Athelia: case report and review of the literature.

The absence of nipple-areola complex is a rare entity and is always associated with other anomalies. This paper described a case of bilateral athelia without other alterations. The atrophy of the dense mesenchyme due to absence of parathyroid hormone-related protein produced in epithelium may lead to nipple involution. Further cases should be studied to corroborate this theory.

Total reconstruction of the alar cartilages with a partially split septal cartilage graft.

The alar cartilage is a unique structure that supports the tip of the nose, keeps the external valve open, and plays an important role in tip aesthetics. Very often the plastic surgeon needs to reconstruct this cartilage, as in secondary rhinoplasties when the lower lateral cartilage is overresected. Many authors have described cartilage grafts taken from the ear and septum, mounted and stitched in various manners, with some very good results. In patients with thin skin, though, any irregularity or distortion in the grafts becomes visible after a short time postoperatively. The authors present an alternative to reconstructing alar cartilage symmetrically using one graft. This graft is obtained by shaping septal cartilage in an "L" form, with a 135-deg angle (instead of a 90-deg angle) between its legs, and then splitting the smaller leg, obtaining a strut from the longer leg and two "lateral crura" from the shorter leg.

Treatment of the nasal hump with preservation of the cartilaginous framework.

Classically, nasal hump reduction is based on the partial resection of the cartilages and bones of the nose, as it was described by Joseph almost a century ago. The cartilaginous portion of the hump consists of a single unity formed by the two upper lateral cartilages and the septal cartilage. During hump reduction in the classic rhinoplasty, this structure is slashed in three pieces, which is the main cause of irregularities, shadows, and pinchings over the long-term results. Late follow-ups of the classical hump removal often show an inverted V-shaped shadow on the dorsum secondary to the destruction of the osseous-cartilaginous transition. The angle and relation between the septal and upper lateral cartilages are reduced, which may compromise the functional aspect. The destruction of the unique anatomy of the cartilaginous hump is one of the main causes of this functional and aesthetic sequela. Here, we present a technique that preserves the cartilaginous framework of the nasal hump by lowering it through the resection of a strip of septum, avoiding the problems described above.

O trago como área doadora de enxerto de cartilagem: estudo anatômico / The tragus as a donor area of cartilage grafts: anatomic study

A orelha externa é uma das principais áreas doadoras de cartilagem. Geralmente, a regiao de retirada de enxertos é a concha da orelha. OBJETIVO. Neste trabalho, propoe-se a retirada de cartilagem também a partir da lâmina do trago, especialmente naqueles casos em que nao dispomos da porçao conchal da cartilagem da orelha. CASUISTICA E MÉTODO. Estudaram-se 40 orelhas de 20 cadáveres, quando foram aferidas as dimensoes da lâmina do trago. RESULTADOS. A cartilagem da lâmina do trago demonstrou ser de bom tamanho para retirada de enxertos, podendo se obter fragmentos de 13,8cm de largura, 21,4cm de altura e 1,6cm de espessura, em média. CONCLUSAO. O enxerto cartilaginoso obtido a partir da lâmina do trago é uma alternativa viável, principalmente para rinoplastias de correçao de dorso e ponta nasal.

[The tragus as a donor area of cartilage grafts: anatomic study]. / O trago como área doadora de enxerto de cartilagem: estudo anatômico.

UNLABELLED: The ear is one of the main donor sites of cartilage grafts. Usually, the main donor site of cartilage grafts in the ear is the conchae. PURPOSE: This study proposes the removal of cartilage grafts also from the "lamina tragi" that is a part of the ear cartilage, specially in those situations where we can not use or we do not want to use the conchae. METHODS: The cartilage of 40 ears was dissected and studied in 20 cadavers where the "lamina tragi" were measured. RESULTS: The cartilage extracted from the "lamina tragi" was shown to be of a good size for cartilage grafts. The fragment obtained measured 13.8 mm in width, 21.4 mm in height and 1.6 mm in thickness on the average. CONCLUSION: The cartilage graft obtained from the "lamina tragi" is a viable alternative, specially for rhinoplasties to correct the dorsum and the tip.

Total reconstruction of the alar cartilage en bloc using the ear cartilage: a study in cadavers.

To determine whether the lamina tragi, isthmus, and cavum conchae are a donor area for reconstruction of the alar cartilage with all its elements (medial crus, junction of the medial and lateral crura, and lateral crus), with the same dimension and en bloc, 40 alar cartilages and 40 lower parts of ear cartilages of 20 cadavers were dissected. Several measurements were taken in the alar cartilages, such as distance, thickness, and angle. Then they were compared with the measurements performed in the ear cartilages and segments removed from the lamina tragi, isthmus, and cavum conchae. This study, done with cadavers, shows that from the lamina tragi, isthmus, and cavum conchae, en bloc resection is possible with characteristics of form and dimension similar to those of the homolateral alar cartilage. The segment removed en bloc from the intermediate part of the lamina tragi, isthmus, and cavum conchae replaces, respectively, the medial crus, junction of the medial and lateral crura, and lateral crus.

Total en bloc reconstruction of the alar cartilage using autogenous ear cartilage.

A new technique is described for increasing the nasal tip by using an en bloc autogenous ear cartilage graft in such a manner as to create, in essence, a replacement of the entire ipsilateral alar cartilage.

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

Presentation of 62 cases of secondary nasal deformities treated by external incision. Several types of endonasal deformities were observed, properly classified and repaired. When excessive resection was observed, local cartilage graft, septonasal or conchal types were employed.