Nasal Wing Research Articles

Ideal Depth of Endotracheal Intubation at the Vocal Cord Level in Pediatric Patients Considering Racial Differences in Tracheal Length.

Numerous formulas that can predict endotracheal intubation depth at the corner of the mouth or the nasal wing of patients have been reported, even though the oral and nasal cavity anatomies differ among patients. Therefore, the purpose of this study was to derive a simple and reliable formula to predict the ideal endotracheal tube insertion depth at the vocal cord level in pediatric patients. The current study was conducted as a retrospective observational study, involving 425 and 335 cardiac pediatric patients in Germany and Japan, respectively, and aimed to determine a formula for predicting tracheal length and ideal depth of endotracheal intubation at the vocal cord level in pediatric patients. The distance between the vocal cords and the carina tracheae was defined as the tracheal length, and was measured on preoperative chest radiographs obtained in the supine position. The tracheal length in cardiac pediatric patients ranged from 6 to 10% of the body height in Germany and from 7 to 11% in Japan. This study revealed racial differences in the tracheal length, that is, in the ideal depth of endotracheal intubation at the vocal cord level. This study suggests that an adequate endotracheal intubation depth can be achieved by inserting endotracheal tubes at the vocal cord level with the minimum tracheal length of each racial group in pediatric patients, for example, 6% and 7% of the body height in Europeans and Asians, respectively. If the endotracheal tube inserted with this method appears to be shallow on chest radiographs, this does not represent an increased risk of accidental extubation, due to an excessively short intubation depth, because the minimum tracheal length for each racial group is considered. That is, it is not due to the endotracheal tube insertion length, but is likely due to the tracheal length of the patient, who has a relatively long tracheal length in the racial group.

Two Cases of Nasal Wing Reconstruction with Composite Tissue Graft from the Auricle

Two Cases of Nasal Wing Reconstruction with Composite Tissue Graft from the Auricle

Posterior auricular artery helix root free flap—part II: clinical application

The surgical repair of full-thickness defects involving the alae nasi is complex. Pedicle flaps such as frontal and nasolabial flaps can be used, but require several interventions with different techniques. In contrast, free flaps from the foot of the ear helix allow the three layers of the nasal wings to be reconstructed in a single operation. Nevertheless, in the classical approach, the vascular pedicle is short. Although some authors have proposed raising the flap in a retrograde manner, this still yields a relatively short pedicle with narrow vessels. In the companion paper, we demonstrated that a posterior auricular artery helix root free flap (PAAHF) can be harvested from the posterior auricular vessels, thus increasing the useful pedicle length. The case of a patient with basal cell carcinoma of the left ala is presented here. A right helix root free flap was anastomosed with the facial vessels at the left mandibular notch. This new flap overcomes the main limitation of the classical helix root flap, namely the length of the pedicle. It has all of the morphological qualities of the classical flap, but with simpler vascular assembly, since autologous venous grafts and complex anastomoses are not required.

296 The Reverse of Medal – Dermatological Complications After Renal Transplantation

Kidney transplant represent the last resort for the patients with end-stage renal disease, but this revolutionary method of treatment is accompanied by multiple complications, the dermatological being among the most common. Bassal cell carcinoma, squamous cell carcinoma, cutaneous lymphoma and Kaposi’s sarcoma are just few of the complications. We present the case of a 62 years old patient, which at the age of 54 he underwent a kidney transplant, without other personal pathological history. This patient presented to the clinic for multiple skin lesions: on the right earlobe and nasal wing, on the right arm and on the bilateral legs, with slow evolution of about two years, round-ovals, relatively well delimited, with dimensions between 0.4/0.3cm-2.5/2.4cm, red-brown, covered by bloody crusts (lesions located in the calves).

Precise localization of parotid duct: a cadaveric study.

