Effects of Nasal Packing on Patients' Post-operative Vital Signs.

Background Since bilateral nasal packing entails nasal and airway obstruction, this practice consequently leads to oral breathing. The resulting hypoxemia may then negatively impact vital signs, including blood pressure (BP), blood oxygen saturation (SpO2), and heart rate (HR). These systemic effects have a detrimental effect on patients. Objective The objective of this study is to observe the effects of bilateral nasal packing on patients' post-operative vital signs. Materials and methods This prospective study was conducted in the department of otolaryngology - head and neck surgery over a six-month period. The study included 83 post-operative patients with nasal surgery, in which bilateral merocele nasal packing was performed. The patients' pulse oximetry, systolic and diastolic BP, and HR were recorded four times the night before and after surgery. A statistical analysis was performed, and the mean values, standard deviation, and range were calculated. A paired sample t-test was also applied. The results are presented in figures and tables. Results The mean age of the participants was 27.65 ± 10.72 years, and 56 (67.5%) were male. Septoplasty was the most common surgery performed, with 63 participants having undergone this procedure (75.9%). When the pre-operative mean values of systolic and diastolic BP, SpO2, and HR were compared with the post-operative mean values, when a bilateral nasal pack was in place, a significant increase was found in all, with a p-value of <0.001 in each. Conclusion Bilateral nasal packing affects patients' vital signs by significantly increasing diastolic and systolic BP and decreasing SpO2. The HR is also significantly increased when packing is in place.

Comparison of the efficacy of fat, cartilage, and bone grafts in traumatic and asymmetric noses.

BACKGROUND: Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. OBJECTIVES: This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry. METHODS: A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools. RESULTS: Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups. CONCLUSION: Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts.

Nasal tip rotation flap for reconstruction of surgical defects on the distal nose.

BACKGROUND: The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. METHODS: A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. RESULTS: A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3-1.6 cm), and the mean defect size was 1.2 cm (range: 0.7-1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. CONCLUSIONS: The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim.

Long-term treatment outcomes in refractory rhinitis medicamentosa managed with nasal surgery.

BACKGROUND: Limited treatment options exist for refractory Rhinitis Medicamentosa (RM). The role of surgery after failed medical management is not well defined. Mucosal contact points and restricted airflow often perpetuate decongestant use. This study assessed the long-term outcomes of nasal surgery in patients with refractory RM. METHODS: A prospective cohort study of refractory RM treated with nasal surgery was performed with ≥12 months follow-up. Refractory RM was defined as nasal decongestant use once per day continuously for ≥4 weeks despite medical therapy. Patients with concomitant sinus disease and nonrhinitis conditions were excluded. Sinonasal Outcome Test (SNOT22), Nasal Symptom Score (NSS), and nasal medication use were assessed. Patients who ceased decongestants were compared with ongoing users. RESULTS: A total of 56 patients (age 48.4 [5.0] years, 50% female) were assessed. Median follow-up was 3.4(1.6-6.2) years. Total cessation of decongestants was achieved in 91.1%, while 5.4% had intermittent use, and 3.6% reported daily use. Ongoing users had higher odds of concomitant asthma (40.0% vs. 3.9%; odds ratio [OR], 16.33 [1.7-159.75]; p = 0.036), reduced symptom improvement (ΔSNOT22, -4.6 [15.7] vs. 27.1 [17], p = 0.009 and ΔNSS, -1.0 [4.2] vs. -6.6 [5.1], p = 0.025), and greater ongoing use of nasal corticosteroid (60.0% vs. 5.9%; OR 24.0 [2.8-203.1]) and saline sprays (40% vs. 3.9%; OR 16.3 [1.7-159.8]) but showed no difference in allergy status (OR, 0.7[0.1-7.1]), previous surgery (OR, 1.0[0.1-10.2]), gastroesophageal reflux (OR 1.0[0.1-10.2], or underlying anxiety/depression (OR 6.1[0.8-45.9]) compared with those who ceased. CONCLUSION: Surgically re-establishing a nasal airway was associated with long-term decongestant cessation and symptom improvement in medically refractory RM.

