RESUMO
Objective:To investigate the postoperative effect of paranasal concavity augment by block united with diced autologous costal cartilage.Methods:The data of 76 patients who were underwent costal cartilage rhinoplasty together with paranasal augmentation from January 2016 to December 2019 were analyzed retrospectively. The surgical technique was described in detail. Medical charts and operative records were reviewed to summary the complications. Patients′subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse, 2 no change, 3 improved, and 4 much improved). Cosmetic effects were evaluated by the measurements of the nasolabial angle and the distance between ACJ and intertragic notch preoperatively and postoperatively.Results:The postoperative follow-up duration was 6 to 34 months. Overall, functional and aesthetic outcome was satisfactory in most patients, and the mean score by the patients′self-evaluation was 3.4±0.5. Graft exposure, mobility, or significant resorption, pneumothorax or significant donor-site pain were not observed. The average nasolabial angle was changed from (78.2±13.2)° preoperatively to (89.8±10.2)° 6 months postoperative at the last follow-up ( t=152.00, P<0.01). And the distance from the alar-cheek junction to the left tragus was increased by 3.8±2.1 (2.2-6.1) mm. Conclusions:Costal cartilage rhinoplasty combined with augmentation of parasal area can improve parasal depression, with stable postoperative effect and fewer postoperative complications, and has a good effect for patients with normal occlusal relationship or mild abnormality.
RESUMO
The patients with mandibular prognathism frequently have a retrusion of the lower nasal base and around the piriform aperture. In such cases, paranasal depression or flattening gives a person a gloomy, tired, depressive and old appearance by accentuating the nasolabial folds. In this case, mandibular set back is not enough to achieve the maximum aesthetic results and facial harmony. Although severe retrusion of maxilla needs large graft for paranasal augmentation or Lefort osteotomies, mild retrusion around the piriform aperture can be restored by simple autogenous onlay bone graft. In order to correct the mild paranasal retrusion combined with mandibular prognathism, we performed sagittal split osteotomy of ramus and retropositioned the distal segment of mandible for mandibular set back. Thereafter, we harvested autogenous bone from the distal portion of a mandibular proximal segment. The harvested bone was about 1 X 2.5cm sized and sculptured in a semilunar shape to fit the paranasal region. Through two separate 1-cm upper buccal incision, the bone grafts were placed around the piriform aperture for contour restoration and fixed with screw. Our operative technique is simple and easy, moreover has no need for another donor site for paranasal augmentation. Using this method, we treated paranasal depression as well as mandibular prognathism at the same time and so, improved facial profile and contour in 5 cases. At the time of follow-up at 1 year, there has been no infection, extrusion or relapse with this technique and patients were satisfied with their aesthetic results.