This study aimed to determine the precise localization and course of parotid duct based on morphometric data obtained by measurements regarding several superficial landmarks and lines. Totally, 46 parotid ducts of 24 formalin-fixed adult amputated heads (12 female and 12 male) aged between 45 and 92years, present in the collection of Anatomy Department, School of Medicine, Mersin University, were evaluated. First, three reference lines were defined: L1: between intertragic notch and labial commissure, L2: between intertragic notch and nasal wing, and L3: between intertragic notch and lateral palpebral commissure. The location of the parotid duct with respect to these lines were recorded. In all sides, parotid duct was detected in the middle 1/3 of L1. In 71.7% of all hemifaces, the parotid duct was making an upward curve around L1. Its proximal end exiting from the anterior border of the parotid gland was 12.34 ± 28.83 mm below the proximal 1/3 point of L1. Then, it was crossing L1 at a point with a mean distance of 53.90 ± 9.69mm from the labial commissure where it is almost at L1 midpoint. Its distal end was located 9.61 ± 2.88mm above the distal 1/3 point of L1. In 21.7% of all hemifaces, PD was observed totally above L1, while the shortest distances of its proximal and distal ends to L1 were 4.35 ± 2.45mm and 13.17 ± 4.52mm, respectively. In 6.5% of all hemifaces, its proximal end was located just on L1, coursing upwards and terminating 11.76 ± 2.53mm above L1.

Reply Re: "Successful Free Bilamellar Eyelid Grafts for the Repair of Upper and Lower Eyelid Defects in Patients and Laser Speckle Contrast Imaging of Revascularization".

To the Editor: Thank you for taking an interest in our article on free bilamellar eyelid grafts. We agree that clinical experience gained over the years and previous studies should be taken into account. We acknowledge that the principle in repairing full-thickness eyelid defects is to combine a vascularized flap with a free graft, to provide an adequate blood supply to the reconstructed tissues. However, our results are rather clear; namely that a free bilamellar eyelid graft has been found to survive without vascular support. The reason for graft survival, despite a lack of perfusion, may be that the periocular region is such a well-vascularized region, known to be forgiving to reconstructive surgery. There are indeed studies reporting failures, as mentioned by Dempsey and Mawn. However, our grafts were small, and the width less than 1 cm. The use of free composite grafts is well known from other specialties, for example, a free composite graft from the outer ear, without any vascularized flap, may be used in the repair of a nasal wing defect. We agree that most of the patients in our cohort were fairly healthy. Due to the limited number of patients included in the study, we were not able to draw any conclusions regarding the effects of impaired microcirculation, due, for example, to years of smoking, cardiovascular disease, diabetes, obesity, or poor diet. A larger study would be needed to perform subgroup analyses to determine whether the survival of a bilamellar autograft is affected in higher-risk populations. There are potential benefits of using a bilamellar autograft, such as avoiding a second surgery and occlusion of the visual axis, especially in patients with poor vision in the contralateral eye. However, there are possible disadvantages, such as lack of vertical lifting during healing, not being able to adjust the final position of the lower lid margin during a second surgery, and potential distress of the patient having to undergo surgery not only on one eyelid but both. We do not advocate the use of free bilamellar autografts in all patients, only in selected cases. The surgical approach may be tailored to the individual patient, taking into account the size of the graft needed and the patient’s health status, such as smoking and diabetes, which might affect the microcirculation. Future studies will be needed to investigate which factors should be taken into consideration. Finally, we would like to point out that the Hughes tarsoconjunctival grafting technique was developed long before modern laser-based techniques were available for the measurement of microvascular perfusion. New technology makes it possible to monitor perfusion and to refine and optimize our surgical procedures.

