Structural grafts and suture techniques in functional and aesthetic rhinoplasty

Cartilage's Contribution in Otology: A Comprehensive Review of Its Role in Ear Surgery

This comprehensive review thoroughly examines the pivotal role of cartilage in otologic surgery, elucidating its multifaceted contributions to both cosmetic and functional outcomes. From reconstructing the external ear to reinforcing the tympanic membrane and restoring the ossicular chain, cartilage emerges as a versatile and resilient biological material with unique properties that make it an invaluable resource for otologic surgeons. The review explores the nuances of cartilage's applications in various surgical contexts, emphasizing its significance in promoting tissue regeneration and healing. The text delves into advancements in tissue engineering, biodegradable scaffolds, and 3D printing technology, pointing toward a future where more precise and personalized interventions may redefine the landscape of otologic surgery. The convergence of these innovations holds the promise of elevating the standard of care, minimizing complications, and improving the quality of life for patients undergoing cartilage-based otologic procedures. This synthesis of current knowledge and future possibilities provides a valuable resource for otologists, surgeons, and researchers in the dynamic field of otology.

The Limits of Evidence in Rhinoplasty

The broad trend toward minimally invasive methods in most surgical fields is contrasted by rhinoplasty: Extended open approaches, an increasing number of grafting techniques, donor site depletion, and extensive osteotomies seem to indicate a trend away from minimally invasive methodology for this particular procedure. This article intends to analyze which factors are involved in this and related developments in rhinoplasty.Evidence-based methodology sets the standards for scientific analysis. For rhinoplasty, however, limitations of established scientific methodology are identified. These include the relative lack of objective outcome measures and the impact of various systematic biases on reported results. These biases include operator dependence, interdependence of techniques, biased selection of outcome parameters, and orthodox treatment bias. Upon critical review, the importance of systematic biases may outweigh the impact of evidence-based study in rhinoplasty. Results should therefore be interpreted with caution. Strategies are suggested to identify and mitigate the impact of biases and to improve reporting and outcome analyses in rhinoplasty.

Anatomy of the nasal latero-lateral cartilage articulation: a micro-MRI study in human specimens

PURPOSE

To study the anatomy of the latero-lateral joint (LLJ) between the upper lateral (ULC) and lower lateral (LLC) crus of the nasal cartilages, usually described as a scroll articulation.

METHODOLOGY

Six nasal pyramids were taken in monobloc from fresh cadavers and imaged on micro-MRI with 0.4 mm slice thickness. Images were jointly interpreted by two head and neck radiologists and one surgeon. The junction between the ULC and LLC, the presence of ligaments and of sesamoid or accessory cartilages were assessed.

RESULTS

Eight LLJs could be analyzed, with four types of junctions: hook-shaped cephalic border of the LLC turned towards the nasal fossa and linear caudal border of the ULC (n = 3), hook-shaped caudal border of the ULC and linear cephalic border of the LLC lateral crus (n = 1), hook-shaped border of both cartilaginous edges with clinging (n = 1) (scroll articulation) or without clinging (n = 3). No ligament or sesamoid cartilage was found, but posterior accessory cartilages were seen in 75% of the cases.

CONCLUSION

The classical scroll articulation of the LLJ has been observed in only 1/8 cases on micro-MRI images. The anatomy of the LLJ could explain the surgical difficulty in raising the tip of the nose in some patients and not in others.

Avoiding Complications in Functional and Aesthetic Rhinoplasty

Historically, nasoseptal surgery favoring functional considerations has compromised aesthetic ones, and vice versa, but modern techniques have evolved that allow symbiotic achievement of both goals. Nasoseptal surgery is among the most commonly performed plastic surgical procedures in the United States, and while it is generally well tolerated, there are a few surgical and aesthetic complications of which to be aware. Herein, we review surgical techniques that improve the nasal airway and nasal aesthetics in a top-down approach with a discussion of possible ensuing complications.

Costal cartilage nasal augmentation rhinoplasty: Study on warping

Background:

To retrospectively study the costochondral graft (CCG) based nasal dorsum augmentation failures due to warping.

Materials and Methods:

All patients fulfilling inclusion and exclusion criteria between January 2008 and December 2011 were included in the study. The details of the dorsal nasal length (DNL) immediate postoperative and 1 week postoperative period as well as the degree of divergence from midline by warping noted down in mm along with age, gender, and nature of graft.

Statistics:

Data analyzed using Statistical Package for the Social Sciences version 17. Descriptive statistics, Chi-square test and one-way analysis of variance are presented. P value ≤0.05 was considered significant.

Result:

One hundred and fifty seven cases fulfilled the criteria. Of these, 44 (28%) were males and rest were females. The mean age of the patients was 24.41 ± 4.9 years with a range of 17-37 years. In 102 cases (65%) had soft CCG while 55 (35%) were identified to be gritty type of CCG. Of the 157 cases, warping was identified in 41 cases (26.1%) and required revision of the surgery. Age group was significantly associated with presence of warping (P = 0.000).

Discussion:

With increase in age, the number of patients with gritty CCG was higher. Older patients had lesser incidence of warping while younger patients had more incidence of warping. The incidence was not significantly related to gender or the DNL. The grafts that were relatively straight had less incidence of warping.