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Chiang CA, Tan PC, Zhou SB. A reinforced framework construction technique using unilateral auricular cartilage in Asian rhinoplasty to prevent long-term nasal tip drooping. J Plast Reconstr Aesthet Surg 2023; 85:134-142. [PMID: 37487259 DOI: 10.1016/j.bjps.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/14/2023] [Accepted: 07/02/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Enhancing nasal tip projection is an important objective in Asian rhinoplasty. Nasal tip enhancement using auricular cartilage is simple and suitable for Asian patients. However, the long-term retraction problem of the auricular framework still needs to be solved for optimal results. OBJECTIVES The authors propose a modified auricular cartilage framework construction technique that provides stronger long-term support to the nasal tip and columellar base. METHODS Eighty-one patients underwent augmentation rhinoplasty between January 2016 and December 2019. The cymba and cavum conchae were harvested from one ear in all cases. The cymba concha was carved and folded to form a caudal septal extension graft (CSEG). The cavum concha was divided into an integrated cap/shield graft and a columella base graft. The columella base graft was diced into particles in size of 1 mm3, and inserted into the gap between CSEG, anterior nasal spine, and the medial crus to strengthen the foundation. The nasal profile was analyzed before the operation and at least 12 months after the operation. The patient satisfaction score was assessed 12 months after surgery. RESULTS Patients were followed up for 12-36 months. The nasal tip projection from both the lateral and basal views was significantly improved. The columella-labial angle was increased from 83.15° (6.20°) to 96.50° (7.40°) (p < 0.05). The nostril tip proportion increased from 0.83 (0.14) to 1.17(0.16) (p < 0.01). A stable long-term outcome was achieved. CONCLUSIONS With the modified framework construction technique, long-term nasal tip drooping can be prevented. This method can be a practical choice for Asian patients seeking augmentation rhinoplasty.
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Affiliation(s)
- Cheng-An Chiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, No. 639 ZhiZaoJu Rd, Huangpu District, Shanghai, China; Department of Cosmetic Surgery, Shanghai BestWay Medical Cosmetic Corporation, No. 120 FenYang Rd, XuHui District, Shanghai, China
| | - Poh-Ching Tan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, No. 639 ZhiZaoJu Rd, Huangpu District, Shanghai, China
| | - Shuang-Bai Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, No. 639 ZhiZaoJu Rd, Huangpu District, Shanghai, China.
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Li Y, Guo H, Tang D, Xin Z, Yang W, Yao P. Application of Auricular Cartilage Scaffold Combined With L-Shaped Prosthesis in Asian Rhinoplasty. J Craniofac Surg 2023; 34:1661-1665. [PMID: 37220717 PMCID: PMC10445630 DOI: 10.1097/scs.0000000000009341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/24/2023] [Indexed: 05/25/2023] Open
Abstract
Rhinoplasty is a common surgical procedure in medical cosmetology. From patients with saddle nose deformity to beauty seekers with low and short noses, this surgery is mainly sought to improve the nose's appearance. To investigate the effect of modified auricular cartilage scaffold combined with L-shaped prosthesis in rhinoplasty. This retrospective study included 54 patients who underwent auricular cartilage augmentation rhinoplasty with L-shaped implants in our hospital from July 2018 to July 2021. The function of nasal ventilation and olfaction was inspected. As a result, the degree of nasal tip protrusion and the changes in the superior lip angle of columella were improved. The patients' satisfaction was measured a year after the surgery. Patients who underwent auricular cartilage augmentation rhinoplasty with L-shaped prosthesis were satisfied with the surgery outcomes. Using a protective auricular cartilage scaffold combined with an L-shaped implant for augmentation rhinoplasty reduced the shortage of the application and reinforced the stability of the auricular cartilage augmentation rhinoplasty. At >12 months follow-up, there were no serious adverse effects on nasal ventilation and olfactory function in any of the patients. The presented method made full use of auricular cartilage so that it reduced the harvest of the cartilage. Besides, it achieved the remarkable lift of the nose tip, thus simulating the appearance of costal cartilage rhinoplasty. Furthermore, the risk of implant exposure was efficiently reduced, making it worthy of clinical application.
