3D photogrammetric analysis in hump nose correction based on nasal tip projection without dorsal augmentation in Asian rhinoplasty

IntroductionHump nose in Asians should be managed differently in consideration of the lateral profile and the balance between the dorsal height and nasal tip projection. We suggest an alternative approach comprising mild rasping and nasal tip projection using a septal extension graft.Material and methodsIn this retrospective study, patients who underwent hump nose correction with rhinoplasty between March 2012 and July 2015 were recruited. Instead of applying conventional dorsal augmentation after humpectomy, our approach involved only smooth dorsal contouring in limited cases. 15 patients were evaluated, with surgical outcomes demonstrated using three-dimensional photogrammetry.ResultsOver the postoperative period, hump height decreased (pre 2.77 ± 2.07, post 0.31 ± 0.55, p = 0.001). Regarding the efficacy of tip projection, both nasal tip protrusion (pre 17.64 ± 4.82, post 20.46 ± 4.05, p = 0.001) and tip projection (pre 19.75 ± 4.26, post 21.83 ± 4.17, p = 0.023) were increased. The hump nose reduction ratio was 84.94% after 6 months and 76.47% after 1 year, whereas increases in nasal tip projection and dorsal augmentation were minimal, with ratios of 14.75% and 12.76%, respectively, after 6 months).ConclusionTherefore, creating a balance between the nasal tip and nasal dorsum in hump nose correction is more important than dorsal augmentation after hump resection in Asians.     

Importance of the levator labii alaeque nasi muscle in dorsal septal deviations

Deviated cartilages structures of the nose can be affected by nasal muscles, and deviation becomes conspicuous when the patient smiles. This condition depends on activity of nasal muscles, particularly the levator labii alaeque nasi muscle. A total of 124 septorhinoplasty operations were performed to correct dorsal concave septal deviation between 2005 and 2009 years. The 70 women and 54 men included in the study had an average age of 28 years. The average follow-up period was 12 months. Open septorhinoplasty was preferred in all cases. The medial part of the levator labii alaeque nasi muscle was extensively dissected from the lateral crus and surrounding tissues. The lateral crura of the alar cartilages were separated from the upper lateral cartilages in the scroll area. The dorsal septal deviation was corrected by combination of bilateral spreader grafts, which reinforced cartilage with horizontal control sutures. Early postoperative period was uneventful. Nasal obstruction was reduced after surgery, and significant subjective postoperative improvements were observed in all patients. Comparison of preoperative and postoperative photographs demonstrated improved dorsal nasal contour. Revision operation was performed in 3 cases. The corrected septal cartilage was in a good position in all revised cases; therefore, septal surgery was not performed in the revision operations. In conclusion, surgical disruption of the anatomic relationship between the muscle with the dorsal septal cartilage and reinforcement of the dorsal septal cartilage with spreader grafts and horizontal control sutures can decrease risk of recurrence.     

Open rhinoplasty for African-American noses

Our aim was to evaluate the use of open rhinoplasty for cosmesis on African-American noses. Thirty African-American patients with Fitzpatrick skin type V or VI and typical African-American noses who had had open rhinoplasty between January 1997 and November 2000, and at least 3-years' follow-up were selected and their casenotes examined retrospectively. Patients' evaluations were recorded at all consultations and the data was recorded on standard protocols together with objective measurements including wound healing and complications. All patients thought that the definition and projection of the tip was successful and 27 of the under projected tips were improved. Two had a persistently slightly wider interalar distance than they wanted. In one the nostrils were asymmetrical. The nasal dorsum was improved in all patients, with no complaints of under or over correction. Revision was necessary in one patient who complained of mobility of the silicone rubber (Silastic) implant that had been placed over the anterior nasal spine. Only one patient was unsatisfied on the subjective evaluation. Columellar scarring was noticed only by the staff, and there were no signs of keloid and hypopigmentation, or hyperpigmentation. Postoperatively, there were two synechiae and one haemorrhage. Open rhinoplasty using the transcolumellar external incision for aesthetic correction of African-American noses gives satisfactory results with few complications.     

