Dorsal Nasal Augmentation: Is the Composite Graft Consisting of Conchal Cartilage and Retroauricular Fascia an Effective Option?

The current techniques in dorsal augmentation rhinoplasty: a comprehensive review

BACKGROUND

An essential aspect of rhinoplasty is the enhancement of the nasal dorsal contour by performing dorsal augmentation (DA) rhinoplasty. A wide range of techniques are available for DA as the demand for aesthetic nasal refinement grows. This review aims to provide a comprehensive overview of the current techniques used in DA rhinoplasty.

MAIN BODY

Research articles on DA rhinoplasty techniques were identified through a comprehensive literature search. Scopus, PubMed, and Web of Science were used as electronic databases. Each database was searched for articles published since its inception. DA rhinoplasty techniques were examined in this literature review. Methodological quality was assessed for the selected studies, and data was extracted to examine materials used, surgical approaches, and reported outcomes for each technique. Various DA methods, including autologous grafts and synthetic implants, are examined in-depth in this review. Comparing approaches can help better understand their respective advantages and limitations.

CONCLUSION

A wealth of techniques is available for DA rhinoplasty, each with advantages. Patients' nasal anatomy, desired outcomes, and potential risks must be considered by surgeons when determining their surgical approach. DA methods continue to evolve rapidly, creating a need for a thorough understanding of the current landscape to make informed decisions.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation

BACKGROUND

Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties.

OBJECTIVES

The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates.

METHODS

We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews.

RESULTS

The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%.

CONCLUSIONS

Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

LEVEL OF EVIDENCE: 4

New Concepts in Dorsal Nasal Augmentation

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.

Evaluation of Safety and Efficacy for an Intranasal Airway Device in Nasal Surgery

Importance

Postoperative packing in nasal surgery often results in nasal obstruction and discomfort. Commercially available silicone intranasal airways (IAs) serve as dual-nasal airway tubes aimed at alleviating this process, but the safety and efficacy of these devices are unknown.

Objective

To evaluate the safety and efficacy of an intraoperatively placed IA device in rhinoplasty and nasal surgery.

Design, Setting, and Participants

In this retrospective record review, the medical records of patients undergoing nasal surgery with insertion of the IA at a single institution from 2012 to 2017 were reviewed. After review of over 200 patients, a questionnaire was developed to assess device efficacy.

Exposures

Use of the IA device. The IA is 12 cm long, anchored across the columella, extends distally along the nasal floor, and has a proximal external portion used for cleaning and maintaining patency. Placed intraoperatively, the device aims to support air flow postoperatively in the face of edema, hemorrhage, and packing.

Results

A total of 302 operations in 300 patients were analyzed, including primary and revision septorhinoplasty. A total of 24 (7.9%) patients self-removed or inadvertently dislodged the IA. Minor acute postoperative complications not unique to airway insertion included cellulitis in 4 (1.3%) participants and epistaxis in 6 (2%). Postoperatively, 1 (0.3%) patient developed dehiscence along transcolumellar incisions. A total of 59 patients (100% compliance) completed the efficacy questionnaire. The mean breathing score was between good and average (2.9 of 5), comfort scores between comfortable and average (2.9 of 5), and mean ease of irrigation score was between very easy and easy (1.96 of 5). The device was irrigated on average 3.57 times per day. A total of 43 (76%) particpiants had full patency or only partial obstruction, compared with 13 (24%) patients with total obstruction. In all patients, with or without obstruction, the effect lasted an average of 4 days.

Conclusions and Relevance

The device is safe and well-tolerated for maintaining patency of the nasal airway in patients undergoing rhinoplasty and nasal reconstruction without increased risk of incisional dehiscence.

Level of Evidence

4.

Use of Nasal Implants and Dorsal Modification When Treating the East Asian Nose

Dorsal augmentation and tip surgery are essential procedures for East Asians seeking rhinoplasty, because they generally have thicker skin and poorly developed nasal dorsum and tip. For dorsal augmentation, many Asian surgeons prefer using alloplastic material, like silicone, Gore-Tex, and filler injection, for cost-effectiveness, easy handling, and short operation times. Compared with autologous implant materials, the use of synthetic implant is suggested to be associated with many complications, such as infection, extrusion, and deviation. However, even with the use of the autologous material, problems such as reabsorption after grafting, donor site complications can take place.

Esthetic Rhinoplasty in the Multiply Operated Nose

PURPOSE

The present study assessed the most common deformities in often-revised noses and their predictable surgical treatments.

PATIENTS AND METHODS

This retrospective case series was designed to review different aspects of patients with rhinoplasty who had more than 2 failed previous rhinoplasties. The main requests of patients, number of operations, and final surgical plan for management of these deformities were reviewed and analyzed.

RESULTS

This study included 38 patients (27 women, and 11 men) who underwent multiple (2 to 10) unsuccessful rhinoplasties before being operated on by the author from 2011 to 2016. Pinch deformity (14 patients), breathing problems (13 patients), and irregularities were the most common complaints. The conchal cartilage (31 patients) and fascia (19 cases) were the most common graft donor sites in definitive treatments.

CONCLUSION

The present study shows that multiple failed rhinoplasties can be properly corrected. Effective management of these patients is best started after a comprehensive preoperative assessment. Then, a conservative predictable approach can be used to overcome the flaws of previous surgeries.

In vivo evaluation of a regenerative approach to nasal dorsum augmentation with a polycaprolactone-based implant

Background

Alternative techniques for nasal dorsum augmentation are of paramount importance in reconstructive and plastic surgery. In contrast to autologous cartilage grafts, tissue-engineered grafts can be created de novo and yield low–none donor site morbidity as compared to autologous grafts like rib or ear cartilage. To address this demand, this study investigated the in vivo regenerative potential of polycaprolactone-based implants as an alternative to autologous cartilage grafting during rhinoplasty.

Methods

Implants were placed at the nasal dorsum in two groups of minipigs and kept in situ for 2 and 6 months, respectively. Subsequently, the implants were harvested and examined by histology (hematoxylin–eosin, alcian blue, and safranin O) and immunostaining (collagen I and collagen II). Further analysis was performed to measure diameter and distance of polycaprolactone struts.

Results

Histological examination revealed a persistent formation of connective tissue with some spots resembling a cartilaginous-like matrix after 6 months. In such areas, cells of chondrocyte appearance could be identified. There was a significant decrease in strut diameter but a non-significant difference in strut distance.

Conclusion

Our results indicated that the investigated polycaprolactone-based implants have shown a regenerative and stable nasal dorsum augmentation after 6 months in vivo. Thus, we believe that customized polycaprolactone-based implants could become an alternative technique for nasal dorsum augmentation without the need for autologous cartilage grafts.