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Xu Z, Li Y, Li D, Zhang R, Zhang Q, Xu F, Chen X. New Strategies for Remnant Ear Treatment in Microtia Reconstruction Based on Morphometric Studies. Laryngoscope 2024; 134:2741-2747. [PMID: 38131383 DOI: 10.1002/lary.31224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Given the lack of specific evaluation indices, it is difficult to determine whether to transpose or abandon remnant ears in lobule-type microtia reconstruction. The authors illuminate referable parameters beneficial for proper treatment of remnant ear in an efficient manner. METHODS A series of 359 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2016 and 2021. Fourteen measuring points and defined distances as well as six ratios of specific distances based on position, plumpness, similarity and the width-to-length ratio of the remnant ear have been described, and relevant tactics for appropriate treatments are introduced. RESULTS Definite morphometric results contribute to attaining satisfactory contours of reconstructed auricles with harmonious earlobes, which exhibit highly similar dimensions and appearances compared to the contralateral normal ears. CONCLUSION With the help of the proposed locating points and measuring approaches, the procedure of remnant ear treatment is systematically clarified. This technique ensures operation safety and contributes to the aesthetic contour of the auricle. LEVEL OF EVIDENCE IV Laryngoscope, 134:2741-2747, 2024.
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Affiliation(s)
- Zhicheng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yiyuan Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Datao Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ruhong Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Feng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xia Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Xiang G, Chen C, Chen K, Liu Q, Sun X, Huang Y, Huang L, Jin J, Shang J, Yang D. Comparing the Analgesic Effects Between the Pre- and Post-costal Cartilage Harvest Cohorts Using Ultrasound-Guided Deep Serratus Anterior Plane Block in Children with Microtia Undergoing Auricular Reconstruction: A Randomized Clinical Trial. Aesthetic Plast Surg 2024; 48:1846-1854. [PMID: 38326498 DOI: 10.1007/s00266-023-03836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method. METHODS This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n = 30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n = 30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24 h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints. RESULTS The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12 h post-operation in comparison with the SAPB-post-cohort (rest 6 h p = 0.002, others p < 0.001). No significant difference in the NRS ear scores existed between the two cohorts (p > 0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p < 0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p = 0.001, p = 0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p < 0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p < 0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p > 0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p = 0.082). There were no blockade-related complications observed in either cohort. CONCLUSION The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia. LEVEL OF EVIDENCE II 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)
- Guihua Xiang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Chunmei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Xiaole Sun
- Department of Gynecology, Peking University Third Hospital, No. 49, Huayuan North Road, Haidian District, Beijing, 100144, China
| | - Yan Huang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Lan Huang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Jing Jin
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Jiantao Shang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China.
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Zhang X, Song Z, Xu Y, Zheng R, Tian L, Guo J, Wang H, You J, Fan F. Rhinoplasty with Mortise-Tenon Cartilaginous Framework for Caudal Septal Cartilage Defects. Aesthetic Plast Surg 2024; 48:1737-1744. [PMID: 37945758 DOI: 10.1007/s00266-023-03733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Rhinoplasty for caudal septal cartilage defects is a challenge due to the difficulty of fixation of the grafts. OBJECTIVES This study presents an approach for correcting defects in caudal septal cartilage with the costal cartilaginous framework using a mortise-tenon technique. METHODS From May 2019 through May 2022, a retrospective analysis of patients with caudal septal cartilage defects underwent rhinoplasty using a mortise-tenon cartilaginous framework by a senior surgeon was performed. The surgical outcomes were evaluated both preoperatively and postoperatively. RESULTS This study involved 17 patients, ranging in age from 27 to 58 years. There were 22.4 months of follow-up on average. There was no long-term or short-term complication observed. The aesthetic outcome of all cases was satisfactory. The mean score for the patients of the perceptions of improvement in their noses was 8.11. CONCLUSION Correction of caudal septal cartilage defects with this costal cartilaginous framework using the mortise-tenon technique is feasible and effective. 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)
- Xulong Zhang
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zhen Song
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Yihao Xu
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Ruobing Zheng
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Le Tian
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Junsheng Guo
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Huan Wang
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jianjun You
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Fei Fan
- The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Han CH. Lateral Margin Graft for Minimizing Visible Lateral Margin on Radix Using Autologous Rib Cartilage in Asian Rhinoplasty. J Oral Maxillofac Surg 2024; 82:422-433. [PMID: 38253317 DOI: 10.1016/j.joms.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Visible lateral margin (VLM) after rhinoplasty is considered one of the potential complications. PURPOSE The purpose is to assess the suitability of implementing a lateral margin graft (LMG) to mitigate the occurrence of a VLM during augmentation rhinoplasty with autologous rib cartilage. STUDY DESIGN, SETTING, SAMPLE This is a retrospective cohort study between January 2016 and April 2022 in a private clinic. The inclusion criteria were patients who underwent augmentation rhinoplasty for esthetic purposes using autologous rib cartilage. Patients who received allogenic tissue grafts or alloplastic materials, those with systemic diseases, and pregnant or breastfeeding females were excluded. PREDICTOR VARIABLE The primary predictor variable is the implementation or nonimplementation of an LMG. MAIN OUTCOME VARIABLES The primary outcome variable is the esthetic satisfaction and the degree of minimization of the VLM when LMG is implemented and when it is not. Therefore, to understand the esthetic satisfaction, the author used the Rhinoplasty Outcome Evaluation (ROE) questionnaire, and to understand the degree of minimization of the VLM, the author measured the lateral margin visibility score (LMVS) using a 5-point Likert scale score. COVARIATES The evaluated covariates included sex, age at surgery, number of previous rhinoplasties, purpose of surgery, and postoperative complications. ANALYSES The data were analyzed using the independent sample t test, paired t test, one-way analysis of variance test. A significance level of P < .05 was employed for all statistical analyses. RESULTS A total of 69 consecutive patients were included in the study, divided into groups 1 (21 patients without LMG) and 2 (48 patients with LMG). Postoperative ROE scores increased by 15.31 ± 4.03 in group 1 and 22.60 ± 6.77 in group 2 compared to preoperative ROE scores (P < .001). In the patients' LMVS, group 1 had a score of 2.48 ± 0.81, while group 2 had a score of 3.06 ± 0.76 points (P = .009). In the surgeons' LMVS, surgeon 1 indicated scores of 2.38 ± 0.74 and 2.94 ± 0.89 points, respectively (P = .007). Furthermore, surgeon 2 indicated scores of 2.28 ± 0.72 and 2.90 ± 0.83 points, respectively (P = .002). CONCLUSION AND RELEVANCE When performing rhinoplasty using autologous rib cartilage, the use of an LMG can minimize the VLM, which increases patient satisfaction and surgical completeness.
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Affiliation(s)
- Chung-Hee Han
- Aesthetic Surgeon, Private Practice, Seoul, South Korea.
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Soylu E, Yenigun A, Ozturan O. Cog graft, a new septal extension graft for designing nasal tip rotation and projection in rhinoplasty. Am J Otolaryngol 2024; 45:104173. [PMID: 38101140 DOI: 10.1016/j.amjoto.2023.104173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Adjusting the nasal tip rotation and tip projection according to the patient's face and wishes is a very important stage in rhinoplasty with the use of a cog graft positioning the tip point in the appropriate place is possible by adjusting the nose length, tip projection and tip rotation together. OBJECTIVE The aim of this study is to facilitate positioning the tip rotation and projection in the appropriate place according to the patient's needs in rhinoplasty with Cog graft. MATERIALS AND METHODS Cog graft was applied in 32 patients who underwent rhinoplasty. Cog graft was prepared from costal cartilage in 10 patients and from septal cartilage in 22 patients. Cog graft was prepared by shaping the superior edge of the septal extension graft like a gear wheel. It is fixed to provide desired projection to the caudal septum. In the position where rotation and projection are evaluated adequately, the graft is fixed with sutures. They were followed in average 18 months (between 6 and 24 months). RESULTS Twenty of the patients were primary cases and 12 were revision cases. The targeted rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. CONCLUSIONS Cog graft is a useful graft with which we can adjust the nose length, projection and rotation appropriately and in a short time with a single graft.
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Affiliation(s)
- Erkan Soylu
- Medipol University, Faculty of Medicine, Department of Otorhinolaryngology, Bagcilar, Istanbul, Turkey
| | - Alper Yenigun
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey.
| | - Orhan Ozturan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
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Park AC, Hutchison DM, Prasad KR, Hernandez K, Dilley KK, Gedeon DN, Wong BJF. Costal Cartilage Considerations: Novel Use of Handheld Ultrasound Device in Rhinoplasty. Laryngoscope 2024; 134:651-653. [PMID: 37300433 DOI: 10.1002/lary.30760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
Handheld ultrasound devices can be used in revision rhinoplasty to evaluate the calcification of costal rib cartilage that is to be harvested for grafting. This article provides instructions on how to perform this technique. Laryngoscope, 134:651-653, 2024.
