Nostril Retainer Research Articles

Outcomes of Presurgical Nasoalveolar Molding using Modified Nostril Retainers in Patients with Unilateral Cleft Lip and Palate at an Average Follow-up of 2 Years.

Presurgical nasoalveolar molding (PNAM) using a modified nostril retainer is a new treatment approach. This study aimed to evaluate the outcomes of early nasal molding using this approach with an average follow-up of 2 years in patients with severe unilateral cleft lip and palate. This retrospective study included 18 patients with unilateral cleft lip and palate without genetic syndromes who underwent PNAM with modified nostril retainers. The Grayson technique was employed with an intraoral plate to approximate cleft segments. Nasal molding was initiated before reducing the cleft width to 5 mm. Measurements, including alar base height ratio (ABHR), nasal floor width ratio (NFWR), columellar length ratio (CLR), columellar angle (CA), and nostril axis inclination on the cleft and non-cleft sides (NAI-C and NAI-NC, respectively), were calculated from standard photographs taken before PNAM (T1), after PNAM (T2), after an average of 1.81 months post-surgery (T3), and after an average of 2.2 years after T3 (T4). Pairwise comparisons of values at the four time points were conducted. NFWR, CLR, CA, NAI-C and NAI-NC significantly increased after PNAM (p<0.05). However, no significant change was observed in ABHR (p>0.05) from T1 to T2. These outcomes were maintained at T4, and no patient developed a mega nostril. The use of a modified nostril retainer for nasal molding appears to provide stability during the high probability of relapse reported in the literature.

Utilization of images and three-dimensional custom-made nostril retainer fabricate for patients with cleft lip and cleft lip nose deformities at Siriraj Hospital: preliminary phase

A prospective study utilizing image analysis to assess nostril openings in post-operative patients with cleft lip and cleft lip nose deformities. This preliminary study seeks to employ two-dimensional (2D) images to fabricate a custom-made nostril retainer. This study was performed at Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. This study included 30 healthy volunteers and 15 patients with cleft lip and cleft lip nose deformities. The nostril opening width and height for all participants were measured, and photographs were taken. An image analysis application was used to fabricate a three-dimensional (3D) custom-made nostril retainer. The mean differences between the direct measurements of the nostril aperture and the measurements obtained through the program did not exceed 2 mm in terms of nostril height, width, or columella. Two-dimensional photographs can be used to create a custom-made, three-dimensional nostril retainer. This retainer allows post-operative patients to maintain their nares without needing to visit the hospital, thereby reducing the cost of care.

Correction of narrow nostril deformity secondary to cleft lip: indications for different surgical methods and a retrospective study.

Cleft lip and/or palate (CLP) can lead to severe nasolabial deformities that significantly affect the appearance of the patient. Among all types of nasolabial deformities, narrow nostril deformities are the most troublesome, causing poor and unstable surgical outcomes. The purpose of this study was to develop an algorithm for surgical method selection for revision of narrow nostril deformities secondary to CLP based on retrospective clinical data. Patients with narrow nostril deformities secondary to CLP were enrolled in the study. Before surgery, patients' clinical data were collected and the width of the nasal floor and the length of the alar rim were measured. Surgical methods were determined according to the measurements. After surgery, a nostril retainer was applied for 6 months to consolidate and maintain the nostril shape. The surgical method and postsurgical changes were recorded for the final summary of the algorithm to select surgical methods for narrow nostril deformities. The data from 9 patients were analyzed. According to the width of the nasal floor and the length of the alar rim, correct surgical methods were determined. Four patients received nasolabial skin flaps to widen the soft tissue of the nasal floor. Three patients received upper lip scar tissue flaps to treat the narrow nasal floor. For the short alar rim, free alar composite tissue flap or narrowing of the nostril of the noncleft side was recommended. The width of the nasal floor and the length of the alar rim are critical elements to consider when selecting the correct surgical method for revising narrow nostril deformities secondary to CLP. The proposed algorithm provides a reference for selecting surgical methods in future clinical practice.

Nasal Retainer 2.0: A New, Cheap, and Reliable Method to Prepare Custom-made Nostril Retainer for Nasal Reconstruction.

