Nasal Hump Treatment With Cartilaginous Push-Down and Preservation of the Bony Cap.

BACKGROUND: Classic nasal hump reduction based on partial resection of the cartilage and bones in the nose may lead to dorsum deformities such as an inverted-V deformity, irregularities, and an open roof. Techniques that preserve the nasal dorsum (namely the push-down and let-down) avoid these problems, but may not always be indicated for very large, broad, or deviated noses, whereas cartilaginous push-down is also indicated for large and deviated humps. Because only the cartilaginous portion of the hump is preserved in the cartilaginous push-down, a rough area may remain where the bony portion is resected. OBJECTIVES: The aim of this study was to develop a variation of the cartilaginous push-down technique which includes a bony cap to preserve the smoothness of the keystone area during nasal hump treatment. METHODS: Forty-eight consecutive patients with indication for nasal hump treatment who underwent cartilaginous push-down procedures with bony cap preservation between August 2018 and October 2019 were studied. RESULTS: We observed related complications in 2 patients (4.2%); in 1 patient (2.1%) the bony cap was lost during the rasping of the nasal bones and the surgery was altered to utilize only the cartilaginous push-down. Another patient (2.1%) experienced a mild hump recurrence during the early weeks following the procedure. All of the remaining patients had their nasal humps treated adequately. CONCLUSIONS: The nasal hump was adequately corrected in most of the study patients (95.8%). Preserving the bony cap while performing the cartilaginous push-down may prevent complications related to the osseous resection of the keystone area.

Myotomy of the levator labii superioris muscle and lip repositioning: a combined approach for the correction of gummy smile.

BACKGROUND: Treatment of excessive gingival display usually involves procedures such as Le Fort impaction or maxillary gingivectomies. The authors propose an alternative technique that reduces the muscular function of the elevator of the upper lip muscle and repositioning of the upper lip. METHODS: Fourteen female patients with excessive gingival exposure were operated on between February of 2008 and March of 2009. They were filmed before and at least 6 months after the procedure. They were asked to perform their fullest smile, and the maximum gingival exposures were measured and analyzed using ImageJ software. Patients were operated on under local anesthesia. Their gingival mucosa was freed from the maxilla using a periosteum elevator. Skin and subcutaneous tissue were dissected bluntly from the underlying musculature of the upper lip. A frenuloplasty was performed to lengthen the upper lip. Both levator labii superioris muscles were dissected and divided. RESULTS: The postoperative course was uneventful in all of the patients. The mean gingival exposure before surgery was 5.22 +/- 1.48 mm; 6 months after surgery, it was 1.91 +/- 1.50 mm. The mean gingival exposure reduction was 3.31 +/- 1.05 mm (p < 0.001), ranging from 1.59 to 4.83 mm. CONCLUSION: This study shows that the proposed technique was efficient in reducing the amount of exposed gum during smile in all patients in this series.

Power instrumentation for shaping the nasal cartilages.

The cartilaginous structures of the nose play an important role in nasal esthetics and function. The handling of these structures has always been very treacherous, and long-term follow-up quite often has shown unexpected results. Based on Gibson's studies, we propose the use of abrasion treatment of the nasal cartilages with the burr power drill. This device can produce controlled weakening on determined regions of the nasal cartilages. If this weakening is done on just one side, the cartilage will bend to the opposite side. On the septal cartilage, this method can be used to straighten it by abrasion on its concave portion. To correct the alar cartilages, the burring is done either to enhance curvatures or to change the conformation of the alar cartilage itself. This method was used in 67 patients with satisfactory results, permitting corrections of septal deviations with very little resections of the septal cartilages and corrections of various tip deformities, with almost no resections at all of the alar cartilages.