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Affiliation(s)
- Yi Li
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Hao Guo
- Department of Plastic Surgery, Shanghai Rongyan Medical Cosmetic Outpatient Department, Shanghai, China
| | - Dongsheng Tang
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Zengtao Xin
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Weiyuan Yang
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Ping Yao
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
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Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft. J Plast Reconstr Aesthet Surg 2023; 77:262-270. [PMID: 36592537 DOI: 10.1016/j.bjps.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A 1-2-mm thin rib cartilage graft was used as a septal extension graft to overcome the drawbacks of traditional rib cartilage rhinoplasty, which often results in a stiff nasal tip. The remaining rib cartilage was placed on the nasal dorsum as an ultrafine diced cartilage wrapped in fascia (UDCWF) graft. This study aimed to assess the stability of thin rib cartilage grafts and measure the resorption rate of the UDCWF graft. METHODS This retrospective study included 53 patients who underwent rhinoplasty with septal extension grafting and nasal dorsum augmentation using a septal cartilage (SC group) or rib cartilage (RC group) graft between June 2017 and June 2020. The nasal length, tip height, sellion height, and nasolabial angle in the preoperative, immediate postoperative, and long-term postoperative periods were analyzed using three-dimensional photogrammetry. RESULTS A total of 26 patients received rib cartilage grafts and 27 patients received septal cartilage grafts. The RC group showed greater maintenance of tip height, nasal length, and tip derotation over time. The relapse ratio in tip height was -3.3 ± 1.6% and -8.4 ± 4.3% in the RC and SC groups, respectively (p = 0.001). The resorption rate of the UDCWF graft was -7.5 ± 3.6% and -7.8 ± 2.3% at the sellion and rhinion, respectively. CONCLUSIONS The thin rib cartilage provided sufficient intrinsic strength to maintain tip height and tip rotation. It can be an effective alternative to rhinoplasty in Asians with features such as thick skin and a short nose. Moreover, the UDCWF graft exhibited an approximately 7.5% resorption rate, leading to lower probabilities of dorsal irregularity and stepping deformity.
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Zhang Z, Yu Z, Song B. Septal extension graft for correcting short nose in East Asians: Review of autologous cartilage grafts and postoperative stability. Br J Oral Maxillofac Surg 2022; 60:1159-1165. [DOI: 10.1016/j.bjoms.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
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Takaishi S. Endoscopic Endonasal Repair of the Orbital Medial Wall Fracture Utilising Nasal Septal Cartilage as the Reconstructive Material. Am J Rhinol Allergy 2022; 36:695-698. [PMID: 35257597 DOI: 10.1177/19458924221086181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To repair orbital medial wall fractures, otorhinolaryngologists often use the silicone sheet technique by inserting an inverted U-shaped silicone sheet into the middle meatus after the removal of fractured bones, and packing gauze inside the silicone sheet for several days to fix the shape of the medial wall. However, this method does not sufficiently reduce the orbital content. OBJECTIVE To describe the surgical procedure to repair medial wall fractures using nasal septal cartilage as the reconstructive material. METHODS First, endoscopic septoplasty is performed. Although the correction of the septal deviation is performed to secure the operative field, the nasal septal cartilage, except the L-strut is resected simultaneously. After septoplasty, the fractured bones of the lamina papyracea are removed from the herniated orbital contents, and then the orbital contents can be reduced without resistance by pushing laterally. Subsequently, the cartilage is inserted beneath the fracture edges of the orbital medial wall with great care to avoid entrapping the orbital soft tissue and extraocular muscles. RESULTS The cartilage can be placed appropriately along the medial wall of the orbit. CONCLUSION This technique enables to repair most cases of orbital medial wall fractures using the endoscopic endonasal approach alone without alloplastic implants.
