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Zhang S, Li Z, Zhang C, Deng R, Wang G, Zhen Y, Zhou J, An Y. Double Reinforcing Strategy with Perpendicular Plate of Ethmoid in Asian Secondary Unilateral Cleft Rhinoplasty: A Finite Element Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04056-4. [PMID: 38839614 DOI: 10.1007/s00266-024-04056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Deviation and asymmetry relapse after secondary unilateral cleft rhinoplasty with septal extension graft is a common yet serious problem especially among Asian patients. Therefore, finding an effective approach to reduce deformity relapse remains a great challenge to plastic surgeons. METHODS In this study, authors established finite element models to simulate different nasal cartilage-corrected options and different reinforcing strategies in secondary unilateral cleft rhinoplasty. A load of 0.01N was given to the nasal tip to simulate the soft tissue pressure, while two loads of 0.5N were separately given to the anterior and posterior part of the septal extension graft to simulate the rhinoplasty condition. Maximum deformations were evaluated to make stability judgments. RESULTS The maximum deformation of different cartilage correction models in ascending order was: UCL deformity with septum correction, normal nasal cartilage, UCL nasal deformity, and UCL nasal deformity with lower lateral cartilage correction. When applied L-strut reinforcement graft was harvested from the perpendicular plate of the ethmoid bone, the maximum deformation of the models decreased significantly, and strong fixation of the septum could further enhance this decreasing effect. CONCLUSIONS Correcting the septum and lower lateral cartilage together could improve the structural stability and symmetry in secondary unilateral cleft rhinoplasty. To keep the corrected septum stable and thus reduce deformity relapse, reinforcing the L-strut with perpendicular plate of ethmoid graft while strongly anchoring the septal cartilage to the anterior nasal spine was proved to be effective in both finite element analysis and clinical observation. 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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Affiliation(s)
- Shiwen Zhang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Zijun Li
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Chong Zhang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Run Deng
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Jin Zhou
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, The School of Engineering Medicine, Beihang University, Beijing, 100083, China.
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China.
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Jomah M, Smith O, Villemure-Poliquin N, Cunningham H. Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104240. [PMID: 38447465 DOI: 10.1016/j.amjoto.2024.104240] [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: 12/23/2023] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.
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Affiliation(s)
- Mohammed Jomah
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology - Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
| | - Oakley Smith
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Noémie Villemure-Poliquin
- Otorhinolaryngologie et Chirurgie Cervico-Faciale, Faculté de Médecine, Université Laval, Montreal, Quebec, Canada.
| | - Heather Cunningham
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada.
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Favero V, Volpato A, Stefanelli F, Drago G, Favero R, Baietto F, Fusetti S, Bissolotti G. Cleft lip and palate outcomes: Multidisciplinary approach for comprehensive management. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101899. [PMID: 38692455 DOI: 10.1016/j.jormas.2024.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
In patients with cleft lip and palate the most common associated dental problem is lateral incisor agenesis, often associated with lack of support and definition of the nasal tip. In many cases, adhesions deriving from surgical procedures and skeletal discrepancy make orthognathic surgery and rhinoseptoplasty unavoidable. In the present case report a dental rehabilitation with canine substitution and prosthetic-implant treatment in a posterior area is described. The use, during rhinoseptoplasty, of a customized titanium prosthesis, which provides projection for the tip of the nose, is also introduced. The patient was administered two questionnaires in order to assess the psychological aspects related to the cleft outcomes and the influence that the treatment conveyed.
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Affiliation(s)
- Vittorio Favero
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy.
