Interdomal Sutures Research Articles

Long-Term Surgical Outcomes of Primary Rhinoplasty.

To examine the impact of primary rhinoplasty on subsequent rhinoplasties for patients with cleft lip nasal deformity. Retrospective cohort study. Tertiary care pediatric hospital. Individuals who underwent definitive cleft lip repair at our institution from 2000 to 2006 with a current age of 18 or older. Number and timing of subsequent rhinoplasties. Among 199 individuals, 94 (47.2%) underwent primary rhinoplasty. Follow-up was 15.0 ± 4.8 years in the PR cohort and 15.0 ± 5.1 years in the NPR cohort (p = 0.993). In bilateral cleft lip, interdomal suture predicted fewer subsequent rhinoplasties (β=-0.310, p = 0.033), while history of primary rhinoplasty predicted greater age at subsequent rhinoplasty (β=1.800, p = 0.040). Among individuals with follow-up beyond age 18, intranasal stenting predicted fewer subsequent rhinoplasties (β=-0.609, p = 0.015). Most underwent subsequent nasal correction aside from 7 (19.4%) and 9 (20.9%) in the PR and NPR cohorts, respectively (p = 0.536). There was no difference in mean subsequent rhinoplasties between cohorts (1.1 ± 0.8 versus 1.3 ± 1.1, p = 0.284). Individuals with complete cleft lip underwent more lifetime rhinoplasties (1.9 ± 1.0 versus 1.2 ± 1.2, p = 0.007). Primary rhinoplasty with interdomal tip sutures in bilateral cleft lip was associated with fewer subsequent rhinoplasties. Primary rhinoplasty may delay subsequent nasal correction, though most who underwent primary rhinoplasty ultimately required nasal correction later in childhood. Postoperative nasal stenting may provide longer-term nasal benefits and should be considered at time of definitive cleft lip repair.

The TRICK-TIP Rhinoplasty: Tip of the Nose Preservation Using the Combined Synergy of Open and Closed Approaches

BackgroundThis study introduces and assesses the outcomes of a novel rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), employing a combined open and closed approach with tip anatomy conservation and structured tip support.MethodsThe procedure involves a low stairstep columellar sectioning, followed by transmembranous and intercartilaginous incisions without skin dissection in the columella or tip. Elevating the entire mobile nose as a three-layered flap provides extensive access to the entire nasal pyramid and septum. Tip modifications, including retrograde cephalic cartilage resection and supratip skin thinning, are performed based on individual cases. A key columellar strut is frequently used, initially sutured in the interdomal space and then turned down for height adjustment and final fixation. Interdomal sutures, supratip sutures, and alar resection are implemented as needed.ResultsOne hundred twenty patients participated, with high satisfaction and a low frequency of adverse effects reported using four FACE-Q™ questionnaires. One hundred and two independent raters evaluated pre and postoperative photographs, scoring “overall nose result” as 3.6 out of 5, with minimal or absent nostril deformities (1.84), soft triangle deformities (1.73), and columellar external scar deformity/visibility (1.35) where 1 is the absence of the deformity and 5 is disfigurement. Complications were absent, and revisions were infrequent.ConclusionsThe combined benefits of the wide-open approach, shortened surgery duration, and nasal tip preservation contribute to outcome optimization. TRICK-TIP rhinoplasty is characterized by simplicity, enabling targeted modifications, preventing soft triangle and rim complications, and facilitating essential tip support while maintaining favorable results.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Interdomal Suture: Maintaining Nasal Tip Projection With East-West Advancement Flap Repairs.

Interdomal Suture: Maintaining Nasal Tip Projection With East-West Advancement Flap Repairs.

Post dermoid excision nasal tip deformity correction using gelatin sponge.

Reconstruction of the nasal tip after the excision of the dermoid cyst is difficult, especially if the size of the dermoid is large. Tip reconstruction using Interdomal sutures of alar cartilages and auricular cartilage graft has been used in such cases. We share a new method to manage the nasal tip defect following excision of nasal dermoid, using an absorbable gelatin sponge. A 13 years old female presented with a swelling tip of the nose for the past 2 years. The CT scan revealed a dermoid cyst at the tip of the nose over the alar cartilage with prominent buckling of the cartilages. The Dermoid cyst was excised through an open rhinoplasty incision. There was a defect of 2.2cm diameter at the tip of the nose with deformed alar cartilages. A piece of absorbable gelatin sponge was folded, cut according to the shape of the cavity, and used to fill the cavity. The skin was draped over the cartilage and gelatin sponge. The post-operative period was uneventful. After 2 years of follow-up, the patient remained asymptomatic and satisfied with a nice contour of the nasal tip.