A cineradiographic study of deglutitive tongue movement in patients with anterior open bite

The purpose of this study was to use cineradiographic images to investigate tongue movement during deglutition in anterior open bite patients with tongue thrust. Each subject had semi-spherical lead markers attached to the tip and dorsal surface of the tongue and was asked to swallow 5 ml of diluted liquid barium. Tongue movement during deglutition was recorded in the mid-sagittal plane with an X-ray VTR system. The deglutition process was divided into 6 stages to analyze the movements of the tip and dorsal surface of the tongue in each stage. In open bite patients, both the tip and dorsum of the tongue were positioned anteriorly and inferiorly at rest and during the buildup of negative intraoral pressure. The dorsum of the tongue tended to move and be positioned anteriorly as the tongue tip protruded and pushed the maxillary and mandibular anterior teeth. The tongue tip traveled a significantly smaller distance from the stage of tongue rest position to that of most retruded tongue tip position and a significantly larger distance from the stage of most retruded tongue tip position to that of tongue tip fixation in open bite patients than in controls.     

Analysis of nasal bone fractures; a six-year study of 503 patients

The aim of this study is to classify the nasal bone fractures based on computed tomography (CT) analysis and patterns of the nasal bone fractures, and review 503 cases treated between 1998-2004 at the Department of Plastic Surgery, Inha University Hospital, Incheon, South Korea.The age, sex, etiology, associated injuries, pattern of fractures and treatments were reviewed and a radiographic study was analyzed. Plain simple radiographs of lateral and Waters view of the nasal bones combined with computed tomography scans were done. Nasal bone fractures were classified into six types: Type I) Simple without displacement; Type II) Simple with displacement/without telescoping; IIA; Unilateral; IIAs) Unilateral with septal fracture; IIB) Bilateral; IIBs) Bilateral with septal fracture; Type III) Comminuted with telescoping or depression.Diagnosis of nasal bone fractures were made positively by plain x-ray films in 82% of cases, negative finding was 9.5% and 8.5% of cases were suspicious of the fractures. Reliability of the plain film radiographs of the nasal bone fracture was 82% in this study. In the most of the fractured nasal bones (93%) the closed reduction was done, open reduction in 4% and no surgical intervention in 3%. Nasal reduction was carried out in average 6.5 days post the injury. The patterns of the nasal bones fractures classified by CT findings were type IIA (182 cases, 36%), IIBs (105 cases, 21%), IIB (90 cases, 18%), IIAs (66 cases, 13%), I (39 cases, 8%) and III (21 cases, 4.3%).We think the CT is necessary for diagnosing nasal bone fracture because the reliability of the plain film was only 82%.     

Effectiveness of chondrofascial ‘cigar’ graft in contouring the nasal dorsum

Irregularities of the nasal dorsum after rhinoplasty are frustrating for the patient and the surgeon. Different grafts and implants have been adopted to camouflage this nasal imperfection. This study was performed to assess the outcome of a composite chondrofascial ‘cigar’ graft for contouring an irregular nasal dorsum. Thirty-six patients who underwent rhinoplasty between May 2014 and October 2016 were studied prospectively. The cartilaginous core of the graft was obtained from the septal or conchal cartilage, while the graft outer sleeve was harvested from the right lateral thigh fascia lata. The graft was secured over the nasal dorsum through an external rhinoplasty approach. The patients were followed up for at least 18 months postoperative. All participants were evaluated objectively by two independent rhinoplasty surgeons and subjectively by Rhinoplasty Outcome Evaluation (ROE) score. Donor site morbidity was also assessed. All patients had satisfactory aesthetic results with no apparent irregularities detected over the nasal dorsum. The ROE score improved, from a mean of 20.94 ± 8.67 (range 8–58) preoperatively to a mean of 79.56 ± 10.65 (range 50–96) postoperatively. Insignificant donor site morbidity was encountered, with inconsequential effects. The chondrofascial cigar graft is a reliable method for contouring dorsal irregularities, particularly in patients with thin nasal skin.     

Versatility of three-dimensional total alar cartilage dissection in aesthetic rhinoplasty

In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.     

Real-time balanced turbo field echo cine-magnetic resonance imaging evaluation of tongue movements during deglutition in subjects with anterior open bite.