| | - Andrea Volpato
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Francesca Stefanelli
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Giampaolo Drago
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Riccardo Favero
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Federico Baietto
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Stefano Fusetti
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Guido Bissolotti
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
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Rios BR, Barbosa S, da Silva WPP, Quirino Louzada MJ, Ervolino E, Kalil EC, Shibli JA, Faverani LP. Polydioxanone Enhances Bone Regeneration After Resection and Reconstruction of Rat Femur with rhBMP2. Tissue Eng Part C Methods 2024; 30:102-112. [PMID: 38271574 DOI: 10.1089/ten.tec.2023.0304] [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] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to assess the bone regeneration potential of a polydioxanone (PDO) scaffold together with recombinant human bone morphogenetic protein-2 (rhBMP-2) for the reconstruction of large bone defect. In total, 24 male rats (6 months old) were subjected to bilateral femoral stabilization using titanium plates to create a 2 mm gap, and reconstruction using rhBMP-2 (Infuse®; 3.25 μg). The bone defects were covered with PDO (PDO group), or with titanium mesh (Ti group). Animals were euthanized on days 14 and 60. Simultaneously, 16 rats received PDO and Ti in their dorsum for the purpose of biocompatibility analysis at 3, 5, 7, and 10 days postoperatively. X-ray densitometry showed a higher density in the PDO group on day 14. On day 60, coverage of the bone defect with PDO showed a larger quantity of newly formed bone than that found for the Ti group, a lower inflammatory infiltrate value, and a more significant number of blood vessels on day 14. By immunohistochemical assessment, runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN) showed higher labeling on day 14 in the PDO group. On day 60, bone morphogenetic protein-2 (BMP-2) showed higher labeling in the PDO group, whereas Ti showed higher labeling for osteoprotegerin, nuclear factor kappa B ligand-activating receptor, RUNX2, and OCN. Furthermore, biocompatibility analysis showed a higher inflammatory response in the Ti group. The PDO scaffold enhanced bone regeneration when associated with rhBMP-2 in rat femur reconstruction. Impact statement Regeneration of segmental bone defects is a difficult task, and several techniques and materials have been used. Recent advances in the production of synthetic polymers, such as polydioxanone (PDO), produced by three-dimensional printing, have shown distinct characteristics that could improve tissue regeneration even in an important bone defect. The present preclinical study showed that PDO membranes used as scaffolds to carry recombinant human bone morphogenetic protein-2 (rhBMP-2) improved bone tissue regeneration by more than 8-fold when compared with titanium mesh, suggesting that PDO membranes could be a feasible and useful material for use in guided bone regeneration. (In English, viable is only used for living creatures capable of sustaining life.
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Affiliation(s)
- Barbara Ribeiro Rios
- Division of Oral and Maxillofacial Surgery and Implantology, Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Stéfany Barbosa
- Division of Oral and Maxillofacial Surgery and Implantology, Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - William Phillip Pereira da Silva
- Division of Oral and Maxillofacial Surgery and Implantology, Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | | | - Edilson Ervolino
- Division of Histology, Department of Basic Sciences, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Eduardo C Kalil
- Dental Research Division, Department of Periodontology, Guarulhos University, Centro, Guarulhos, Brazil
| | - Jamil Awad Shibli
- Dental Research Division, Department of Periodontology, Guarulhos University, Centro, Guarulhos, Brazil
| | - Leonardo P Faverani
- Division of Oral and Maxillofacial Surgery and Implantology, Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
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Effectiveness of Absorbable Plates for the Treatment of Nasal Septal Cartilage Fractures. Ann Plast Surg 2022; 89:637-642. [DOI: 10.1097/sap.0000000000003299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Secondary Cleft Rhinoplasty: A National Survey of Surgical Practice by Accredited Cleft Palate Teams. Plast Reconstr Surg Glob Open 2022; 10:e4644. [PMID: 36381488 PMCID: PMC9645790 DOI: 10.1097/gox.0000000000004644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
UNLABELLED Patients with cleft lip often undergo a primary rhinoplasty at the time of lip repair, and further surgical correction with secondary cleft rhinoplasty (SCR) is often warranted for improved form and function. The purpose of this study was to better elucidate current practice patterns and trends for how SCR is performed in the United States. METHODS We administered a survey to team surgeons affiliated with cleft lip and palate care teams approved by the American Cleft Palate Craniofacial Association (ACPA). RESULTS We received responses from 40 ACPA-approved teams for a response rate of 20.7%, with 59 total ACPA team surgeons completing the survey. 88.1% of surgeons perform intermediate cleft rhinoplasties. Among those who perform an intermediate cleft rhinoplasty, the mean age at which they would first consider the procedure is 5.83±2.66 years. The mean age for consideration of definitive cleft rhinoplasty was 15.86 ± 1.73 years. In both unilateral and bilateral cleft lips, a closed approach was more common in intermediate rhinoplasty, while an open approach was more common in definitive rhinoplasty (P < 0.001). The use of autologous grafts was more common in definitive rhinoplasty (P < 0.001), with 65% of respondents utilizing autologous grafts in greater than three-quarters of their procedures. CONCLUSIONS When comparing intermediate with definitive cleft rhinoplasty, we found significant increase in the use of open techniques, autologous cartilage use for augmentation of the nasal tip, dorsal nasal support, and columellar sup- port. The considerable variability among surgeons highlights the lack of consensus regarding SCR.