Is Computed Tomography Necessary Before Septoplasty? Correlation With Physical Examination and Patient Complaints.

INTRODUCTION: Septoplasty is one of the most common surgeries performed by otorhinolaryngologists. The gold standard for the evaluation of septal deviation is anterior rhinoscopy and nasal endoscopy. Frequently, computed tomography (CT) is also performed, although the correlation between septal deviation on CT and physical examination is unclear. OBJECTIVES: To study the relationship between symptoms and physical and radiological evaluation in patients who underwent septoplasty. METHODS: A prospective study of patients with nasal obstruction and septal deviation who underwent septoplasty. Anterior rhinoscopy and nasal endoscopy were performed by the surgeon, and the CT was evaluated by a radiologist. The degree of obstruction was evaluated in three distinct septal locations. The Nasal Obstruction Symptom Evaluation (NOSE) score was used before the surgery and two months after the surgery. RESULTS: The study included 43 patients, of whom 60.5% were male, with an average age of 37.09 years (±12.56). The degree of septal deviation in the physical examination was significantly different from that observed in CT (p˂0.05). Cartilaginous or maxillary crest septal deviations >75% were more commonly recognized by physical examination, while osseous septum deviations of 25%-50% were more easily detected by CT. There was no difference between the degree of septal deviation and the preoperative NOSE. The median preoperative NOSE was 60, and the postoperative was 5, with significant improvement (p<0.05). CONCLUSION: CT doesn't appear to be useful in the evaluation of septal deviation since it is different from the findings of a physical examination and isn't associated with the NOSE score. Clinical decisions should be based on a physical examination and patient complaints.

Merkel Cell Carcinoma: An Otolaryngological Point of View of An Unusual Sinonasal Mass.

Merkel cell carcinoma is a pathologic diagnosis mainly observed in sun-exposed cutaneous areas, like the head and neck. Ultraviolet (UV) exposure and immunosuppression are the common predisposing factors. Merkel cell carcinoma of the head and neck is quite an uncommon disease. This case report involves a 56-year-old man who exhibited a skin lesion on the nasal dorsum with a mass in the right maxillary sinus. The biopsies from both sides were diagnostic for Merkel cell carcinoma. The patient underwent endoscopic sinus surgery and removal of the skin lesion with free margins. The patient has been free of disease for the last 20 months now and maintains follow-up with endoscopy and imaging in the Ear Nose Throat office. Only a few cases of Merkel cell carcinoma of the nasal mucosa have been reported in the literature. We report our approach and management of this rare pathologic presentation.

A Novel Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) 3D Printing Method for Nasal Framework Reconstruction Using Microvascular Free Flaps.

The need for a total or subtotal nose resection represents a dramatic situation for any patient and a challenge for the reconstructive surgeon. Because even in the most skillful hands, an optimal result may be difficult to achieve. In this way, sometimes a free flap reconstruction is needed. A subtotal nasal reconstruction is presented using a fasciocutaneous free flap supported by computer-aided design (CAD), computer-aided manufacturing (CAM), and novel 3D printed guide to recreate the nasal cartilage framework. A successfully free flap reconstruction of the nasal framework was achieved supported by the CAD/CAM 3D printed template. We present a novel approach for nasal total or subtotal reconstruction using a CAD/CAM 3D printed model to create the nasal framework, based on the anatomical and radiological evaluation of the patient.

[Disfiguring neurinoma of the nose tip and the columella-rhinosurgical aspects]. / Dysfigurierendes Neurinom der Nasenspitze und der Columella ­ rhinochirurgische Aspekte.

Neurinomas in the nose and the nasal sinuses are rare. In the present work, we present an exceedingly rare case of a disfiguring neurinoma involving the nasal columella. Treatment of choice is complete resection of the tumor. For an optimal view for tumor resection and esthetic and functional reconstruction, we recommend an open surgical approach.

