Nasal Cartilage Research Articles

PREDICTABLE FACIAL ESTHETICS BY PRESURGICAL NASOALVEOLAR MOULDING IN NEONATES - A CASE REPORT

A Cleft is a congenital abnormal space or gap in the upper lip and palate. Although plastic surgery has made great advances in the area of cleft surgery, aesthetical corrections of the decient columella and nasal cartilages were difcult. presurgical naso-alveolar molding (PNAM) at an early stage is used to reduce soft tissue and cartilaginous deformity. This article presents a case report of a 6-day-old baby boy with a left-sided unilateral incomplete cleft lip and palate, with no signicant medical history or any associated systemic illness. He was referred with the primary need for a feeder plate. The width of the cleft was measured from the base of the alveolus on one side to the other and was approximately 7 mm. The nal impression was made with a custom tray. NAM appliance was fabricated and inserted in the patient's mouth. Orthodontic wire of 21 gauzes was used for wire bending to support the acrylic forming a nasal bulb. In 2 months, the followup patient was recalled at each 15 days intervals for 1 and a half months for activation and modication of the plate to gradually approximate the alveolar segments. After 2 months of follow-up, it was shown that the cleft palate gap was reduced to 3mm from 7mm. PNAM allows overall improvement in the aesthetics of nasolabial complex in cleft conditions and minimizes the extent and the numbers of surgery. The cleft deformity was signicantly reduced in size with the NAM therapy in the present case

A Modified Naso-Alveolar Molding Device for Unilateral Cleft Lip and Palate

Objective: Naso-alveolar-molding(NAM) is used to reshape the nasal cartilage and mold the maxillary alveolar arch before surgical cleft/lip repair. The study aimed to modify the conventional-NAM-device to lessen the severity of cleft lip/palate deformity and make the overall procedure simpler and beneficial, with fewer hospital recall visits.Methods: Sixty-six patients with unilateral cleft lip/palate were selected: 21 males and 12 females were fitted with a conventional-NAM-device, whereas 18 males and15 females were fitted with a modified-NAM-device. The inter-alveolar gap ranged between (14.5 and 13.5)mm. A presurgical-NAM-device was applied in the second week after the birth. Standardized parameters of cleft lip/palate were measured on the cast. Nostril width, columellar height, and columellar angle were measured on photographs. The number of recall visits was recorded. The modified device was similar to the conventional-NAM-device. However, the nasal stent was made of acrylic and separated from the plate. The thickness of the acrylic stent ranged from 10 to 3mm. The thicker and heavier acrylic was placed on the bigger arch side, and the thin part was placed on the small arch side.Results: A difference was observed between the conventional and modified device in the time taken to reduce the inter-alveolar-gap. Additionally, with the modified device there were fewer recall visits to the hospital. Furthermore, when the conventional NAM was compared with the modified device, the latter showed a significant improvement regarding the patients’ outcome (One-way-ANOVA or Kruskal-Wallis).Conclusions: The modified device is an effective and non-invasive device for accelerating the alignment of the alveolar segments to create the foundation upon which excellent lip/primary nasal surgery results can be achieved. This modification made the procedure more beneficial and simpler for the patient and parents. At the same time, recall visits were reduced by half when compared to those required for the conventional device.

Nasal Sesamoid Cartilages: Fact or Fiction? An Anatomical Study of the Lateral Nasal Ala.

To evaluate the presence of cartilage in the lateral nasal ala (LNA) via histological analysis of alar Mohs surgical specimens. An accurate understanding of nasal anatomy is essential to optimize esthetic and reconstructive surgical outcomes. LNA anatomy is typically pictured to include discreet accessory and sesamoid cartilages; however, the authors debate the actual presence of these structures. A blinded reviewer analyzed 101 lateral nasal alar histologic specimens from 362 tissue blocks using a Hematoxylin and Eosin (H&E) stain to assess for the presence of cartilage. Out of the 362 tissue blocks histologically analyzed, only 1 included cartilaginous components. We conclude that the presence of sesamoid and accessory cartilages in the LNA within our sample set is exceedingly rare.

Discordant growth of nasal cartilage and bone contributes to phenotypic variability of the skull in a mouse model.