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Levin M, Ziai H, Shapiro J, Roskies MG. Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review. Facial Plast Surg 2022; 38:428-433. [PMID: 35189658 DOI: 10.1055/s-0042-1743251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nasal septal perforation is an uncommon pathology that is difficult to surgically repair and may significantly impact patients' quality of life. Existing treatments have high complication and failure rates. The use of polydioxanone (PDS) plates to repair septal perforations is an innovative approach that has demonstrated superior outcomes to the conventional techniques. This study aimed to review the literature on PDS plates for nasal septal perforation reconstruction. PubMed, OVID Medline, and OVID Embase databases were searched for relevant articles in June 2021. Search terms included nasal septal perforation, polydioxanone, septal perforation, septal repair, nasal septum, and PDS plate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to for this systematic review. Database searches yielded 80 articles. Seven articles were included representing 74 patients. All studies reported the use of PDS plates in addition to other materials. They all reported closure rates of at least 80%. The majority of studies reported no postoperative complications. Nasal septal perforation reconstruction with PDS plates is a promising approach that has demonstrated positive outcomes. Further larger studies are required to evaluate the long-term efficacy of using PDS plates on patients with septal perforations.
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Affiliation(s)
- Marc Levin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Shapiro
- Temerty Faculty of Medicine, University of Toronto Temerty, Toronto, Ontario, Canada
| | - Michael G Roskies
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Faculty of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Facial Plastic and Reconstructive Surgery, Sinai Health System, Toronto, Ontario, Canada
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Kim YB, Nam SM, Park ES, Choi CY, Cha HG, Kim JH. Nasal Reconstruction of a Frontonasal Dysplasia via Septal L-Strut Reconstruction Using Costal Cartilage. Cleft Palate Craniofac J 2021; 59:1306-1313. [PMID: 34402319 DOI: 10.1177/10556656211036614] [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: 11/15/2022] Open
Abstract
OBJECTIVE Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. DESIGN Retrospective review from June 2008 and August 2017. METHODS Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. RESULTS The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. CONCLUSIONS Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.
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Affiliation(s)
- Yong Bae Kim
- WONJIN Plastic Surgery Clinics, Seoul, Republic of Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Chang Yong Choi
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Han Gyu Cha
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jun Hyun Kim
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Gürsoy K, Teymur H, Kiziltay A, Hasirci N, Koçer U. Biomechanical analysis of a modified suture technique for septal extension grafts: Transloop suture. J Plast Reconstr Aesthet Surg 2019; 72:1825-1831. [PMID: 31277927 DOI: 10.1016/j.bjps.2019.05.046] [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] [Received: 05/05/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND A successful rhinoplasty procedure requires a well-defined and properly projected nasal tip; however, surgical control of the nasal tip is difficult. The aim of this investigation was to assess the efficacy and safety of a modified suture technique, which can be used to fix the caudal septal extension graft during primary rhinoplasty of the Asian population and revision septorhinoplasties of the Caucasian population, and to compare it with those of other commonly used techniques. METHODS After peeling of perichondrium of scapular cartilages, cartilage pieces of 3 × 1 cm in size and 2 mm in thickness were divided into two from the midline. These pieces were repaired end-to-end using three different repair techniques: two simple interrupted in Group A (n = 40), vertical figure-of-eight in Group B (n = 40) and modified vertical figure-of-eight (transloop) in Group C (n = 40). All repaired cartilage specimens were subjected to a biomechanical analysis, in which four different forces were applied: tension, lateral bending, shearing and buckling. RESULTS According to the tensile test, Group C had statistically significantly higher strength than Group A at 2 mm range. The lateral bending test similarly revealed that Group C had statistically significantly higher strength at 1.5 mm and 2 mm range than Group A. However, there was no statistically significant difference between the three groups in the assessment of shearing and buckling forces. CONCLUSION The modified transloop suture technique provides a more stable repair, and we consider that it can be used as an alternative suture repair method.
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Affiliation(s)
- Koray Gürsoy
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ulucanlar Cd, Altindag, 06230, Ankara, Turkey.
| | - Hakan Teymur
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ulucanlar Cd, Altindag, 06230, Ankara, Turkey
| | - Aysel Kiziltay
- Middle East Technical University, Central Laboratory, Dumlupinar Bulvari, 06800 Ankara, Turkey
| | - Nesrin Hasirci
- Middle East Technical University, Faculty of Arts and Sciences, Department of Chemistry, METU BIOMATEN-Center of Excellence in Biomaterials and Tissue Engineering, Dumlupinar Bulvari, 06800, Ankara, Turkey
| | - Uğur Koçer
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ulucanlar Cd, Altindag, 06230, Ankara, Turkey
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