Long-Term Effect of Intermediate Rhinoplasty in Unilateral Complete Cleft Lip Nasal Deformity

Intermediate rhinoplasties are performed during preschool to reduce the patients' psychosocial burden. At our institution, limited dissection of the cartilages followed by suspension and interdomal sutures was performed through an alar rim incision on the cleft side to minimize the risk of iatrogenic nasal growth restriction. However, the long-term outcomes of "limited intermediate rhinoplasty" through skeletal growth are uncertain. A retrospective review of all unilateral complete cleft lip and/or palate patients who underwent definitive rhinoplasty was performed. To avoid the confounding effect of primary rhinoplasty, only the patients who did not receive primary rhinoplasty were included in the analysis. The maneuvers performed during definitive rhinoplasty were analyzed and compared between patients who underwent intermediate rhinoplasty and those who did not. A total of 60 Korean patients (27 female and 33 male) underwent definitive rhinoplasty at the average age of 20.6 years old (17.1-25.5). Forty-three (71.6%) patients previously underwent intermediate rhinoplasty. A combination of 6 maneuvers was performed based on the deformity of each subunit (alar medialization, interdomal with suspension sutures, nostril sill depression correction, septoplasty, osteotomy, and hump rasping). The average number of maneuvers performed during definitive rhinoplasty was significantly higher in the intermediate group (3.31 versus 2.1, P=0.012). Alar medialization and nostril sill depression correction were more frequently performed in the intermediate group, while the frequencies of other maneuvers were not statistically different. While intermediate rhinoplasty improves the patients' psychosocial well-being, the effects of "limited intermediate rhinoplasty" manipulating only the cartilages do not seem to last until skeletal maturity. A more comprehensive dissection allowing the release of the lower lateral cartilage in the hinge area along with septoplasty may be more effective in providing longer-lasting effects.

An Update on the Surgical Management of the Bulbous and Boxy Tip.

The bulbous and box tips are two common morphologies encountered in rhinoplasty. Nasal tip reshaping is a challenging aspect of rhinoplasty. Understanding the classifications of nasal tip morphologies aids when performing a nasal-facial analysis. The management algorithm for both tip morphologies shares various techniques. These techniques include but are not limited to cephalic trim, transdomal sutures, and interdomal sutures. A graduated approach to managing the variations in bulbous and boxy tips will help in achieving consistent results. New concepts applied to the management include supporting alar rims with alar contour grafts, closing dead space through a series of techniques, and managing the soft-tissue envelope, which is often in excess.

Paediatric nasal dermoid: evaluation and management.

The aim of this study was to present the evaluation and current management of congenital paediatric nasal dermoid. There has been a trend towards less invasive surgical excision techniques, including purely endoscopic excision, endoscopic-assisted approaches and midline excision with nasal bone osteotomies and bone flap. These approaches allow adequate access for both total resection and nasal contour and skull base reconstruction. Following resection, if nasal bone osteotomies are insufficient for restoring nasal appearance, free temporoparietal fascial graft and/or conchal cartilage can be considered. For nasal tip deformities, interdomal sutures and free fat grafting are a suitable option. Complete surgical excision remains the treatment of choice for nasal dermoid lesions. The surgical approach taken and reconstruction depends on the type of lesion (cyst versus sinus or fistula), location (intranasal versus extranasal), whether or not there is intracranial extension, and experience of the surgical team.

Role of cartilage correcting sutures in single-stage secondary rhinoplasty for unilateral cleft lip nose deformity.

Introduction:The purpose of this study is to highlight the role of cartilage correcting suture in single-stage surgical correction for secondary unilateral cleft lip nose deformity with three-dimensional observations of preoperative and postoperative nasal forms.Material and Methods:Between July 2017 and June 2019, 18 consecutive patients of unilateral cleft lip nose deformity aged between 16 and 28 years underwent surgical correction. The corrective procedure of nose involved columellar lengthening, medial and lateral nasal osteotomies along with augmentation of premaxilla by bone graft at premaxilla, and alar base wedge resections. Focus was laid to correct nasal cartilaginous framework using tip sutures along with repositioning of lower lateral cartilages, fixation of the alar cartilage complex to the septum, and the upper lateral cartilages. We investigated the following surgical interventions and nasal tip suture techniques, which were transdomal suture, interdomal suture, lateral crural mattress suture, columella septal suture, and intercrural suture.Results:We achieved adequate esthetic and functional results in all the patients without any morbidity.Conclusion:This concept of simultaneous approach toward complete single-stage correction of secondary cleft lip nasal deformity incorporating various cartilage suture using 5-0 nylon in developing nation like ours, where the patient presents late with complex conditions showed promising esthetic and functional outcome.

Aesthetic Outcomes of Nasal Burow's Grafts With Interdomal Sutures After Mohs Micrographic Surgery.