Total nasal reconstruction always represents a challenge for the plastic surgeon, who must deal both with the reconstructive procedure and compliance of the patient. This kind of reconstruction often requires more than one step. Therefore, more prolonged and emphasized scarring than normal can occur, thus resulting in a higher risk of nostril stenosis. Although several nasal retainers have been described, traditional premade retainers could be poorly tolerated by patients and need to be adequately customized to improve patient compliance. Herein, the authors propose a new, cheap, and reliable method to prepare customized nasal retainers which can be used after every step of nasal reconstruction.

Defining the Treatment Gap in Nasoalveolar Molding: Factors Affecting the Utilization of NAM in an Urban Cleft Center.

Many cleft centers incorporate NasoAlveolar Molding (NAM) into their presurgical treatment protocols. However, there are limited data on eligible patients who do not receive or complete NAM. This study characterizes the demographics associated with non-utilization or completion of NAM. A single-institution retrospective review was performed of all patients with cleft lip and alveolus undergoing primary unilateral and bilateral cleft lip repair from 2012-2020. Patients were grouped based on utilization or non-utilization of NAM. Demographic and treatment data were collected, including documented reasons for not pursuing or completing NAM. Of 230 eligible patients, 61 patients (27%) did not undergo or complete NAM (no-NAM). In this group, 37 (60.7%) received no presurgical intervention, 12 (19.7%) received presurgical nostril retainers, 3 (4.9%) received lip taping, 1 (1.6%) received a combination of taping/nostril retainers, and 8 (13.1%) discontinued NAM. The most common reasons for not receiving NAM were sufficiently aligned cleft alveolus (21.3%), medical complexity (16.4%), late presentation (16.4%), and alveolar notching (18%). Compared to the NAM group, the no-NAM group had significantly lower rates of prenatal cleft diagnosis/consult, and significantly higher proportion of non-married and non-English speaking caregivers. Multivariable analysis controlling for insurance type, primary language, prenatal consult, marital status, and age at first appointment found that age at first appointment is the only statistically significant predictor of NAM utilization (P < .001). Common reasons for non-utilization of NAM include well-aligned cleft alveolus, medical complexity, and late presentation. Early presentation is an important modifiable factor affecting rates of NAM utilization.

Efficacy of Postsurgical Nostril Retainer in Patients with Unilateral Cleft Lip and Palate Treated with Presurgical Nasoalveolar Molding and Primary Cheiloplasty-Rhinoplasty.

The aim of this investigation was to determine whether the nasal form of patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding therapy, primary lip-nose surgery, and postsurgical nostril retainer was different from that of patients treated with presurgical nasoalveolar molding and primary lip and nose surgery alone. This cross-sectional, retrospective review focused on 50 consecutive patients with nonsyndromic unilateral cleft lip and palate: 24 treated with nasoalveolar molding and primary lip and nose surgery followed by postsurgical nostril retainer (group 1) compared with 26 patients treated with nasoalveolar molding and primary lip and nose surgery without postsurgical nostril retainer (group 2). Polyvinyl siloxane nasal impressions were performed at an average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparisons of cleft-side versus noncleft side nasal measurements were performed within group 1 and group 2, as well as comparisons of differences between the two groups. Cleft-side nasal dimension was statistically significantly better in group 1 than in group 2 across all measures except nasal projection ( p < 0.05). Group 1 showed less difference between the cleft side and noncleft side in all six measurements than did group 2 ( p < 0.05). There was a significant difference in the nasal shape of patients who used a postsurgical nostril retainer compared with those who did not. Patients who used a postsurgical nostril retainer showed better nasal shape at an average age of 12 months compared with the control group. Therapeutic, III.

A Custom-Made Nostril Retainer for Adult Population.

Nostril retainers are used in cleft lip nose surgery in the post-operative period to maintain alar diameter and resistance against contraction. Various custom made splints were described in the literature to mimic this function when nostril retainers cannot be used for economic or logistic reasons. The authors designed a nostril retainer made by silicone urinary catheter for adult age patients which can be prepared easily. The splint can be used in both unilateral cleft lip nose surgery and operations in the alar wing of the nose.