Contemporary trends in rhinoplasty.

The problem with the appearance of the nose or breath disturbance are relatively frequent in plastic surgery patients. The nose is distinctly aesthetic dominance of the face, therefore individual approach to nose operation is a necessary thing. The basic conditions for successful outcome of the operation are proper clinical examination and precise operating plan. There are several types of operations by type of defect: Nasal tip surgery (soft nose), complete rhinoplasty (total nose surgery inclusive corrections of osteotomies) and reconstructive nose surgery (septoplasty, saddle nose corrections, ethnical nose corrections). A special category including nose deformity or associated with cleft deformity in the face area. Nose surgery is delicate and difficult surgery. The emphasis is on surgeon´s experiences, both in terms of surgical technique and. Keywords: nose deformity, rhinoplasty, nose surgical technique, nose osteotomy, reconstructive nose surgery, septoplasty.

Osseous-Cartilaginous Spreader Graft and Nasal Framework Reconstruction.

Revision rhinoplasties and saddle nose deformities usually require grafting for reconstruction. Between January 1, 2000, and January 1, 2017, autologous rib grafts were used in 127 secondary and tertiary rhinoplasty patients [(57/127 females) and (70/127 males)]. Osseous-cartilaginous rib grafts (OCRGs) were divided into three parts (i.e., 1/3 upper peripheral, 1/3 central, and 1/3 lower peripheral). The harvested OCRGs were also shaped as vertical strips using a number 11 scalpel blade. These OCRGs were shaped to form the L-strut cartilaginous graft (LSCGs), osseous-cartilaginous spreader grafts (OCSGs), osseous-cartilaginous onlay grafts, nasal valve grafts (NVGs), and lower lateral cartilaginous grafts (LLCGs). The upper peripheral portion of the rib was usually used as an onlay graft for dorsal reshaping. The shape of this part was minimally convex after being cut from the main graft, and the convex shape was very appropriate for use as an onlay graft. The middle portion of the graft that consisted of the osseous and cartilaginous structure was used for the OCSGs. The middle portion of the graft that contained only cartilage was used for the LSCGs, NVGs, and LLCGs. OCRGs were used for the dorsal, alar, septal, upper lateral, and columellar struts for all patients. OCSGs were used for all of the septal grafts to provide further stability. In the nasal valve failure patients, the rib cartilage was fixed onto the lower lateral and upper lateral cartilage and was sutured using polyglactin to improve nasal valve function. One edge of the graft was sutured over the septum, and the other edge was positioned against the maxillary crest to allow for air flow at the nasal valve. After an OCSG was sutured to the septum, a flat and smooth dorsum was shaped before the dorsal onlay graft was placed and fixed. The bone fragments of the grafts that consisted of spreader and onlay grafts were tied to the radix nasi bone without any space. After 6 months of follow-up, a minimally warping defect was apparent in 8 patients but none of these patients requested another surgery. The analysis of the questionnaire responses revealed that >90% of the patients were satisfied with the outcome of the procedure. Level of evidence IV 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 .

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty.

Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.

Plain Language Summary: Improving Nasal Form and Function after Rhinoplasty.

OBJECTIVE: This plain language summary serves as an overview in explaining rhinoplasty and to aid patients and clinicians in their discussion of expectations, planning care, and improving surgical outcomes. The summary applies to patients 15 years of age and older and is based on the 2017 "Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty." The evidence-based guideline includes research to support effective identification and treatment of rhinoplasty candidates. The guideline was developed as a quality improvement opportunity for pre- and postoperative management of rhinoplasty patients by creating clear recommendations to use in medical practice.

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary.

Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline executive summary is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patient satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The guideline development group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.