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Affiliation(s)
- Asher C Park
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Beckman Laser Institute, University of California Irvine, Irvine, California, USA
| | - Dana M Hutchison
- Beckman Laser Institute, University of California Irvine, Irvine, California, USA
| | - Karthik R Prasad
- Department of Otolaryngology, Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Kelly Hernandez
- Beckman Laser Institute, University of California Irvine, Irvine, California, USA
| | - Katelyn K Dilley
- Beckman Laser Institute, University of California Irvine, Irvine, California, USA
| | - David N Gedeon
- Department of Radiology, University of California Irvine, Orange, California, USA
| | - Brian J-F Wong
- Beckman Laser Institute, University of California Irvine, Irvine, California, USA
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
- Department of Biomedical Engineering, Samueli School of Engineering, University of California Irvine, Irvine, California, USA
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Liu Y, Wang S, Yang J, Wang D, Li Y, Lin L. Application of 3D printing in ear reconstruction with autogenous costal cartilage: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 176:111817. [PMID: 38071836 DOI: 10.1016/j.ijporl.2023.111817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE In recent years, 3D printing technology has been employed as a production method that builds materials layer upon layer, providing notable advantages in terms of individual customization and production efficiency. Autologous costal cartilage ear reconstruction has seen substantial changes due to 3D printing technology. In this context, this research evaluated the prospects and applications of 3D printing in ear reconstruction education, preoperative planning and simulation, the production of intraoperative guide plates, and other related areas. METHODOLOGY All articles eligible for consideration were sourced through a comprehensive search of PubMed, the Cochrane Library, EMBASE, and Web of Science from inception to May 22, 2023. Two reviewers extracted data on the manufacturing process and interventions. The Cochrane risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the research. Database searching yielded 283 records, of which 24 articles were selected for qualitative analysis. RESULTS The utilization of 3D printing is becoming increasingly widespread in autogenous costal cartilage ear reconstruction, from education to the application of preoperative design and intraoperative guide plates production, possessing a substantial influence on surgical training, the enhancement of surgical effects, complications reduction, and so forth. CONCLUSION This study sought to determine the application value and further development potential of 3D printing in autologous costal cartilage ear reconstruction. However, there is a lack of conclusive evidence on its effectiveness when compared to conventional strategies because of the limited number of cohort studies and randomized controlled trials. Simultaneously, the evaluation of the effect lacks objective and quantitative evaluation criteria, with most of them being emotional sentiments and ratings, making it difficult to execute a quantitative synthetic analysis. It is hoped that more large-scale comparative studies will be undertaken, and an objective and standard effect evaluation system will be implemented in the future.
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Affiliation(s)
- Yicheng Liu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Senmao Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jingwen Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Di Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Yifei Li
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Lin Lin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
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Li CL, Xie YZ, He A, Liu NH, Cui CX, Chen Y, Fu Y, Zhang T. Quantitative Framework Fabrication with Autogenous Costal Cartilage in Microtia Reconstruction. Laryngoscope 2024; 134:148-153. [PMID: 37243347 DOI: 10.1002/lary.30748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Hearing improvement is another basic requirement for microtia patients in addition to aesthetic needs. This quantitative framework fabrication method can reduce the learning curve, obtain satisfactory aesthetic results with few complications, and reserve a certain space for future canalplasty. Laryngoscope, 134:148-153, 2024.
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Affiliation(s)
- Chen-Long Li
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - You-Zhou Xie
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Aijuan He
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ning-Hua Liu
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chun-Xiao Cui
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ying Chen
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yaoyao Fu
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Zhang Z, Wu J, Yu Z, Zhang Y, Zhang J, Song B. Novel "Z" Technique to Overcome Warping of Costal Cartilage. Aesthet Surg J 2023; 44:20-25. [PMID: 37540898 DOI: 10.1093/asj/sjad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Dorsal augmentation with costal cartilage is generally used for aesthetic rhinoplasty. However, the tendency of costal cartilage to warp may jeopardize the aesthetic outcome. OBJECTIVES The aim of this study was to describe a new "Z" technique to overcome the warping of costal cartilage after implantation and to evaluate the efficacy of this technique in vitro. METHODS A total of 31 pairs of porcine costal cartilage grafts (40 mm × 10 mm × 5 mm) were obtained and kept in Dulbecco's Modified Eagle Medium (Sigma-Aldrich, St. Louis, MO) to maintain cell viability. Paired grafts were obtained and randomly allocated for preparation by the accordion technique and the "Z" technique. Standardized photographs (obtained immediately after operation and at 4 weeks) were used for warping analysis. Biomechanical testing was performed to measure the graft's capacity to resist deformation by an external force. RESULTS Cell viability of the grafts at 4 weeks was comparably good in the accordion group and the Z group (61.88% ± 4.47% vs 67.48% ± 7.03%, P = 0.55). Warping angle was comparable between the 2 groups (P > 0.01). The capacity to resist external force was significantly better in the Z group; the force needed to cause deformation was 3.98 ± 1.04 N in the Z group vs 1.61 ± 0.47 N in the accordion group in lateral view (P < 0.0001), and 1.33 ± 0.41 N vs 0.96 ± 0.24 N, respectively, in frontal view (P = 0.0013). CONCLUSIONS The "Z" technique appears to be a simple and effective method to minimize the tendency of costal cartilage to warp after implantation.
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Yeo H, Lee D, Paik D, Son D. The Ninth and Tenth Costal Cartilages Are Available and Safe Options for Rhinoplasty: A Cadaveric Anatomical Study. Plast Reconstr Surg 2023; 152:628e-632e. [PMID: 36877627 DOI: 10.1097/prs.0000000000010360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
SUMMARY Some practitioners prefer the ninth costal cartilage for autogenous rhinoplasty, but few anatomical studies focus on tapering shape and harvesting safety regarding pneumothorax risk. Therefore, the authors studied the size and related anatomy of the ninth and tenth costal cartilages. Twelve fresh cadavers (24 ribs) were studied. The authors measured the length, width, and thickness of the ninth and tenth costal cartilages at the osteochondral junction (OCJ), midpoint, and tip. To evaluate safety during harvesting, the authors measured the thickness of the transversus abdominis muscle beneath the costal cartilage. The mean lengths of the ninth and tenth cartilages were 99.1 ± 25.0 and 60.6 ± 22.5 mm, respectively. The ninth cartilage was 11.8 ± 2.6, 9.0 ± 2.4, and 2.5 ± 0.5 mm wide, and the tenth cartilage was 9.9 ± 2.0, 7.1 ± 2.0, and 2.7 ± 0.5 mm wide at the OCJ, midpoint, and tip, respectively. The ninth cartilage was 8.4 ± 2.0, 6.4 ± 1.5, and 2.4 ± 0.6 mm thick, and the tenth cartilage was 7.0 ± 2.2, 5.1 ± 1.7, and 2.3 ± 0.5 mm thick at each point. For the transversus abdominis muscle, the thickness was 2.1 ± 0.9, 3.7 ± 1.0, and 4.5 ± 1.3 mm at the ninth cartilage and 1.9 ± 0.5, 2.9 ± 1.1, and 3.7 ± 1.4 mm at the tenth cartilage at each point. The size of the cartilage was sufficient for autogenous rhinoplasty. The transversus abdominis muscle provides thickness for safe harvesting. Furthermore, if this muscle is breached during cartilage harvest, the abdominal cavity is exposed, but the pleural cavity is not. Consequently, there is a very low risk of pneumothorax at this level.
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Affiliation(s)
- Hyeonjung Yeo
- From the Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital
| | - Dongkyu Lee
- From the Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital
| | | | - Daegu Son
- Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine
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Luo K, Chen Z, Jiang Z, Cai S, Zhou Y, Cui W, Sheng Y, Lin Y, Chen Y, Cai Z. Ear reconstruction stage I: Minor modifications in sculpting the auricle support using the 7th and 8th costal cartilages. J Plast Reconstr Aesthet Surg 2023; 84:357-364. [PMID: 37390545 DOI: 10.1016/j.bjps.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The verisimilitude of the reconstructed auricle and its long-term stability largely depends on the framework sculpting. This study described three kinds of minor modifications based on Firmin's way of sculpting the auricle framework and reported the clinical outcomes achieved with them. METHODS We conducted a retrospective study of congenital microtia patients undergoing detail-improved auricular reconstruction from June 2016 to June 2020. The three kinds of minor modifications included: (1) fabricating the base frame using the 7th costal cartilage, (2) fabricating the helix and the antihelix complex using the 8th costal cartilage, and (3) fabricating the helix using the combination of the 8th and 9th costal cartilage. RESULTS Ninety-eight patients (aged 9-27 years, 62.2% male) were included. Ninety-five patients (97.0%) adopted minor modifications 1, 2, and 3 patients (3.0%) adopted minor modifications 1, 2, and 3. All patients achieved an excellent auricle appearance and a well-laid foundation for subsequent operations. During the follow-up period, 89 patients (90.8%) were satisfied with the reconstructed auricles, 6 (6.1%) complained of hypertrophic scars in the retroauricular sulcus or pigmentation in the skin graft area, and 3 (3.1%) developed surgery-related complications. CONCLUSIONS Three minor modifications of the auricle framework sculpting can make more satisfactory use of cartilage and adjust with the flexibility of the reconstructed auricle in different situations, making it similar to the contralateral auricle, thus, improving patients' satisfaction.
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Affiliation(s)
- Kexian Luo
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Zaihong Chen
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Zhiyuan Jiang
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Siyuan Cai
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Yucheng Zhou
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Wei Cui
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Yang Sheng
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - You Lin
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Youxin Chen
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Zhen Cai
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China.
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Burton BN, Gilani S. Thirty-day surgical site complications following rhinoplasty with cartilage grafts. J Plast Reconstr Aesthet Surg 2023; 84:459-461. [PMID: 37413738 DOI: 10.1016/j.bjps.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles Health, 959 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Sapideh Gilani
- Division of Otolaryngology, Department of Surgery, University of California San Diego, 200 West Arbor Drive, MC 8654, San Diego, CA 92103, USA.
