Correction Of Secondary Nasal Deformity Research Articles

Assessment of open rhinoplasty in correction of secondary nasal deformities associated with congenital anomalies in maxillofacial region

Purpose: Nasal deformities associated with cleft lip are one of the most difficult nose correction procedures. This study aims at correction of the nasal deformity that occurred after the initial repair of the lip, which was done at an early age, and achieving the best possible results aesthetically and functionally. Methods: The sample included patients presenting at the department of oral and maxillofacial surgery in Hospital between 2017-2018. We applied open rhinoplasty technique to correct nasal deformity according to a specific protocol. One year post operation, we analyzed clinical images before and after surgery and compared the results with the ideal normative values within society. Functional results were evaluated and the level of satisfaction of patients aesthetically was determined. Results: 10 patients aged between 16-35 years old were included in our study. The results showed improvement in the aesthetic aspect of the nose through the correction of the emergence and rotation of the tip of the nose. This technique did not significantly affect the functional results. Therefore the functional results were satisfactory. This technique has achieved good and satisfying results aesthetically and functionally. Conclusion: The data collected from this study demonstrates that open rhinoplasty technique in nasal deformities is effective in aesthetic improvement and it presents satisfactory results at the functional level.

Role of Fresh Frozen Cartilage in Revision Rhinoplasty.

Correction of secondary nasal deformities frequently requires cartilage to build the framework of the nose. Traditionally, autologous costal cartilage has been used because of the paucity of the septal cartilage. Because of associated donor-site complications and increased operating time, irradiated allografts have been used. These grafts have a higher rate of resorption and infection. Thus, the authors have used fresh frozen, nonirradiated, cadaveric rib cartilage as donor cartilage to avoid these shortcomings, and they present their early experience. The operative data of 50 patients who underwent secondary rhinoplasty performed by the senior author between 2014 and 2017 were analyzed. The outcomes of the rhinoplasty were evaluated by preoperative and postoperative photographs by four blinded plastic surgeons, and the results were tabulated using the Independent Rhinoplasty Outcome Score. Fifty patients were followed up over an average period of 3.35 months (range, 1 to 18 months). There was only one complication (infection, 2 percent), which did not need revision surgery. There was no warping or extrusion in this cohort. The authors believe that fresh frozen, nonirradiated cartilage allografts are an evolving source of donor cartilage grafts for revision rhinoplasty because they are associated with lower complication rates. However, further long-term studies with an increased sample size are necessary to prove that fresh frozen cartilage grafts are better than other sources. Therapeutic, IV.

The effects of Y-shaped conchal cartilage transplantation on the correction of nasal deformity secondary to cleft lip and its influence on mental health

Patients who undergo corrective surgery for cleft lip are known to be at risk for subsequently developing secondary nasal deformity. The aim of this study was to investigate the effects of Y-shaped conchal cartilage transplantation on the correction of nasal deformity secondary to cleft lip and its influence on mental health. Sixteen patients with nasal deformity secondary to cleft lip admitted to The First People's Hospital Xuzhou (Xuzhou, China) from February 2014 to February 2015 were selected for the study. Conchal cartilage was taken from the patients and made into a Y-shaped stent, which was then transplanted into the nasal columella. The surgical outcomes and patient satisfaction were evaluated and HADS was used to compare the preoperative and postoperative mental health. After the affected side of the nose was corrected, the nasal profiles of 12 patients were significantly improved, the height of nasal columella and nostril was significantly increased, the nasal base and breadth were significantly shorter than those before operation and the nose wing-nasal breadth index on the affected side was significantly increased compared to that before operation and the differences were statistically significant (P<0.05). The satisfaction of each index after the operation was more than 90%. The mental health of patients after operation was notably improved compared to before operation and the difference was statistically significant (P<0.05). After the correction of secondary nasal deformity to cleft lip through Y-shaped conchal cartilage transplantation, the shape of the nasal tip was stable without the recurrence of deformities or distortion on the donor site of the auricle. Y-shaped conchal cartilage transplantation is an ideal treatment method for the moderate and severe secondary nasal deformity to cleft lip and effective perioperative mental intervention can improve the patient's mental health status, an outcome that is worth popularizing in clinical applications.

Correction of secondary nasal deformity of cleft lip with autogenous costal cartilage framework

To investigate the correction of secondary nasal deformity of cleft lip with autogenous costal cartilage framework. 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. 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. Autogenous costal cartilage framework can be used for the correction of secondary nasal deformity of cleft lip with satisfactory results.

A Comparative Study of the Medial Crura of Alar Cartilages in Unilateral Secondary Cleft Nasal Deformity

The purpose of this study was to confirm whether the medial crus on the cleft side is primarily hypoplastic compared with the noncleft side and to evaluate the displacement of the medial crus on the cleft side presenting the validity of the "medial crus elevation" method. Thirty unilateral cleft lip nasal deformity patients underwent medial crus elevation. The thickness, width, and length of the medial crus on both sides were measured. The difference in the height of both foot plates was also measured. There were no significant differences between the cleft and noncleft sides in width, thickness, or length except proximal thickness. The foot plate on the cleft side was displaced downward. The medial crus on the cleft side is not hypoplastic, and it is merely displaced downward. These results show the validity of the medial crus elevation method for the correction of secondary nasal deformities in cleft patients.