Characterization of Mexican pediatric nostril sill

Introduction: The nostril sill is defined as the “facial subunit composed of fibro-adipose soft tissue whose topographic delimitation is given by four anatomical limits: the medial crura of the columella on its medial limit, the nasal wing on its lateral limit, the nasal vestibule in its upper limit, and the upper lip on the lower limit.” It represents an essential element in the appearance, balance, and function of the nose. The study and classification of the nostril sill in the healthy Mexican pediatric population are the necessary tools for facial reconstruction since it is generally affected in patients with cleft lip and palate and craniofacial malformations. Objective: The objective of the study is to describe the nostril sill in the Mexican pediatric population using standardized photographs taken in frontal and basal projections and classifying according to Oh et al. and to study if there is a significant relationship between nostril sill with age and gender. Materials and Methods: An observational cross-sectional study was carried out in a sample size of 83 healthy children aged between 3 and 12 years, simple randomly chosen. The classification was performed with facial photographs in frontal and basal projections. The data analysis was performed with descriptive statistics, kappa concordance coefficient was used between observers, and bivariate analysis was used to evaluate the association of the nostril sill classification with age and gender. Results: Of the 83 volunteers, 51.8% (n = 43) were female and 48.2% (n = 40) male, with a mean age of 7.38 years. The 74.6% (n = 62) were classified as a nostril sill Type I, 14.4% (n = 12) as Type III, and 10.8% (n = 9) as Type II, with a Cohen's kappa coefficient between observers of 0.92 (almost perfect agreement). In the bivariate analysis with Chi-square test, no statistically significant association was found between age (P = 0.420) and sex (P = 0.524). Conclusion: The nostril sill of the nostril represents a fundamental nasal subunit that every reconstructive surgeon must recognize and locate. It is crucial to describe and classify the nostril sill according to ethnic and racial characteristics, in the Mexican pediatric population, the most frequent corresponds to Type I, followed by Type III and finally the least frequent Type II, and that gender and age are not associated with a specific type.

The Place of Dentofacial Orthopaedics in the Treatment Planning of Facial Clefts: About Two Clinical Cases

Facial clefts are considered as predominant malformations of the oro-facial sphere due to their frequency, aesthetic and functional repercussions. The overall prevalence of cleft palates is estimated at 1 per 700 births in the general population, with 77% of isolated cases, 16% associated with another malformative pathology, and 7% associated with a known syndrome. They can disrupt soft tissues (upper lip, nasal threshold, nasal wing, palate veil), hard tissues (alveolar arch, dental germs, palate), or both.They constitute a congenital dysmorphosis for which the therapeutic management extends from birth to the end of adolescence. Orthodontic care has evolved considerably in recent years, mainly due to the synergy of the different specialities involved in the care of these children by the multidisciplinary team.These cleft lips and palates have a multifactorial and complex etiology requiring a multidisciplinary approach. Orthodontic treatment has a strategic place in this treatment and involves temporary, mixed, and permanent dentition.The aim of this article is to review the place of dentofacial orthopaedics in the therapeutic calendar of facial cleft management.

Assessement of the Nasal Shape after Orthognathic Maxillary Surgery

Background : Orthodontic and/or surgical modifications to the jawbone could undoubtedly have aesthetic effects on the shape or position of the nose.Aim : Cephalometric analysis was used to evaluate the aesthetic alterations (dimensional and positional) of the nose in this patients.he PIDAQ was cross-culturally adapted into Malay version by forward- and backward-translation processes, followed by psychometric validation.Methods : To compare cephalometric changes in the nose, a cross-sectional study was conducted from January to March 2019. A sample of 20 orthognathic patients was included in this study. Their mean age was 22.40 (+/-6.98 years). The amplitude of the surgical movements of all patients were measured, using measurements on profile teleradiographs and on photos of faces taken before and after surgery. The statestical analysis of cephalometric data before and after surgery was performed using the Wilcoxon test. The significance level was p≤0.05.Results : The results revealed that a significant reduction in the angular values of SNA (°) (p<0.001), GoGn/SN (°) (p=0.038), Occ/Sn (°) (p=0.007) and AoBo (mm) (p=0.025). No statistically significant differences were noted for specific cephamometric variables before and after surgery. For the comparison of facial photographs, all the values of the specific measurements before and after were significant with the exception of Prn - SN.Conclusion : The width of the base of the nasal wing increased, the displacement and the amount of rotation of the nasal tip also increased in most patients. In contrast, a drop in the X-axis to Prn distance was noted.