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Affiliation(s)
- Shinya Takaishi
- Department of Otorhinolaryngology, 26799Jikei Kashiwa University School of Medicine, Chiba, Japan
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Pshenisnov KP, Pshenisnov KK. Invited Discussion on: M-Shaped Auricular Cartilage as Modified Septal Extension Graft: A Study by Three-Dimensional Anthropometric Analysis in Asian Rhinoplasty. Aesthetic Plast Surg 2021; 45:2295-2299. [PMID: 33855581 DOI: 10.1007/s00266-021-02278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Kirill P Pshenisnov
- Division of plastic surgery, European Medical Center, 7 Orlovsky per, Moscow, 129110, Russian Federation
- Yaroslavl State Medical University, Yaroslavl, Russian Federation
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Chou DW, Farrior EH, Tamplen M. Novel Osteochondral Caudal Septal Extension Graft in Septorhinoplasty. Facial Plast Surg Aesthet Med 2021; 24:310-311. [PMID: 34297905 DOI: 10.1089/fpsam.2021.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David W Chou
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Edward H Farrior
- Farrior Facial Plastic and Cosmetic Surgery, Tampa, Florida, USA
| | - Matthew Tamplen
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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Yoon SH, Kim CS, Oh JW, Lee KC. Optimal harvest and efficient use of septal cartilage in rhinoplasty. Arch Craniofac Surg 2021; 22:11-16. [PMID: 33714247 PMCID: PMC7968986 DOI: 10.7181/acfs.2020.00486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nasal septal cartilage is used to obtain favorable aesthetic and functional outcomes in rhinoplasty, but is often difficult to harvest or the harvested amount is insufficient. Therefore, the objective of this study is to introduce how to harvest septal cartilage optimally without losing and use harvested cartilage efficiently. METHODS From March 2015 to January 2020, we tried to harvest as much septal cartilage as possible while maintaining the L-strut in 30 patients. A spreader flap and septal rotation suture were used instead of a spreader graft. Also in patients who needed a spreader graft and septal extension graft, a spreader graft was used on one side and a one-piece spreader graft combined with a septal extension graft was performed on the other side. For tip plasty, a columella septal suture was performed first. Postoperative patient satisfaction was assessed using the Rhinoplasty Outcome Examination questionnaire. RESULTS No serious complications were observed. The patient satisfaction score was 50% or above in 27 patients (90%) and less than 50% in only three patients (10%). The average score was 81.5 points. CONCLUSION For septal cartilage deficiency, a spreader flap, the septal rotation suture, or onepiece spreader graft combined with a septal extension graft was used. The nasal tip was sufficiently rotated using the columellar septal suture technique first. These techniques made it possible to obtain good aesthetic outcomes using only septal cartilage, without harvesting other cartilage.
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Affiliation(s)
- Sung Ho Yoon
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Cha Soo Kim
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Oh
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun Cheol Lee
- Department of Plastic and Reconstructive Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Deviated nose: Physiological and pathological changes of the nasal cavity. Arch Plast Surg 2020; 47:505-515. [PMID: 33238336 PMCID: PMC7700847 DOI: 10.5999/aps.2020.01781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/27/2020] [Indexed: 11/08/2022] Open
Abstract
Deviated nose is highly challenging in rhinoplasty since the surgeon should consider both aesthetic and functional aspects of the nose. Deviated nose correction is surgically complex, and a thorough understanding of the mechanical and physiological changes of intranasal structures, including the septum and turbinates, is necessary for functional improvement.
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Kim TK, Jeong JY. Surgical anatomy for Asian rhinoplasty: Part II. Arch Craniofac Surg 2020; 21:143-155. [PMID: 32630985 PMCID: PMC7349142 DOI: 10.7181/acfs.2020.00234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/11/2022] Open
Abstract
Surgical anatomy for Asian rhinoplasty Part I reviewed layered anatomy with neurovascular system of the nose. Part II discusses upper two-thirds of nose which consists of nasal bony and cartilaginous structures. Nasal physiology is mentioned briefly since there are several key structures that are important in nasal function. Following Part III will cover lower one-third of nose including in-depth anatomic structures which are important for advanced Asian rhinoplasty.
