Shield graft for the nasal tip

Onlay cartilage grafts have been used in the region of the nasal tip since first reported in 1895, and renewed interest in the procedure has increased steadily during the past ten years. Throughout the past five years, 43 cases of noses that lack tip projection have been treated by us with the use of the shield graft technique. There was an improvement in appearance that satisfied the aesthetic criteria in all cases. The complications were few, and the results seemed more natural and pleasing when compared with the results of other techniques that enhance projection.     

Cartilage grafts for the nasal tip

Control over nasal tip projection is essential in rhinoplasty. Nasal projection is defined as the length of the perpendicular drawn from the anterior facial plane to the tip-defining point. Between 1989 and 1991, 300 patients underwent an external rhinoplasty. In 94 (31%) an autologous graft for the nasal tip was used. The aesthetic result was pleasing to the vast majority of the patients. Nasal tip rigidity resolved in all patients within one year post-operatively. One patient needed revision surgery, because of graft resorption. The nasal lobule shield-type graft, made of autologous cartilage, is one of the most important methods to maintain projection. The graft may also control length, (counter)rotation of the nose and refinement of the tip. The external approach facilitates in-situ suturing and sculpting of the graft.     

鼻尖部神经鞘瘤切除及同期鼻尖成形术2例

目的 通过近期相关文献复习了解鼻尖部神经鞘瘤的病史病理特点、临床表现和诊治,在外科切除的同时行鼻尖成形术.方法 报告2例鼻尖部神经鞘瘤的临床病理特点,同期行鼻尖成形术,其中1例应用自体鼻中隔软骨行鼻尖成形术.结果 病理显示神经鞘瘤,2例患者均对外鼻形态满意.结论 鼻尖部神经鞘瘤临床少见,在外科切除的同时应用自体鼻中隔软骨行鼻尖成形术可以得到满意的外鼻形态.     

Surgery of the nasal tip

Summary  The nasal tip is considered most difficult area in entire rhinoplasty. The shape of the nasal tip is altered primarily by changes of lower lateral cartilages. or by badly performed surgery. For the assessment of the tip, its shape must be considered in relationship to the rest of the nose and face. Various types of tip deformities may be encountered. Tip may be overprojected, underprojected, bulbous or retruded columella may be deformed or there may be alar flaring. Tip surgery should be properly planned and accomplished meticulously to achieve pleasing results. Delivery flap technique provides excellent exposure and can deal with most of the tip deformities successfully.     

Surgery of the nasal tip

Ten operative procedures for surgery of the nasal tip are described and illustrated with case photographs. A working understanding of the various tip techniques described should allow the rhinoplastic surgeon to achieve consistently good results.     

Cranio-caudal transdomal sutures for the nasal tip correction

The goal of the nasal tip plastic surgery is to reduce or increase, change the shape or/and projection, rotation and contour the tip. This report presents our technique for the reduction and lifting of the nasal tip with a proportional reduction (trim) of the alar cartilage and suture technique—cranio-caudal transdomal sutures. The aim of this study is to analyze and compare the effectiveness of three tipplasty suture techniques to modify nasal tip projection and rotation. Our research is based on 297 operated patients, 165 of them were women (55, 5%) and 132 were men (44, 5%). Rhinoseptoplasty with open approach was applied to 144 of them (48, 4%) and to 153 (51, 6%) of the patients was applied endonasal (delivery) approach. In this paper we compare the postoperative results of three suture methods. We discuss advantages and shortcomings of our technique, compared with the other surgical procedures. There is no one “right” way to nasal tip surgery, only optimal methods for individual cases.     

Columellar tympanoplasty

This article discusses the problem that ossicular reconstruction presents when the malleus handle has been destroyed and a columella must be used. The technical problems and failures of the past twenty-five years are exposed in an effort to glean the lessons of this experience. A comparison of three types of columella currently used--bone, ceramic, and polyethylene--is presented. Since there have been disadvantages and excessive failure rates with each type of columella, other techniques have been attempted and are described. Many of the questions posed by the efforts to develop adequate solutions to the problems of columellar tympanoplasty are restated here in the hope that cooperative research and development between surgeon and manufacturer will continue and prosper.     

Plastic surgery indications for the repair of nasal tip and nasal alae defects

Analyze methods of reconstruction of non-transfixing and transfixing loss of substance of the nasal tip and nasal ala. We would like to share the attitude guiding our selecting of the different methods to rehabilitate this mobile and functional portion of the nose. We retrospectively studied 32 cases of defects of the tip and ala treated between 2007 and 2009. There were 26 basal cell carcinomas, 5 squamous cell carcinomas and 1 melanoma. The minimum postoperative follow-up was one year. For reconstruction we used local flaps: medial dorsal flap, bilobed flap, transverse island flap and regional flaps: fronto-glabellar flap, forehead flap, nasolabial flap. In this study we analyzed the aesthetic and functional result achieved at the nasal orifice. We also studied the histopathological reports regarding safety tissue margins, both in depth and peripherally. Most of the defects of the tip and the alae of less than 1 cm were repaired by local flaps; bilobed or transverse island flaps. For the median region, the Rintala mid-dorsal flap appears to give better results. Tissue losses greater than 1 cm often required the use of a fronto-glabellar flap that allowed delivery of more tissue with less scarring at the donor site. The nasolabial flap may have the disadvantage of removing the crease and sometimes a certain thickness at the arc of rotation, which might require further thinning at a later stage. For transfixing loss of substance, we must repair all the layers: skin, cartilage and mucosa. The forehead flap with respect to the principles of the aesthetic subunits of the nose is the flap of choice. We stress on the importance of ample resection with adequate safety margins peripherally and in depth.     

Evaluation of nasal tip surgery.

Nasal tip surgery has been evaluated with respect to correction of the lower lateral cartilages. Indications, techniques, results, and complications related to three generic approaches to the lower lateral cartilages are described. In 673 consecutive rhinoplasties the commonest type of nasal tip surgery was excisional, utilizing either a marginal or cartilage splitting technique. These techniques were utilized: 1. to accomplish debulking, and 2. to accomplish the installation of facets. The excisional technique found its greatest utility in primary rhinoplasties. The version technique, utilizing a change of direction of the thrust of the lower lateral cartilages was utilized in a variety of situations, particularly for the correction of moderately congenitally hypoplastic tip cartilages. It also found great utility in surgery of the Negro or cleft palate nose, increasing tip projection, correcting unacceptable bifidity, and in revision rhinoplasty. Augmentation rhinoplasty, utilizing conchal cartilage as an elastic strut was particularly useful for severe hypoplastic cartilage deficits, the Negro nose, columellar retraction, and alar rim deficits. The overall complication rate of lower lateral rhinoplasty was 17.4 percent. The rate of unacceptable complications related to lower lateral rhinoplasty was 2.7 percent.     

Quantitative analysis of nasal tip projection

Previously described methods for quantifying nasal tip projection were evaluated. Fifty-one nasal profiles were analyzed and scored by expert rhinoplastic surgeons. The noses and faces were then evaluated quantitatively using several methods. The methods were found to vary widely in their correlation with the experts' subjective analyses. Several helpful relationships and guides were obtained: 1. Aesthetic tip projection does not correlate well with upper lip length. 2. A new method described in this paper showed the best correlation with the experts' opinions (regression, r value = 0.8132). This method related tip projection to total nasal length (including upper lip length). 3. The second new method tested in this report yielded helpful data by comparing tip projection with overall facial length. 4. After slight modification the method previously described by Goode proved useful as nasal length and desired tip projection formed a 3:4:5 right triangle.