Defining dysmorphic facial features in congenital Zika syndrome.

Congenital Zika syndrome (CZS) constitutes a recently identified malformation caused by Zika virus infection during pregnancy. Limited data is available to date on the facial dysmorphic features of these patients. This study evaluated the facial dysmorphisms of children with CZS, compared with clinically healthy children, using clinical examination and standardized photographic images. Sixty-three children with CZS (9.70 ± 3.2 months-age), and 31 Controls (8.67 ± 6.2 months-age) joined the study. Seven out of 15 indices differed between groups: midfacial height (MFH)/horizontal facial reference (HFR) (p = .0003), interalar distance/HFR (p = .0027), nasal root depth/MFH (p = .0030), posterior nasal length/MFH (p = .0002), vertical position of the ear/MFH (p <.0001), ear length/MFH (p = .0005), chin height/total facial height (CH/TFH) (p <.0001). A CH/TFH of 0.229 showed 93.9% sensitivity and 80.6% specificity in diagnosing CZS. Children with CZS had broad, short faces, decreased intercanthal distance, short posterior nasal length, prominent nasal root, broad nasal wings, and high-set and long ears. Increased chin height index provided the most accurate diagnostic potential.

Perfect prognosis of a boy with alveolar rhabdomyosarcoma of the nasal wing treated with brachytherapy and chemotherapy.

Perfect prognosis of a boy with alveolar rhabdomyosarcoma of the nasal wing treated with brachytherapy and chemotherapy.

Alecgrama®: Técnica segura para Alectomia – relato de caso.

Descrever uma técnica segura para redução de base alar, através ressecção da pele, diminuindo a distância inter-alar melhorando a harmonia nasal no conjunto facial. Detalhamentos de Caso: Ao longo dos anos as técnicas cirúrgicas têm evoluído muito, e não é o contrário com a Alectomia, cujo propósito é diminuição de largura da base alar. O objetivo principal foi apresentar o resultado de um caso clínico de Alectomia feito através da técnica de Alecgrama® de Algarve &amp; Oliveira (diagrama de redução das asas nasais sem comprometer a estética e função do nariz), deixando-o mais harmônico com o perfil do paciente. Foi realizada a metodologia com a descrição detalhada do caso clínico realizado, com os benefícios de contribuir indiretamente para um grupo de indivíduos que se encontra na mesma situação. Foram relacionados aspectos ainda não observados na literatura. A metodologia bibliográfica foi utilizada com revisão da literatura pertinente com base em buscas através do MEDLINE, EMBASE, LILACS e SciELO. Conclusão: A técnica cirúrgica do Alecgrama®, mostrou-se eficaz para atender os objetivos da cirurgia e dos pedidos da paciente. A reconstrução nasal através da diminuição da base alar utilizando-se procedimento adequado e minimante invasivo, atingiu as expectativas e foi condizente com o resultado funcional e estético, sem processo de inflamação e com cicatrização apropriada, mesmo com a complexidade da estrutura nasal.

Management plan of a paediatric outpatient department during the SARS-CoV-2 epidemic.

With the novel coronavirus (2019-nCoV) infection outbreak and spread, serious cases of infection and neonatal infection have been reported. Moreover, children show milder cases and a better prognosis than adults. The outpatient Department of Paediatrics has played a crucial role in the prevention and control of novel coronavirus (2019-nCoV) infection in children. Based on previous experience and existing diagnosis and treatment guidelines, we present the relevant strategies of this particular paediatric outpatient department when responding to the epidemic. Conclusion: Concurrently, we hope that this article can act as a reference in the fight against SARS-CoV-2 infection. Further modifications will be made in the future with the increase in clinical experience and changes in the disease. This article is protected by copyright. All rights reserved.

