperatorias naturales. Esta técnica no presenta estigmas quirúrgicos, por lo que no es necesario la utilización de injertos para reparación del dorso nasal. Es rápida y fácil de realizar por cualquier cirujano especialista en rinoplastias.


Abstract Introduction: Dorsal preservation rhinoplasty is an innovative technique in primary reduction rhinoplasty, achieving adequate nasal ventilation and natural aesthetic results. Aim: To describe the aesthetic and functional results in patients undergoing dorsal preservation rhinoplasties. Material and Method: A non-randomized "before-after" intervention study was carried out, where the aesthetic and functional variables were evaluated before surgery and then at six months. The aesthetic variable was evaluated using the Utrecht questionnaire (CU), the visual analog scale of nasal appearance (VAS), and a set of clinical photos. The functional variable using the Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire. Results: A total of 15 patients underwent dorsal preservation rhinoplasty. There were no intraoperative and postoperative complications. No patient who underwent surgery presented dorsal irregularities, asymmetries, or inverted "V" deformities. A statistically significant improvement (p < 0.01) was observed in the UC, VAS, and NOSE results. Conclusion: Dorsal preservation rhinoplasty results in a functional nose, with natural postoperative dorsal lines. This technique does not present surgical stigmata, so it is not necessary to use grafts to repair the nasal dorsum. It is quick and easy to perform by any rhinoplasty surgeon.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rhinoplasty/methods , Esthetics , Nasal Septum/surgery , Postoperative Care , Nasal Obstruction/surgery , Surveys and Questionnaires , Plastic Surgery Procedures
14.
Article in English | WPRIM | ID: wpr-929014

ABSTRACT

At present, nasal abnormalities is often classified from different perspectives, such as the alar-columella relationship, nasal base width, and the condition of alar hyperplasia. However, due to the impact of race and region, different people may be applied to different classification methods, resulting in different clinical diagnosis and treatments. So far, there is no unified standard for alar deformity classification to guide clinical treatment. In alar-columella relationship, the retracted ala and the hanging columella, hanging ala and retracted columella are easily confused. According to the classification of nasal base width, it is easy to confuse the alar flare with wide alar base. Therefore, the accurate preoperative evaluation of the nasal ala and the selection of appropriate clinical treatments for different abnormalities are beneficial for surgeons to achieve perfect rhinoplasty results.


Subject(s)
Humans , Cleft Lip , Hyperplasia , Nasal Septum/surgery , Nose , Preoperative Care , Rhinoplasty/methods
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 81(3): 379-382, sept. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1389790

ABSTRACT

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.


Subject(s)
Humans , Female , Middle Aged , Rhinoplasty/methods , Nasal Cartilages/abnormalities , Nasal Cartilages/surgery , Nose/abnormalities , Nasal Septum/surgery
16.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(3): 360-366, set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1144901

ABSTRACT

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.


Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.


Subject(s)
Humans , Rhinoplasty/methods , Nasal Obstruction/surgery , Nasal Septum/surgery , Turbinates/surgery , Nasal Obstruction/diagnosis , Treatment Outcome
17.
Rev. cir. (Impr.) ; 72(4): 281-286, ago. 2020. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1138712

ABSTRACT

Resumen Objetivo: La nariz mestiza presenta características muy diferentes de la caucásica resultando en un desafío quirúrgico para el cirujano estético facial. El objetivo del estudio fue describir el manejo quirúrgico de la nariz mestiza con injerto de extensión septal y evaluar los resultados estéticos. Materiales y Método: Estudio de una serie de casos de corte longitudinal, muestra de 25 pacientes. Se realizó un plan quirúrgico mediante abordaje abierto y el uso de injerto de extensión septal, se compararon las fotos pre y postoperatorias midiendo el ángulo y la proyección de la punta nasal, junto con el nivel de satisfacción postoperatoria de los pacientes. Se utilizó estadística descriptiva que incluyó frecuencias absolutas y relativas. Resultados: 56% de los pacientes corresponden al sexo femenino, al 52% se colocó injertos espaciadores, 8% necesitó alotomía, el 100% mejoró el ángulo nasolabial y solo un paciente presentó hematoma septal a los 10 días postquirúrgico, se resolvió con drenaje, la encuesta de satisfacción realizada a los pacientes postquirúrgicos mostró un resultado satisfactorio. Conclusiones: La técnica quirúrgica con injerto de extensión septal es de gran utilidad, se logró una correcta definición, proyección/rotación de la punta nasal y mayor estabilidad estructural del trípode central, con resultados armónicos satisfactorios en su apariencia de frente y de perfil, evitando colocar injertos en la punta nasal.