We previously determined a nonlinear relationship between connexin 43 (Cx43) function and craniofacial phenotypic variation in the mutant mouse model G60S/+, and that this variation was driven by nasal bone deviation. While nonlinearities in the genotype-phenotype map appear to be common, few studies have looked at the developmental processes that underlie this nonlinearity. Here, we investigated the potential tissue-level developmental determinants of the variation in nasal bone phenotype in G60S/+ mice through postnatal development. The deviated nasal bone phenotype arises by postnatal day 21 and becomes more severe by 3 months in G60S/+ mice. Measures of nasal bone remodeling including the number of osteoclasts, mineralizing surface, mineral apposition rate, and bone formation rate are significantly greater in G60S/+ mice compared to wild-type mice at 2 months, but these differences do not correspond with nasal bone deviation. The degree of nasal bone deviation does significantly and negatively correlate with the ratio between nasal bone and cartilaginous nasal septum length. Our findings indicate that the mean phenotypic changes observed between G60S/+ and wild-type mice are due to reduced bone growth, but the increased phenotypic variation found within mutant mice is due to discordant growth between nasal cartilage and bone.

Clinical efficacy analysis of functional rhinoplasty assisted by nasal endoscopy

Objective: To analyse the clinical effect of endoscopy-assisted functional rhinoplasty. Methods: Twenty-one patients with congenital or traumatic deviated nose with nasal obstruction admitted to Qilu Hospital (Qingdao) from January 2018 to December 2021, including 8 males and 13 females, aged 22 to 46 years, were retrospectively analysed. Endoscopy-assisted functional rhinoplasty was performed in all patients. Deviated nasal septum was corrected, nasal septum cartilage graft was prepared through open approach assisted by endoscopy, the nasal frame structure was adjusted with the endoscopy-assisted rhinoplasty combined with middle and inferior turbinoplasty, and the patient's nasal ventilation function and external nose cosmetology were restored. Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal acoustic reflex and nasal resistance were examined preoperatively and 6 months postoperatively. The minimum cross-sectional area of the first two nasal cavities (MCA) MCA1 and MCA2 and their distance between nostrils to the minimum cross-sectional area (MD) MD1 and MD2 were recorded, and the ratio of both sides (expressed in a/b) was calculated. The nasal volume of 5 cm depth from nostril (NV5) and nasal resistance total (RT) were recorded to evaluate the nasal ventilation function to analyse the clinical effect of functional rhinoplasty assisted by nasal endoscope. SPSS 25.0 software was used for statistical analysis. Results: At 6 months after the operation, for nasal ventilation evaluation, the VAS and NOSE scores of nasal obstruction decreased significantly than those before the operation ((1.81±0.81) points vs (6.71±1.38) points, (4.19±2.06) points vs (12.05±2.67) points, all P<0.05). In the objective indexes, MCA1, MCA2 and NV5 were significantly increased whereas RT, MCA1a/MCA1b, MCA2a/MCA2b, MD1a/MD1b and MD2a/MD2b were significantly decreased compared with those before the operation (all P<0.05). The MD1 and MD2 levels before and after operation had no significant differences (all P>0.05). In the evaluation of external nose morphology, postoperative ROE was significantly increased, and the deviation value of nasal appearance was significantly decreased ((16.19±2.56) points vs (10.24±3.24) points, (1.55±1.16) mm vs (5.63±2.41) mm, all P<0.05). In terms of postoperative patient satisfaction, 19 cases (90.5%) were very satisfied with nasal ventilation function, 2 cases (9.5%) were satisfied with nasal ventilation function; 15 cases (71.4%) were very satisfied with nasal appearance, and 6 cases (28.6%) were satisfied with nasal appearance. Conclusions: Nasal endoscopy-assisted functional rhinoplasty can improve the nasal ventilation function and external nasal morphology at the same time, with good clinical effect and high patient satisfaction.