Secondary rhinoplasty: reconstitution of the allar cartillages by a rhinoplasty with an external incision

Objetivo: Apresentaçäo de 62 casos de deformidades nasais secundárias tratadas por incisäo externa. Resultados e Conclusäo: Foram verificadas diversas formas de deformidades de ponta, que foram classificadas e reparadas. Quando foi constatada ressecçäo excessiva utilizamos enxerto de cartilagem local, enxerto de septo ou cartilagem conchal

Mastoplastia redutora com cicatrizes reduzidas: tecnica cirurgica / Reduction mammaplasty with shortened scars: surgical technique

A mastoplastia redutora e atualmente uma das cirurgias mais frequentemente realizadas. O objetico principal e a reducao de volume mamario, mas tambem ha preocupacao com cicatrizes, que se inadequadas podem comprometer o resultado operatorio. A Disciplina de Cirurgia Plastica da FMUSP segue a tendencia moderna de reducao da extensao das incisoes, e consequentemente das cicatrizes. A partir da decada de 80, desenvolveu-se no Servico, tecnica que incorpora estes principios. Os resultados sao satisfatorios e a tecnica e simples o suficiente para ser aplicada no programa de treinamento dos residentes.

Osteotomia estetica do mento: analise critica de sua indicacao / Esthetic osteotomy of the chin: critical analysis of its indication

Os autores apresentam uma casuistica de 34 pacientes com microgenia submetidos a osteotomias de avanco do mento para melhora do perfil facial. Analisam as principais indicacoes deste metodo cirurgico para a correcao estetica do mento, ressaltando suas vantagens em relacao aos outros metodos descritos na literatura.

Uso de creme anestésico tópico para pequenos procedimentos em cirurgia plástica / Use of topical anesthetic cream form minor procedures in plastic surgery

Os autores avaliaram a eficácia e tolerabilidade de uma mistura de lidocaína 5//e prilocaína 5//em diversos tipos de cirurgias plásticas de pequeno porte. Os resultados mostraram que nas incisöes superficiais de até 1 mm de profundidade näo houve queixa por parte de qualquer paciente, enquanto que naquelas onde a profundidade ia até 2 mm, 54//dos pacientes também näo se queixaram. Em níveis globais, 72,5//dos pacientes näo se queixaram de dor, em 17,5//a dor foi leve e em apenas 10//a dor foi considerada de moderada a intensa. Nas incisöes mais profundas, nas quais havia necessidade de infiltraçäo de anestésico local, todos os pacientes näo sentiram a picada de injeçäo, nem se queixaram da dor pela difusäo do anestésico. Consideramos esse creme anestésico importante para os casos de cirurgias plásticas de pequeno porte, no sentido de tranquilizar o paciente quanto à dor e facilitar sua adesäo à cirurgia

The simultaneous correction of lip and nasal deformities in unilateral congenital clefts: preliminary results / Correçäo simultânea das deformidades labial e nasal em fissurado unilateral: resultados iniciais

Os autores apresentam sua experiência na correçäo simultânea das deformidades labial e nasal, utilizando a associaçäo das técnicas de Millard e McComb. Em 28 pacientes obtiveram 67,85% de casos com sensível melhora do contorno nasal, sem observar qualquer intercorrência relativa à aplicaçäo do método, e com a persistência dos bons resultados após três anos de acompanhamento pós-operatório

Fístula salivares do lábio inferior associadas a fissuras lábio-palatinas / Lower lip salivary fistulas associated with cheft lip and palate

Os AA. apresentam neste trabalho, o estudo de família com síndrome de fístulas de lábio inferior e fissura labial e/ou palatina em três geraçöes. O caso desta paciente com fístula congênita de lábio inferior associada a fissura lábio-palatina transforâmen unilateral esquerda corrobora com a idéia de que esta patologia, embora rara, interessa näo só o geneticista como ao cirurgiäo plático, do ponto de vista genético e epidemiológico. A investigaçäo da árvore genealógica desta família é sugestiva de herança autossômica dominante com expressividade variável

Treatment (ou management) of alar deformity in secondary rhinoplasty, upon external incision

The authors report their experience on treating 32 cases of postoperative alar deformit with external incision, and they conclude that the advantages, mainly represented by a wide exposure and the facility on execution of the correction's procedures, plainly justify the method

Saddle-nose and oriental nose treatment, upon external incision

The authors propose to treat the saddle nose by means of an external incision. 3 cases with varied ethiologies and the alternatives used for their correction are discussed