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13
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Li H, Wang Y, Qian J, Wang B, Liu T, Zhang Q. A Two-Stage Method for Adult Congenital Microtia: The Essentials of 15-Year Experience. Laryngoscope 2023; 133:2148-2153. [PMID: 36537375 DOI: 10.1002/lary.30531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/31/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
HYPOTHESIS Treatment of congenital microtia in adults remains challenging due to the unique physiological characteristics of the costal cartilages and retroauricular skin, which interfere with obtaining a satisfactory aesthetic result; thus, different perspectives and technical modifications during treatment are warranted. This article aims to present complementary new information and essential tips to refine the surgical technique in adult microtia reconstruction. METHODS A total of 346 adult microtia patients underwent surgical intervention at the Auricular Reconstruction Center of Plastic Surgery Hospital (Beijing, China) between 2006 and 2021. Each patient underwent a rigorous preoperative evaluation and stages one and two surgeries. RESULTS Patients were followed in our clinic for 6 months to 10 years (average: 15.3 months). The postoperative complication rate was 8.1%, which included cartilage exposure, broken helix, local hematoma, infection, poor skin graft survival, and scar hypertrophy. CONCLUSIONS Our results showed that the two-stage treatment strategy for adults is versatile, reliable, and effective for the treatment of congenital microtia. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2148-2153, 2023.
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Affiliation(s)
- Hanbo Li
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Qian
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingqing Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tun Liu
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingguo Zhang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Yang Y, Yue X, Yu X, Pan B. Free dermofat grafting for chest deformity in microtia reconstruction. J Plast Reconstr Aesthet Surg 2023; 82:130-136. [PMID: 37163828 DOI: 10.1016/j.bjps.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/09/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Chest deformity is one of the complications that occurs after costal cartilage harvesting for auricle reconstruction. In this study, we presented a novel method of free dermofat grafting to repair cartilage defect and aimed to evaluate its effect in ameliorating chest deformity. METHODS Seventy-six pediatric patients were included in the study, comprising free dermofat grafting group (n = 38) and control group (n = 38). After harvesting costal cartilage, empty perichondrial space of right seventh costal cartilage was filled with free dermofat grafts in free dermofat grafting group. Thoracic computed tomography (CT) was performed three months after surgery and 3D colormap quantification was performed to quantify chest surface asymmetry. The quantified data were further analyzed to compare chest asymmetry level in free dermofat grafting and control groups. RESULTS In the free dermofat grafting group, the mean of asymmetry level was 2.2 mm. While in the control group, the mean of asymmetry was 5.7 mm. After a comparison between the two groups, the level of asymmetry showed a significant difference (p < 0.01). CONCLUSION Free dermofat grafting method is easy to perform and a feasible option for ameliorating chest deformity in microtia reconstruction.
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Affiliation(s)
- Yang Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China
| | - Xiaowei Yue
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China
| | - Xiaobo Yu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China.
| | - Bo Pan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China.
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15
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Fu X, Yin C, Liang Y, Zhou R, Wang D, Wang C. Hybrid Autologous Costal Cartilage Grafting for Augmentation Rhinoplasty in Asian Patients. J Craniofac Surg 2023; 34:1320-1324. [PMID: 37076943 PMCID: PMC10205115 DOI: 10.1097/scs.0000000000009281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Autologous costal cartilage has been used for augmentation rhinoplasty in Asia for many years. This study aimed to assess the effectiveness and safety of hybrid grafting of costal cartilage for dorsal augmentation, septal reconstruction, and tip augmentation for Asian patients. METHODS A surgical technique was introduced and patients having rhinoplasty using this technique from April 2020 to March 2021 were retrospectively studied. In this technique, costal cartilage was meticulously carved or diced and grafted in various ways mainly based on the anatomic characteristics of nasal skin and subcutaneous soft tissues as well as bone and cartilage framework. The surgical outcomes, patient satisfaction, and complications retrieved from the documented medical records were reviewed and analyzed. RESULTS Twenty-five patients having rhinoplasty with the proposed technique were followed up from 6 months to 12 months. As for cosmetic outcomes, 21 patients were graded as good, 3 patients were graded as fair, and only 1 patient was graded as poor. Those patients who were not graded as good had over-rotated tips, insufficient dorsal augmentation, or asymmetry of nostrils and soft tissue contracture. The overall patient satisfaction was as high as 96.0%. Local infection occurred in 1 patient and hematoma was not observed. Warping and visibility of costal cartilage were not observed in any patients. Slight displacement of diced cartilages was found in 2 patients near the radix 1 week postoperatively. CONCLUSIONS Hybrid autologous costal cartilage grafts can be used for both tip refinement and dorsal augmentation for East Asian patients and achieve an outcome of a natural-looking nose with minimal complications. LEVEL OF EVIDENCE Level IV.
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Zheng R, Wang X, Wang H, You J, Xu Y, Zhang X, Guo J, Fan F. Improvement of Nasal Dorsal Onlay Graft Appearance after Augmentation Rhinoplasty with Costal Cartilage for Thin-Skinned Patients. Aesthetic Plast Surg 2023; 47:330-335. [PMID: 36071240 DOI: 10.1007/s00266-022-03082-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The camouflage of the nasal dorsum is very important for thin-skinned patients. In this study, the authors presented an improved method for these patients and evaluated the safety and efficacy of this method in augmentation rhinoplasty. METHODS Fifty-two thin-skinned nose Chinese patients, ranging in age from 18 to 42 years, who underwent open augmentation rhinoplasty with modified perichondrium on dorsal onlay graft were included in the study. Among these patients, 24 of them were primary cases, and the other cases were secondary. The Rhinoplasty Outcomes Evaluation (ROE) scale and Visual aid scoring (VAS) questionnaire were used to evaluate aesthetic outcomes. RESULTS During the long-term follow-up (ranging from 6 to 20 months), the ROE scores of each item before and after surgery were statistically significant in our study. The total scores of the preoperative and postoperative ROE scale of the study were 9.77 ± 3.18 and 20.65 ± 1.88, respectively, which indicated reasonably high satisfaction. According to the VAS questionnaire, patients' own evaluations of the nasal dorsal improvement rendered a high satisfaction rate. One case of fat liquefaction at the donor site and two cases of warping occurred and no other major complications were encountered. CONCLUSION Covering the two edges of the graft with perichondrium on the onlay dorsal graft seems a convenient and effective method for thin-skinned augmentation rhinoplasty, which was the best choice for camouflage of the nasal dorsum in our department. 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)
- Ruobing Zheng
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Xin Wang
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Huan Wang
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Jianjun You
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Yihao Xu
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Xulong Zhang
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Junsheng Guo
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China
| | - Fei Fan
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33, Badachu Road, Shijingshan, Beijing, 100730, People's Republic of China.
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17
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Jeong HY, Cho KS, Bae YC, Seo HJ. Simple method of saddle nose correction: A double-layer dermofat graft: case report. Medicine (Baltimore) 2022; 101:e30300. [PMID: 36107523 PMCID: PMC9439822 DOI: 10.1097/md.0000000000030300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Saddle nose deformities are typically reconstructed with cartilage grafts; however, conchal cartilage grafts are and associated with a risk of damage to the posterior auricular ligament and insufficient amounts, and costal cartilage grafts require invasive surgery under general anesthesia. We proposed a double-layer dermofat graft as an alternative to these methods. PATIENT CONCERNS Two patients with type IV saddle nose deformity underwent reconstruction with nasal augmentation with a double-layer dermofat graft harvested from the gluteal sulcus. DIAGNOSIS After operation, photogrammetric analysis demonstrated an improvement in the dorsal depression area, which corresponded to the angle between the sellion, most depressed point, and pronasale. Rhinoplasty Outcome Evaluation questionnaire was assessed. INTERVENTIONS The graft was divided into 2 sections; the first section was implanted transversely into the depressed nasal framework, and the second section was inserted vertically from the nasion to the supratip break for augmentation. OUTCOMES Both patients reported high satisfaction with the Rhinoplasty Outcome Evaluation questionnaire. The mean preoperative angle between the sellion, most depressed point, and pronasale was 157.8°, and the mean postoperative angle at 6 months was 176.9°. CONCLUSION The simple method double-layer dermofat graft technique demonstrated excellent outcomes in saddle nose deformity correction, did not require cartilage, and was easily performed under local anesthesia.
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Affiliation(s)
- Ho Yoon Jeong
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City, Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan City, Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City, Korea
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City, Korea
- *Correspondence: Hyung Joon Seo, Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City 49241, Korea (e-mail: )
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Drake VE, Mowery AJ, Nellis JC. An update on rib grafting in rhinoplasty: which rib is right? Curr Opin Otolaryngol Head Neck Surg 2022; 30:209-214. [PMID: 35906971 DOI: 10.1097/moo.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In revision or posttraumatic rhinoplasty, the quantity and quality of septal cartilage available for grafting is often deficient and auricular cartilage often provides insufficient strength for structural nasal reconstruction. Accordingly, rib cartilage serves as a reliable, abundant source of cartilage for grafting. However, the various sources of rib cartilage carry respective benefits and weaknesses. This review examines recent studies, novel applications and a comparison of the primary sources of rib cartilage, including autologous cartilage, irradiated cadaveric rib and fresh frozen cadaveric cartilage. RECENT FINDINGS Options for rib cartilage include autologous, irradiated cadaveric rib, and more recently, reports on fresh frozen cadaveric cartilage. Studies continue to conclude that autologous and irradiated donor cartilage carry equivalent results, have similar rates of complication and have a comparable cost profile. SUMMARY Regardless of the source, rib cartilage plays an important role in structural rhinoplasty, especially in revision cases. Although the risks, benefits and long-term results of autologous and radiated homologous cartilage have been evaluated in observational studies, fresh frozen rib cartilage will need further follow up before widespread use, although preliminary literature shows promise.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Lin Y, Chen B, Zhu X, Ma Y, Liu J, Wang M, Chen X. "An integrated clip-shaped costal cartilage carving approach for rhinoplasty". J Plast Reconstr Aesthet Surg 2022; 75:2796-2801. [PMID: 35562289 DOI: 10.1016/j.bjps.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/25/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal tip management is considered to be one of the most complicated and challenging parts of rhinoplasty in East Asian patients. Within current rhinoplasty surgical practice, costal cartilage serves as an ideal source for grafting due to its ability to provide strong support to the nasal tip. METHODS From March 2013 to December 2021, integrated clip-shaped costal cartilage grafts were applied to patients with primary (n = 12) or secondary (n = 3) short nose deformities. The costal cartilage was carved into an monobloc clip-shaped cartilage graft and then placed on the nasal septum and fixed with sutures. The nasal length index, projection index, and nasolabial angles were measured preoperatively and postoperatively. Postoperative evaluation at 8 months was performed using a grading scale. RESULTS A total of 15 patients were included in this study with an average age of 23.7 ± 3.6 years. The mean follow-up period was 14.3 ± 5.3 months and ranged from 8 to 26 months. There were statistically significant differences between the preoperative and postoperative values in nose length index and projection index. Also, the nasolabial angle was significantly reduced. Postoperative evaluation, conducted at a minimum of 8 months following surgery, showed that 86.6% (13/15) of patients felt that their surgical results were good or excellent. No patients rated the results as "poor". CONCLUSION The integrated clip-shaped costal cartilage carving approach has been shown to be a practical method of obtaining satisfactory esthetic outcomes in patients with nasal deformities.