Good Manufacturing Practice–compliant change of raw material in the manufacturing process of a clinically used advanced therapy medicinal product–a comparability study

The development of medicinal products often continues throughout the different phases of a clinical study and may require challenging changes in raw and starting materials at later stages. Comparability between the product properties pre- and post-change thus needs to be ensured. Here, we describe and validate the regulatory compliant change of a raw material using the example of a nasal chondrocyte tissue-engineered cartilage (N-TEC) product, initially developed for treatment of confined knee cartilage lesions. Scaling up the size of N-TEC as required for the treatment of larger osteoarthritis defects required the substitution of autologous serum with a clinical-grade human platelet lysate (hPL) to achieve greater cell numbers necessary for the manufacturing of larger size grafts. A risk-based approach was performed to fulfill regulatory requirements and demonstrate comparability of the products manufactured with the standard process (autologous serum) already applied in clinical indications and the modified process (hPL). Critical attributes with regard to quality, purity, efficacy, safety and stability of the product as well as associated test methods and acceptance criteria were defined. Results showed that hPL added during the expansion phase of nasal chondrocytes enhances proliferation rate, population doublings and cell numbers at passage 2 without promoting the overgrowth of potentially contaminant perichondrial cells. N-TEC generated with the modified versus standard process contained similar content of DNA and cartilaginous matrix proteins with even greater expression levels of chondrogenic genes. The increased risk for tumorigenicity potentially associated with the use of hPL was assessed through karyotyping of chondrocytes at passage 4, revealing no chromosomal changes. Moreover, the shelf-life of N-TEC established for the standard process could be confirmed with the modified process. In conclusion, we demonstrated the introduction of hPL in the manufacturing process of a tissue engineered product, already used in a late-stage clinical trial. Based on this study, the national competent authorities in Switzerland and Germany accepted the modified process which is now applied for ongoing clinical tests of N-TEC. The described activities can thus be taken as a paradigm for successful and regulatory compliant demonstration of comparability in advanced therapy medicinal products manufacturing.

Application of a Modified Costal Cartilaginous Framework in Correction of Severe Saddle Nose Deformity.

Insufficient support of the nasal septum due to congenital or secondary deficiency leads to severe saddle nose deformity, which presents an unpleasant appearance. The purpose of this study is to present our approach to constructing a costal cartilaginous framework with autologous costal cartilage for correction of severe saddle nose deformities. A retrospective analysis was conducted of patients who underwent correction of severe saddle nose deformity (type 2 to type 4) by a senior surgeon from January 2018 to January 2022. Preoperative and postoperative measurements were conducted to evaluate the surgical outcomes. A total of 41 patients ages 15 to 50 years completed the study. The average follow-up time was 20.6 months. No short-term complications were observed. Revisional operations were performed on 3 patients. All patients were satisfied with the aesthetic results. Analysis of objective measurements showed that the nasofrontal angle, columellar-labial angle, and tip projection improved significantly in type 2 cases, the nasofrontal angle and tip projection improved significantly in type 3 cases, and tip projection improved significantly in type 4 cases. Application of this modified costal cartilaginous framework, which consists of a fairly stable foundation layer and an aesthetic contour layer of block costal cartilage, has achieved satisfactory results over the long term.

Initiation to the management of a case of cleft lip and palate in Madagascar: Naso-Alveolar Molding

Introduction: Cleft lip and palate represent the most common facial anomaly in the world, with a prevalence of 4.66‰ in Madagascar in 2016. These malformations constitute aesthetic, functional and social damage. Pre-surgical orthodontic management has not yet been applied in Madagascar. The objective of our study was to report the case of a patient with a cleft lip and palate treated pre-surgically by "Naso-Alveolar Molding". Observation: This is a 3-month-old male child with a bilateral nasolabio-alveolar cleft associated with a total secondary cleft. The initial exo-buccal examination revealed 15mm (left) and 16mm (right) nasal cleft widths, 6mm (left) and 5mm (right) lip cleft widths. The intraoral examination showed 3mm (left) and 4mm (right) of alveolar cleft widths. The treatment consisted of the placement of “Naso-Alveolar Molding”. The evolution having been favorable after a month marked by the reduction of the width of the slits and an aesthetic improvement exo-buccal. Discussion: Pre-surgical orthodontics is performed in infancy to facilitate feeding, reduce cleft width, and reposition deformed nasal cartilages and alveolar processes; to lengthen the deficient columella in the neonatal period. The main objective being to minimize the extent of surgery that would have to be performed. The malleability of the nasal cartilage at the infantile stage indicates the orthodontist to its conception and to ensure a favorable prognosis. Conclusion: The treatment of cleft lip and palate consists of a multidisciplinary approach including Dento-Facial Orthopedics.