INTRODUCTION: The aim of this study was to evaluate tongue movements in subjects with anterior dental open bites during deglutition by using real-time balanced turbo field echo cine-magnetic resonance imaging. METHODS: The study included 28 subjects. Two groups were formed according to the presence of anterior open bite (at least 2 mm). The open-bite group (OBG) consisted of 18 patients (14 girls, 4 boys) with a mean age of 14.5 +/- 2.7 years. The control group (CG) consisted of 10 patients (5 girls, 5 boys) with a mean age of 14.5 +/- 2.6 years. We evaluated deglutition during 3 stages: oral (stage 1), pharyngeal (stage 2), and esophageal stage (3). RESULTS: Results indicated that (1) in the OBG, from stage 2 to stage 3, the anterior portion of the tongue dorsum was elevated [corrected] whereas its midportion was lowered [corrected]; (2) in the CG, its posterior portion was lowered [corrected] from stage 2 to stage 3; (3) in the CG, the tongue tip was positioned more posteriorly [corrected] at stage 2 than at stage 1; (4) in the OBG, the tongue tip moved more anteriorly in all stages of deglutition than in the CG. CONCLUSIONS: Compensatory tongue functions occur in patients with anterior dental open bites. Dynamic MRI is a promising tool for evaluating swallowing patterns in these patients.     

淋巴管瘤或淋巴血管瘤性巨舌症的外科手术治疗

目的：总结淋巴管瘤或淋巴血管瘤性巨舌症的外科治疗经验。方法：分析7例淋巴管瘤或淋巴血管瘤性巨舌症的手术病例，舌背及舌前部有病变者采用术式1；舌背中央、舌前部、舌腹及舌系带均有病变者采用术式2治疗。结果：术式1治疗5例，术式2治疗2例。全部病例术后语言功能正常，4例术后随访10年肿瘤无复发。取得长期效果。结论：两种术式治疗淋巴管瘤或淋巴血管瘤性巨舌症，远期效果好。     

Unilateral cleft lip/palate children: The incidence of type 6 septal deformities in their parents

BACKGROUND: The overall incidence of pathological septal deformity has been found to be significantly higher in unilateral cleft lip/palate (UCLP) children than in control children. Of the seven types of septal deformity according to Mladina's classification, type 6 has been found to be the most frequent in UCLP children, occurring in only 3.7% of the control children. OBJECTIVE: To investigate the incidence of type 6 septal deformity in the parents of UCLP children. PATIENTS AND METHODS: UCLP children (N=62) and their parents (N=91) were examined for type 6 septal deformities. RESULTS: Type 6 was found in at least one parent of a UCLP child in 58% of cases. However, it was not found in the parents whose UCLP children did not show a type 6 septal deformity. CONCLUSION: Type 6 septal deformity is almost a rule in children suffering from UCLP. Type 6 was not seen in the parents whose UCLP children did not show a type 6 septal deformity. There is a morphogenetic predisposition for the development of CLP in children whose parents carry a type 6 septal deformity.     

舌癌好发部位与慢性不良刺激的关系研究

目的:分析舌癌好发于舌缘、舌尖的原因。方法:36例舌癌病人按有无慢性不良刺激因子(包括残根、残冠、锐尖锐缘、倾斜牙、不良修复体)分为有刺激因子组和无刺激因子组,把发病部位分为经常受牙齿摩擦刺激的舌缘、舌尖部;和很少受牙齿摩擦刺激的舌腹、舌背、舌根部两亚组。结果:有不良刺激因子组和无不良刺激因子组中不同亚组的构成比有显著性差异,前者的舌缘、舌尖部的构成比(91.7%)显著高于后者(8.3%),而后者中不同亚组构成比相近(58.1%、41.7%)。结论:病患牙及不良修复体对舌的长期慢性不良刺激是舌癌好发于舌缘舌尖部的重要相关因素。     

鼻骨-眶-筛骨及相邻颌面骨骨折所致畸形的整体修复

目的 不断改进和完善鼻骨-眶-筛骨（NOE）及相邻颌面骨骨折所致畸形的修复方法.方法 对76例NOE及伴有相邻颌面骨骨折患者采用多个隐蔽切口进行手术复位、固定.同时修复外伤性鼻畸形、眶壁缺损、矫正眼球内陷、修复伴发的相邻颌面骨骨折.结果 经术后3～6个月随访,所有NOE及伴有相邻颌面骨骨折患者术后外形和功能均得到整体的改善或恢复.3例术前眼球内陷明显,术后仍有轻度内陷;2例术后复视未完全恢复;5例陈旧性骨折,术后面中部突度及宽度恢复不理想,经二次整形修复,效果满意.结论 NOE及伴有相邻部位骨折要予以整体修复才能取得良好的手术效果.     

Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate

Thirty-five patients (range 16-59 years) with cleft-lip nasal deformity treated by external rhinoplasty were evaluated for satisfaction and perception of outcomes. Treatment involved alar base relocation and augmentation of the asymmetric nasal tip with auricular cartilage grafts. The patients completed a satisfaction survey and interview at the 2-year follow-up visit. A visual analogue scale (VAS) numbered 0-10 was also used by the patients to grade outcome compared to preoperative appearance at 4 anatomic sites. Prior to surgery, the nasal tip was perceived as being most deformed (15/35), followed by alar position (12/35) and nasal apertures (8/35). The site on the nose most improved by surgery was the tip (15), followed by alar position (10), symmetry of nostrils (6) and dorsum (4). The highest VAS score was for the tip (8.32), followed by alar position (7.59), dorsum (7.41) and symmetry of nostrils (6.73). No patients suffered long-term pain for more than 2 months following surgery. All patients were prepared to undergo such procedure for a second time, if necessary. The unilateral cleft-lip nasal deformity can be improved in the eyes of the patient, using the combination of external rhinoplasty with alar base relocation, where necessary, and auricular cartilage augmentation of the nasal tip.     

应用"L"型硅胶假体与膨体聚四氟乙烯补片修复单侧唇裂鼻畸形17例报道

目的:探讨应用“L”型硅胶假体与膨体聚四氟乙烯(ePTFE)补片修复单侧唇裂鼻畸形的方法及效果。方法:在纠正错位软骨的基础上,在“L”型硅胶假体上的鼻尖部附加一(ePTFE)薄片,用5-0尼龙线将两者缝合固定,对单侧唇裂鼻畸形患者进行鼻背、鼻尖、鼻翼、鼻小柱的加固和塑形。结果:“L”型硅胶假体与(ePTFE)补片联用,可使扁平的鼻梁、鼻尖及塌陷的鼻翼抬起,使鼻小柱挺立,大大改善了鼻的外观,效果满意,优良11例,改善6例。结论:应用“L”型硅胶假体与ePTFE修复单侧唇裂鼻畸形,是一种简便有效的方法。     

Concomitant open reduction of a nasal bone fracture combined with a zygomatic fracture through a subciliary incision

Nasal bone fracture is the most common of the fractures of the facial skeleton. For centuries, these injuries have been managed with closed reduction, but because of low surgeon satisfaction rates and high revision rates, open reduction is advocated in cases involving severe deviation of the nasal dorsum associated with septal fractures. There are many surgical approaches that can be used to expose the nasal bones, but we present a case where the subciliary incision was used to reduce and fixate the fracture in a patient with combined zygomatic fractures. Owing to the abundance of other concomitant facial fractures with nasal bone fractures, this approach can be used in patients with combined injuries to the facial skeleton, in whom an open reduction of the nasal bones is also required.     

Cephalometric long-term follow-up of nasal augmentation using iliac bone graft.

INTRODUCTION: Iliac bone grafts for nasal augmentation are characterized by resorption. In this article, the relationship between graft resorption and soft tissue retrusion is examined by cephalogram-based measurements. METHODS: Ten patients with nasal deformity underwent iliac bone grafts to the nose and were monitored using cephalograms at intervals. On every image, three distances were measured; the tip height and the upper and lower lengths of the graft. RESULTS: The upper length of the grafted bone reached 90% stability after 6 months, and the lower length reached 70% stability between 1 and 2 years postoperatively. At the tip, supported by the lower part of the grafted bone, the soft tissue projection reached 90% stability after 6 months. DISCUSSION: The lower part of the iliac bone grafted onto the nasal dorsum supports the projecting soft tissue of the nasal tip. Thus subsequent resorption of the graft results in retrusion of the nasal tip. However, the degree of soft tissue retrusion was obviously less than the amount by which the supporting bone resorbed. It seems likely that the augmentation effect persists due to the formation of scar tissue.     