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Affiliation(s)
- Yanyan Lin
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China
| | - Ben Chen
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China
| | - Xiuying Zhu
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China
| | - Yingjie Ma
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China
| | - Jia Liu
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China
| | - Min Wang
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China
| | - Xi Chen
- Department of Plastics and Cosmetic, The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Road, Wenzhou 325000, China.
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20
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Gu T, Li X, Yang X, Yu L, Ma J. Comparison of Free Diced and Multiple Toothpick-Shaped Costal Cartilage Injection Techniques for Augmentation Rhinoplasty. Aesthetic Plast Surg 2021; 46:1360-1368. [PMID: 34595596 DOI: 10.1007/s00266-021-02605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The free diced costal cartilage (FDCC) injection technique has been used in the augmentation rhinoplasty for a long time. In order to lower the incidence of nasal contour irregularities and graft displacement, we developed the multiple toothpick-shaped costal cartilage (MTCC) injection technique. This comparative study was conducted to introduce and assess this new technique. METHODS This retrospective analysis included 51 patients who underwent augmentation rhinoplasty with either the FDCC or MTCC injection technique at the 17th Department of Plastic Surgery in the Plastic Surgery Hospital between July 2014 and May 2020. The patients were divided into the FDCC (n = 30, 58.82%) and MTCC (n = 21, 41.18%) groups. General data, postoperative patient satisfaction, complications and revision rate were compared between the groups. RESULTS Except for the follow-up period, there were no significant differences in general data (age, sex, preoperative dorsum deformity, preoperative rhinoplasty history) between the groups. Postoperative patient satisfaction, complications and revision rate were similar between the two groups. CONCLUSIONS The MTCC injection is a safe and effective technique for augmentation rhinoplasty. Like the FDCC injection technique, the new technique is relatively easy to perform and time-saving with concealed scarring and minimal postoperative edema. Most of its revision surgeries are also easy to perform by simple rasping and reinjection. According to our experience, the new technique may have wider indication as well as lower incidence of nasal contour irregularities and graft displacement. Therefore, we suggest that the MTCC injection technique is reliable and worthy of recommendation. 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)
- Tianyi Gu
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Xin Li
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Xiaoning Yang
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Lu Yu
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Jiguang Ma
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
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Doval AF, Ourian A, Boochoon KS, Chegireddy V, Lypka MA, Echo A. Comparing plastic surgery and otolaryngology surgical outcomes and cartilage graft preferences in pediatric rhinoplasty: A retrospective cohort study analyzing 1839 patients. Medicine (Baltimore) 2021; 100:e26393. [PMID: 34160421 PMCID: PMC8238294 DOI: 10.1097/md.0000000000026393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/30/2021] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Rhinoplasty in children has raised concerns about its safety in the pediatric population. There is scarcity of evidence describing outcomes and surgical techniques performed in pediatric rhinoplasty. We analyzed post-operative complications and cartilage preferences between plastic surgeons and otolaryngologists.Data was collected through the Pediatric National Surgical Improvement Program from 2012 to 2017. Current Procedure Terminology codes were used for data extraction. Patients were grouped according to type of rhinoplasty procedures (primary, secondary, and cleft rhinoplasty). A comparison between plastic surgeons and otolaryngologists was made in each group in terms of postoperative complications. Additionally, a sub-group analysis based on cartilage graft preferences was performed.During the study period, a total of 1839 patients underwent rhinoplasty procedures; plastic surgeons performed 1438 (78.2%) cases and otolaryngologists performed 401 (21.8%) cases. After analyzing each group, no significant differences were noted in terms of wound dehiscence, surgical site infection, readmission, or reoperation. Subgroup analysis revealed that plastic surgeons prefer using rib and ear cartilage, while otolaryngologists prefer septal and ear cartilage.The analysis of 1839 pediatric patients undergoing three types of rhinoplasty procedures showed similar postoperative outcomes, but different cartilage graft utilization between plastic surgeons and otolaryngologists.
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Affiliation(s)
- Andres F. Doval
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston
| | - Ariel Ourian
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston
| | | | - Vishwanath Chegireddy
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston
| | - Michael A. Lypka
- Department of Plastic and Reconstructive Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston
- Texas A&M Health Science Center, College of Medicine. Bryan, TX
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Chang B, Cornett A, Nourmohammadi Z, Law J, Weld B, Crotts SJ, Hollister SJ, Lombaert IMA, Zopf DA. Hybrid Three-Dimensional-Printed Ear Tissue Scaffold With Autologous Cartilage Mitigates Soft Tissue Complications. Laryngoscope 2021; 131:1008-1015. [PMID: 33022112 PMCID: PMC8021596 DOI: 10.1002/lary.29114] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/24/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the use of highly translatable three-dimensional (3D)-printed auricular scaffolds with and without novel cartilage tissue inserts in a rodent model. STUDY DESIGN Preclinical rodent animal model. METHODS This prospective study assessed a single-stage 3D-printed auricular bioscaffold with or without porcine cartilage tissue inserts in an athymic rodent model. Digital Imaging and Communications in Medicine computed tomography images of a human auricle were segmented to create an external anatomic envelope filled with orthogonally interconnected spherical pores. Scaffolds with and without tissue inset sites were 3D printed by laser sintering bioresorbable polycaprolactone, then implanted subcutaneously in five rats for each group. RESULTS Ten athymic rats were studied to a goal of 24 weeks postoperatively. Precise anatomic similarity and scaffold integrity were maintained in both scaffold conditions throughout experimentation with grossly visible tissue ingrowth and angiogenesis upon explantation. Cartilage-seeded scaffolds had relatively lower rates of nonsurgical site complications compared to unseeded scaffolds with relatively increased surgical site ulceration, though neither met statistical significance. Histology revealed robust soft tissue infiltration and vascularization in both seeded and unseeded scaffolds, and demonstrated impressive maintenance of viable cartilage in cartilage-seeded scaffolds. Radiology confirmed soft tissue infiltration in all scaffolds, and biomechanical modeling suggested amelioration of stress in scaffolds implanted with cartilage. CONCLUSIONS A hybrid approach incorporating cartilage insets into 3D-printed bioscaffolds suggests enhanced clinical and histological outcomes. These data demonstrate the potential to integrate point-of-care tissue engineering techniques into 3D printing to generate alternatives to current reconstructive surgery techniques and avoid the demands of traditional tissue engineering. LEVEL OF EVIDENCE NA Laryngoscope, 131:1008-1015, 2021.
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Affiliation(s)
- Brian Chang
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California, U.S.A
| | - Ashley Cornett
- Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, Michigan, U.S.A
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Zahra Nourmohammadi
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Jadan Law
- Department of Biomedical Engineering, Michigan Engineering, Ann and Robert H. Lurie Biomedical Engineering Building, Ann Arbor, Michigan, U.S.A
| | - Blaine Weld
- Department of Biomedical Engineering, Michigan Engineering, Ann and Robert H. Lurie Biomedical Engineering Building, Ann Arbor, Michigan, U.S.A
| | - Sarah J Crotts
- Center for 3D Medical Fabrication, Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, U.S.A
| | - Scott J Hollister
- Center for 3D Medical Fabrication, Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, U.S.A
| | - Isabelle M A Lombaert
- Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, Michigan, U.S.A
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - David A Zopf
- Department of Biomedical Engineering, Michigan Engineering, Ann and Robert H. Lurie Biomedical Engineering Building, Ann Arbor, Michigan, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
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Kemal O, Aksoy A, Daş YK, Tütüncü Ş, Karabulut H, Yildirim U, Terzi O. What Is the Effect of Different Costal Cartilage Carving Methods on Warping during Rhinoplasty? Plast Reconstr Surg 2020; 146:838e-840e. [PMID: 33235006 DOI: 10.1097/prs.0000000000007381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ozgur Kemal
- Department of Otolaryngology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | | | | | - Şerife Tütüncü
- Department of Histology and Embryology, Ondokuz Mayis University Faculty of Veterinary Medicine, Samsun, Turkey
| | - Huseyin Karabulut
- Department of Otolaryngology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Uğur Yildirim
- Department of Otolaryngology, Erzincan Education and Research Hospital, Erzincan, Turkey
| | - Ozlem Terzi
- Department of Public Health, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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24
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Leto Barone AA, Arun A, Samaha GJ, Shallal CC, Redett RJ, Steinberg JP. Design of a Novel Reproducible Cartilage-Sparing Autologous Technique for Microtia Repair. Facial Plast Surg Aesthet Med 2020; 23:224-229. [PMID: 33185490 DOI: 10.1089/fpsam.2020.0457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Microtia reconstruction through manual carving of autologous rib cartilage has a steep learning curve, is operator dependent, is time consuming, requires multiple stages, and frequently results in suboptimal results with poor patient satisfaction. The use of temporoparietal fascia over polypropylene implants achieves excellent cosmetic outcomes in a single stage, although is burdened by infection and extrusion in some cases. We describe the development of a hybrid technique with a novel device that allows for standardization of the cartilaginous construct, minimization of the need for donor cartilage and operative time, and minimization of the number of stages. Clinical Trial: NCT03624608.
