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At least 1,765 records · Page 98Linked to original sources
PubMed1997

Use of alar batten grafts for correction of nasal valve collapse.

OBJECTIVE: To determine the efficacy of alar batten grafts for the correction of internal and external nasal valve collapse. DESIGN: In this retrospective study, a questionnaire was used to ask patients to rate their nasal breathing before and after application of alar batten grafts. SETTING: Private practice and academic tertiary referral medical center. PATIENTS: The questionnaire was given to 63 patients who underwent application of alar batten grafts between 1980 and 1995. Forty-six patients (73%) responded and were included in the study. INTERVENTION: Alar batten grafts were applied into a precise pocket via a limited endonasal incision or via the external rhinoplasty approach. The grafts consisted of curved septal cartilage or auricular cartilage and were applied to the site of maximal lateral nasal wall collapse. The convex surface of the cartilage was oriented laterally to allow maximal lateralization of the collapsed portion of the lateral nasal wall. In most cases, alar batten grafts were applied caudal to the existing lateral crura and extended from the lateral one third of the lateral crura to the piriform aperture. OUTCOME MEASURES: The degree of nasal airway obstruction was determined by subjective scoring on a scale from 1 (no obstruction) to 5 (complete obstruction) before and after surgery. The patency of the internal airway was also assessed on physical examination. RESULTS: The results of the study revealed that all but 1 of the 46 patients experienced an improvement in their nasal airway obstruction. The mean improvement in nasal airway obstruction was 2.5 on a scale of 5. Patients that had the least improvement had intranasal scarring in the region of the internal nasal valve, loss of vestibular skin, or excessive narrowing at the piriform aperture. Physical examination revealed a significant increase in the size of the aperture at the internal or external nasal valve after the application of the alar batten grafts. There was minimal postoperative fullness in the supraalar region, where the alar batten grafts were applied. With time, this fullness decreased, leaving little evidence of the graft and an overall improvement in the aesthetic result. CONCLUSIONS: Alar batten grafts are effective for long-term correction of internal and external nasal valve collapse that is not complicated by intranasal scarring in the region of the nasal valve, loss of vestibular skin, or excessive narrowing at the piriform aperture.

Cartilage↗
PubMed1982

The surgical closure of nasoseptal perforations.

Although nasoseptal perforations are uncommon--becoming even more so with early diagnosis and treatment of nasal trauma along with continuing refinements in septal surgery--a myriad of suggested techniques continue to exist for their closure. The conventional success rate is often unacceptably low so that Silastic prostheses are now being used to relieve the symptoms of septal perforation. The successful surgical closure of perforation of the nasal septum is still difficult. This treatment has been greatly facilitated by the use of the external rhinoplasty, without compromising the airway or causing cosmetic deformity. Supportive autogenous graft material is used routinely, while the perforation is closed using bilateral, bipedicled mucoperichondrial flaps. This paper omits a complete discussion of etiology. The indications for surgical correction are discussed in detail. The main contraindication to attempting correction is the size and the position of the perforation. The paper is based on 7 years' experience during which period 18 patients have had this surgery. The technical details of the operation are described with the aid of diagrams and photographs.

Humans↗
PubMed1982

Management of the scoliotic nose.

The twisted nose represents an enigma to many rhinoplasty surgeons because of its frequent recurrence following correction. Reasons for failure include improper preoperative evaluation, failure to understand and compensate for the dynamics of cartilage and faulty surgical execution. One cannot expect a perfectly straight nose on all occasions but an analytic evaluation and appropriate surgical execution can routinely yield an apparently straight nose. The dynamics of the twisted nose are explored with special emphasis on the septal contribution to the scoliosis. The contribution of the bony and cartilaginous structures to the deformity is emphasized. An appreciation of the nasal cartilage-osseous unit is essential to understand the production of the twisted nose and its subsequent correction.

Cartilage↗
PubMed1992

Surgical lengthening of the short columella: division of the depressor septi muscles.