Reconstrução nasal total: uso da "técnica em sanduíche" durante a residência / Total nasal reconstruction: use of the "sandwich technique" during residency

Introdução: Um dos locais mais comuns para o surgimento de câncer de pele é o nariz e, devido à sua distinta estruturação em três dimensões, a reconstrução do suporte da ponta nasal apresenta-se como um desafio para os cirurgiões plásticos. Métodos: Este artigo apresenta uma das opções de reconstrução nasal total utilizando como recursos o retalho frontal bilateral e o enxerto de cartilagem auricular bilateral em bloco. Apresentamos um relato do uso da "técnica em sanduíche", constituída por dois retalhos frontais intercalados pelas cartilagens auriculares. Enquanto o primeiro retalho origina o novo teto das fossas nasais, a cartilagem configura o formato tridimensional e garante o suporte da nova estrutura nasal. O segundo retalho fica, então, responsável pela cobertura exterior. Resultados: Neste caso comprovou-se tanto a mínima morbidade da área doadora quanto a excelente perfusão dos retalhos autonomizados, o que se considerou um resultado amplamente satisfatório. Conclusões: Embora a reconstrução nasal total seja um procedimento infrequente na vida do cirurgião plástico, a técnica aqui descrita mostra-se como uma opção atraente para estes casos.

Introduction: One of the most common sites of skin cancer is the nose, and because of its distinct three-dimensional structure, reconstruction of the nasal tip support is challenging for plastic surgeons. Methods: This article presents an alternative option for total nasal reconstruction using the bilateral frontal flap and the block bilateral auricular cartilage graft. We present an account of the use of the "sandwich technique", consisting of two frontal flaps interspersed by auricular cartilage. While the first flap gives rise to the new roof of the nasal fossa, the cartilage configures the threedimensional shape and provides support for the new nasal structure. The second flap is then responsible for the outer coverage. Results: In this case, both the minimal morbidity of the donor area and excellent perfusion of the autonomized flaps were verified, leading to a largely satisfactory result. Conclusions: Although total nasal reconstruction is an infrequent procedure in the career of a plastic surgeon, the technique described here is a viable option for these cases.

Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilaterais / Primary treatment of lip and nasal deformity in unilateral cleft lip or cleft lip and palate

Introdução: A fissura labiopalatina é a deformidade congênita mais frequente dentre as malformações craniofaciais, afetando principalmente o lábio superior, nariz e palato. A realização da queiloplastia associada à rinoplastia primária em tempo único é uma tendência. Avaliamos a correlação entre a gravidade da fissura, a idade cirúrgica e a qualidade estética do resultado pós-operatório. Métodos: Foram avaliados 26 pacientes com fissuras labiais ou labiopalatinas unilaterais, com idades entre 3 e 12 meses, operados pela técnica de queilorrinoplastia de Göteborg/McComb. Foi feita uma avaliação fotográfica do pré e pós-operatório por cinco cirurgiões plásticos separadamente e os dados analisados. Resultados: A idade média de realização do procedimento foi de 6,5 ± 3,15 meses, sendo que somente sete pacientes (26,9%) foram operados na idade de 3 meses preconizada pelo protocolo. Foi encontrada correlação entre a gravidade da fissura e a qualidade dos resultados, ao mesmo tempo em que não foi encontrada associação entre a idade da cirurgia e os resultados. Todos os casos do estudo foram considerados ótimos ou satisfatórios. Conclusões: A utilização de uma técnica de queiloplastia que seja de fácil reprodutibilidade, com bons resultados estéticos, e que possa ser utilizada em conjunto com outras técnicas de tratamento primário do nariz é uma boa opção a ser adotada por centros de tratamentos deste tipo de paciente. A gravidade da fissura é um fator importante na qualidade dos resultados. Quanto mais grave a fissura os resultados tendem ser piores. A idade da cirurgia, neste estudo, não teve correlação com a qualidade nos resultados.