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Affiliation(s)
- Angelo A Leto Barone
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anirudh Arun
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Georges J Samaha
- Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christopher C Shallal
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jordan P Steinberg
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Kherani S, Noel CW, Nazir T, Bitar MA. Irradiated homologous costal cartilage grafts for single-stage open airway reconstruction in severe subglottic stenosis for children under the age of one. Int J Pediatr Otorhinolaryngol 2020; 136:110167. [PMID: 32535496 DOI: 10.1016/j.ijporl.2020.110167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/01/2020] [Accepted: 05/30/2020] [Indexed: 11/18/2022]
Abstract
We present two cases of premature infants with Cotton-Myer grade 3 subglottic stenosis where endoscopic balloon dilation failed. In an attempt to avoid tracheostomy, both patients underwent open single stage anterior graft larnygotracheoplasty (LTP) with irradiated homologous rib and temporalis fascia grafts. After postoperative reconstruction, the airway was resized to grade 1 in one child, and to grade 2 in the other. One child remained free of stridor post-operatively and avoided the need of a tracheostomy tube. The other child ultimately required a tracheostomy, though she is now in the process of being decannulated. Homologous costal cartilage grafts in open anterior airway LTP may be a reasonable alternative to tracheostomy in young patients with advanced SGS.
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Affiliation(s)
- Safeena Kherani
- Department of Otolaryngology - Head and Neck Surgery, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Christopher W Noel
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tanvir Nazir
- Department of Otolaryngology - Head and Neck Surgery, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamad A Bitar
- Department of Otolaryngology - Head and Neck Surgery, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates; Department of Otolaryngology - Head and Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon.
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Vila PM, Jeanpierre LM, Rizzi CJ, Yaeger LH, Chi JJ. Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 146:347-354. [PMID: 32077916 PMCID: PMC7042943 DOI: 10.1001/jamaoto.2019.4787] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/26/2019] [Indexed: 11/14/2022]
Abstract
Importance Augmentation rhinoplasty requires adding cartilage to provide enhanced support to the structure of the nose. Autologous costal cartilage and irradiated homologous costal cartilage (IHCC) are well-accepted rhinoplasty options. Tutoplast is another alternative cartilage source. No studies, to our knowledge, have definitively demonstrated a higher rate of complications with IHCC grafts compared with autologous costal cartilage grafts. Objective To compare rates of outcomes in the published literature for patients undergoing septorhinoplasty with autologous costal cartilage vs IHCC grafts vs Tutoplast grafts. Data Sources For this systematic review and meta-analysis, the MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for articles published from database inception to February 2019 using the following keywords: septorhinoplasty, rhinoplasty, autologous costal cartilage graft, cadaveric cartilage graft, and rib graft. Study Selection Abstracts and full texts were reviewed in duplicate, and disagreements were resolved by consensus. Only patients who underwent an en bloc dorsal onlay graft were included for comparison to ensure a homogenous study sample. A total of 1308 results were found. After duplicate records were removed, 576 unique citations remained. Studies were published worldwide between January 1, 1990, and December 31, 2017. Data Extraction and Synthesis Independent extraction by 2 authors was performed. Data were pooled using a random-effects model. Main Outcomes and Measures All reported outcomes after septorhinoplasty and rates of graft warping, resorption, infection, contour irregularity, and revision surgery among patients receiving autologous grafts vs IHCC vs Tutoplast cartilage grafts. Results Of 576 unique citations, 54 studies were included in our systematic review; 28 studies were included after applying inclusion and exclusion criteria. Our search captured 1041 patients of whom 741 received autologous grafts and 293 received IHCC grafts (regardless of type). When autologous cartilage (n = 748) vs IHCC (n = 153) vs Tutoplast cartilage (n = 140) grafts were compared, no difference in warping (5%; 95% CI, 3%-9%), resorption (2%; 95% CI, 0%-2%), contour irregularity (1%; 95% CI, 0%-3%), infection (2%; 95% CI, 0%-4%), or revision surgery (5%; 95% CI, 2%-9%) was found. Conclusions and Relevance No difference was found in outcomes between autologous and homologous costal cartilage grafts, including rates of warping, resorption, infection, contour irregularity, or revisions, in patients undergoing dorsal augmentation rhinoplasty. En bloc dorsal onlay grafts are commonly used in augmentation rhinoplasty to provide contour and structure to the nasal dorsum.
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Affiliation(s)
- Peter M. Vila
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Northwestern University, Chicago, Illinois
| | - Latoya M. Jeanpierre
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Christopher J. Rizzi
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lauren H. Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John J. Chi
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Guo F, Lin L, Yu X, Song Y, Yang Q, He L, Pan B, Jiang H. Classification of the concha-type microtia and their new suitable treatment strategies without autogenous costal cartilage grafting. Int J Pediatr Otorhinolaryngol 2020; 130:109801. [PMID: 31821964 DOI: 10.1016/j.ijporl.2019.109801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Numerous corrective methods have been successfully applied in concha-type microtia reconstruction over the past several decades, and autogenous rib cartilage grafting has become a routine technique in a two or three-stage operation. However, it still remains a challenge due to the effective use of the large volume of the remnant cartilage and skin involved. The objective of this study was to clarify how this remnant cartilage and skin could be manipulated for new suitable treatment strategies without autogenous costal cartilage grafting. METHODS A total of 424 patients with concha-type microtia operated at our Center from January of 2012 to June of 2019 have been reviewed and analyzed cases. At the same time, a classification system for grading the severity of concha-type microtia was created on the basis of anatomical findings and ear size. RESULTS A total of 436 ear cases (involving 424 patients), showing concha-type microtia, were included in our study and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. The concha-type microtia were classified into four graded types: Grade I (n = 151), Grade II (n = 101), Grade III (n = 93), and Grade IV (n = 79). A total of 352 ears in 345 patients with Grade I to III concha-type microtia were followed up for 1 month to 7 years (average, 14.7 months). 329 patients (95.4%) were satisfied with the aesthetic outcomes of the corrected ear. CONCLUSIONS Individual corrective methods and aesthetic outcomes for patients with Grade I to III of deformity were described in this study. The authors present new suitable approaches according to a progressive classification system which provide conservative and individualized methods of treatment in early stages of life.
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Affiliation(s)
- Fengfeng Guo
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - Lin Lin
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - Xiaobo Yu
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - YuPeng Song
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - Qinghua Yang
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - LeRen He
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - Bo Pan
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- The Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College, Beijing, China.
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28
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Xu Z, Zhang R, Zhang Q, Xu F, Li D, Li Y. New Strategies for Tragus and Antitragus Complex Fabrication in Lobule-Type Microtia Reconstruction. Plast Reconstr Surg 2019; 144:913-921. [PMID: 31568304 DOI: 10.1097/prs.0000000000006043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The creation of a high-defining tragus and antitragus complex remains a demanding challenge during staged lobule-type microtia reconstruction. The success of the complex carving relies greatly on proper operation of the cartilage, which is commonly residual cartilage of various sizes. The authors discuss the relevant details for sculpting the tragus and antitragus complex based on cartilage remnants in various conditions. METHODS A series of 562 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2007 and 2016. Because of the various sizes and shapes of the remnant cartilage used for the tragus and antitragus complex reconstruction, the authors have described possible scenarios for fabrication and introduced relevant tactics for appropriate treatment. RESULTS Corresponding methods for various scenarios in tragus and antitragus complex fabrication have been shown to demonstrate a satisfactory appearance. The results demonstrate the achievement of a harmonious tragus and antitragus complex for the integrity of a constructed ear. CONCLUSIONS Proper use of the residual cartilage for tragus and antitragus complex sculpture plays a vital role in acquiring a favorable contour of the auricle in microtia reconstruction. The introduced approach enhances the aesthetics and functionality of the complex for modern life. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Zhicheng Xu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine
| | - Ruhong Zhang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine
| | - Qun Zhang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine
| | - Feng Xu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine
| | - Datao Li
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine
| | - Yiyuan Li
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine
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29
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Farinelli L, Aquili A, Manzotti S, Graciotti L, Messi MM, Gigante A. Characterization of human costal cartilage: is it an adapt tissue as graft for articular cartilage repair? J BIOL REG HOMEOS AG 2019; 33:69-77. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata. [PMID: 31169006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Several techniques and different biological or artificial tissues have been proposed as graft to restore articular defects. However, among the numerous and heterogeneous procedures proposed over time, the current literature findings are not conclusive. The aim of the current study is to evaluate if human costal cartilage can be suitable as graft for restoring articular cartilage defects. Knee articular cartilage and costal cartilage samples were obtained respectively from patients that underwent anterior cruciate ligament reconstruction (samples from notch plasty) or knee joint replacement and ear reconstruction or rhinoplasty through rib graft. The samples were stained with hematoxylin eosin, safranine-O, Gomori paraldehyde-fuchsin and Von Kossa for light microscopy. Immunohistochemistry was performed using anti-collagen I, II, IV and anti-SOX9 antibodies. Furthermore, samples were analyzed by transmission electron microcopy (TEM). In both cartilage, the cells are arranged in quite similar layers and the matrix show the same hyaline appearance: presence of type II collagen and solphated glycosaminoglycans, and absence of type I collagen and SOX-9. The bigger difference between the two hyaline tissues is the presence of perichondrium that surrounds all the specimens of costal cartilage. It consists of two separate layers where the inner one seems to get thinner with aging. The results show that rib cartilage seems to be an adapt tissue as graft for articular cartilage repair from a histological point of view. However, to date its therapeutic potential remains to be clearly defined by animal and clinical studies.