Role of nostril retainers after rhinoseptoplasties in cleft lip and palate patients

Background: There are many different nostril retainers used worldwide after primary cheilorhinoplasties. There are few studies concerning its convenience and necessity.

Preoperative nasoalveolar moulding in a patient with a unilateral cleft lip and palate using a modified nostril retainer: a technical note

Preoperative nasoalveolar moulding in a patient with a unilateral cleft lip and palate using a modified nostril retainer: a technical note

Presurgical Orthopedic Treatment Using Modified Nostril Retainers in Patients With Unilateral Cleft Lip With or Without Cleft Palate.

This study aimed to present a new technique for presurgical orthopedic treatment of patients with unilateral cleft lip with or without cleft palate (UCL±P) by means of modified nostril retainers manufactured using a special mold with soft acrylic or orthodontic acrylics material. Nasal molding with the modified nostril retainer is considerably effective and comfortable for the patient.

Nostril suspension and lip adhesion improve nasal symmetry in patients with complete unilateral cleft lip and palate

There is a difference between complete and incomplete cleft lip with regard to the nasal shape. Severe nasal deformity is found in almost all cases of complete cleft lip. This problem has been approached by preoperative nasoalveolar moulding, primary nasal correction and the use of a nostril retainer. We corrected the nasal deformity associated with complete cleft lip by using the combination of a nostril suspender and lip adhesion before cleft lip repair. The present article outlines this treatment strategy and assesses the effects of our treatment on nasal deformity. Fourteen patients with complete cleft lip and palate were assigned to two groups for retrospective analysis: group A comprised seven patients, who underwent cleft lip repair after a combination of nostril suspension and lip adhesion, while group B had seven patients, who received cleft lip repair alone. In group A, a nostril suspender was fabricated and fitted to each patient at the initial visit, while lip adhesion was done at 1 month of life. At 1 year postoperatively, four parameters (nostril symmetry, alar cartilage slump, alar base level and columellar tilt) were scored on a scale of 1-4 to compare nasal shape between the two groups. With respect to nostril symmetry, alar cartilage slump and columellar tilt, group A showed less deformity compared with group B and the difference between the two groups was statistically significant. The use of a nostril suspender and lip adhesion can achieve dynamic correction of the nasal deformity associated with complete cleft lip.

Primary Rhinoplasty by Open Approach With Repair of Bilateral Complete Cleft Lip

Nasal deformities inherent to a cleft are challenging. A controversy existed regarding the best time to correct these nasal problems. Now, there is a consensus that these nasal deformities are better to be dealt with along with repair of cleft lip.Primary cheilorhinoplasty involves proper reconstruction of clefted musculoaponeurotic complex by placing the muscles in their proper anatomic-physiologic orientation through careful identification, dissection, and mobilization of paranasal and labial musculature. In short, cleft repair is a muscle repair that enhances the establishment of a normal nasolabial complex. Delicate dissection and accurate repositioning of the lower alar cartilages during a primary lip repair will definitely help to establish a normal nasal shape. The nasal tissues must be supported with accurately placed sutures either by an open or a closed approach. The author prefers the open approach as published by Trott and Mohan (Br J Plast Surg 1993;46:215-222) with modifications because it has the added advantage for the identification and proper repositioning of the lower alar cartilages by accurately placed sutures under direct vision and the incisions of this procedure can be carried out through hidden rim incisions without any residual scars even in the colored population who were offered with this technique. Silicone nostril retainers, if available, during the immediate postoperative period will definitely promote the proper contours and the patency of the nostrils.Since 1994, the author has been performing this technique for patients with complete unilateral and bilateral cleft lip, which were presented separately. Patients with incomplete cleft lip were not included in this study because the nasal deformities were minimal, although the technique can be adopted for the correction of incomplete cleft lip nasal deformity also. Till December 2007, a total of 142 children with complete bilateral cleft lip with gross nasal deformities have been operated on and followed up.