Modern possibilities of pathogenetic therapy of patients with allergic rhinitis

The incidence of allergic rhinitis has been increasing rapidly worldwide in recent years. About 40% of the world’s population suffer from allergic inflammation of the nasal mucous membrane. Clinical manifestations of allergic rhinitis are absence or difficulty of nasal breathing, itching, sneezing, nasal congestion and rhinorrhoea, as well as swelling of the face, the presence of dermatitis in the region of the nasal wings, general malaise, smell disturbance. Manifestations of allergies by ENT organs in most cases do not pose a threat to life, but they can cause the development of other pathological processes, bad sleep, irritability, decreased efficiency, mood swings, which, in turn, adversely affects human health and reduces the quality of life. The pathogenesis of allergic rhinitis is based on an immediate hypersensitivity. According to the modern classification, depending on the nature of the course of the disease it is common to identify intermittent and persistent forms.At present, the drugs of choice in the treatment of patients with allergic rhinitis are intranasal glucocorticosteroids. However, the presence of a concomitant pathology of the nasal cavity in the patient, such as deviated septum, not only significantly impairs the course of nasal inflammatory process, but also creates obstacles to adequate delivery of topical drugs to all parts of the nasal cavity, which, in turn, reduces their effectiveness.For patients suffering from allergic rhinitis in combination with other pathology of the nasal cavity, combined oral medications may be a good alternative to intranasal sprays. Certain interest for doctors is caused by the appearance of a combined antihistamine drug on the Russian market, which includes a blocker of leukotrienes and H1-histamine receptors of the second generation – montelukast and levocetirizine. The drug can be used both in adults and children from 15 years old for treatment of intermittent and persistent forms of allergic rhinitis.Timely and properly performed therapy of allergic rhinitis allows to eliminate symptoms of the disease and prevent the development of complications.

Reconstruction of Small and Medium-Sized Nasal Defects Using an Omega Advancement Flap.

The nose is the most common area where malignant skin tumors occur. Repair with a flap after tumor excision provides esthetically and functionally acceptable results. In this study, we aimed to present the use of an omega (Ω) advancement flap, which can be applied in all anatomic regions of the nose, in 2 cm or smaller defects. Between 2015 and 2017, 18 patients underwent repair with omega (Ω) advancement flap in the nose after tumor removal. The pathology of 17 patients was basal cell carcinoma, and keratoacanthoma in 1 patient. The average defect diameter was 1.6 × 1.56 cm. The defects were in the nasal tip, nasal wing, lateral nasal wall, and supratip region. After tumors were excised from the safe margin, and were repaired using an omega advancement flap in the same session. No flap necrosis, dehiscence, or infection was observed in the early postoperative period. Three patients developed hematoma under the flap, which was drained. No tumor recurrence was observed during the postoperative follow-up period. The results were satisfactory in all patients. The omega advancement flap is a safe procedure that can be easily applied in the same session for the repair of small-to-medium-sized nasal defects.

Infected Nasolabial Cyst

A 33-year-old female presented to the dental clinic with complaints for rapid increasing (during last several days) of the painful edema in upper lip area and elevation of the left ala of the nose. Examination also revealed elevation of the nasal floor and a painful strictly demarcated oval shape fluctuated swelling (Panel A, arrows) underneath the mobile mucosa from the upper right central incisor to the upper left canine. Cone-beam computed tomography (Panel B: panoramic view) showed no periradicular bony changes in the segment of anterior maxilla. According to medical history the upper central incisors were endodontically treated several years ago due to the caries and pulpitis. Diagnosis of subperiosteal radicular/peripheral residual cyst was excluded and the diagnosis of infected nasolabial cyst (synonyms: developmental fissural cyst, nasal wing cyst) was established. The extraosseous cystic lesion was excised with intraoral approach under local anesthesia by Ievgen I. Fesenko, PhD 1 month after the treatment of cyst`s infected state. The histopathology confirmed the clinical diagnosis revealing an epithelial lining with a signs of fibrosis and inflammation of the cystic wall. 1-year follow-up showed no signs of recurrence.

