Modified technique to increase nostril cross-sectional area after using rib and septal cartilage graft over alar nasal cartilages

Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

OBJECTIVE

To evaluate and compare the costal cartilage lateral crural strut graft's (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty.

METHODS

This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed.

RESULTS

While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort's preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF.

CONCLUSION

The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

Anatomical Study of the Lateral Crural Strut Graft in Rhinoplasty and Its Clinical Application

BACKGROUND

Lateral crural strut graft has been used in rhinoplasty to correct deformities such as bulbous nasal tip, lateral crus malposition, alar retraction, collapsed external valve, lateral crus concavity, and alar deformity after domal suture. Despite its widespread use, the lateral crural strut graft has not been the subject of studies that show its benefits objectively and statistically.

OBJECTIVES

To assess nasal anatomical variations in cadavers that underwent rhinoplasty using the lateral crural strut graft, considering the clinical applications of this graft.

METHODS

The study was conducted with 16 human cadavers that underwent rhinoplasty with lateral crural strut graft. The variables were basilar nasal width, interalar width, columella-nasal tip height, nostril's width, and length and width of the graft. Measurements were taken with a digital caliper before and after rhinoplasty, and nostril cross-sectional area was measured with a computer program. All measurements were submitted to statistical analysis.

RESULTS

Most of the cadavers were young, male, and black. Variables values were increased, but only basilar nasal width, columella-nasal tip height, and nostril cross-sectional area showed statistically significant differences (P < .05), leading to changes in the alar base, the nasal tip projection and the external nasal valve.

CONCLUSIONS

Lateral crural strut graft improves external nasal valve and increases nasal tip projection and basilar nasal width.

Autogenous rib grafts for reconstruction of the manubrium after resection: technical refinements and outcomes

OBJECTIVE

Sternal reconstruction after resection is essential for restoring the rigidity of the chest cavity. However, no consensus has been reached regarding the most physiologic or efficacious material for this procedure. We present our clinical experience with autogenous rib grafts for reconstruction of the manubrium after resection and discuss the refinements in this procedure.

METHODS

Twelve consecutive patients with a confirmed diagnosis of a primary neoplasm in the manubrium between March 2003 and August 2013 were analyzed retrospectively. All patients underwent manubrium resection and immediate reconstruction with autogenous rib grafts.

RESULTS

No cases of perioperative mortality were noted. The median operation time was 129 minutes. One patient experienced mild paradoxical movement; the other patients recovered well without any complications. The median follow-up period after surgery was 69 months. Two patients died. One patient with chondrosarcoma died as a result of cardiac disease 26 months after surgery and another patient with non-Hodgkin lymphoma died as a result of local recurrence 6 months after surgery. Computed tomographic scans for the other 10 patients have shown neither dislocation nor abnormality of the transplanted ribs; moreover, no absorption of the grafts or recurrence was noted. None of the patients required prescription analgesics for the pain at the donor site at the 3-month follow-up visit.

CONCLUSIONS

This case series demonstrates the successful use of autogenous rib grafts in the reconstruction of the manubrium after resection. We consider that the reconstruction technique is a safe and effective alternative to a complex problem.

Lateral crus graft with autologous rib cartilage for cleft lip nostril asymmetry: a report of 35 cases

A surgical technique of lateral crus strut graft to correct the deformity of nostril contour and improve asymmetric nostril shape by autologous rib cartilage was reported. Thirty-five patients (20 males and 15 females), with a mean age of 19 years (range of 16-26 years) were included in this study. All of the patients suffered moderate to severe unilateral cleft lip nostril deformity and underwent surgical technique of lateral crus strut graft by autologous rib cartilage to correct the asymmetric nostril contour from 2010 to 2012. The views of the nostril contour on both sides were reviewed and some parameters were measured at different time points (preoperatively, and 3 months and one year postoperatively) including the long axis and short axis of the nostrils. The differences in nostrils including long axis, short axis, elliptical area and eccentricity on the both sides were compared at different time points. The differences in the long axis and eccentricity of the nostrils on the two sides were decreased significantly between the preoperative view and postoperative view (P<0.05). The surgical technique of lateral crus graft with autologous rib cartilage is effective to correct the abnormal nostril contour and improve the asymmetry for unilateral cleft clip patients.