Primary definitive nasal correction in patients presenting for late unilateral cleft lip repair.

Almost 25 percent of unilateral cleft lip and palate patients present with their deformity in their teens or later years in the developing world. Because more than 80 percent of the world population lives in the developing world, the established protocol for repair of these deformities is not applicable to these patients. Despite the magnitude, there are no significant reports in the literature that deal with this problem. Several issues need to be addressed, but the author limits himself here to the correction of the nasal deformity. The patients at this age are very much concerned with the aesthetic outcome. Procedures described hitherto for primary nasal correction in infants are not successful in restoring nasal shape and symmetry at this late age of presentation. Our experience with radical correction of secondary nasal deformity in unilateral cleft lip patients presenting late prompted us to extend the concept by undertaking a definitive primary correction of the nasal deformity in cleft patients presenting late. Twenty-two patients with unilateral cleft lip deformity (nine male patients and 13 female patients) with ages ranging from 13 to 22 years, presenting between August of 1997 and December of 2000, are included in this study. Of these, 11 patients had a cleft of the lip alone, eight also had a cleft of the alveolus, and three had a cleft of the palate continuous with the cleft lip. All patients showed some maxillary hypoplasia. An external rhinoplasty with lip repair was carried out in all patients. The corrective procedures on the nose included columellar lengthening; augmentation along the pyriform margin, nasal floor, and alveolus using bone grafts; submucous resection of the nasal septum; repositioning of lower lateral cartilages; and augmentation of nasal dorsum by bone graft. Clinical follow-up ranged from 4 to 24 months, and the median follow-up period was 13 months. Results have been very good, and much better than results seen earlier with other primary rhinoplasty techniques. While repairing unilateral cleft lip in adolescents, the author thinks it would be most appropriate to address the entire gamut of the deformity in a single stage, provide complete vector reorientation, and augment the hypoplastic elements by autologous tissue. It is not just the fear of poor follow-up, but that merely correcting the lip deformity in these patients without attempting definitive rhinoplasty, in the author's opinion, would be insufficient surgical intervention.

Radical correction of secondary nasal deformity in unilateral cleft lip patients presenting late.

It is universally acknowledged that correction of a cleft lip nasal deformity continues to be a difficult problem. In developing countries, it is common for patients with cleft lip deformities to present in their early or late teens for correction of severe secondary lip and nasal deformities retained after the initial repairs were carried out in infancy or early childhood. Such patients have never had the benefit of primary nasal correction, orthodontic management, or alveolar bone grafting at an appropriate age. Along with a severe nasal deformity, they present with alveolar arch malalignments and anterior fistulae. In the study presented here, a strategy involving a complete single-stage correction of the nasal and secondary lip deformity was used. In this study, 26 patients (nine male and 17 female) ranging in age from 13 to 24 years presented for the first time between June of 1996 and December of 1999 with unilateral cleft lip nasal deformity. Eight patients had an anterior fistula (diameter, 2 to 4 mm) and 12 patients had a secondary lip deformity. An external rhinoplasty approach was used for all patients. The corrective procedures carried out in a single stage in these patients included lip revision; columellar lengthening; repair of anterior fistula; augmentation along the pyriform margin, nasal floor, and alveolus by bone grafts; submucous resection of the nasal septum; repositioning of lower lateral cartilages; fixation of the alar cartilage complex to the septum and the upper lateral cartilages; augmentation of nasal dorsum by bone graft; and alar base wedge resections. Medial and lateral nasal osteotomies were performed only if absolutely indicated. The median follow-up period was 11 months, although it ranged from 5 to 25 months. Overall results have been extremely pleasing, satisfactory, and stable. In this age group (13 years of age or older), it is not fruitful to use a technique for nasal correction that corrects only one facet of the deformity, because no result of nasal correction can be satisfactory until septal deviations and maxillary deficiencies are addressed along with any alar repositioning. The results of complete remodeling of the nasal pyramid are also stable in these patients because the patients' growth was nearly complete, and all the deformities could be corrected at the same time, leaving no active deforming vector. These results would indicate that aesthetically good results are achievable even if no primary nasal correction or orthodontic management had been previously attempted.

Melanotic neuroectodermal tumor of infancy (MNTI) of the hard palate: presentation and management

Objective: To discuss the presentation and management of melanotic neuroectodermal tumor of infancy (MNTI) of the hard palate. Method: Case presentation and literature review. Case: A 6-month-old girl presented with a slow growing, non-tender anterior oral hard palate mass. Radiologic imaging revealed a well-circumscribed cystic lesion containing teeth. After excision, histopathologic and electron microscopic evaluation revealed MNTI. No recurrence was seen at 12-month follow-up. Conclusions: This case and a review of the literature reveal MNTI to be a rare, benign hard palate tumor, which may present as a smooth, firm, painless, slow-growing anterior palatal lesion. Imaging reveals a well-circumscribed cystic lesion. Complete excision should be curative. Management requires attention to the potential need for palatal reconstruction, orthodontic care and correction of secondary nasal deformities.

Secondary rhinoplasty.

The correction of secondary nasal deformities produced by excessive resection poses difficult problems for the surgeon. We describe our technique using cartilage autografts. Shaping the cartilage carefully, using Rethi's incision, and immobilization of the grafts have yielded excellent results in our patients.