Diced cartilage for dorsal augmentation in rhinoplasty: effect on nasal projection and frontal nasal width.

This research study was designed to evaluate the aesthetic consequences of different dorsal augmentation techniques using diced cartilage on dorsal width and projection in rhinoplasty. Patients were assigned to three groups based on the dorsal augmentation technique used: diced cartilage wrapped in fascia (DCIF), free diced cartilage under fascia (DCUF), and free diced cartilage without fascia (FDC). Dorsal projection and dorsal aesthetic width were measured at two levels using pre- and postoperative photographs. A total of 98 patients were included in the study. DCIF was used in 51 patients, FDC in 27 patients, and DCUF in 20 patients. There was no significant difference in nasion projection, rhinion projection, or width of the dorsal aesthetic lines at the intercanthal and keystone levels among these groups. Significantly greater nasion and rhinion projection was observed with DCIF in thin-skinned patients followed-up for 6-12 months (nasion, P = 0.028; rhinion P = 0.039) but not at>12 months. Two patients with a graft infection and one with graft malposition were encountered in the DCIF group. Experience from this study suggests that the application of FDC prevents such complications without sacrificing the dorsal augmentation and that DCIF is a better choice for more severe deformities.

Effect of lateral crural cut overlay and medial crural cut and overlay in creating and maintaining tip projection and rotation: a randomised single-blind trial.

Lateral crural cut and overlay (LCC) or medial crural cut and overlay (MCC) are two of the many techniques applied to ensure an adequate nasal tip projection and rotation, but little evidence supports their long-term efficacy. Fifty-four rhinoplasty candidates were studied prospectively in this randomised clinical trial. The subjects were randomly divided into two groups according to the use of LCC or MCC. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardised photographs taken before and at three and 12 months after surgery were used to compare nasolabial angle and projection between groups. Patients' satisfaction with the cosmetic results and nasal obstruction were evaluated using the Standardised Cosmesis and Health Nasal Outcomes Survey (SCHNOS). LCC and MCC were each used in 26 cases. Preoperatively, the nasolabial angle, tip projection, and other characteristics were not significantly different between the groups. There was no significant difference in tip rotation stability (p = 0.624) and projection (p = 0.329) between the groups postoperatively, but patients' satisfaction with the cosmetic results was significantly higher in the MCC group (p = 0.046). It seems that both LCC and MCC are effective techniques in rhinoplasty. Compared with LCC, the use of MCC in qualified hands may increase the patients' satisfaction with the cosmetic results.

Comparing the efficacy of lateral crural overlay versus transposition technique on cephalic malposition in septorhinoplasty.

Cephalic malposition is an anatomical variant that is found particularly in Middle Eastern people. Malpositioning of the alar cartilage may cause both functional and aesthetic problems. This study aimed to investigate and compare the functional and aesthetic outcomes of the two techniques used to correct cephalic malposition of the lower lateral cartilage: lateral crural overlay (LCO) and lateral crural transposition. This current randomised double-blinded clinical trial was performed on 40 patients who were referred for rhinoplasty in 2017-2018. They were randomly divided into two groups, the lateral crural transposition group (n = 20), and the LCO group (n = 20). The angle between the lateral crura and the midline, nasal rotation, nasal tip projection, nasal axis deviation, columella labial angle, and nasofacial angle, plus a visual analogue scale (VAS) and the 10-item Standardised Cosmesis and Health Nasal Outcomes Survey (SCHNOS), were assessed for each patient before surgery and after 12 months, and further compared between the two groups. Both techniques successfully improved the lateral crural angle, nasal tip rotation, and columella labial angle (p < 0.05). Despite the satisfactory outcomes of the VAS and SCHNOS based on both the patients' and the surgeons' opinions (p < 0.05), comparison of the indices revealed insignificant differences between the two groups (p> 0.05). We obtained successful aesthetic and functional outcomes with both techniques.

Occult level IV metastases in clinically node-negative patients with oral tongue squamous cell carcinoma.

OBJECTIVE: The present study was conducted to determine the rate of level IV lymph node involvement among node-negative (N0) necks in patients with squamous cell carcinoma of the tongue. METHODS: The study comprised 32 patients with squamous cell carcinoma of the tongue, with tumour-node-metastasis staging of T1-3N0M0, who were admitted to the Otolaryngology Department at Tehran University of Medical Sciences from March 2012 to March 2014. After a complete diagnostic evaluation, wide primary tumour excision (with 1.5-2 cm margins) and extended supraomohyoid neck dissection (levels I-IV) were accomplished. RESULTS: Occult metastasis was found in 28 per cent of the patients. Level I, II and III metastases were the most common (18.75, 18.75 and 15.62 per cent, respectively). Level IV metastasis was found in 6.25 per cent of patients. CONCLUSION: Supraomohyoid neck dissection appears to be an appropriate treatment for N0 tongue squamous cell carcinoma and there is no need for level IV lymph node dissection in a N0 patient.