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OBJECTIVE@#To investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty.@*METHODS@#A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale.@*RESULTS@#Patients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points ( P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation ( P<0.05), but there was no significant difference between 7 days and 6 months after operation ( P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend.@*CONCLUSION@#After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body's own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.
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Humanos , Feminino , Adulto , Masculino , Rinoplastia , Estudos Retrospectivos , Reoperação , Cartilagens Nasais , Septo Nasal , CicatrizRESUMO
Objective:Unidentified filling objects (UFO) can cause adverse results including infections, overfilling, asymmetry, foreign body granulomas, dislocation or psychological panic. To remove UFO accurately, it is important to locate and identify the injected substances preoperatively. This study investigated the viability of using MRI to correctly locate and identify injected substances by relating MRI to gross and pathological microscopic examination.Methods:Eighty-two facial UFO patients from 2013 to 2017 were studied by the experts of the Department of Image, Xinhua Hospital of Dalian University. Five of the patients were male and seventy-seven were female. The age ranged from 17 to 58 years with average 29.4 years. They came to our hospital for removal of UFO after they had facial injective fillers in the illegal medial offices. The injected sites involved in the forehead, temple, malar, cheek, nose, nasolabial folds, and chin. All the patients＇ faces were examined with MRI preoperatively, using T1W, T2W and fat-suppressed sequences. Based on the guides of MRI, UFOs were removed with their capsules by open approach. Samples were recorded with digital pictures and then were fixed in 10% formalin solution for microscopic examination of HE stained slices.Results:Based on MRI, gross and microscopic examination, UFO were classified into 3 types, gel-like fillers, solid particles, and growth factors. Gel-like fillers appeared strongly hyperintense on T2 W and STIR sequences and hypointense on T1 W sequences. Grossly, they looked like gruel covered by altered soft tissue. Under the light microscope, many pieces of blue-stained material were dispersed in subcutaneous tissue infiltrated with a large number of mononuclear cells and foreign-body giant cells. Solid particles had low to intermediate signal intensity on T1 W and T2 W images. Grossly, they were like sand merging in soft tissue. The biopsy showed crowed bubbles surrounded by tissue filled with a large number of mononuclear cells and foreign-body giant cells. For growth factors affected tissue, it was hard to differentiate between normal and abnormal on MRI. The affected tissue appeared as somehow hypointense on T1 W sequences and hyperintense on T2 W fat suppressed sequences. During the operation, the affected region was easy bleeding and full of fibrofatty tissue. Under the microscope, there were increased small blood vessels and collagens.Conclusions:Based on MRI, gross and microscopic examination, UFO can be classified into 3 types, gel-like fillers, solid particles, and growth factors. MRI is very important for doctors to assess the patient＇s conditions and make the plan of operation. MRI is also useful for doctors to locate UFO and understand the relationship between UFO and their nearby organs.
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Objective:To assess the possibility of allogenic decalcified bone matrix used as material to rebuild the midline structure in rhinoplasty.Methods:From January 2018 to June 2018, allogenic decalcified bone matrix was used as material to rebuild the midline structure in rhinoplasty in six carefully selected patients, who did not have enough septum and conchal cartilage to be harvested and refused to have costal cartilage harvested. Nasal length and tip projection were measured preoperatively, 2 weeks and 18 months postoperatively.Results:All patients were satisfied with the appearance of the nose two weeks after operation. However, four patients experienced the reduction of tip projection in 18 months postoperatively and needed revised rhinoplasty. In the revised operation, the implanted allogenic decalcified bone matrix could not be removed integrally. Matrix residues were harvested and observed under the microscope, which showed fragment of the matrix and fibers surrounded by inflammatory cells and foreign-body giant cells. No osteocyte was found in the ground substances of bone.Conclusion:The commercial allogenic decalcified bone matrix applied in this study is not recommended to use as the material for rebuilding the midline structure in rhinoplasty.
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Objective:To find out the optimal ratio of tip projection to nasal length for Chinese in order to help doctors to reduce the dissatisfactory rate of rhinoplasty.Methods:The authors retrospectively reviewed the records of patients with rhinoplasty from June 2015 to June 2018. The patients were classified into satisfactory, underprojected and overprojected groups. The average, maximum, minimum of tip projection (TP), nasal length (NL) and TP/NL, median of TP/NL of each group were measured. The results were used in later patients to assess their efficacy by comparing the dissatisfactory rates of patients before and after June 2018.Results:In satisfactory group, the mean of TP/NL was 0.63 with minimum 0.56, maximum 0.69, and median 0.64 in primary cases, while the mean of TP/NL was 0.63 with minimum 0.52, maximum 0.75, and median 0.64 in secondary cases. In underprojected group, the mean of TP/NL was 0.60 with median 0.58. In overprojected group, the mean of TP/NL was 0.64 with median 0.65. The dissatisfactory rates of patients before and after June 2018 were 8% and 2.2%, respectively ( P>0.05). Conclusions:The optimal ratio of tip projection to nasal length for Chinese is near 0.63-0.64. Combined with the desire of patient, it is possible for doctors to satisfy the patients by controlling tip projections between 2.5 cm to 2.8 cm.