Sculpturing and reconstructive procedures in aesthetic and functional rhinoplasty.
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Patients requiring surgical correction of skeletal dysplasia and malocclusion often present with a co-existing function and/or aesthetic nasal deformity. This article reviews the techniques of nasal surgery, rationale for combined nasal and orthognathic surgery, and timing of corrective nasal and jaw surgery.
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The nasal sequelae of unilateral cleft lip and palate are almost always present: more or less severe deformities, essentially consisting of nostril deformity and deviated septum. After an anatomical study of nasal deformities and the consequences of the primary procedures of cheiloplasty or cheilorhinoplasty, the authors review all of the most satisfactory technical aspects of secondary proposed in the literature. Five clinical cases illustrate the therapeutic strategy and the results.
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The most common procedures to reconstruct a severe saddle-nose deformity are autogenous costal cartilage, iliac bone grafting, or Silastic implants. Each of them has its specific disadvantages. As an alternative solution, an autogenous bilateral conchal graft in sandwich technique is described. A 3-layer graft for the dorsum and a 2-layer graft to support the depressed columellar -tip area grants a more natural and elastic reconstruction of the nasal framework. The conchal grafts are taken by an incision made on the preauricular surface of the ear. How to plan the curved grafts by meticulous "cross-hatching" and to immobilize them in the recipient area by transcutaneous suturing is demonstrated.