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Affiliation(s)
- L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - A Aquili
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - L Graciotti
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - M M Messi
- Maxillofacial Surgery Unit, University Hospital "Ospedali Riuniti" Umberto I, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
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Jiang Z, You X, Cai Z, Liu Q, Du L, Cui W, Chen Z, Sheng Y. [Effectiveness of autologous costal cartilage transplantation in repair of Binder's syndrome]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:1056-1060. [PMID: 30238735 PMCID: PMC8430002 DOI: 10.7507/1002-1892.201802064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/02/2018] [Indexed: 11/03/2022]
Abstract
Objective To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder's syndrome. Methods Between June 2012 and June 2017, 8 cases of Binder's syndrome were admitted. There were 3 males and 5 females, aged 16-31 years (mean, 22 years). All patients were conformed to the typical manifestations of Binder's syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder's syndrome was evaluated. Results All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in 1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation ( P<0.05). The difference in nasal dorsum length, nasal tip projection rate, and nasion projection between actual values at 6 months after operation and normal values was no significant ( P<0.05). There was significant difference in nasal columella-lobule ratio between actual value at 6 months after operation and normal value ( P>0.05). Conclusion Autogenous costal cartilage transplantation in repair of Binder's syndrome can obviously improve patients' appearance of the external nose and middle face, and obtain the persistent effectiveness.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
| | - Xiaobo You
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072,
| | - Zhen Cai
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
| | - Quan Liu
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
| | - Liping Du
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
| | - Wei Cui
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
| | - Zaihong Chen
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
| | - Yang Sheng
- Department of Plastic Surgery, Sichuan Provincial People's Hospital & Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China
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Wan R, Pang X, Ren J. Using Four-Layer Sculpted Rib Cartilage Framework to Increase Transverse Height of the Reconstructive Ear in One Operative Stage for Microtia Patients. Aesthetic Plast Surg 2018; 42:167-175. [PMID: 29214334 DOI: 10.1007/s00266-017-1014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This case study improves an operative method of ear reconstruction for microtia patients by using a four-layer rib cartilage framework to increase transverse height of the reconstructive ear to a natural level in one operative stage. MATERIALS AND METHODS The procedures of ear reconstruction were conducted from February 2014 to May 2016. The ear framework used in the procedures was fabricated from autologous rib cartilage into a four-layer spliced sculpture. Totally 23 patients with unilateral microtia were willing to be enrolled in this study. RESULTS After the operation, 23 patients achieved 2.3-2.8 cm transverse height of reconstructed ears, which was basically the same as the normal side. Both patients and their families felt satisfied with the results. Follow-up was performed at 6-16 months after the procedures. Only one case showed significantly lowered transverse height of the reconstructed ear, compared to the normal one. It was due to the sleeping position of the patient (10-year-old boy), which put the reconstructed ear under pressure and reduced the transverse height of the ear. CONCLUSIONS The method of four-layer sculpted autologous rib cartilage ear reconstruction has good clinical effect. It can provide a reconstructed ear that reaches normal transverse height and avoids a third operation to increase the transverse height by rib cartilage transplantation. 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)
- Rui Wan
- Department of Plastic Surgery, TongRen Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, Hubei, China.
| | - Xingyuan Pang
- Department of Plastic Surgery, TongRen Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, Hubei, China
| | - Jun Ren
- Department of Plastic Surgery, TongRen Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, Hubei, China
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Abstract
Revision rhinoplasties and saddle nose deformities usually require grafting for reconstruction. Between January 1, 2000, and January 1, 2017, autologous rib grafts were used in 127 secondary and tertiary rhinoplasty patients [(57/127 females) and (70/127 males)]. Osseous-cartilaginous rib grafts (OCRGs) were divided into three parts (i.e., 1/3 upper peripheral, 1/3 central, and 1/3 lower peripheral). The harvested OCRGs were also shaped as vertical strips using a number 11 scalpel blade. These OCRGs were shaped to form the L-strut cartilaginous graft (LSCGs), osseous-cartilaginous spreader grafts (OCSGs), osseous-cartilaginous onlay grafts, nasal valve grafts (NVGs), and lower lateral cartilaginous grafts (LLCGs). The upper peripheral portion of the rib was usually used as an onlay graft for dorsal reshaping. The shape of this part was minimally convex after being cut from the main graft, and the convex shape was very appropriate for use as an onlay graft. The middle portion of the graft that consisted of the osseous and cartilaginous structure was used for the OCSGs. The middle portion of the graft that contained only cartilage was used for the LSCGs, NVGs, and LLCGs. OCRGs were used for the dorsal, alar, septal, upper lateral, and columellar struts for all patients. OCSGs were used for all of the septal grafts to provide further stability. In the nasal valve failure patients, the rib cartilage was fixed onto the lower lateral and upper lateral cartilage and was sutured using polyglactin to improve nasal valve function. One edge of the graft was sutured over the septum, and the other edge was positioned against the maxillary crest to allow for air flow at the nasal valve. After an OCSG was sutured to the septum, a flat and smooth dorsum was shaped before the dorsal onlay graft was placed and fixed. The bone fragments of the grafts that consisted of spreader and onlay grafts were tied to the radix nasi bone without any space. After 6 months of follow-up, a minimally warping defect was apparent in 8 patients but none of these patients requested another surgery. The analysis of the questionnaire responses revealed that >90% of the patients were satisfied with the outcome of the procedure. 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)
- Safvet Ors
- SO-EP Aesthetic and Plastic Surgery Clinic, Seyitgazi Mah. Seyyid Burhaneddin Bulv. No: 51/A, 38050, Kayseri, Turkey.
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Nazım C. Commentary on 3D Photogrammetric Analysis of the Nasal Tip Projection and Derotation Based on the Nasal Tip Quadripod Concept. Aesthetic Plast Surg 2017; 41:1164-1166. [PMID: 28432416 DOI: 10.1007/s00266-017-0870-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
Asian noses are mainly characterized by a low nasal dorsum, a short nose and an underprojected nasal tip due to underdeveloped (short and weak) alar cartilages. The goals of the surgery are to increase the tip projection, elongate the nose and augment the dorsum. In Asian noses the structural approach helps strengthen the weak cartilages and add definition to the nasal tip. There are various methods to increase tip projection and definition. Columellar strut, caudal septal extension graft, tip grafts and lateral crural grafts in order to elongate the upper legs of the nasal tip tripod can be used. The method described in this article seems a useful solution in Asian rhinoplasty patients who do not want to use rib cartilage. The "Skiff Graft" functions similar to caudal septal extension graft with its elongation and raise effect at the caudal septum. However in cases which need significant increase in tip projection and nose elongation, this method may be insufficient. In such cases, stronger structural grafts prepared from rib cartilage will give a better tip definition and more predictable outcome.
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Affiliation(s)
- Cerkes Nazım
- Cosmed Plastic Surgery Center, Hakkı yeten cad. Ascıoglu plaza Floor 2, 34365, Istanbul, Turkey.
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Chen Z, Luo C, Shang X, Yang H, Yang L, Wulan H, Han Y. [Application of multislice computed tomography volume rendering and 3D printing technique of costal cartilage for auricular reconstruction]. Zhonghua Zheng Xing Wai Ke Za Zhi 2017; 33:97-101. [PMID: 30070801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the value of Multislice computed tomography volume rendering(VR) technique and 3D printing technique in auricular reconstruction. METHODS Six patients were enrolled for auricular reconstruction with costal cartilage,including 5 congenital microtia patients and 1 traumatic auricular defect patient. We harvest the three-dimensional reconstructive data of the contralateral sixth, seventh, eighth and ninth costal cartilage with VR technique.Three-dimensional solid models were 3D printed with nylon material according to the data exported in STL format.Preoperativesimulation was performed on the models, accordingly, we determined the strategies of costal cartilage harvest and framework fabrication, and operations were performed based on the pre-designed plan. RESULTS In all 6 patients, the actual costal cartilage harvest and framework fabrication process was consistent with the preoperative design and simulation results, and more scientific than before.The shapes of reconstructed ears were vivid and natural. No complications such as infection,absorption,distortion and chest deformity happened. CONCLUSIONS Through costal cartilage VR and 3D printing technique, we could make more reasonable preoperative design and simulation. The results can be improved with reduced injury, while avoiding the risks of thoracic deformity.
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Tian L, You J, Wang H, Wang S, Zhang B, Xu Z, Lu X, Fan F. [Comparison of costochondral nasal framework reconstruction and silicone graft implantation in improving the midface depression of Binder syndrome]. Zhonghua Zheng Xing Wai Ke Za Zhi 2016; 32:405-409. [PMID: 30067010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the clinical effects of costal cartilage grafts and silicon with auricular cartilage in correcting the midfacial depression of Binder syndrome. METHODS We followed up eighteen cases of Binder syndrome treated in our department between 2008-2015.Silicon with auricular cartilage grafts were applied for six cases, costal cartilage scaffold reconstructed in 12 cases. MB-Ruler software was used for preoperative and postoperative measurement of lateral profile. Data obtained was analyzed statistically. RESULTS Silicone group: Angle of convexity of the face with the nose reduce (6.66 ± 2.05) °,Nasal tip-length quotient increase 0.053 ± 0.015,Tip projection anterior glabellar line quotient increase (7.07 ± 4.35) % (P < 0.05). Costalchondral group: Angle of convexity of the face with the nose decreases(11.32 ±2.27) °,Angle of convexity of the face without the nose decreases (5.96 ± 2.17)°,Nasal tip-length quotient increase 0.920 ± 0.049,Tip projection anterior glabellar line quotient increased (11.73 ±7.53)%,nasolabial angle reduce (11.71 ±7.68)°(P <0.05).Independent samples t test between two groups showed that compared to the silicon, costochondral nasal framework reconstruction can get more significant results in increasing angle of convexity of the face (including nose and without nose) and nasal tip-length quotient (P < 0.05). CONCLUSIONS Costochondral nasal framework reconstruction is better suited to improve the midfacial depression of Binder syndrome, especially the nasal outcome.