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Abstract
Mestizo noses have mesorrhine nasal characteristics. They have a modest osteocartilaginous framework, nasal tips that tend to be bulbous with poor projection and rotation, and skins that tend to be thick and acne prone. A structural rhinoplasty approach is performed, focusing on anatomic findings. Conservative tissue excision with preservation or reinforcement of support structures of the nose is done. Structural grafting and suturing techniques are used to remodel cartilage and create better definition and support. The skin and soft tissue envelope is managed medically and surgically. The objective is to create balanced-looking noses that bring patients closer to their own aesthetic ideal.
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Affiliation(s)
- Roxana Cobo
- Department of Otolaryngology, Centro Médico Imbanaco, Carrera 38A #5A-100 Consultorio 222, Cali, Colombia.
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Nassimizadeh A, Nassimizadeh M, Wu J, Yoo DB. Correction of the Over-resected Nose. Facial Plast Surg Clin North Am 2019; 27:451-463. [PMID: 31587765 DOI: 10.1016/j.fsc.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Overzealous reduction during rhinoplasty may result in manifold functional as well as aesthetic injuries to the nose and is a prevailing antecedent of revision rhinoplasty. Although challenges for the revision rhinoplasty surgeon abound, careful assessment of the anatomic deficiencies of the nose, accurate evaluation and management of a patient's expectations, and precise planning and execution of surgical technique serve to facilitate a successful result. Contemporary techniques for correction of the over-resected nose are discussed, with special attention directed toward costal cartilage grafting and diced cartilage fascia techniques.
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Affiliation(s)
| | | | - Jinli Wu
- Yoo Plastic Surgery, 120 S Spalding Drive Suite 303, Beverly Hills, CA 90212, USA
| | - Donald B Yoo
- Donald B. Yoo, M.D., Inc, Facial Plastic & Reconstructive Surgery, Beverly Hills, CA, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California - Los Angeles, Los Angeles, CA, USA.
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Caudal Septal Extension Graft Sutured with Absorbable Material and Not Fixed to the Nasal Spine Region Compared with the Conventional Fixation Method: A Retrospective Study. Aesthetic Plast Surg 2019; 43:759-767. [PMID: 30815733 DOI: 10.1007/s00266-019-01330-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The caudal septal extension graft (CSEG) is a predictable method for positioning the tip and columella during rhinoplasty, and it is commonly performed using permanent sutures and in some cases fixating the graft to the nasal spine region (NSR) (conventional method). Whether this predictability is preserved when using absorbable sutures has yet to be determined. METHODS We performed a retrospective assessment of 1146 patients who underwent rhinoplasty performed by the same surgeon using the CSEG method from 2008 through 2017 in an academic setting. We utilized a computer-based patient record system for automatic data collection comparing outcomes of two groups: a group of patients who were operated on using the conventional fixation method (2008-2011) (group 1) with a second group in which absorbable sutures were used without fixation to the NSR (2011-2017) (group 2). The average follow-up period was 33.2 months. Patients operated on using a combination of methods and patients with less than 6 months of follow-up were excluded. All cases had the same septum-to-extension graft suturing technique with either permanent or absorbable suture material. This technique was side-to-side fixation with simple interrupted stitches. RESULTS Outcomes were measured in terms of reoperation rates and complication rates grouped in 10 categories. There were no statistical differences in complication or reoperation rates between group 1 and group 2 except for suture extrusion and/or foreign body reaction (3.9% and 0.2%, respectively, P < 0.0001). Tip deprojection was of rare and similar occurrence in both groups (0.9% and 0.8%, respectively, P 0.88). CONCLUSION Suturing CSEG with absorbable material and not fixing it to the NSR is a reliable variation in the conventional technique. 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 .