Primary Rhinoplasty by Open Approach With Repair of Unilateral Complete Cleft Lip

Nasal deformities inherent to a cleft are challenging. Controversy was existing regarding the best time to correct these nasal problems. Now, there is consensus that these nasal deformities are better to be dealt with along with the repair of the cleft lip.Primary cheilorhinoplasty involves proper reconstruction of the clefted musculoapeneurotic complex by placing the muscles in their proper anatomic-physiologic orientation through careful identification, dissection, and mobilization of the paranasal and the labial musculatures. In short, the cleft repair is a muscle repair, and this enhances the establishment of a normal nasolabial complex. Delicate dissection and accurate repositioning of the lower alar cartilages during the primary lip repair will definitely help to establish a normal nasal shape. The nasal tissues must be supported with accurately placed sutures either by an open or by a closed approach. The author prefers the open approach technique as published by Trott and Mohan, with modifications, because it has the added advantage for the identification and proper repositioning of the lower alar cartilages by accurately placed sutures under direct vision, and the incisions of this procedure can be carried out through the hidden rim incisions without any residual scars even in the black population who were offered this technique. Silicone nostril retainers, if available, during the immediate postoperative period will definitely promote the proper contours and the patency of the nostrils.Since 1994, the author has been using this technique for patients with complete unilateral and bilateral cleft lips, which are presented separately. Patients with incomplete cleft lip are not included in this study because the nasal deformities are minimal, although the technique can also be adopted for correction of incomplete cleft lip nasal deformity. Until December 2007, a total of 255 children with complete unilateral cleft lip with gross nasal deformities have been operated on and followed up with.

A Novel Nostril Retainer Designed by a Patient

The importance of using a nostril retainer to prevent collapse in congenital (cleft lip/nose deformity) or acquired nostril stenosis is well established [1]. In addition to standard silicon retainers, use of various types of retainers, including suction tubes [2], nasogastric tubes [3], silicon urinary catheters [4], or custom-made retainers made from the rubber part of an infusion set, has been reported in the literature [5]. Many of these retainers were devised for congenital cleft lip/nose cases and their use in adults is not easy. We report on a nostril retainer that was developed by a 72-year-old male patient (an industrial engineer) from a paper clip and can be used in adult patients. He reported that he designed the retainer because he was unable to keep standard silicon nostril retainers in his nose for a longer period of time (Fig. 1). Compared to all other retainers discussed in the literature, the paper-clip retainer occupies the least intranasal space. This presents a significant

The Use of Nasal Splints in the Primary Management of Unilateral Cleft Nasal Deformity

Primary surgical correction of the cleft lip nasal deformity is routinely performed at the Craniofacial Center at Chang Gung Memorial Hospital. Over time, however, there is a tendency for the lower lateral cartilage to retain its memory and, subsequently, recreate the preoperative nasal deformity. Therefore, it is current practice to use a nostril retainer for a period of at least 6 months to maintain the corrected position of the nose. The aim of this study was to qualitatively assess the benefit of postoperative nasal splinting in the primary management of unilateral cleft nasal deformity. Data from two groups of 30 patients with complete unilateral cleft lips each were retrospectively collected and analyzed. The first group served as a control (no nasal splints), and the second group used the nasal retainer compliantly for at least 6 months postoperatively. All patients had their primary lip repair at 3 months of age. A photographic evaluation of the results when the patients were between 5 and 8 years of age was conducted. The parameters used to assess the nasal outcome were nostril symmetry, alar cartilage slump, alar base level, and columella tilt. The first scores were based on residual nasal deformity, and the second set were based on overall appearance. It was found that the mean scores of residual nasal deformity for all four parameters in patients who used the nasal stent were statistically better than the scores of patients who did not (p values ranged from 0.0001 to 0.005). The overall appearance scores for the four parameters in the patients who used the nasal stent after surgery were also statistically better than the scores for those who did not (p values ranged from 0.0001 to 0.01). The results show that postoperative nasal splinting in the primary management of the unilateral cleft nasal deformity serves to preserve and maintain the corrected position of the nose after primary lip and nasal correction, resulting in a significantly improved aesthetic result. Therefore, it is recommended that all patients undergoing primary correction of complete unilateral cleft deformity use the nasal retainer postoperatively for a period of at least 6 months. (Plast. Reconstr. Surg. 103: 1347, 1999.)

The use of nasal splints in the primary management of unilateral cleft nasal deformity.

