Rinoplastia secundaria: infección nasal en el postoperatorio / Secondary rhinoplasty: postoperative nasal infection

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.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery.@*METHODS@#The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation.@*RESULTS@#All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied.@*CONCLUSION@#Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Anatomical Conditions in Simultaneous Orthognathic Surgery and Structural Rhinoplasty. A Clinical Series / Condiciones Anatómicas en Cirugía Ortognática y Rinoplastia Estructural Simultanea. Una Seria Clínica

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.

Evaluación clínica para el aumento del mentón en pacientes sometidos a rinoplastia / Clinical evaluation for chin augmentation in patients undergoing rhinoplasty

Introducción: el análisis detallado de las proporciones nasofaciales desempeña un papel fundamental para lograr la armonía facial e identificar desequilibrios; asi se dirige el tratamiento quirúrgico para lograr mejores resultados postoperatorios. El objetivo de este estudio fue determinar la prevalencia de pacientes sometidos a rinoplastia que requerían, además, un aumento del mentón. Materiales y métodos: se seleccionaron 100 pacientes voluntarios sometidos a rinoplastia entre los 17 y 55 años y se les realizó un estudio fotográfico preoperatorio. Se realizó un análisis facial del tercio inferior de la cara mediante tres métodos: González-Ulloa, Goode y Silver, y se hizo un análisis univariado y bivariado. Resultados: 100 pacientes voluntarios ingresaron al estudio; de estos, 7 fueron excluidos y quedaron 73 mujeres y 20 hombres; la edad mínima fue de 17 años y la máxima de 55 años, con un promedio de 28,4 años. La edad media de los hombres fue de 30,9 años y de las mujeres de 28,2 años. Del total de pacientes, 96,7 % de los pacientes cumplían con 2 o 3 métodos para aumento del mentón; de estos, 78,8 % eran mujeres y 21,1 % eran hombres. Conclusión: un análisis adecuado de las proporciones nasofaciales es fundamental para determinar los procedimientos necesarios para lograr un buen resultado quirúrgico y una mayor satisfacción del paciente. Estos métodos no sustituyen el juicio estético del cirujano; sin embargo, proporcionan un estándar objetivo para el diagnóstico de los desequilibrios faciales.

Introduction: Detailed analysis of nasofacial proportions plays a fundamental role in achieving facial harmony and identifying imbalances; thus, surgical treatment is directed to achieve better postoperative outcomes. The aim of this study was to determine the prevalence of patients undergoing rhinoplasty who also required chin augmentation. Materials and methods: 100 volunteer rhinoplasty patients between 17 and 55 years of age were selected and a preoperative photographic study was performed. Facial analysis of the lower third of the face was performed by three methods: Gonzalez-Ulloa, Goode and Silver, univariate and bivariate analysis was performed. Results: 100 voluntary patients entered the study, 7 of these were excluded, leaving 73 women and 20 men, the minimum age was 17 years and the maximum 55 years, with an average of 28.4 years. The mean age of the men was 30.9 years and of the women 28.2 years. Of the total number of patients, 96.7% of the patients com- plied with 2 or 3 methods for chin augmentation, of these 78.8% were women and 21.1% men. Conclusions: Adequate analysis of nasofacial proportions is essential to determine the procedures necessary to achieve a good surgical outcome and greater patient satisfaction. These methods do not replace the surgeon's aesthetic judgment; however, they provide an objective standard for the diagnosis of facial imbalances.

Polígonos de la punta nasal / Nasal tip polygons

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

Medidas para optimizar cuidados post rinoplastia. Revisión sistemática de la literatura / Measures to optimize rhinoplasty post operative care, systematic review of the literature

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.

Rinoplastia en nariz mestiza, un desafío quirúrgico / Rhinoplasty in mestizo nose, a surgical challenge

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.

External rhinoplasty based on the classification of alar retraction associating with exposure of the nostrils / 中华耳鼻咽喉头颈外科杂志

Objective: To introduce a classification of alar retraction, and to discuss the therapeutic strategy of alar retraction with cartilage graft and the satisfaction evaluation of patients after operation. Methods: A retrospective analysis was performed on 88 patients with alar retraction admitted to the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University from January 2015 to December 2020, including 20 males and 68 females, aged 20 to 48 years, with an average age of 28.98 years. All patients underwent external rhinoplasty according to a series of treatment plans determined by the classification of alar retraction based on nostril exposure. Visual Analogue Scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) were used to conduct satisfaction survey before and 12 months after operation. Wilcoxon signed-rank test was used to analyze patient satisfaction. Results: A total of 88 patients were included in this study. According to the classification of alar retraction based on nostril exposure, 45 cases were mild, 23 cases were moderate, and 20 cases were severe. There were 16 cases of unilateral and 72 cases of bilateral alar retraction. The patients were followed up for 12 to 18 months, with an average of 13.37 months. The VAS score and ROE score after each type of surgery were higher than those before surgery, with statistically significant (all P<0.05). Among them, the difference in VAS score (6.75±1.29) and in ROE satisfaction (67.70±7.38) of patients with severe alar retraction were the most significant improvement. Conclusion: The classification of alar retraction based on nostril exposure in the frontal view can comprehensively evaluate the severity of alar retraction, and makes the treatment algorithms systematic and comprehensive. The satisfaction of patients is relatively high.