Introduction: Cleft lip and palate, the most frequent congenital craniofacial deformity, mainly affects the upper lip, nose, and palate. One possible treatment is single-stage lip repair with primary rhinoplasty. Here we assessed the correlations among cleft severity, surgical age, and aesthetic results. Methods: A total of 26 patients with unilateral cleft lip or cleft lip and palate aged 3-12 months underwent surgical lip repair associated with the Göteborg/McComb rhinoplasty technique. Steps before and after surgery were separately evaluated by five plastic surgeons using pictures and the data were analyzed. Results: The average patient age at surgery was 6.5 ± 3.15 months, and only seven patients (26.9%) underwent surgery at 3 months of age as recommended by the protocol. Cleft severity and results quality were associated, whereas surgical age and aesthetic results were not correlated. Results in all cases were considered optimal or satisfactory. Conclusions: The lip repair technique, which presents good reproducibility and aesthetic results and can be used with other primary treatment techniques for the nose, should be adopted by treatment centers managing cleft lip and palate. Cleft severity is an important factor in results quality; the greater the severity, the worse the results. In the present study, surgical age was not correlated with results quality.

Versatility of the mid-forehead flap in facial reconstruction / Versatilidade do retalho médio-frontal nas reconstruções faciais

Introduction: Reconstruction of complex facial defects is a challenge to the plastic surgeon. Different missing anatomical units must be accessed in different ways and with individualized goals, always tailoring the options to the patient's needs. The objective is to examine the role of the mid-forehead flap in the reconstruction of different anatomical facial units. Methods: Retrospective analysis of patients who were operated on by the author from February 2010 to June 2015. Patients were evaluated according to age, sex, lesion etiology, defect location, number of operations performed per patient, and postoperative complications. Results: Fifteen patients (mean age, 69 years) underwent facial reconstruction with a mid-forehead flap. Thirteen patients required more than one operation for pedicle refinement and transection. There was one case of partial necrosis of the flap in the columella region, with satisfactory healing by second intention. There was no infection or hematoma. All secondary cartilage grafts showed integration into the recipient bed. Conclusions: The mid-forehead flap remains an important tool for the reconstruction of major facial defects. It allows the transfer of frontal tissue in an efficient and reliable way with minimal deformity in the donor area, resulting in an esthetically acceptable reconstruction.

Introdução: A reconstrução de defeitos complexos faciais é um desafio ao cirurgião plástico. Diferentes unidades anatômicas ausentes devem ser acessadas de maneiras distintas e com objetivos próprios, sempre adequando as possibilidades ao paciente em questão. O objetivo é mostrar o papel do retalho médio-frontal na reconstrução de diferentes unidades anatômicas faciais. Métodos: Análise retrospectiva de pacientes operadas pela autora, no período de fevereiro de 2010 a junho de 2015. Os pacientes foram avaliados em relação à idade, sexo, etiologia da lesão, localização do defeito, número de tempos cirúrgicos realizados por paciente e complicações pós-operatórias. Resultados: Quinze pacientes foram submetidos à reconstrução facial com retalho médiofrontal, com média de idade de 69 anos. Treze pacientes necessitaram mais de um tempo cirúrgico para refinamento e transecção do pedículo. Houve um caso de necrose parcial do retalho na região da columela, com cicatrização satisfatória por segunda intenção. Não houve infecção ou hematoma. Todos os enxertos cartilaginosos secundários se integraram ao leito receptor. Conclusões: O retalho médio-frontal permanece como importante ferramenta na reconstrução de grandes defeitos faciais. Permite a transferência de tecido frontal de forma eficiente e confiável com mínima deformidade na área doadora, possibilitando uma reconstrução esteticamente aceitável.

Tratamento estético da columela nasal: columela oculta e columela pendente / Aesthetic treatment of retracted and hanging nasal columellas

Os autores revelam, no presente trabalho, suas abordagens frente às alterações estéticas da columela nasal, mais observadas em sua prática clínica, a columela oculta e a columela pendente. Para a columela oculta os autores descrevem o uso de um retalho condro-mucopericondral do septo nasal como escolha preferencial. Para o tratamento da columela pendente os autores utilizam as abordagens, direta e indireta, descritas por Randall, nos casos leves a moderados, e para os casos mais acentuados utilizam uma associação de táticas além de uma modificação do que é descrito por Armstrong e Joseph. Suas opções de tratamento são confrontadas com o que há descrito na literatura da especialidade e seus resultados comparativos são apresentados.