A new surgical procedure is described to correct the difficult problem of the short columella without resorting to cartilage grafts. The ready recourse to these grafts, so much in vogue at the present time in primary rhinoplasties, should be carefully and completely re-examined, since the final result very frequently yields no real benefits and may permanently deface the area from which the cartilage has been taken. The present technique combines trimming of the upper lateral nasal cartilages with approximation of the alar cartilages and excisions of the depressor septi muscles and/or contiguous orbicularis oris muscle.

Adult↗
PubMed1994

Nasal septal perforations must and can be closed.

In this time of increasing occurrence of septal perforations caused by cocaine abuse, the plastic surgeon who deals mainly in rhinoplasty must learn to treat these defects with sophisticated methods. Too many septal perforations, especially large ones, are not treated because the surgical techniques are difficult. This article describes and illustrates two methods that close all kinds of perforations. Local flaps should be considered obsolete. A perforation up to 4 cm in diameter must be repaired in one step. This includes wide dissection of the mucoperichondrium and mucoperiosteum, suture of the hole on both sides, and interposition of parietal fascia or cartilage, sometimes with the help of bilateral small buccal flaps to cover the gap between the columella and the dissected mucoperichondrium containing the closed perforation on both sides. For closure of perforations greater than 4 cm in diameter, a three-step procedure which uses a composite three-layered buccal flap including ear concha cartilage is described. In the second step, the spoon-shaped flap is fed into the nasal cavity to fill the septal defect. The third step divides the pedicle. In many cases a unilateral or bilateral alotomy or the section of the columellar base may facilitate the suture of the flaps.

Humans↗
PubMed1993

Treatment of alar cartilages: should the "domes" be interrupted?

The author emphasizes that conservative rhinoplasty techniques are frequently satisfactory, but in certain techniques there is a limit to which nasal tips can be reshaped. In certain circumstances, therefore, interruption of the "domes" of the alar cartilages is suggested to achieve the most satisfactory aesthetic results.

Cartilage↗
PubMed1979

External septorhinoplasty.

One of the disadvantages of the usual endonasal technique of rhinoplasty is the poor surveyability of the surgical field. By joining the left and right marginal incision via a transverse columellar incision and elevating the skin of the columella and the dorsum nasi, the infrastructure of the nose can be exposed. The good exposition results in a meticulous surgery of the nasal dorsum, precise correction of the triangular cartilages, good access to the septum and more a-curate augmentation procedures of the prespinal area, columella or nasal dorsum. This "external" approach is more or less a synthesis of the subcutaneous endonasal method and surgery under visual control, with the only sacrifice of a small scar which has marked advantages on the other hand. The results of the external approach to septorhinoplasty in 30 patients with cosmetic and functional complaints are discussed. No complications attributable to the method were seen. Especially for difficult cases as revisional operations, congenital nasal deformities and multiple traumatic damaged noses the external approach appears to be very useful.

Anesthesia, General↗
PubMed1989

Cranial nasal bone grafts.

Reconstitution of the nasal scaffolding with maintenance of soft tissue proportions either following severe facial trauma or as a sequela to aesthetic rhinoplasty misadventures frequently is best achieved using the stability afforded by bone grafts. Split cranial bone grafts offer many advantages and may be the donor site of choice, and may even allow such surgery to be performed on an outpatient basis in some cases. The use of miniplate or screw osteosynthesis, now commonly accepted as a superior technique in craniomaxillofacial procedures, may simplify fixation of these calvarial nasal bone grafts with an apparent decrease in the risk of resorption.

Adult↗
PubMed1983

Tip rhinoplastic operations using a transverse columellar incision.

In more than 300 cases of aesthetic and corrective rhinoplasty, the author's experience should encourage plastic surgeons to consider the use of the transverse columellar incision for better exposure of the nasal tip area. Five case studies are briefly included and the author encourages the reader to look upon this operative approach with more favor and not consider it a technique to be tabooed or avoided.

Adult↗
PubMed1983

A measuring scale for objective evaluation of the nasal shape.