Functional and Aesthetic Outcomes of No-Dissection Nasal Dorsum Using Subdorsal Septal Excision in Preservation Rhinoplasty.

Dorsal preservation (DP) caused privilege change in the concept of rhinoplasty and a promising superior functional and aesthetic transformation in rhinoplasty surgery. Avoiding dissection of the dorsal nasal bone and cartilage will leave the soft-tissue envelope intact, leading to a fine and smooth appearance, faster operation with less subsequent edema, and overall preservation of the dorsal aesthetic line. This prospective study included 113 patients who underwent DP rhinoplasty for nasal hump treatment with minimum dissection of nasal dorsum soft-tissue envelope. Results were evaluated using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). The mean preoperative SCHNOS score was 7.21; the mean obstructive score was 2.95 ± 1.068 and the mean aesthetic score was 4.27 ± 0.771. The average lowering of the dorsal hump was 4.4 mm. Approximately 96% of patients showed improvement in the SCHNOS score after surgery, 86.7% (98 patients) showed improvement in the obstructive symptoms and 95.6% (108 patients) showed improvement in the aesthetic score. Complications were seen in 22.11% (most commonly residual hump in 13.27% of cases and dorsal indentation in 5.31%), bleeding was seen in 2.65%, and granuloma formation at the dorsal osteotomy site was seen in 0.88%. There was a very significant improvement in the aesthetic, obstructive, and overall SCHNOS score ( P = 0.000) for each parameter. DP rhinoplasty is a safe and very effective procedure, with very low risk of complications. Most of the treated patients have improvement of the obstructive and aesthetic outcome after surgery. Therapeutic, IV.

The Efficacy of Topical Lactoferrin on Wound Healing in an Experimental Animal Model of Nasal Septum Perforation.

The aim of the present experimental animal study was to investigate the efficacy of bovine lactoferrin (LF) on wound healing in an animal model of nasal septum perforation (NSP).Twenty-two, 8 to 10 weeks of age, male Sprague-Dawley rats were separated into two groups. Nasal septum perforation was created in each rat. The saline (control) and 0.05 mg LF (study) groups were delivered locally for 14 days. On the 14th day of the study, after the sacrifice, the cartilage nasal septa of the animals were excised. The degeneration and regeneration observed in the nasal septum epithelium and cartilage, the number of acute inflammatory cells, the number of eosinophils, the amount of new vessel formation, the amount of granulation, and the collagen density were examined microscopically. The microscopic parameters and macroscopic healing of NSPs were analyzed. The epithelium regeneration, the fibroblast number, the granulation tissue formation, the collagen density, and the macroscopic healing were significantly higher in the LF group (p < 0.05). Besides, the acute inflammatory cell count was lower in the LF group (p = 0.034). In conclusion, the topically delivered LF can improve wound healing in an experimental rat model of NSP.

Hybrid columellar strut using nasal crest bone of the maxilla and conchal cartilage for nasal tip stability in rhinoplasty for East Asian patients

Background Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method.Methods A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups.Results In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability.Conclusions We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.

Effect of NAM on Nasal Symmetry and Proportions in Patients with UCLP: A Systematic Review

