The Effects of Mucoperichondrial Flap Elevation on Septal L-Strut Cartilage: A Biomechanical and Histologic Analysis in a Rabbit Model

Saddle Nose Deformity Reconstruction with a Allograft Bone

OBJECTIVE

Providing lasting cosmetic and functional results for patients with saddle nose deformity with allograft.

METHODS

This report describes experience with using a of freeze-dried allograft bone allograft in 58 patients who underwent dorsal augmentation over 5-year period (2018-2023). Thirty-eight patients had saddle-shaped deformity of the nose, and 16 patients had post-traumatic cases with saddle nose deformities. All patients underwent a clinical examination using computed tomography. Before surgery using a 3D model, the graft was contoured according to the shape of the nasal defect. The grafts were installed using a closed approach and were placed under the periosteum of the bone. Using lateral photographs, anthropometric measurements of the nose were taken before and after surgery to assess aesthetic outcome after surgery. To assess the results of aesthetic rhinoplasty (UQ), the Portuguese version of the Utrecht Questionnaire was used, which contains a visual analogue scale (VAS) on a 5-point Likert scale.

RESULTS

A total of 56 patients were satisfied with the results of the surgical procedure. No complications or major graft resorption was observed. An analysis comparing preoperative and 1-year follow-up data using 3D scanning showed a significant increase in dorsal height without dorsal expansion. After rhinoplasty, the mean visual analog scale (VAS) aesthetic score improved significant from 2.3 preoperatively, 3 months postoperatively 8.4, and 8.9 1 year postoperatively.

CONCLUSION

The use of freeze-dried allograft bone is a useful method of dorsal augmentation in rhinoplasty without donor site complications.

LEVEL OF EVIDENCE II

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The Principles and Practice of Primary Endonasal Rhinoplasty

ABSTRACT

The purpose of this article is to provide a guide for plastic surgeons, regardless of experience level, seeking to improve his/her endonasal rhinoplasty skills and comfort level. We have presented the advantages of our technique and its unifying principles and demonstrated how endonasal rhinoplasty can be used to achieve safe, anatomical, and predictable outcomes. Endonasal rhinoplasty is a separate thought process from open rhinoplasty and should not be viewed as a competing but rather parallel technique that is broadly applicable to many nasal deformities.We have described the basic goals of all rhinoplasties and highlighted 2 false assumptions that are responsible for most adverse rhinoplasty outcomes and 4 anatomical deficits that surgeons must recognize preoperatively to maximize function, proportion, and contour. Finally, the majority of primary rhinoplasties can be performed with 1 of 2 operative strategies that depend on the relationship of the dorsum to the lower nose. Because surgeons often presume that they will not be able to "see well enough" in endonasal rhinoplasty or worry they have not been adequately trained in the technique, we have provided a step-by-step guide to help overcome such fears and help these surgeons to achieve results that will exceed their patients' goals.

Reconstruction of a Severely Damaged Cartilaginous Septum with a Bypass L-Strut Graft using Costal Cartilage

OBJECTIVE

 Reconstruction of a weakened septal cartilage is a key procedure for the correction of deformed noses. However, when septal mucoperichondrium dissection is technically challenging, reconstruction of the lower two-thirds of the nose should be performed bypassing the damaged septal cartilage and mucosa. This article summarizes our experience with treating patients with severely damaged septal cartilage with bypass L-strut graft using costal cartilage.

METHODS

 We retrospectively reviewed 26 patients who underwent rhinoplasty using bypass L-strut graft. Autologous costal cartilage was used for creating L-strut in two different ways: (1) by fashioning the L-shaped graft as one unit using the sixth rib cartilage and (2) by integrating a dorsal strut with a columellar strut using slices of the seventh rib cartilage. The caudal strut is fixated to the anterior nasal spine; the dorsal L-strut is placed on the nasal dorsum with no fixation to the nasal bone. Medical records were assessed for demographic, clinical, and treatment information.

RESULTS

 One-piece-type L-strut graft was used for 11 patients and integrated-type L-strut graft was used for 15 patients. No statistical differences were found in postoperative aesthetic outcomes between the two groups. The postoperative assessment of surgical outcomes was excellent in 10 patients, good in 10, fair in 6, and poor in none. Functionally, all 26 patients experienced improvements in nasal breathing.

CONCLUSION

 Bypass L-strut graft using costal cartilage is a useful surgical maneuver of septal reconstruction in particular nasal deformity when the creation of the septal mucoperichondrial pocket is difficult or better to be avoided.

Defining a New Variable That May Impact Long-term Postoperative Nasal Tip Support: The Biomechanical Properties of the Columellar Strut Graft

BACKGROUND

Although columellar strut grafts (CSGs) are considered among the fundamental steps for providing nasal tip support, a downward rotation of the nasal tip in patients with strut grafts can still be encountered. Patient-related factors such as nasal skin thickness can allow the plastic surgeon to anticipate certain drawbacks that can be encountered in the healing phase, but patient-based differences of nasal cartilage and the resulting impact have yet to be investigated. The purpose of this study was to evaluate the effect of the biomechanical properties of CSGs on late postoperative nasal tip position and support.

METHODS

The study was undertaken with the participation of 20 patients undergoing closed-technique primary rhinoplasty with CSGs. Each cartilage specimen was biomechanically analyzed to calculate the modulus of elasticity. Preoperative and postoperative images were obtained to determine nasal tip position and rotation with quantitative measurements. Postoperative 3- and 12-month measurements were evaluated according to their relationship with the elasticity modulus of the utilized cartilages.

RESULTS

The evaluation demonstrated that the elasticity modulus can impact the long-term support of the nasolabial angle in which an increase in the coefficient of elasticity can result in a decrease in long-term nasal tip support.

CONCLUSION

The results of the study reveal a new objective variable that can impact nasal tip dynamics and patient-related differences following rhinoplasty. This study not only brings forth a different perspective in the evaluation of nasal tip dynamics but can also provide data for determining ideal values for cartilage prefabrication.

Cartilage suspension using a poly (lactic-co-glycolic) acid system

BACKGROUND

This study aims to determine whether a bar-like implant made of poly lactic-co-glycolic acid (PLGA) could be used for cartilage suspension and whether the implant would be suitable for rhinoplasty.

METHODS

Three types of in vivo animal experiments were performed. First, the ear cartilage was incised in a full-thickness pattern, and the PLGA system was placed between the upper and lower cartilage to offer support to the tissue. Second, after the ear cartilage was forcibly bent, an implant was placed in the cartilage. For these rabbits, the outer aspect of the ear cartilage was assessed at 2, 4, 8, 10, and 12 weeks postoperatively. In addition, tissue samples were collected for histological evaluation 12 weeks after surgery. Third, the bar-like nasal implant was used for nasal septal suspension. We obtained micro-computed tomography (CT) images and evaluated the inflammatory reaction at 12 weeks postoperatively.

RESULTS

The results of both the ear suspension and bending retention tests revealed that the characteristic shapes of the cartilage were well preserved at 12 weeks postoperatively. Moreover, no abnormal inflammatory reaction was present in any site in the experimental group. We successfully implanted the bar-like nasal implant in the rabbit's septum, and no complications occurred. Furthermore, the physical examination and the micro-CT images did not reveal any nasal obstruction or inflammation.

CONCLUSIONS

We confirmed that an implant made of PLGA can be maintained in the cartilage tissue and believe that this can be applied in rhinoplasty as an alternative to autologous cartilage.