Evaluating preoperative expectations and post-operative results of the physical aspects of a rhinoplasty is a challenge. Using a graphic scale of 4 aspects of the nose--length, width, hump, and tip--can enable almost anyone to achieve a more or less objective evaluation of nasal characteristics. The scale ranges from 1, being the "nicest," to 7, being the "worst." The scales can be prepared on translucent sheets suitable for superimposing on pre- and postoperative photographs, and the differences in scores give a value to the result.

Esthetics↗
PubMed1985

Nasal anatomy: the muscles and tip sensation.

The author stresses the importance of columellar sensation, nasal tip sensation, and the role of the nasalis muscles in determining the postoperative results of corrective rhinoplasty, especially as these have an influence on the "drooping tip" and the columellar base. Specific anatomic details of this area are emphasized in order to help the plastic surgeon understand better the "normal" anatomy of this region and the effects that operative procedures have on successful results if the surgeon understands especially the role of the nasalis muscles.

Humans↗
PubMed1988

Apex columellar cartilage graft.

The classical rhinoplasty techniques do not give the best results when used on thick skin noses. We have developed a new technique, apex columellar cartilage graft, for correcting nasal tip projection in thick skin noses.

Adolescent↗
PubMed1984

Rhinoseptoplasty.

Severe deviations of the nasal septum and entire nasal bony and cartilaginous framework can be treated adequately only by a classical rhinoplasty coupled with an atypical submucous resection. All of the cartilaginous and osseous septum are removed and the operation is completed with the insertion of a cartilaginous support formed from cartilage strip grafts obtained from the resected septal cartilage.

Humans↗
PubMed1986

Dermofat graft for profileplasty.

The use of the dermofat graft is recommended to correct the microgenia in the treatment of profileplasty with or without rhinoplasty. The technique is described and the advantages over inclusions of bone and cartilage grafts are enumerated. Attention is called to the tolerance and long-lasting results. Some cases are presented.

Adipose Tissue↗
PubMed1986

Aesthetic considerations of the cleft lip operation.

The results of a cleft lip operation are checked from the anterior, the profile, and the caudal views and even if the deformities are minimal, for aesthetic reasons they should be repaired. Philtrum length, philtrum shape, philtrum depth, nasolabial triangular area, vermilion thickness, Cupid's bow peak, horizontal upper lip groove, vermilion border, alar size, depth of alar groove, nasal deviation, nostril shape, nasal tip, columella height, sill shape, columella width, and facial balance of the anterior, profile, and caudal views are used as aesthetic checkpoints for the results of a cleft lip operation. If deformities are found, the aesthetic plastic surgeon should repair them to achieve a more satisfactory result. In addition, augmentation rhinoplasty, augmentation mentoplasty, or other craniofacial surgery may be performed.

Chin↗
PubMed1988

Calibrated alar base excision: a 20-year experience.

Conflicting guidelines for excisions about the alar base led us to develop calibrated alar base excision, a modification of Weir's approach. In approximately 20% of 1500 rhinoplasties this technique was utilized as a final step. Of these patients, 95% had lateral wall excess ("tall nostrils"), 2% had nostril floor excess ("wide nostrils"), 2% had a combination of these ("tall-wide nostrils"), and 1% had thick nostril rims. Lateral wall excess length is corrected by a truncated crescent excision of the lateral wall above the alar crease. Nasal floor excess is improved by an excision of the nasal sill. Combination noses (e.g., tall-wide) are approached with a combination alar base excision. Finally, noses with thick rims are improved with diamond excision. Closure of the excision is accomplished with fine simple external sutures. Electrocautery is unnecessary and deep sutures are utilized only in wide noses. Few complications were noted. Benefits of this approach include straightforward surgical guidelines, a natural-appearing correction, avoidance of notching or obvious scarring, and it is quick and simple.

Evaluation Studies as Topic↗
PubMed1993

Use of umbrella graft for nasal tip projection.

An adequate nasal tip projection is of the utmost importance for good nasal aesthetics. Conventional rhinoplasty procedures are not adequate for achieving nasal tip projection in "tips with inadequate projection" (TIP). This article describes our technique of using an umbrella-shaped cartilage graft to the tip. The graft is carved from caudal septal and alar cartilages. The results and advantages of the technique are discussed.

Adult↗