ABSTRACT
BACKGROUND: The aim of this study is to describe the efficacy of the alar extension graft for the correction of external nasal valve collapse and to evaluate the functional and aesthetic results. METHODS: The study included 51 patients who underwent alar extension grafting for external nasal valve collapse. Pre- and post-operative rhinomanometry was performed before and after surgery. NOSE and SNOT 20 questionnaires were completed before and 9 months after surgery. Patients were also asked about their post-operative satisfaction. RESULTS: 90% of patients were subjectively satisfied with the post-operative improvement in nasal breathing. There was a significant improvement in the values of the pre- and post-operative NOSE and SNOT 20 questionnaire scores. Rhinomanometry showed increased nasal flow with a statistically significant difference between pre- and post-operative results. CONCLUSIONS: The alar extension graft has been proved to be effective and reliable in the surgical treatment of external nasal valve collapse, improving the patients' objective and subjective breathing with good functional and aesthetic results. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
ABSTRACT
INTRODUCTION: Grafts play key roles in functional and aesthetic rhinoplasty. Autologous grafts are generally preferred for their biocompatibility and less visibility when used in a fragmented fashion. The aim of this study was to review mechanically fragmented cartilage grafts techniques described in the literature, outlining indications, outcomes, and complications. MATERIAL AND METHODS: A systematic review of articles published from 1999 until December 2022 was conducted, using the following key words: "rhinoplasty," "cartilage," and "graft." Studies were selected according to the inclusion and exclusion criteria, and data were extracted and grouped for subgroup analysis. Rates of partial resorption, total resorption, surgical revision, and major and minor complications were statistically analyzed. RESULTS: Thirty eligible studies were included. Three cartilage fragmentation methods were identified: diced, shaved, and crushed. Cartilage grafts were further divided into injectable and noninjectable grafts. Diced cartilage was the most commonly used. Dorsal irregularities were the main indication. Overall, 1.68% of patients experienced partial resorption, 0.27% experienced total resorption, and 1.46% needed revision. The partial resorption rate in the diced group was significantly lower than that in the shaved group. Injectable grafts showed a higher rate of partial resorption. The revision rate was higher with noninjectable grafts. CONCLUSION: The partial resorption rate was lower in patients treated with diced cartilage. Injectable grafts are malleable and suitable for the correction of minimal irregularities, although they are affected by a higher rate of partial resorption. Wrapping materials may be used when significant augmentation is required.
ABSTRACT
BACKGROUND: Precise tip contouring is paramount to achieve pleasant cosmetic results in rhinoplasty. Loss of tip projection or rotation, supra-tip deformities, as well as long-lasting edema, may jeopardize the outcome, thus leading to patient's dissatisfaction or re-intervention. Several approaches were previously reported, sometimes with considerable drawbacks or conclusions mainly supported by experience. The aim of this study is to describe the inter-alar ligaments flap for tip and supra-tip contouring and to comparatively assess its efficacy and safety. METHODS: The study included 147 patients who underwent primary structured open rhinoplasty and divided into 2 groups: group 1 underwent harvesting and repositioning of the inter-alar ligaments flap, group 2 underwent conventional tip dissection. Tip edema, supra-tip definition and fullness were blindly scored at 2-, 6- and 12-month post-operative follow-up. Naso-labial angle was measured at 2 and 12 months post-operatively. Univariate analysis and and multivariable regression model were performed. RESULTS: Supra-tip definition was significantly higher in group 1 at 2-, 6- and 12-months post-operative follow up (p<0.05, p<0.01 and p<0.01, respectively). Tip edema and supratip fullness were significantly lower in group 1 at each time point (p<0.01). Naso-labial angle, as well as its modification between 2- and 12-months post-intervention, did not differ in the 2 groups. All findings were confirmed when controlled for eventual confounders. CONCLUSIONS: The inter-alar ligaments flap proved to be versatile, effective and consistently reliable in reducing tip edema and improving supra-tip definition. It may be tailored to the patient, partially folded to improve tip projection or used to camouflage tip grafts.