External and internal nasal valve. Diagnostic and treatment methods for dysfunction

The purpose of the work is the analysis of diagnostic methods of nasal valve dysfunction according to Pubmed database and national medical journals during the period from 1997 to 2019. A brief analysis of the definition of the zones of the external and internal nasal valve, diagnostic methods, including external nasal dilators, spiral computed tomography, assessment of the degree of displacement of the nasal wing using various aspirators is given. Various methods for treating nasal valve dysfunction, such as external and internal dilators, strengthening the nasal wings, suture techniques, expanding the edge of the pear-shaped hole, implantation of absorbable polymers into the side wall of the nose are critically evaluated. Our own original correction method is described for dysfunction of the external nasal valve caused by the vertically located legs of the inferior lateral cartilage.

Evaluation the effect of isogenically prepared platelet-rich plasma on the viability of composite graft in the rabbit model (Experimental study)

Aim: Necrosis in composite grafts used for the repair of tissue defects in the nasal wings, columella, and nasal sidewalls after tumor resection or trauma is an important problem related to the size of the graft. Success in the surgical or medical interventions on the recipient field or graft in order to enhance composite graft survival is clinically limited. The aim of this study is to research the effect of platelet-rich plasma (PRP) on composite graft viability during graft operation. Materials and Methods: One of the eight adults New Zealand white rabbits was used isogenically to obtain PRP. Circular full-thickness chondrocutaneous composite grafts in 2 cm diameter were excised from the both ears of each remaining seven rabbits. Right ears were separated as experimental group and left ears were selected as control group. In the experimental group, PRP was applied subcutaneously to the four different points on inner and outer surfaces at the graft donor and topically to the graft sides. The composite graft was turned 180°, and it is sutured back to the donor area. PRP was also applied on suture lines. Composite grafts formed in control group were turned for 180° and sutured without any application. At the end of the 21st day, histological evaluation was performed following measurement and photodocumentation of living and necrosis areas. Results: In the control group, except one total necrosis, partial necrosis and viable areas were identified at the other composite grafts. Mean viable area measurements in the experimental group were 33.62% and 21.15% in the control group (P

Three-dimensional evaluation of important surgical landmarks of the face during aging

BackgroundOne surgical objective is creating an aesthetically satisfying outcome. The morbidity increases with age. Standard values for areas of the face, which are frequently surgically treated, are needed for the surgeon. Methods240 Caucasians aged 21–65 were divided into six subgroups by gender and age. They were scanned by a three-dimensional (3D) scanner. Distances and angles in faces between landmarks were evaluated. ResultsDuring aging, the relation of the eye’s width to the eye’s height became significantly smaller (M: p=0.001, F: p≤0.0001). The outer contour of the nose became significantly sharper with increasing age (M: p=0.001, F: p=0.0021). Seen from caudal, the nose formed an isosceles triangle with the base between the left and right alar curvature and the base had an average length of 31.35mm±2.97mm. The leg of this triangle had an average length of 33.67mm±2.09mm. The nose got longer and wider during aging; the age-dependent changes between the different groups of males (p≤0.0001) and the difference between females and males were significant (p≤0.0001). The thickness of the nasal wings remained the same size during a lifetime. Females had significantly greater heights for both lips (p≤0.0001, p=0.027). In males and females, the heights decreased with increasing age. ConclusionThis study provided a database of measurements of parts of the face, especially those parts that can underlie various surgical treatments.

Alar base symmetrization suture in ethnic rhinoplasty

Alar base surgery has been widely studied in modern rhinoplasty. After the equalization of the dorsum-tip relationship and the improvement of the nasolabial, nasocolumellar and nasofrontal angle, also alar base, needs to be harmonized also. Several classifications of alar base deformities have been described, as well as many techniques for correcting them. This work aims to demonstrate that alar base symmetrization suture (abss) is effective in keeping the nasal wings symmetrical immediately after alar wedges resection and also permits maintenance of the symmetrization during time. It is a simple technique to perform with long-lasting esthetic results. Level of evidence: Level V, therapeutic study.