Aim: The mongrel nose has very different characteristics from the caucasian one resulting in a surgical challenge for the facial cosmetic surgeon. The objective of the study was to describe the surgical management of the mongrel nose with graft of septal extension and to evaluate the aesthetic results. Materials and Method: Study of a series of cases of longitudinal section, sample of 25 patients. A surgical plan was performed using an open approach and the use of graft of septal extension, the pre and postoperative photos were compared by measuring the angle and projection of the nasal tip, together with the level of postoperative satisfaction of the patients. Descriptive statistics that included absolute and relative frequencies were used. Results: 56% belong to the female sex, 52% were placed spacer grafts, 8% needed an allotomy, 100% improved the nasolabial angle and only one patient presented septal hematoma at 10 days post surgery, it was resolved with drainage, the satisfaction survey of post-surgical patients showed a satisfactory result. Conclusions: The surgical technique with graft of septal extension is very useful, a correct definition, projection/rotation of the nasal tip and greater structural stability of the central tripod were achieved, with satisfactory harmonic results in its front and profile appearance, avoiding place grafts on the nasal tip.


Subject(s)
Humans , Male , Female , Rhinoplasty/methods , Patient Satisfaction , Nasal Septum/surgery , Surveys and Questionnaires , Longitudinal Studies , Sex Distribution , Age Distribution
18.
Braz. j. otorhinolaryngol. (Impr.) ; Braz. j. otorhinolaryngol. (Impr.);86(3): 343-350, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1132596

ABSTRACT

Abstract Introduction: Nasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. Objective: We aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. Methods: A prospective observational study was conducted between March 2017-May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. Results: Twenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. Conclusion: Reformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.


Resumo Introdução: A obstrução nasal é uma das queixas otorrinolaringológicas mais comuns, e o colapso ou obstrução da válvula nasal interna é a principal causa da obstrução das vias aéreas nasais. Objetivo: Objetivamos avaliar a válvula nasal interna pré, e 3 meses pós-rinoplastia utilizandotomografias computadorizadas reformatadas e avaliar sua correlação com a melhora do sintoma obstrutivo utilizando a escala NOSE, do Inglês Nasal Obstruction Symptom Evaluation. Método: Um estudo observacional prospectivo foi realizado entre março de 2017 e maio de 2018 em um centro de otorrinolaringologia de atenção terciária. Foram incluídos pacientes que apresentavam obstrução nasal secundário a colapso da valva nasal interna e deformidade nasal. Pacientes com sinusite, polipose nasal e tumores nasais foram excluídos. Resultados: Vinte pacientes consecutivos, a maioria do sexo masculino (n = 14; 70%) com média de idade de 22,2 ± 2,8 anos, foram submetidos a rinoplastia eincluídos no estudo. Não houve correlação significante entre as avaliações tomográficas pré / pós cirúrgicas do ângulo/área da valva nasal interna e os escores NOSE. Foi detectada uma diferençã altamente significante entre os escores médios da escala NOSE entre o pré e pós-operatório (p < 0,0001), mas não nos resultados da avaliação por tomografia computadorizada. Conclusão: As medidas reformatadas de tomografias computadorizadas da área e ângulo da valva nasal interna pré e pós cirúrgicas não tiveram valor. Entretanto, os escores da escala NOSE pré e pós-rinoplastia mostraram uma diferença significante ao determinar o grau de melhora do sintoma obstrutivo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Nasal Obstruction/surgery , Nasal Septum/surgery , Rhinoplasty/methods , Tomography, X-Ray Computed , Nasal Obstruction/diagnostic imaging , Prospective Studies , Nasal Septum/diagnostic imaging
19.
Rev. bras. cir. plást ; 35(2): 254-257, apr.-jun. 2020. ilus
Article in English, Portuguese | LILACS | ID: biblio-1103842