Intradermal hyaluronidase: The answer to treatment in softening a fibrous thick supratip skin in rhinoplasty?

@# It is a common goal for rhinoplastic surgeons to make the best-looking tip with proper projection, maintaining the tip lobule appearance with a supratip break. (Figure 1) However, a fibrous thick skin with fullness may not achieve the ideal tip. It is one of the nuisances in rhinoplasty that makes tip definition surgery difficult. The supratip area remains firm and convex causing a wide bulbous feature of the tip. Several techniques have been introduced with good results however some may still result in supratip fullness because of the firm fibrous nature of thick skin.1-3 Hyaluronidase is an enzyme that depolymerizes hyaluronic acid which is present in the epithelium.4 The use of intradermal hyaluronidase for thick skin was discovered by the junior author (JMP) in one of his rhinoplasties when he injected hyaluronidase in a nose with fillers containing hyaluronic acid. The fillers not only instantly dissolved but the skin also softened, so he tried injecting intradermally in his subsequent rhinoplasties on non-filler noses with fibrous thick skin and indeed found the same effect of softening of the fibrous supratip skin. We here describe the technique used in this preliminary clinical series.

Combined cartilage graft reconstruction of the nasal tip complex after resection of nasal tip schwannoma: A case report

Objective@#To present a rare case of nasal tip schwannoma and describe its resection and reconstruction using combined cartilage grafts.@*Methods@#Design: Case Report Setting: Tertiary Government Training Hospital Patient: One@*Results@#A 13-year-old boy presented with a progressively enlarging nasal tip and severe left nasal obstruction causing breathing difficulties and psychosocial distress. There was a bulging septal mass obstructing 90% of the left nasal cavity. Septal incision biopsy revealed schwannoma and definitive surgery via open rhinoplasty approach was done. The non-encapsulated schwannoma extended from the subcutaneous nasal tip to the left septal mucosa. There was no evidence of skin or cartilage invasion, but prolonged pressure from the expansile schwannoma caused severe lower lateral cartilage and anterior septal atrophy leading to a collapsed and expanded nasal tip after resection. To correct this, a total reconstruction of the anterior tip complex was done using combined ear cartilage seagull wing graft, shield graft and septal extension graft. @*Conclusion@#Nasal tip and septal schwannoma is rare and can cause significant nasal obstruction and deformity. Complete excision is vital to avoid recurrence. Total reconstruction of the lower lateral cartilages using autologous septal and ear cartilage grafts may be a safe and effective technique that yields acceptable aesthetic results.

Study on the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty / 中国修复重建外科杂志

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.

One-year clinical observation of muscular force balance reconstruction technique for the correction of secondary nasal malformation after cleft lip surgery / 华西口腔医学杂志

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.

Three-dimensional reconstruction reveals the correlation between the extent of alveolar clefts and secondary nasal deformity in adults / 华西口腔医学杂志

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.

Use of sail excision in Alar Morphology modification of asian noses

@#Globular hanging nasal alae, described as convex round shaped alar lobule which may be an aesthetic nuisance in the final result of rhinoplasty, are commonly seen among Southeast Asian noses. Such alar lobule morphology is an important part of nasal aesthetics and should not be disregarded. Surgical techniques used to address a hanging ala include direct external approaches. External rim excision was proposed to address hidden columella, sigmoid alae, small nostrils, dropped rim and foreshortened nose.1,2 Rim tissue was excised in full thickness fashion and sutured in one layer. Others proposed alar groove excision followed by alar repositioning and full-thickness skin grafting to reposition the alar base and correct hanging alae.3 Although these approaches have been proven to correct hanging alae, they leave a visible scar and/or permanent alar rim deformity if not done cautiously, especially on thick skinned patients.1-3 The alar rim may not be natural looking since it is lined by a scar, thus losing the lobular texture of the rim. A vestibular incision has been proposed to correct a hanging ala with unsightly scar.4 A maximum of 3mm elliptical vestibular skin was recommended to be removed to lift the alar rim with significant results. However, this recommendation was based on estimates and surgeon’s experience in western noses and may be insufficient for Asian noses. In addition, performing this technique without specific landmarks is difficult in achieving accurate results, especially when performed by a novice surgeon. Hence, further modification is important to address these concerns. Attempting to address the hanging alae in Asian noses, the senior author (ECY) modified the vestibular incision and came up with the sail excision technique based on the patient’s nasal anatomy.5 By presenting definite landmarks, the technique resulted in an alar lift procedure with reproducible outcomes. Furthermore, after performing sail excision in several patients, the authors noted the effect of this technique on alar morphology. This procedure is done by excising a precisely marked piece of inner nasal vestibular skin that is shaped like the sail of a boat to achieve a symmetrical and redictable result. This creates a lifting effect and improves the alar columellar disproportion specially when combined with septal advancement techniques.6,7 Furthermore, limiting the excision along the inner vestibular area and rolling the alar rim skin inwards results in correction of hanging ala (with a hidden scar) without an obvious, external scar. After performing the technique on several patients, we observed that in addition to its effect on lifting a hanging ala, the sail excision technique also changes the alar morphology from a globular-shaped lobule to a more aesthetically pleasing ridge-shaped lobule. To the best of our knowledge, such an effect of sail excision on alar morphology has not been described in the literature. This article aims to demonstrate the effect of the sail excision technique on alar rim morphology of Asian noses by describing the step-by-step procedure, surgical landmarks, and pearls in performing this technique.