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Kolodzynski MN, Kon M, Egger S, Breugem CC. Mechanisms of ear trauma and reconstructive techniques in 105 consecutive patients. Eur Arch Otorhinolaryngol 2016; 274:723-728. [PMID: 27714497 PMCID: PMC5281643 DOI: 10.1007/s00405-016-4299-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/06/2016] [Indexed: 12/02/2022]
Abstract
Acquired auricular deformities may diminish facial esthetics and cause psychological distress. The aim of this article is to provide an overview of the type of injuries and applied reconstructive techniques in a large academic hospital in The Netherlands. A retrospective chart review was conducted for the last 105 patients who underwent auricular reconstruction for an acquired deformity. Data concerning gender, affected side, cause of injury, anatomical region, the previous and further surgeries, type of cartilage, and skin cover used were collected and analyzed. 105 patients were included. Acquired auricular deformities were mainly caused by bite injuries (22 %), traffic accidents (17 %), burns (9.5 %), and post-otoplasty complications (9.5 %). The upper third of the auricle was most often injured (41 %), followed by the entire auricle (19 %). 70 % of cases required reconstruction with costal cartilage. The most common form of cutaneous cover was a postauricular skin flap (40 % of cases). This study gives a complete overview of causes and treatment of acquired auricular deformities. The results are comparable with the results of similar studies found in literature. Bite wounds are the leading cause of acquired auricular injuries. The upper third is most commonly affected. In the largest percentage of reconstructions, costal cartilage and a postauricular flap were used to correct the deformity.
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Affiliation(s)
- Michail N Kolodzynski
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Moshe Kon
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Silvan Egger
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Ma J, Cai L, Wang K, Wang C, Li X, Zhao X, Zhang T. [Costal cartilage for rhinoplasty]. Zhonghua Zheng Xing Wai Ke Za Zhi 2016; 32:25-28. [PMID: 27197476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Augmentation rhinoplasty is a commonly procedure in clinical work for a plastic surgeon. Autologous costal cartilage is widely used in aesthetic rhinoplasy because of the abundant in quality. However, the cartilage may warp, and it is not easy-handling for inexperienced plastic surgeons. We-used diced cartilage combined with thin strips as columellar struts, which can be easily shaped, and reduce the warping incidence. METHODS From July 2012 to March 2014, 61 patients were performed diced costal cartilage for nasal augmentation via endonasal approach. Standardized photographs are obtained before and after surgery. Postoperative outcome is graded by patient's self-evaluation of the nasal appearance with a satisfaction scale. RESULTS Among the 61 cases, 25 were revision cases. The follow-up time was no less than 6 months, with an average time of 10.9 months. 28 patients reported improved or better nasal appearance. One patient required revision surgery because of overcorrection. Supratip step-off was observed in one patient and corrected by external reshaping. No warping, infection, irregularity, absorption, airway obstruction, or donor-site morbidity were observed. All patients were satisfied with the final appearance. CONCLUSIONS Diced costal cartilage is a reliable option for nasal augmentation and revision rhinoplasty. Good outcomes can be achieved postoperatively, with aesthetically pleasing appearance and simple procedure.
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Liu SC, Lin DS, Wang HW, Kao CH. A useful technique for adjusting nasal tip projection in Asian rhinoplasty: Trapezoidal caudal extension cartilage grafting. Ear Nose Throat J 2016; 95:E17-E22. [PMID: 26829689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
The purpose of this article is to present our experience with Asian patients in (1) using a trapezoidal caudal extension cartilage graft to adjust the tip projection in tip refinement for augmentation rhinoplasty, especially for the correction of short nose, and (2) avoiding complications of augmentation rhinoplasty with alloplastic implants. We conducted a retrospective chart review of 358 rhinoplasties that were performed by the corresponding author from January 2004 through July 2009. Patients were included in this study if they had undergone open rhinoplasty with a trapezoidal caudal extension cartilage graft as the only tip-modifying procedure. Patients in whom any additional grafting was performed that might have altered the nasal tip position were excluded. The surgical results were analyzed in terms of the degree of satisfaction judged separately by investigators and by patients. A total of 84 patients-46 males and 38 females, all Asians, aged 13 to 61 years (mean: 29.3)-met our eligibility criteria. Postoperative follow-up for 24 months was achieved in 62 patients. At the 24-month follow-up, the surgeons judged the results to be good or very good in 57 of the 62 patients (91.9%); at the same time, 56 patients (90.3%) said they were satisfied or very satisfied with their aesthetic outcome. Good nasal tip projection, a natural columellar appearance, and improvement in the nasolabial angle were achieved for most patients. Two patients required revision rhinoplasty to correct an insufficient augmentation and migration of the onlay graft. No severe complications were observed during the 2-year follow-up. We have found that trapezoidal caudal extension cartilage grafting in nasal tip refinement is an easy technique to learn and execute, its results are predictable, and it has been associated with no major complications. We recommend trapezoidal caudal extension cartilage grafting for Asian patients as a good and reliable alternative for managing tip projection and support.
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Affiliation(s)
- Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Gong Rd., Neihu District, Taipei, Taiwan 114, R.O.C
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Abstract
Satisfactory and consistent long-term results in primary and secondary rhinoplasty rely on adequately resupporting or reconstructing the nasal osseocartilagenous framework. Autogenous rib cartilage has been our graft material of choice for major nasal reconstruction when sufficient septal cartilage is not available. The rib provides the most abundant source of cartilage for graft fabrication and is the most reliable when structural support is needed.
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Affiliation(s)
- Christopher Spencer Cochran
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
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Varadharajan K, Sethukumar P, Anwar M, Patel K. Complications Associated With the Use of Autologous Costal Cartilage in Rhinoplasty: A Systematic Review. Aesthet Surg J 2015; 35:644-52. [PMID: 26229125 DOI: 10.1093/asj/sju117] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Autologous costal cartilage grafts are common in rhinoplasty. To date, no formal systematic review of complications associated with autologous costal cartilage grafting in rhinoplasty exists. OBJECTIVES The authors review current literature to examine the rates of donor and recipient site complications associated with autologous costal cartilage in rhinoplasty. METHODS Databases (EMBASE, PubMed, MEDLINE, and Cochrane Database of Systematic Reviews) and references of pertinent articles were searched between January 1980 to July 2014 to find studies evaluating rates of complications with autologous costal cartilage grafting in rhinoplasty. These studies were then screened with specific inclusion/exclusion criteria, and data were extracted from included studies and pooled for analysis. RESULTS A total of 21 eligible studies were included. Pooled donor site complication incidence was pneumothorax (0.1%), pleural tear (0.6%), infection (0.6%), seroma (0.6%), scar-related problems (2.9%), and severe donor site pain (0.2%). Pooled recipient site complications were as follows: warping (5.2%), infection (2.5%), displacement/extrusion (0.6%), graft fracture (0.2%), and graft resorption (0.9%). CONCLUSIONS Autologous costal rhinoplasty remains a safe procedure, but is associated with not insignificant rates of minor recipient site complications, such as warping. LEVEL OF EVIDENCE 4 Therapeutic.
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Affiliation(s)
- Kiran Varadharajan
- Dr Varadharajan is a Core Surgical Trainee, Department of ENT, West Middlesex University Hospital, London, UK. Dr Sethukumar is a Research Fellow ENT, Dr Anwar is a Specialist Registrar ENT, and Dr Patel is a Consultant ENT, Department of ENT, St. Mary's Hospital, London, UK
| | - Priya Sethukumar
- Dr Varadharajan is a Core Surgical Trainee, Department of ENT, West Middlesex University Hospital, London, UK. Dr Sethukumar is a Research Fellow ENT, Dr Anwar is a Specialist Registrar ENT, and Dr Patel is a Consultant ENT, Department of ENT, St. Mary's Hospital, London, UK
| | - Mohiemen Anwar
- Dr Varadharajan is a Core Surgical Trainee, Department of ENT, West Middlesex University Hospital, London, UK. Dr Sethukumar is a Research Fellow ENT, Dr Anwar is a Specialist Registrar ENT, and Dr Patel is a Consultant ENT, Department of ENT, St. Mary's Hospital, London, UK
| | - Kalpesh Patel
- Dr Varadharajan is a Core Surgical Trainee, Department of ENT, West Middlesex University Hospital, London, UK. Dr Sethukumar is a Research Fellow ENT, Dr Anwar is a Specialist Registrar ENT, and Dr Patel is a Consultant ENT, Department of ENT, St. Mary's Hospital, London, UK
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Fang DB, Shen YH, Zhu XW, Fang JJ, Mao QQ, Tan FQ, He QW, Shen BH, Xie LP. [Penile necrosis resulting from post-circumcision microwave diathermy: A report of 9 cases]. Zhonghua Nan Ke Xue 2015; 21:428-431. [PMID: 26117941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision. METHODS We retrospectively analyzed the clinical data about 9 cases of penile necrosis resulting from postoperative microwave diathermy following circumcision. The 9 males, aged 20 - 39 (mean 26) years, underwent traditional circumcision for redundant prepuce or phimosis in other hospitals, followed by microwave diathermy for 30 - 60 minutes daily, which resulted in penile necrosis. With no response to conservative therapy, the patients were referred to our hospital at 3 -30 days postoperatively. Of the 9 patients, 5 presented with dry gangrene and 4 with moist gangrene. Six of the patients underwent partial penectomy, including 1 that received penis lengthening.3 months later, while the other 3 underwent total penectomy for total penile necrosis followed by penile reconstruction 3 months later, with deep inferior epigastric perforator (DIEP) flaps and by implantation of the 12th costal cartilage in 2 cases and with epigastric groin island flaps and by urethroplasty in the other. RESULTS The patients were followed up for 2 - 8 years, and all could urinate smoothly in the standing position. Of the 6 men treated by partial penectomy, 1 received penis lengthening and achieved a penile length of 7 cm and 5 had the remaining penile length of 3 -5 cm, 4 with erectile function and the other 2 capable of sexual intercourse. The 3 men treated by total penectomy achieved nearly normal external appearance of the penis, with a finalized length of (11.7 ± 1.3) cm, a circumference of (11.4 ± 2.1) cm, and a normal feel of the skin. Of the 3 cases of penile reconstruction, 2 achieved sufficient erectile hardness of the penis (grade 3) for sexual intercourse, while the other 1 remained impotent. CONCLUSION Post-circumcision microwave diathermy may result in penile necrosis, for the management of which, early debridement is necessitated and penile lengthening or reconstruction can be performed according to the severity of the lesion and needs of the patient.