Autologous fascia lata graft for contour restoration and camouflage in tertiary rhinoplasty

Tertiary rhinoplasty is a surgical procedure to correct nasal deformities that have been developed after prior unsuccessful surgeries. Such surgery requires complicated manipulations and tissue grafting for proper restoration. In the current study, we report the use of fascia lata graft combined with cartilage grafts for contour restoring and camouflage. Twenty-three patients who had severe nasal deformities were included, of whom 14 were men and 9 were women. Their ages ranged between 24 and 34 years (mean, 29 y). All patients were twice previously operated on by surgeons other than the authors. An informed consent was obtained from all patients. After harvesting the costal cartilage, the fascia lata graft (mean size, 2-3 cm) was uniformly harvested from the right lateral thigh. Application of the fascia lata and the cartilage graft was achieved through the open rhinoplasty incision. The fascia lata was applied over the cartilage in the dorsal region in 20 patients (86.9%), applied over the reconstructed alar and dome area in the nasal tip in 8 patients (34.7%), and applied over both areas simultaneously in 4 patients (17.3%). Postoperative follow-up was between 14 and 35 months (mean, 24.5 mo); clinical evaluation, photographic documentation, and a questionnaire form related to donor-site morbidity and patient satisfaction were applied after 12 months of the follow-up period. Results showed that all patients had an improved aesthetic result, and no apparent irregularities were observed in the integument of the aesthetic lines. No complications or no requirement for revision surgery was observed later on. In conclusion, refinements of the nasal dorsum and the nasal tip in tertiary rhinoplasty are indeed important and difficult to be managed. Placing the fascia lata over the applied cartilage grafts provide a good cover that conceals the possible irregularities or distortions that may appear in the late postoperative period.     

单侧唇裂术后继发鼻畸形分类的研究

目的 建立单侧唇裂术后继发鼻咽形的分类方法。方法 观察５６例单侧唇裂术后患者外鼻石膏模型各标志点间距离,发现总结鼻畸形的特征;在术中观察鼻软骨间的相对位置关系。结果 将鼻畸形分成３度：Ⅰ度鼻畸形仅表现患侧鼻下１／３形态异常;Ⅱ主莅 健侧鼻下１／３形态受累;Ⅲ度伴鼻背偏斜。结论 此分类方法简单易行,可为临床修复鼻畸形选择手术方法提供依据。     

Reconstruction of saddle nose deformity with three-dimensional costal cartilage graft

Saddle nose deformity is characterized by depression of the nasal bone and the cartilage dorsum associated with a collapse in the upper lateral and alar cartilages. Etiopathogenesis usually involves trauma or invasive excision of the bone and cartilage. Surgical treatment for functional and aesthetic recovery relies on the use of grafts. Options for grafting include autogenous tissue such as bone or cartilage and alloplastic augmentation. Nine patients with saddle nose deformity underwent surgical reconstruction with autogenous costal cartilage. The deformity was the result of trauma in seven patients and secondary to surgery in two patients. Cartilage obtained from the sixth and seventh ribs was used as the graft material to compensate for the low nasal dorsum. Cartilage was used as a single unit and shaped to cover the nasal dorsum and the lateral nasal walls completely. The upper lateral cartilages were fixed to shaped cartilage graft. Additional cartilage grafts into the columella and septum were also placed in all patients. Functional and aesthetic outcome was satisfactory in all patients. As a result, using costal cartilage graft, a single unit allowed more predictable and reliable reconstruction of the saddle nose deformity than the conventional dorsal grafts.     

Initial effects of the tongue crib on tongue movements during deglutition: a Cine-Magnetic resonance imaging study

The objective of this study was to investigate the initial effects of a tongue crib on tongue movements during deglutition by using real time balanced turbo field echo (B-TFE) Cine-MR imaging. A total of 21 patients were evaluated in this study. The open-bite group (OBG) consisted of 11 patients (seven girls, four boys) who had a mean age of 11.09 +/- 2.02 years and a mean overbite of -5.14 +/- 1.83 mm. These patients were evaluated initially (T1) and while wearing a tongue crib (T2). A total of 10 patients (five girls, five boys) with a mean age of 14.5 +/- 2.6 years and with a mean overbite of 1.6 +/- 0.5 mm served as controls (CG), and only initial records were obtained from these patients. T2 was compared with T1 and CG. T1 was also compared with CG. We evaluated deglutition during three stages matching oral (1), pharyngeal (2), and esophageal (3) stages. Our results indicated that the tongue's tip positioned more posteriorly when the crib was in place (T2) compared with both T1 and CG; the anterior portion of the tongue's dorsum was at a lower position in T2 compared with both T1 and CG at stage 3; the midportion of the tongue's dorsum was at a lower position in T2 than in T1 and CG at stages 1 and 2. To compensate for the posterior position of the tongue's tip (caused by the tongue crib), adaptive changes occurred in the anterior and midportions of the dorsum of the tongue.