This study discusses approaches for aesthetic correction of nasal columellas, i.e. retracted and hanging columellas, most commonly observed in clinical practice. We describe a chondral-mucoperichondrial nasal septal flap and direct or indirect approaches described by Randall as our preferred procedures to correct retracted and mild to moderate hanging columella, respectively. A combination of procedures is used in more severe cases, in addition to modified Armstrong and Joseph's approaches. These treatment options are compared to other literature reports on this specialty.

Correção da deformidade da cartilagem alar com cartilagem conchal em pacientes fissurados unilaterais / Alar cartilage deformity correction using conchal cartilage in patients with unilateral cleft lip-nose

Rhinoplasty in patients with cleft lip and palate is a challenging surgery to the plastic surgeon because it involves the correction of multiple factors associated whith and altered anatomy. Methods: A retrospective analysis of 15 patients that were submitted to surgery perfomed by the author, beteween February 2009 and January 2012, was performed. Investigated parameters included age, gender, and type of cleft. Results: All patients were subjected to open rhinoplasty using a "Folded" conchal cartilage for alar cartilage deformity correction on the cleft side, with satisfactory results. Necrosis of the columella, which healed by secondary intention, was reported in a single case (6.7%). Conclusions: The "folded" conchal cartilage graft is a good option for correcting alar cartilage deformities in patients with cleft lip or unilateral clef lip and palate.

A rinoplastia do paciente com fissura labiopalatal é uma cirurgia desafiadora, por envolver a correção de múltiplos fatores de uma anatomia alterada. Método: Foi realizada análise retrospectiva de 15 pacientes operados pelo autor, no período de fevereirode 2009 a janeiro de 2012. Foram analisados parâmetros como idade, gênero e tipo de fissura. Resultados: Todos os pacientes foram operados com a técnica de rinoplastia aberta utilizando-se cartilagem conchal "dobrada" para correção da deformidade da cartilagem alar do lado da fissura, com resultado satifatórios. Houve 1( 67%) caso de necrose do retalho columelar, que cicatrizou por segunda intenção. Conclusões: O enxerto de cartilagem conchal "dobrada" é uma boa opção de enxerto no tratamento da deformidade da cartilagem alar afetada do paciente com fissura labial ou labiopalatal unilateral.

Avaliação da permeabilidade das vias aéreas com a utilização dos enxertos expansores (spreader grafts)em rinoplastia: estudo preliminar / Permeability evaluation of the air flow using spreader grafts in rhinoplasty: preliminary study

Introdução: Os enxertos expansores (spreader grafts) vêm sendo utilizados em rinoplastias desde 1983 e sua utilização se tornou rotineira. Entretanto, não existem estudos comprovando a eficácia na melhora do fluxo nasal após utilização dos enxertos alargadores. Objetivo: O objetivo desse estudo foi avaliar prospectivamente a utilização dos enxertos expansores em rinoplastias, analisando o grau de melhora na permeabilidade e fluxo nasal desses pacientes, por meio da rinometria acústica e espelho de Altmann. Método: Foram operados 7 pacientes, com idade entre 23 e 35 anos, no período de março a agosto de 2009. Os pacientes apresentavam queixa estética como motivação primária e durante o procedimento cirúrgico foram colocados enxertos expansores bilateralmente, através de exorrinoplastia. Nos períodos pré e pós-operatório de 3 meses, os pacientes foram submetidos à realização de medidas rinométricas e de fluxo nasal com auxílio do espelho de Altmann. Resultados: No período observacional, não houve complicação relacionada à remoção da cartilagem septal ou ao uso dos enxertos expansores. As análises rinométricas e do espelho de Altmann demonstraram objetivamente a efetividade dos enxertos alargadores na prevenção de alterações funcionais após rinoplastias. Conclusão: Os dados desse estudo sugerem que a utilização dos enxertos expansores se mostrou eficaz, por meio de melhor avaliação funcional realizada no pós-operatório pela rinometria acústica.

