Classification pattern and step-by-step procedure for cartilage grafts with silicone implants for nasal tip plasty in Asians

A retrospective study on different kind of cartilage frameworks on Asian rhinoplasty

BACKGROUND

The character of Asian nose usually presents low projection of tip, short columellar, and short nose, necessitating the construction of a cartilage framework to achieve optimal results. The objective of this study was to evaluate the structural characteristics, stability, and postoperative outcomes of the integrated fixed framework, 1+1 framework, 2+1 framework, 4+1 framework, and Y-shaped framework.

METHODS

A retrospective analysis was conducted on a cohort of 612 patients who underwent rhinoplasty and were admitted between February 2017 and December 2022. According to rhinoplasty framework, the patients were categorized into fixed frameworks (integrated fixed framework group, 1+1 framework group, 2+1 framework group) or elastic frameworks(4+1 framework group, Y-shaped framework group). The stability of rhinoplasty frameworks was assessed by measuring nasal tip projection and nasolabial angle at both one and twelve months post-surgery. Postoperative follow-up included monitoring complications occurrence and evaluating patient satisfaction.

RESULTS

The mean duration of follow-up was 25.23 months (rang from 24 to 54 months). The overall satisfaction rate reached 89.37 %(547/612), with the highest satisfaction rate observed in 2+1 framework group.Compared with the integrated fixed, 1+1, 2+1 framework group, the nasolabial angle and nasal tip projection of 4+1, and Y-shaped framework group decreased more obviously(P < 0.001).

CONCLUSIONS

Nasal frameworks in Asians are generally classified as fixed frameworks or elastic frameworks. The stability of the fixed frameworks surpasses that of the elastic frameworks. The secure fixation of the strut to the anterior nasal spine can enhance the overall stability of the framework.

LEVEL OF EVIDENCE STATEMENT

IV.

Lollipop-Like Costal Cartilage Graft with a Peach-Shaped Head for East Asian Rhinoplasty

BACKGROUND

Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head.

METHODS

A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment.

RESULTS

A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported.

CONCLUSION

The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients.

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 .

Autologous Costal Cartilage With Expanded Polytetrafluorethylene (ePTFE) Implants for the Treatment of Nasal Deformity After Unilateral Cleft Lip Repair

OBJECTIVE

To repair and reconstruct the secondary nasal deformity after unilateral cleft lip repair, we used autologous costal cartilage and expanded polytetrafluorethylene (ePTFE) to get a better nasal shape.

METHOD

Nineteen patients with nasal deformity after unilateral cleft lip repair were treated from July 2018 to July 2021. During the operation, autologous costal cartilage was carved and formed and then implanted into the nasal tip and nasal columella, while the back of the nose was raised with ePTFE.

RESULT

Nineteen cases were followed up for 6 to 30 months. No transplanted cartilage and swelling were exposed or discharged. The appearance was good, and the patients were satisfied.

CONCLUSION

Autologous costal cartilage combined with ePTFE is an ideal treatment for nasal deformity after cleft lip repair.

Diced Cartilage Rhinoplasty for Cleft Nose Deformities: Determining the Flexibility of the Cartilage Framework

BACKGROUND

The objective of this trial is to evaluate the flexibility of the cartilaginous component of the cleft nose after diced cartilage rhinoplasty by determining the degree of possible bending in relation to the vertical nasal dorsum axis and to compare with to a control group of the unaffected population.

PATIENTS AND METHODS

Fifteen cleft nose patients with diced cartilage rhinoplasty were included in this study, as well as a control group of 15 unaffected individuals. The angle of maximum nasal bending is measured between the basic and maximum bending axis and performed by the same rater twice at least 2 weeks apart to account for intrarater reliability. Study groups were compared with Fisher and independent t test.

RESULTS

The maximum bending to the left side was 16.10 ± 5.03 degrees for the study group and 23.95 ± 6.54 degrees for the control group (P = 0.001). The maximum bending to the right side were 16.54 ± 6.73 degrees for the study group and 23.00 ± 8.88 degrees for the control group (P = 0.034).

CONCLUSION

Diced cartilage graft injection for dorsal augmentation yields reproducible and esthetically pleasing outcomes with good flexibility and natural feel of the nasal tip. Although there is a significant difference compared with a nonaffected control group in maximum bending capacity, all patients in this study were satisfied with the results.

Application of Conchal Cartilage Grafts in Nasal Tip Plasty: Comparison and Experience of 3 Methods

INTRODUCTION

The autologous conchal cartilage of good elasticity is easy to harvest, thus is often used in nasal tip plasty of East Asians. However, the operation techniques vary a lot among different surgeons. This article aims to introduce 3 techniques commonly used in clinical practice.

METHODS

One hundred three patients were included in this study and divided into 3 groups according to the shape of the nasal tip during 2017 to 2019. The patients were followed up for at least 6 months. All patients were measured with Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). ImageJ software was used to measure and calculate the projection ratio for lateral position standard image, and columella-labial angle (CLA) was measured.

RESULTS

In group 1, SCHNOS for nasal obstruction (SCHNOS-O) score were 13.23 ± 7.61 and 14.49 ± 10.55 (P > 0.05); SCHNOS for nasal cosmesis (SCHNOS-C) score were 66.55 ± 31.23 and 21.73 ± 18.91 (P < 0.001); projection ratio were 0.51 ± 0.04 and 0.57 ± 0.05 (P < 0.001); CLA were 91.02° ± 5.67° and 93.55° ± 4.64° (P > 0.05), preoperative and postoperative, respectively. In group 2, SCHNOS-O score were 16.76 ± 13.44 and 15.44 ± 9.26 (P > 0.05); SCHNOS-C score were 61.87 ± 44.14 and 19.16 ± 29.37 (P < 0.001); projection ratio were 0.50 ± 0.05 and 0.58 ± 0.03 (P < 0.001); CLA were 92.32° ± 6.39° and 94.86° ± 5.96°(P > 0.05), preoperative and postoperative, respectively. In group 3, SCHNOS-O score were 15.25 ± 7.83 and 17.73 ± 11.66 (P > 0.05); SCHNOS-C score were 52.03 ± 33.38 and 17.73 ± 11.66 (P < 0.001); projection ratio were 0.53 ± 0.05 and 0.57 ± 0.02 (P < 0.001); CLA were 91.65° ± 5.75° and 93.21° ± 5.38° (P > 0.05), preoperational and postoperational, respectively.

CONCLUSIONS

None of these 3 techniques cause or aggravate nasal obstruction, and all of them can achieve high cosmetic satisfaction. Technique 1 and technique 2 are suitable for the patients with moderate and moderate to severe short nose that is common in East Asia, which can better increase the protrusion of the tip and length of the nose. Technique 3 is suitable for the patients with better shape of the nose, who need to slightly increase the protrusion of the nasal tip and increase the upward rotation.