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Jiayu Z, Qiaoli S, Qinghua Y, Leren H, Haiyue J. [Experimental study of the influence of expanded capsule on biomechanics of autograftedcostal cartilage]. Zhonghua Zheng Xing Wai Ke Za Zhi 2015; 31:205-208. [PMID: 26536690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the effect of the expanded capsule on biomechanics of the transplanted autologous costal cartilage. METHODS Ten New Zealand white rabbits aged 3 months were involved and four 15 ml tissue expanders were implanted symmetrically on the back of each rabbit. After 1 month, expanded capsules were removed (experimental group) on the left side and were reserved (control group) on the right side. Meanwhile, the 6th and 7th costal cartilage without the perichondrium were taken out and each cartilage was divided into two pieces and put under the expanded capsule symmetrically. The cartilage at the upper sides and lower sides were taken out at 4 weeks and 8 weeks later, respectively. All the cartilages were sculptured for the demand of the machine text. The tension and compression property of the cartilages were assessed by the material testing machine (Instron 5967) and the results were analyzed statistically. RESULTS 8 weeks lateral, the average ultimate tension strength was (4. 954 + 2. 8) MPa in experimental group and (2.939 + 0.842) MPa in control group. The average compressive strength was (58.74 ± 13.77) MPa in experimental group, and (47.61 ± 11.41) MPa in control group. The biomechanics property of the cartilages in the experimental group is better than the control group, and the differences were statistically significant. CONCLUSIONS Removing the expanded capsule is benefical to maintain the biomechanics of autologous costal cartilage.
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Hong C, Zheng D, Lu L. [Correction of severe alar retraction with alar rotation flap]. Zhonghua Zheng Xing Wai Ke Za Zhi 2015; 31:19-21. [PMID: 26027318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the therapeutic effect of alar rotation flap for severe alar retraction. METHODS Patients with severely retracted alar underwent ala reconstruction using alar rotation flaps and autogenous cartilage batten grafts. First, costal cartilage was used to reshape the nasal tip and nasal dorsum. Then cartilage patch was used to extend and thicken the retracted alar. Then the alar rotation flap was transferred to correct retracted alar. RESULTS Fourteen patients with severe alar retraction underwent alar reconstruction with alar rotation flap and alar batten grafts. The alar retraction was corrected in all cases, with improvements functionally and aesthetically. No recurrence of alar retraction was noted. The incision healed with acceptable cosmetic results, with obvious scar in only one patient (one side). CONCLUSIONS The alar rotation flap is an effective and reliable surgical option to correct severe alar retraction. Scar can be kept inconspicuous by precise placement of the incision within the junction of the ala and the nasal dorsum, following principles of the aesthetic nasal subunits.
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Correia-Sá I, Amarante J, Horta R, Neto T, Silva Á, Marques M. Secondary rhinoplasty using the technique of Turkish Delight: a case report and a brief review of the literature. ACTA MEDICA PORT 2015; 28:122-6. [PMID: 25817507 DOI: 10.20344/amp.5505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 12/23/2014] [Indexed: 11/20/2022]
Abstract
Rhinoplasty is a demanding task, especially when augmentation of the nasal contour is required. Autologous cartilage grafts are challenging. Contour and alignment of the graft are difficult goals. It is presented a case of a successfully nasal dorsum augmentation in a secondary rhinoplasty with the Turkish Delight technique and a brief review of literature. A 33-years-old female, with history of complete unilateral cleft nasal deformity on the right, and severe nasal deformity, previously submitted to other procedures, was referred to our Center. As she presented a visible cartilage graft, it was decided to perform the Turkish Delight technique. The autograft was effective for increasing of the nasal dorsum, at four years post-operative. There was no evidence of extrusion. The patient is satisfied with the result. The technique is effective in the reconstruction of complex dimorphism of the nasal dorsum, particularly in secondary rhinoplasty.
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Affiliation(s)
- Inês Correia-Sá
- Department of Plastic and Reconstructive Surgery. Hospital de S. João. Porto. Portugal. Faculty of Medicine. University of Porto. Porto. Portugal
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Abstract
IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012, at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kristin K Constantine
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Jim Gilmore
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Kenneth Lee
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Joseph Leach
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
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Shang Q, Jiang H, Zhou J, He L, Yang Q. [PRELIMINARY HISTOLOGICAL OBSERVATION OF EFFECT OF EXPANDED CAPSULE ON COSTAL CARTILAGE AUTOGRAFT]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:741-744. [PMID: 26455229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the effect of the expanded capsule on the growth of autogenous costal cartilage. METHODS Sixteen New Zealand white rabbits at the age of 3 months (weighing, 2.2-2.5 kg; male or female) were selected and four 15 mL tissue expanders were implanted on the back symmetrically. After 1 month, the expanded capsule formed, the tissue expanders were removed; the capsule of the left side was removed (experimental group), and the capsule of the right side was reserved (control group); meanwhile, the right 7th and 8th costal cartilage without the perichondrium was divided into segments and placed into the capsule of 2 groups symmetrically. At 4 and 8 weeks after transplantation, the cartilage was harvested for the general, weighing, and histological observations. RESULTS One rabbit died during the experiment, and the other 15 rabbits survived. The differences of cartilage weight between before and after transplantation showed more obvious increase in the experimental group [(0.003 4 ± 0.002 7) g and (0.005 8 ± 0.001 4) g] than those in the control group [(-0.000 3 ± 0.001 9) g and (-0.003 9 ± 0.005 3) g] at 4 and 8 weeks, showing significant differences between 2 gouprs (t = 4.331, P = 0.029; t = 6.688, P = 0.008). The change of cartilage weight at 8 weeks was significantly higher than that at 4 weeks in the experimental group (t = -3.098, P = 0.001); but the change of cartilage weight at 8 weeks was significantly lower than that at 4 weeks in the control group (t = 2.491, P = 0.009). The histological observation showed that the activity of the cartilage was enhanced in 2 groups at 4 and 8 weeks when compared with normal cartilage, and more obvious change was observed in the experimental group than in the control group. And the acellular area was seen in the cartilage at 8 weeks in the control group. The Masson staining results showed that the color was deeper in the experimental group than in the control group. CONCLUSION The removal of the expanded capsule during operation is beneficial to the growth of autogenous costal cartilage. The results can provide corresponding experimental guidance for the clinical problems.
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Wang M, Wang B, Zheng H, Wu S, Shan X, Liu Z, Zhuang F. [The application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method]. Zhonghua Zheng Xing Wai Ke Za Zhi 2014; 30:84-88. [PMID: 24941755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method. METHODS The first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus. Split-thickness skin was taken from temporal and accipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface. RESULTS From July 2010 to August 2012, 20 cases (22 ears) were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average, 13 months). CONCLUSIONS The application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.
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Benzaouia A, Serghini S, Oukessou Y, Abada R, Rouadi S, Mahtar M, Roubal M, Kadiri F. [Free nonvascularized bone graft evolution after mandibular resections: 45 cases report]. Rev Laryngol Otol Rhinol (Bord) 2014; 135:145-150. [PMID: 26521358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The resection of mandibular benign tumors often require reconstruction. The purpose of our study is to present the middle and long-term results of 45 patients, treated by free no-vascularized bone graft after resection of benign tumors, dominated by the ameloblastoma. The PSIM type III hemimandibulectomy was the most frequent (58%). A combined approach was necessary in the majority of cases. The immediate reconstruction by corticospongeal iliac grafts fixed by screws plaques with intermaxillary blockage was the most used technique (95%). The mean follow was 4.5 years. The evolution was marked by good osteointegration of the graft, with good functional and morphologic results in 40%. The infection and bone resorption represented the major complications and were interrelated, so the infection was noted in 9 cases. The bone resorption hampered the evolution with a bad functional and morphological result in 4 cases (9%).
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Li J, Guo XP, Wang KH, Zhao DH, Han T, Lang YH, Pong LJ. [Correction of secondary nasal deformity of cleft lip with autogenous costal cartilage framework]. Zhonghua Zheng Xing Wai Ke Za Zhi 2013; 29:167-169. [PMID: 25069339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the correction of secondary nasal deformity of cleft lip with autogenous costal cartilage framework. METHODS 237 cases with secondary nasal deformity of unilateral cleft lip were treated. The rib cartilage was harvested through a mini-invasive incision, and was fabricated as a C-shaped framework, as well as some cartilage fragments. Through transcolumella incision, the C-shaped framework was implanted to support the depressed alar and the cartilage fragments were used to augment the nasal base. RESULTS Satisfactory cosmetic and functional results were achieved in all the patients with primary healing. 93 patients were followed up one year after operation with good cosmetic results. CONCLUSIONS Autogenous costal cartilage framework can be used for the correction of secondary nasal deformity of cleft lip with satisfactory results.
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