Application of modified Rintala flap in nasal tip reconstruction.

INTRODUCTION: For nasal tip reconstruction, we must consider optimal results including color match, good tissue coverage, excellent flap viability, and good aesthetic result. METHODS: In this study, 25 patients who had nasal tip skin tumors were included, and reconstruction of the defects by dorsal nasal advancement flap (Rintala) was done. The advantages and disadvantages of the Rintala flap were described for all patients with nasal tip basal cell carcinoma (BCC). All patients filled out the consent form before reconstruction and tumor surgery. RESULTS: In this study, 25 patients (11 women and 14 men) ranging from 25 to 72 years old (mean, 53 years) underwent operation with dorsal nasal advancement flap (Rintala). Reconstruction of nasal tip defects after complete tumor excision was done with free margin. After sedation analgesia, we used bilateral parallel incision in both sides of the nasal sidewalls from corner to glabellar region; Burow triangles are excised bilaterally in lateral to the base of the flap. CONCLUSIONS: In case of midline tip defects with 1.5 to 2.5 cm in diameter, a modified Rintala flap is a good choice for reconstruction of this difficult area. This is a superiority-based randomized flap that makes an aesthetic nasal tip after tumor excisions without any fear from ischemia or necrosis of the flap.

Anatomic variations found on dissection of depressor septi nasi muscles in cadavers.

OBJECTIVES: To define variations of the depressor septi muscle in Iranians; to provide guidance for modification of this muscle during rhinoplasty in patients with an active muscle and short upper lip; and to correlate our findings with our clinical experience to develop the applied algorithms. METHODS: This study was conducted by dissecting 82 depressor septi nasi muscles in 41 Iranian cadavers. Origin and insertion points of each muscle were studied. RESULTS: Three variations were found in muscle insertion points: periosteal, orbicularis oris, and floating. Forty-four percent of the muscles were inserted into the periosteum of the maxilla (n = 36); 39% of muscles were inserted into the orbicularis oris muscle (n = 32); and 17% were diminutive or floating (n = 14). Periosteal insertion was thicker and stronger than the other variations. In all cadavers, the origin of the muscle was medial crus of alar cartilage and caudal of the nasal septum. CONCLUSIONS: This cadaveric dissection showed that the percentage of depressor septi muscle insertions is not similar to that found in other surveys. In this study, periosteal insertion of the depressor septi muscle was the most common variation.