Rinoplastia cerrada: una técnica vigente / Closed Rhinoplasty: a current technique

La rinoplastia cerrada es una cirugía que se realiza con el fin de cambiar la estructura de la nariz, con fines cosméticos o reparadores. Se busca realizar pequeños retoques que logren un aspecto natural. Es una de las cirugías estéticas más complejas y representa un reto para el cirujano, pues combina técnica con sensibilidad y ciencia con arte. En este artículo describimos esta técnica con el objetivo de demostrar su eficacia y vigencia, sin compararla con la rinoplastia abierta, pues no es motivo de discusión en este trabajo, por lo que no podemos asegurar que una opción es mejor o peor que la otra. Lo más conveniente es que los cirujanos estén capacitados para realizar cualquiera de estas. Con la rinoplastia cerrada se logran resultados que llenan las expectativas tanto de los pacientes, como de los cirujanos y el post operatorio es breve y prácticamente sin incidentes. Es una propuesta que tiene indicaciones precisas en el marco de una rinoplastia preservadora, que es tendencia a nivel mundial en la actualidad.

Closed rhinoplasty is a surgery that is performed in order to change the structure of the nose, for cosmetic or restorative purposes. It seeks to make small touches that achieve a natural appearance. It is one of the most complex cosmetic surgeries and represents a challenge for the surgeon, as it combines technique with sensitivity and science with art. In this article, we describe this technique in order to demonstrate its effectiveness and validity, without comparing it with open rhinoplasty, since it is not a matter of discussion in this work, so we cannot guarantee that one option is better or worse than the other. It is best if surgeons are trained to perform any of these. With closed rhinoplasty, results are achieved that meet the expectations of both patients and surgeons, and the postoperative period is brief and practically uneventful. It is a proposal that has precise indications within the framework of conservative rhinoplasty, which is currently a worldwide trend.

Tratamiento de punta nasal mestiza en rinoplastía secundaria / Treatment of mestize tip nose in secundary rhinoplasty

ANTECEDENTES: la nariz mestiza constituye un reto en la adecuada trasformación estética y funcional de la rinoplastia, más aún cuando esta se realiza en una segunda intervención y los tejidos nasales ya se encuentran alterados, no pudiendo hacer una adecuada reconstrucción de las estructuras anatómicas sin el uso de injertos cartilaginosos de otras áreas del cuerpo. OBJETIVO: el propósito de este trabajo es de evaluar los resultados obtenidos de una reconstrucción de la punta nasal, realizada en pacientes que ya fueron sometidos a una rinoplastia sea esta secundaria o cuaternaria. METODOLOGIA: estudio retrospectivo, de casos de pacientes que se sometieron a una nueva intervención para mejorar aspectos estéticos y funcionales nasales, que ya fueron operados en más de 1 oportunidad. HALLAZGOS: se tiene un universo de 10 pacientes en los que se realizó una rinoplastia secundaria o cuaternaria donde se utilizó injerto costal para conformar el esqueleto cartilaginoso y el uso de un injerto de extensión septal, todo esto para mejorar la estética y funcionalidad nasal.

Rinoplastia secundaria en pacientes con fisura labiopalatina / Secondary Rhinoplasty in Patients with Clef lip and Palate

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)

Modificaciones de la punta nasal posterior a rinoplastia transcartilaginosa / Modifications of Nasal Tip After Transcartilaginous Rhinoplasty

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)

Rinoplastia de preservación dorsal, una nueva filosofía: Experiencia en el Hospital Naval Almirante Nef / Dorsal preservation rhynoplasty, a new philosophy: Experience in the Almirante Nef Naval Hospital

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.

Classification of alar abnormalities and the relevant treatments / 中南大学学报(医学版)

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.