Introduction : Nasal reconstruction presents a challenge in case of patients with unilateral cleft lip and palate (UCLP). Correction of the nasal deformity to achieve a symmetrical nose from the deficient columella and malformed nasal cartilage in cleft patients presents a great challenge. Nasoalveolar molding (NAM) was developed as a neoadjuvant therapy for patients with cleft lip and palate to improve nasal deformity before surgical intervention. The aim of this systematic review was to understand more about the effect of NAM on nasal symmetry and proportions in patients with UCLP. Method : We searched for manuscripts involving patients with UCLP who received NAM prior to cleft lip repair. Electronic literature searching of the PubMed, Scopus, Cochrane and Google scholar databases was conducted for the studies that had been published up to December 2021. Result : Presurgical NAM demonstrated benefits in nasolabial form when compared with patients who did not receive any presurgical infant orthopaedic appliances (PSIO). The use of presurgical NAM helps to achieve favourable reshaping of the nose and decrease the severity of the initial cleft deformity, resulting in improvement on nasolabial form. These changes lead to improved nasal symmetry and proportions in UCLP patients. Conclusion: The preponderance of evidence in this review suggests that presurgical NAM is a beneficial adjuvant therapy for nasal deformity correction and helps achieve nasal symmetry in patients with UCLP. However, there is insufficient evidence to conclude whether presurgical NAM produces these benefits at the time of nasal maturity.

Effects of Chitosan on Chondrocytes Derived from Human Nasal Septal Cartilage.

The aim of this study was to evaluate the influence of chitosan on the growth of nasal septal chondrocytes (NSCs). The final goal was to establish a novel methodology to enhance nasal septal cartilage regeneration. Human NSCs were isolated and their morphology was examined using Alcian blue staining and observed by light microscopy. The isolated NSCs were grown with various concentrations of chitosan and the expression of COL2A1 was investigated. NSCs were successfully isolated from nasal septal cartilage. Co-culture with 0.2% of chitosan greatly enhanced proliferation of NSCs compared to control cells. However, 0.5% of chitosan was harmful to NSCs, resulting in cell detachment from the culture plate. Furthermore, the addition of 0.2% chitosan significantly improved the expression of COL2A1 in NSCs. To our knowledge, this is the first report to demonstrate that chitosan could effectively guide the attachment and growth of human NSCs. Chitosan appears to be a promising additive for NSC culture, which sets the stage for studying tissue regeneration in nasal septal cartilage deficiency, rhinoplasty, and craniofacial reconstruction.

Application of Platelet-Rich Plasma in Nasal Tip Reconstruction with Medpor Prosthesis

Objective: To observe the effect of platelet-rich plasma (PRP) on reducing ear cartilage absorption and nasal tip complications after nasal tip plasty with medpor prosthesis. Methods: During the conventional medpor rhinoplasty, PRP was injected locally around the tip and columella of the nose with medpor material. The morphology of the nasal tip cartilage and the shape of the nasal tip were observed at least 1 year after the surgery, and the status of cartilage absorption was judged. The statistical differences between the control group and the experimental group were analyzed by χ²-test. Results: After observation for 1 year, a total of 71 cases underwent conventional medpor rhinoplasty, of which 21 cases had cartilage resorption, and 10 cases had a prominent shape of the nasal tip prosthesis that required repair; In the platelet-rich plasma treatment group, there were 18 cases, 1 case of cartilage absorption, and 0 case requiring repair. There are significant statistical differences in clinical practice. Conclusion: PRP can significantly reduce the absorption of ear cartilage, maintain the appearance of the nasal tip, and improve the satisfaction of patients with medpor prosthesis rhinoplasty.

Congenital Erythropoietic Porphyria about a succcessful evolution case

BACKGROUND: Congenital erythropoietic porphyria is an extremely rare autosomal recessive disease. Caused by a deficiency of the enzymatic activity of uroporphyrinogen synthetase III (UROS), collect accumulation of porphyrins of the type I isomer and alterations in the synthesis of the heme group, responsible for the clinical manifestations, mainly cutaneous, hematological, ophthalmic and bone. Diagnosis is based on elevated levels of type I uroporphyrinogen in urine and fecal coproporphyrinogen and clinical findings. CLINICAL CASE: This is a 31-year-old female patient who presented since childhood, multiple hyper and hypopigmented macules both on the back of the hands and on the face, slight destruction of the nasal cartilage, areas of scarring and perioral retraction, sclerodermiform changes, erythrodontia and marked retraction of the phalanges, who was diagnosed with congenital hematopoietic porphyria, who began conservative treatment, achieving an adequate evolution and clinical stability. CONCLUSIONS: It is important to know the different manifestations of this disease to show a prompt diagnosis and avoid known progression, since despite being a rare disease, it can have high morbidity in untreated patients.