Post-Mohs reconstruction of distal nasal defects is challenging. Many repair options exist, each with advantages and disadvantages. Utilization of a Burow's graft in combination with manipulation of the underlying nasal cartilages with interdomal sutures is an underreported yet effective repair option. To present the authors' experience with Burow's grafts facilitated by interdomal sutures for repair of nasal defects after Mohs micrographic surgery (MMS). Patients who underwent repair with Burow's grafts and interdomal sutures from 2013 to 2017 at a single university were identified. Demographics, follow-up, and complications were recorded. Two independent, board-certified dermatologists evaluated photographs for cosmesis and alar symmetry. Thirty-one patients were identified. A total of 5/31 patients (16.1%) experienced minor complications without permanent sequelae. A total of 4/31 (12.9%) patients underwent cosmetic revision. No incidences of pincushioning, nasal valve dysfunction, or graft necrosis occurred. Aesthetic ratings were good to excellent with mean visual analog score of 80.8. Alar symmetry was excellent. A Burow's full-thickness skin graft facilitated by an interdomal suture to maintain nasal tip orientation and projection is an elegant repair technique for distal nasal oncologic defects with good to excellent aesthetic outcomes. It should be considered in the armamentarium for repair of distal nasal defects after MMS.

Large Nasal Tip Defects—Utilization of Interdomal Sutures Before Burowʼs Graft for Optimization of Nasal Contour

Large Nasal Tip Defects—Utilization of Interdomal Sutures Before Burowʼs Graft for Optimization of Nasal Contour

Interdomal sutures for nasal tip refinement and reduced wound size

Interdomal sutures for nasal tip refinement and reduced wound size

Evaluation of Using Interdomal Suture and Crescentic Skin Excision with Standard Cleft Lip Repair for Correction of Cleft Lip-Nose Simultaneously with Primary Lip Repair

Evaluation of Using Interdomal Suture and Crescentic Skin Excision with Standard Cleft Lip Repair for Correction of Cleft Lip-Nose Simultaneously with Primary Lip Repair

Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique.

The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen. The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach. In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors' interdomal suturing technique between the years 2011 and 2013. The average age of the patients was 25.3 years. Intercrural sutures (PDS 4.0 straight needle, Cincinnati, Ohio) were placed as mattress-like suture in the tip region, with the knot buried between both alar cartilages. The suture is tightened progressively according to the tip definition and narrowing sought. The patients were followed for 12 months. All of the patients demonstrated a significant reduction in lobule and tip widths. This series had only 1 complication of tip asymmetry that was revised 1 year after the initial operation. There were no cases of infection, allergic reaction, or extrusion of the suture. Despite the lack of a large volume of patients, our study confirms that this technique is indeed an attractive and highly predictable option for achieving adequate tip refinement and definition when using a nondelivery endonasal rhinoplasty.

Use of the "Septal T" as a Spacer and Conformer for a Properly Contoured Nasal Tip in Rhinoplasty.

The complex issue of obtaining an aesthetically pleasing and structurally stable nasal tip brings into play a vast array of maneuvers and techniques, often performed through an open approach.1 Although these approaches are numerous and different, they all share the attainment of a stable tip cartilaginous structure, and then, if necessary, some sort of refinement or camouflage on top. An obvious situation in which such camouflage is unnecessary is the thick-skinned patient for whom sharp definition intrinsically may be welcome. As epitomized by Daniel,2,3 the ideal tip configuration will usually resemble a gently opened diamond. A similar concept is found, often with different suture terminology, in the work of other well-known surgeons.4,5 After appropriate repositioning, tensioning, or stiffening of the lateral crura as necessary, transdomal and interdomal sutures will be used to appropriately shape the domes and allow the gentle anterior domal divergence that will be stabilized by posterior dome equalization sutures. Some final camouflage may be necessary at this point. Various grafts are commonly utilized for this purpose, including segments from the cephalic trim, intercrural soft tissue, crushed cartilage, or even deep temporal fascia if harvested for other reasons.6,7 A specific drawback that will oftentimes detract somewhat from the result of an otherwise well-executed rhinoseptoplasty is a residual V-shaped infralobular cleft, extending from between the domes to the middle and medial crura. This is obviously more evident with thin skin and can be bothersome to the patient preoperatively. In such a patient, the surgeon must note the necessity of gently filling the gap between the new domes, as well as the indentation in continuity that flows below the columellar lobular angle and resides between the medial crural segments along the columella. Beginning in 2014, the senior author (E.R.) noticed …

Nasal Tip Sutures: Techniques and Indications

The surgical anatomy of the nasal tip is determined by intrinsic factors, such as the nasal tip volume, shape, definition, and symmetry. These factors are intimately related to the morphology of the lower lateral cartilages. Tip sutures reduce the need for grafts and allow the surgeon to manipulate the tip with a high degree of precision and better long-term clinical outcomes. In this review, we evaluated common nasal tip suture techniques to clarify the similarities and differences among them. The following nasal tip suture techniques were investigated: medial crural fixation suture, middle crura suture, transdomal (dome creating, dome binding, domal definition) suture, interdomal suture, lateral crural mattress suture, columella septal suture, intercrural suture, tip rotation suture, craniocaudal transdomal suture, lateral crural spanning suture, suspension suture, tongue-in-groove technique, and lateral crural steal. Tip sutures increase tip projection, narrow the tip, provide stabilization, and provide tip rotation. The sutures may be used separately or together. Nasal tip sutures have long been used as noninvasive suture techniques. Each suture technique has unique benefits, and various key points must be considered when using these techniques.