Introduction: Spreader grafts have been used in rhinoplasty since 1983, and over the years, its use became routine. However, there are no studies proving the effectiveness in improving nasal air flow after the use of spreader grafts. Objective: The objective of this study was to evaluate prospectively the use of spreader grafts in rhinoplasty, analyzing the degree of improvement in nasal permeability and nasal flow of those patients through acoustic rhinometry and Altmann mirror. Method: This study included 7 patients between 23 and 35 years, operated from March to August, 2009. The patients aesthetics complains were the primary motivation and during surgery, graft expanders were placed bilaterally through open rhinoplasty. In the pre and 3 months, post operative, patients were under rhinometric measures and nasal flow through the Altmann mirror. Results: During the observation period, there were no complication related to the septal cartilage harvested or the use of graft expanders. Rhinometric analysis and mirror Altmann objectively demonstrated the effectiveness of spreader grafts in the prevention of functional changes after rhinoplasty. Conclusion: The results suggested that the use of spreader graft is effective, using acoustic rhinometric as a post operative method of evaluation.

Rinoplastia em nariz fissurado / Rhinoplasty in the cleft nose

Introdução: As fendas labiopalatinas são as anomalias congênitas mais comuns e prejudicam frequentemente a harmonia do nariz, sendo facilmente percebidas nos indivíduos acometidos. Para se conseguir um resultado harmonioso e simétrico em um nariz bastante deformado, é preciso usar estruturas adicionais que vão garantir um bom resultado ao longo prazo. Objetivo: Analisar a enxertia cartilaginosa como um procedimento cirúrgico na técnica de rinoplastia estética e demonstrar sua aplicação para a sustentação e definição da ponta nasal nas sequelas de fissuras labiopalatinas. Método: Foi realizado um estudo retrospectivo, transversal, analisando pacientes em tratamento em um hospital infantil público e em uma clínica particular, que se submeteram ao tratamento cirúrgico para correção de sequela de fenda labiopalatina, no período de outubro de 2005 a abril de 2009. Resultados: Foram submetidos 24 pacientes ao tratamento cirúrgico, 14 eram do sexo masculino e 10 do feminino. A idade média foi de 13,75 anos, sendo que a maioria dos pacientes apresentava idade entre 11 e 15 anos. Dois pacientes foram submetidos à cirurgia do lábio e nariz no mesmo tempo cirúrgico, quatro haviam sido submetidos a rinoplastia prévia. Conclusão: De acordo com os resultados obtidos e com a análise dos procedimentos cirúrgicos, pode-se concluir que as técnicas usadas na rinoplastia estética podem ser aproveitadas na cirurgiade nariz fissurado, apresentando resultados duradouros, tanto para sustentação como para a definição da ponta nasal.

Background: The cleft lip nose is the most common congenital anomaly in the face and frequently compromises the entire structure of the nose, being easily notice able by the patients. To be able to get a harmonious and symmetric outcome in a very deformed nose,it is necessary to use additional structures that will guarantee a good long-term result. Objective: To analyze the cartilaginous graft as a surgical procedure in the aesthetic rhinoplasty technique and to demonstrate its application to sustain and to define the nasal tipin the sequels of the cleft nose. Methods: This research is a retrospective and transversal study that analyzed patients in a public children’s hospital and a private clinic that received surgical treatment to correct cleft nose sequels in the period of October 2005 and April 2009. Results: The study observed the results of 24 patients, 10 females and 14 males. The average age was 13.75 years, and most of the patients were between 11 and 15 years old. Two patients operated nose and lip at the same surgical procedure, and four patients had previous rhinoplasties. Conclusions: The cartilaginous graft techniques used in the classic rhinoplasty can be used in the cleft nose, leaving functional and aesthetical results that are very satisfactory, but most of all, with long-term results.