Fascial turnover flap - an effective method to resolve cartilage exposure after autologous microtia reconstruction

Introduction. Microtia presents a congenital ear deformity ranging from a minor and barely visible defect to a complete absence of the ear. Currently, there are three options for ear reconstruction: autologous costal cartilage, silicon prothesis, and prosthetic ear. Ear reconstruction with autologous costal cartilage is usually performed in two stages. During the first stage, the cartilaginous framework is fabricated and placed under the skin, in the anatomical position of the ear. In the second stage, the elevation of the frame is performed. During these procedures, complications such as vascular compromise of the skin envelope can occur. Cartilage exposure can lead to its resorption and distortion, leading to an unsatisfactory anatomical result, and this should be resolved as soon as possible. Cartilage exposure at the convex part of the frame is especially problematic. The goal of this paper is to show that fascial turnover flap is a safe method to deal with cartilage exposure as a complication. Outlines of cases. We present two patients with anotia and hemifacial microsomia. Both underwent autologous cartilage microtia repair. In both patients, the cartilage exposure at the convex part of the ear was revealed as a complication. Fascial turnover flap has been used to resolve this complication in both patients. Conclusion. Fascial turnover flap is a safe method to deal with cartilage exposure after microtia reconstruction with autologous cartilage.

Chondroitin sulfate is not digested at all in the mouse small intestine but may suppress interleukin 6 expression induced by tumor necrosis factor-α

Salmon nasal cartilage proteoglycan (PG) was orally administered to mice. The PG digest was recovered from the small intestine, and its sugar chain size and unsaturated disaccharide content were examined. The elution position of the PG digest following Sepharose CL-4B chromatography was consistent with that of actinase-digested PG prior to administration. The PG digest was incubated with chondroitinase ABC, which resulted in the elution pattern of the unsaturated disaccharides being identical to that of the degraded product of actinase-digested PG. The core protein of PG was digested in the mouse small intestine, but chondroitin sulfate, which is the sugar chain of PG, was not degraded at all. Then, the effects of chondroitin 4- and 6-sulfates on human colon cancer cells were examined. These chondroitin sulfates were found to suppress the expression of interleukin-6 induced by TNF-α. Overall, the chondroitin sulfate chain may act on the intestinal epithelium and suppress inflammation of the intestinal tract.

Effectiveness of Absorbable Plates for the Treatment of Nasal Septal Cartilage Fractures.

Nasal bone fractures are the most common type of facial fracture. Nasal bone fractures often occur in combination with septal cartilage fractures, because the nasal septal cartilage acts as a vertical strut and provides structural support for the nose and bilateral nasal airway. However, the treatment for nasal septal cartilage fracture remains controversial, and if untreated, nasal septal cartilage fracture can lead to various complications, such as nasal obstruction and posttraumatic nasal and septal deformity. This study aimed to evaluate the effectiveness and safety of our procedure in which septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. Between January 2017 and November 2020, 21 patients with nasal septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. The severity of the septal cartilage fracture was graded from 0 to 3 according to the computed tomography septal grading system. The numeric graded scale of nasal septal cartilage fracture was evaluated preoperatively and 6 months postoperatively using a computed tomography scan. Of 21 patients with septal cartilage fractures, 12 were treated with a polycaprolactone (PCL) mesh plate, and 9 were treated with a polydioxanone (PDS) plate. In the PDS plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.50 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.25, P = 0.023). In the PCL mesh plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.00 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.50, P = 0.034). The effectiveness of the PCL mesh plate and that of the PDS plate group according to the septal grading scale were 1.45 (SD, 0.522) and 1.18 (SD, 0.603), respectively. However, these differences were not statistically significant. Our study shows that septoplasty using absorbable plates provides satisfactory and safe clinical outcomes in patients with nasal septal cartilage fractures.

A TGF-loading hydrogel scaffold capable of promoting chondrogenic differentiation for repairing rabbit nasal septum cartilage defect.