Nasal Reconstruction of a Frontonasal Dysplasia Deformity Using Aesthetic Rhinoplasty Techniques.

Nasal Reconstruction of a Frontonasal Dysplasia Deformity Using Aesthetic Rhinoplasty Techniques.

A preliminary observation on interdomal suture through bilateral reverse-J incisions to repair cleft lip nose deformity in the setting of traveling charity programs

Background Nasal appearance is one of the most important factors in determining the success of a cleft repair. This preliminary study aimed to evaluate a simple variant of primary nose repair technique to achieve an optimal nasal esthetic outcome along with the lip repair in the setting of traveling charity programs, where time is an obvious limitation.

Nose tip refinement using interdomal suture in caucasian nose.

Summary Introduction: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. Objective: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. Method: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture), 2. Interdomal suture with alar cartilage weakening (cross-hatching), 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique) based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance), domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique) under local anesthesia. Conclusion: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose.

The “X-Graft” for Nasal Tip Surgery

Sir: Rhinoplasty in Asians requires augmentation, lengthening, and increased tip projection.1 Grafts commonly used in the tip such as extended spreader grafts, caudal septal extension grafts, and columellar struts require long, straight, flat segments of cartilage. With smaller, potentially weaker quadrangular cartilages,1 harvesting sufficient cartilage for tip work is particularly difficult in Asians. The authors present a new graft design for tip surgery that offers excellent stability and minimizes cartilage use. Open rhinoplasty is performed, the lower lateral cartilages are fully mobilized and separated in the midline, and septal harvest is performed, leaving a generous 1.5-cm caudal and dorsal strut. The upper lateral cartilage is separated from the dorsal septum unilaterally. An extended spreader graft is sutured between the septum and lower lateral cartilage using 5-0 polydioxanone. The extended spreader graft can be positioned diagonally to project above the dorsum of the nose for greater tip projection. A modified caudal septal extension graft is sutured onto the contralateral caudal inferior septum, projecting superoanteriorly to meet the extended spreader graft in the midline. The two grafts are sutured together (Figs. 1 and 2). The membranous septum is opposed to the construct.Fig. 1.: Schematic illustration of the procedure.Fig. 2.: Intraoperative photograph.The new construct is tested for stability. The lower lateral cartilages are pinned temporarily to the X-graft using a 26-gauge needle after determining appropriate tip projection, rotation, and dorsal lengthening. The lower lateral cartilages are then sutured to the X-graft. Interdomal sutures can be applied to narrow a bulbous tip. The caudal septal extension graft is sutured to the inferiormost portion of the caudal septum, and the angle between the grafts should be as close to 90 degrees as possible to maximize stability. Conchal cartilages can be used with their concave surfaces facing each other so that opposing warping forces allow the X-graft to lie in the midline. There are many advantages of the X-graft, including the following: economy and flexibility in the use of cartilage grafts; only two shorter, separate pieces of cartilage are required; conventional caudal septal extension grafts requires a larger contiguous piece of cartilage; and the combination of extended spreader graft and an extended columella strut requires longer cartilage. Curved conchal cartilage can be used. The bilateral graft design allows curved cartilage to be used to achieve a final straight construct. The X-graft provides a strong construct for tip surgery. The extended spreader graft and caudal septal extension graft of the X-graft emulate a pillar-and-beam construct. The caudal septal extension graft is anchored firmly to the caudal septum, lowering the chance of postoperative shortening. Deviations of the caudal septum must be addressed before the X-graft can be used. The caudal septal extension graft can be extended to the nasal floor/maxillary crest, and a columella strut can reinforce the X-graft if the caudal septum is weak. Severely deviated caudal septa will not be suitable candidates for the X-graft. The X-graft is an excellent choice for the Asian rhinoplasty patient in whom cartilage is scarce. It gives a strong construct for tip surgery and with economical use of cartilage. To date, the authors have used the X-graft for both primary and revision rhinoplasties, with excellent clinical results in over 115 patients. Dong Hak Jung, M.D., Ph.D. Ian Loh, M.B.B.S., M.Med. Shimmian Rhinoplasty Clinic Seoul, South Korea DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Rhinoplasty

Rhinoplasty