ABSTRACT

Hemangioma infantil (HI) é o tumor vascular mais comum e a neoplasia benigna mais frequente da infância, com maior incidência no sexo feminino e na população branca. Quase 60% dos casos ocorrem em cabeça e pescoço, sendo o tratamento ativo durante a fase proliferativa mais frequentemente indicado, em decorrência dos possíveis problemas funcionais e do potencial desfigurante. Relatamos um caso de paciente com hemangioma infantil involuído de ponta nasal e lábio superior, tratado de forma expectante durante a infância, submetida à correção da deformidade residual com técnicas de rinoplastia, associado à zetaplastia e lipoenxertia do lábio superior com bom resultado e satisfação do paciente.


Infantile hemangioma (IH) is the most common vascular tumor and the most frequent benign neoplasm in childhood, with the highest incidence in females and the white population. Almost 60% of cases occur in the head and neck, and active treatment during the proliferative phase is the most frequently indicated, due to possible functional problems and disfiguring potential. We report a case of a patient with involute infantile hemangioma of the nasal tip and upper lip, treated expectantly during childhood, submitted to residual deformity correction with rhinoplasty techniques, associated with zetaplasty and upper lip grafting with good results and patient satisfaction.


Subject(s)
Humans , Female , Adult , History, 21st Century , Rhinoplasty , Wounds and Injuries , Case Reports , Nose , Nose Diseases , Vascular Neoplasms , Hemangioma , Lip , Rhinoplasty/adverse effects , Rhinoplasty/methods , Wounds and Injuries/surgery , Nose/surgery , Nose/pathology , Nose Diseases/surgery , Nose Diseases/pathology , Vascular Neoplasms/surgery , Vascular Neoplasms/pathology , Hemangioma/surgery , Hemangioma/pathology , Lip/surgery , Lip/pathology
20.
Rev. bras. cir. plást ; 35(2): 258-259, apr.-jun. 2020.
Article in English, Portuguese | LILACS | ID: biblio-1103844

ABSTRACT

Introdução: O aumento da projeção da ponta nasal às vezes se torna necessário para a obtenção de uma boa proporção entre ela e o dorso. Inúmeras técnicas e táticas são descritas com essa finalidade utilizando enxertos cartilaginosos obtidos do septo nasal, concha auricular e cartilagem costal. Quando esse aumento deve ser discreto é proposto o uso dos excedentes de cartilagens alares laterais em forma de "pseudo-retalhos". Métodos: Em rinoplastias abertas primárias os excedentes das cartilagens alares, geralmente removidas, são utilizados como "pseudo-retalhos", dobrados sobre si mesmos, em forma de "suspensório de soldado francês", sobre o domus das cartilagens alares, tendo como acolchoamento de apoio os tecidos moles delas próprias, e o tecido mole interdomal, geralmente desprezado, que é liberado, e elevado para sobre os domus. Ele é mantido, descolado e deslocado para a ponta nasal, e fica contido pelos "pseudo-retalhos" das cartilagens alares ali suturados ou cobrindo o extremo do enxerto estrutural da columela. Foram operados com essa tática 36 pacientes. Resultados: 35 com bons resultados e um apresentou um abcesso de ponta nasal, provocado pela exposição endonasal de um fio de sutura não absorvível, que foi removido. Houve necessidade de uma segunda intervenção, utilizando novo enxerto auricular, ainda com resultado insatisfatório. O método é relativamente simples para quem opera narizes. Conclusão: A ponta nasal pode ser discretamente mais projetada utilizando os excessos de cartilagens alares, "pediculadas" no domus.


Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.


Subject(s)
Humans , Male , Female , Middle Aged , History, 21st Century , Paranasal Sinuses , Rhinoplasty , Case Reports , Nose , Retrospective Studies , Evaluation Study , Nasal Cartilages , Nasal Mucosa , Paranasal Sinuses/surgery , Rhinoplasty/adverse effects , Rhinoplasty/methods , Nose/surgery , Nasal Cartilages/surgery , Nasal Mucosa/surgery
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