Hydrogel-based tissue engineering has been widely used to repair cartilage injury. However, whether this approach can be applied to treat nasal septum cartilage defects remains unclear. In this study, three gelatin methacrylate-based scaffolds loaded with transforming growth factor (TGF)-β1 (GelMA-T) were prepared, and their effects on repair of nasal septum cartilage defects were examined. In vitro, the GelMA-T scaffolds showed good biocompatibility and promoted the chondrogenic differentiation of bone mesenchymal stem cells. Among three scaffolds, the 10% GelMA-T scaffold promoted chondrogenic differentiation most effectively, which significantly improved the expression of chondrocyte-related genes, including Col II, Sox9, and ACAN. In vivo, 10% GelMA-T scaffolds and 10% GelMA-T scaffolds loaded with bone mesenchymal stem cells (BMSCs; 10% GelMA-T/BMSCs) were transplanted into a nasal septum cartilage defect site in a rabbit model. At 4, 12, and 24 weeks after surgery, the nasal septum cartilage defects exhibited more complete repair in rabbits treated with the 10% GelMA-T/BMSC scaffold as demonstrated by hematoxylin & eosin, safranine-O, and toluidine blue staining. We showed that GelMA-T/BMSCs can be applied in physiological and structural repair of defects in nasal septum cartilage, providing a potential strategy for repairing cartilage defects in the clinic.

Novel Z Technique to Overcome Warping of Costal Cartilage.

Rhinoplasty has become one of the most popular operations in recent years and autologous costal cartilage is usually chosen as the graft material in dorsal augmentation. However, the warping tendency of rib cartilage may jeopardize the aesthetic results of rhinoplasty.1,2 Many methods have been proposed to address this problem. The accordion technique is based on the theory that protein polysaccharides—the biomechanical infrastructure of all cartilage—produce interlocking stresses (intrinsic forces) that lead to warping.3 In this procedure, to break the recoil mechanism responsible for warping, transverse cuts were made through 75% of the graft width every 1 to 2 mm along the entire graft length, alternating between its two sides.4 This method has been widely used for dorsal augmentation but has not eliminated the problem; mild warping is still reported. Our group theorizes that this technique eliminates the graft’s intrinsic warping forces but increases the graft’s pliability and therefore the likelihood of distortion when an external force is applied. When grafts are implanted for dorsal augmentation, the following conditions will occur. First, although the costal cartilage is carved to match the shape of the nasal bone, a small space will exist between graft and bone, allowing a slight displacement of grafts. Second, the length of the dorsal graft (~4 cm) increases the rate of external forces, including gravity, inspiratory and expiratory forces, and asymmetric facial muscle activity. Third, the caudal end of the graft is fixed firmly to the nasal tip cartilage framework, but the cephalic end is only loosely placed under the periosteum; this makes the graft susceptible to deformation when it undergoes external forces. Therefore, the graft’s pliability magnifies the effect of external forces and contributes to the warp of dorsal graft. A good prefabricated technique to decrease the risk of warping should not only eliminate intrinsic warping forces but also decrease the deforming effect of external forces. To achieve this, the authors combined the principles of the oblique split technique and accordion technique to create a new Z technique for nose dorsal augmentation. Different from the accordion technique, oblique cuts (45 degrees to the longitudinal axis) were made along the graft length every 4 mm, with alternate short (5.5 mm) and long incisions (10.0 mm) made on the two sides (Fig. 1). The warping angles and biomechanical test of the Z technique were compared with the accordion technique in an in vitro study. The results indicated that by changing the cutting direction and the angle of the incision to the longitudinal axis, not only were the intrinsic warping forces eliminated, but also every part of the operated graft was antagonistic to each other so that the pliability and effects of external forces were decreased.Fig. 1.: Accordion technique and Z technique. The grafts were incised along the length of the graft; the spacing between two adjacent cuts is about 4 mm in both techniques. The cuts are 90 degrees to the long axis in the accordion technique and 45 degrees to the long axis in the Z technique.Although further in vivo studies should be performed, the novel Z technique is a simple and reliable procedure to overcome the problem of costal cartilage warping after dorsal augmentation in rhinoplasty. ACKNOWLEDGMENTS This work was supported by the National Natural Science Foundation of China (grant 82072182) and the Shaanxi Province Key R&D Program Project, China (grant 2020SF-179). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. DISCLOSURE The authors declare that they have no competing interests.