Primary surgical correction of the cleft lip nasal deformity is routinely performed at the Craniofacial Center at Chang Gung Memorial Hospital. Over time, however, there is a tendency for the lower lateral cartilage to retain its memory and, subsequently, recreate the preoperative nasal deformity. Therefore, it is current practice to use a nostril retainer for a period of at least 6 months to maintain the corrected position of the nose. The aim of this study was to qualitatively assess the benefit of postoperative nasal splinting in the primary management of unilateral cleft nasal deformity. Data from two groups of 30 patients with complete unilateral cleft lips each were retrospectively collected and analyzed. The first group served as a control (no nasal splints), and the second group used the nasal retainer compliantly for at least 6 months postoperatively. All patients had their primary lip repair at 3 months of age. A photographic evaluation of the results when the patients were between 5 and 8 years of age was conducted. The parameters used to assess the nasal outcome were nostril symmetry, alar cartilage slump, alar base level, and columella tilt. The first scores were based on residual nasal deformity, and the second set were based on overall appearance. It was found that the mean scores of residual nasal deformity for all four parameters in patients who used the nasal stent were statistically better than the scores of patients who did not (p values ranged from 0.0001 to 0.005). The overall appearance scores for the four parameters in the patients who used the nasal stent after surgery were also statistically better than the scores for those who did not (p values ranged from 0.0001 to 0.01). The results show that postoperative nasal splinting in the primary management of the unilateral cleft nasal deformity serves to preserve and maintain the corrected position of the nose after primary lip and nasal correction, resulting in a significantly improved aesthetic result. Therefore, it is recommended that all patients undergoing primary correction of complete unilateral cleft deformity use the nasal retainer postoperatively for a period of at least 6 months.

The treatment of cleft lip nose by using nostril retainers

The treatment of cleft lip nose by using nostril retainers

小児鼻軟骨骨折の保存的治療

For children with nasal cartilage fractures, conservative treatment is preferred to surgical procedures.Nasal bone fracture is common, and its manipulations have been described in many reports. On the other hand, cartilage fractures of the nose are less common and more difficult to treat. Even without any defect of nasal tissue, deformity of the nostril border or saddle nose deformity may result from cartilage fracture.We applied nostril retainers (Koken Co.) to fix the nostril borders and dorsum nasi of three patients, two six-year-old girls and one seven-year-old boy. In one patient, deformity was absent after three months, but it then reappeared. Three more months of application proved to be a sufficient fixation period and no deformity or stiff scarring remained. Satisfactory results were obtained after six months of application in all three patients.We assume that the fractured fragments were fixed appropriately, or that contraction of the surrounding tissue was prevented by the use of nostril retainers. In children, connective tissue is less firmly attached to the adjacent skin as in adults. Although we have had no experience with adult patients, this simple procedure is effective, and its use should be considered in the treatment of children with fracture of the nasal cartilage.

The Use Of A Red Rubber Tube As Nostril Splint

AbstractThis is a simple, effective, inexpensive and easily available substitute for the more conventional acrylic nostril retainer.

The use of mucosa-lined flap in nasal reconstruction

A relatively new method of nasal reconstruction using a mucosa-lined flap is described. Surgery with mucosa-lined flaps is not yet commonly performed. Two cases are described in which this technique was employed. In the first case, a deeply penetrating squamous cell carcinoma of the right side of the nose, including the nasal mucosa, was excised. The nasal lining defect was closed with a free full thickness oral mucosa graft, and a median forehead flap was used to cover the nasal defect. In the second case, an ulcerated squamous cell carcinoma on the left side of the nose was excised and two-stage reconstruction performed. During the first stage, a free oral mucosa graft was transplanted into the nasal defect with its mucosal surface facing into the nasal cavity. A median forehead island flap was transferred to cover the inner layer of the graft. In the second stage, the obliterated nasal orifice was opened, and the inner lining was constructed by a segment of oral mucosa wrapped around a silicone nostril retainer. Application of an oral mucosa-lined flap would seem to be a superior method for nose reconstruction, since it does not distort the shape of the nose, and it reestablishes a patent nostril and preserves the delicate appearance of the nose.