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Nasal Elongation with Septal Half Extension Graft: Modification of Conventional Septal Extension Graft Using Minimal Septal Cartilage. Aesthetic Plast Surg 2018; 42:1648-1654. [PMID: 30218153 DOI: 10.1007/s00266-018-1219-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In Asian rhinoplasty, a septal extension graft can be used for both tip projection and derotation of the alar cartilage. However, patients often do not have enough harvestable septal cartilage to create the septal extension graft. We therefore devised a method with which to fix the derotated alar cartilage with a small amount of septal cartilage. METHODS From January 2012 to December 2016, 23 patients underwent short nose correction with a septal half extension graft made of septal cartilage and were postoperatively monitored for at least 6 months. The alar cartilage was completely separated from the adjacent structures, especially the scroll area and hinge complex, for caudal derotation. The septal half extension graft was then harvested from the septal cartilage and secured to the caudal septum and the lateral crura of the alar cartilage. Photographs of the patients were compared immediately before surgery and 1 year after surgery. RESULTS Of the 23 patients, 21 (91%) had satisfactory results without short nose recurrence. Two (9%) patients developed recurrence: undercorrection and poor tip projection in one patient each. Aesthetic assessment of short nose correction was performed by comparing the columellar labial angle before and after surgery. Our method reduced the columellar labial angle by 6.2% (paired t test, p < 0.05, t = 31.698). CONCLUSION In patients who cannot undergo conventional septal extension graft due to insufficient amounts of septal cartilage, the septal half extension graft could be a promising alternative technique for short nose correction with minimal septal cartilage harvesting. 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 .
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Hybrid Approach for Asian Rhinoplasty: Open Approach Without Transcolumellar Incision. Facial Plast Surg Clin North Am 2018; 26:269-283. [PMID: 30005784 DOI: 10.1016/j.fsc.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The hybrid approach delivers unlimited exposure and technical access, enabling all the procedures of the open approach. In addition, the hybrid approach is flexible in its extent of "dissection/ exposure" It can be more of a classic endonasal or limited access approach in some cases or open structural rhinoplasty and reconstruction in others. The benefits of the nonopen approach deserve equal attention among Asian rhinoplasty surgeons and residents-in-training courses. The difference is not merely that it spares an incision, it is an opportunity to fine-tune minor millimeters of changes in every step of rhinoplasty, a real and significant benefit.
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Schwannoma of the Membranous Nasal Septum: a Clinical Report With Aesthetic Approach. J Craniofac Surg 2018; 29:e120-e122. [PMID: 29381644 DOI: 10.1097/scs.0000000000004092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Schwannoma is an uncommon tumor of nerve sheath that arises from any peripheral, cranial, or autonomic nerve. Only 4% of head and neck schwannomas originate from the sinonasal tract, and a finding of a schwannoma in the nasal septum is exceedingly rare. The authors experienced nasal septal schwannoma with the functional and aesthetic consideration of nasal contour. The authors present an open rhinoplasty approach for nasal septal schwannoma which has not been reported in the previous literature yet.
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Abstract
BACKGROUND There are many techniques for correcting short nose deformities and the septal extension graft is the most commonly performed technique among Asians. In many Asian patients septal cartilage, however, is too small and insufficient to perform an effective septal extension graft. Therefore, we designed a novel technique, named hybrid septal extension graft to overcome this pitfall in Asian tip plasty. METHODS From February 2010 to March 2013, 41 patients with primary (N = 30) or secondary (N = 11) short nose deformity underwent a hybrid septal extension graft. The hybrid septal extension graft is a modified septal extension graft which uses the small septal cartilage along with irradiated homologous costal cartilage. Irradiated homologous costal cartilage was carved into a shape of a thin batten and securely fixed bilaterally to the caudal septum. Harvested septal cartilage was located between the 2 irradiated homologous costal cartilage batten grafts and fixed with sutures. Then, the alar cartilage was fixed at the end of the septal cartilage graft. The nasal lengths, nasal tip projections, and nasolabial angles were measured pre- and postoperatively. RESULTS The hybrid septal extension graft showed enough nose lengthening and a decreased nostril show, even in cases with a very small septal cartilage. CONCLUSIONS The authors present a novel technique for correction of short nose deformity in Asians. The hybrid septal extension graft provides good results with minimal complications and overall patient satisfaction was very high.
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