Rib Cartilage Graft Research Articles

Tissue Engineering Auricular Cartilage: A Review of Auricular Cartilage Characteristics and Current Techniques for Auricular Reconstruction.

Microtia and anotia are congenital auricular anomalies that negatively impact the psychosocial development of those affected. Because auricular cartilage is a type of elastic cartilage that lacks regenerative capacity, any notable defect in its structure requires a surgical approach to reconstructing the auricle. While there are several reconstructive options available between alloplastic and prosthetic implants, autologous rib cartilage grafts remain the most commonly used treatment modality. Still, this widely used technique is accompanied by significant patient discomfort in a young child and carries additional risks secondary to the traumatic process of rib cartilage extraction, such as pneumothorax and chest wall deformities, and the final esthetic results may not be ideal. To circumvent these limitations, tissue engineering approaches have been used to create a realistic-looking ear that mirrors the complex anatomy of the normal ear. This article reviews the biochemical and biomechanical properties of human auricular cartilage as they relate to design criteria. In addition, a variety of cell sources, biocompatible scaffolds, scaffold-free techniques, and mechanical and biological stimuli are discussed. This review aims to identify knowledge gaps in the literature related to auricular cartilage characteristics and make recommendations to drive the field of auricular tissue engineering.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery

To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

AUTOGENOUS RIB GRAFT FOR NASAL RECONSTRUCTION, PANORAMIC REVISION

Introduction: It is remarkable the increase in the last decades of rhinoplasties for aesthetic and functional reasons. Some congenital, iatrogenic or traumatic etiologies originate a deficient or deformed nasal dorsum that needs correction with a dorsal augmentation. A deficient osteocartilaginous dorsum is the most frequent drawback requiring augmentation with graft material. Objective: to detail the current information related to autogenous rib grafting for nasal reconstruction. Methodology: a total of 33 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 24 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, SciELO, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: graft, autologous, rhinoplasty, costal, nose, deformity. Results: Costal cartilage is a remarkable material in reconstructive septorhinoplasty, mainly in revision surgery because it requires large amounts of tissue. This autologous material presents a low incidence of complications. With increasing age it is more likely that this cartilage is calcified, so its procurement and manipulation will be more complex. The most commonly used cartilage is the septal cartilage, however, in several cases the septal cartilage may not be sufficient for the intervention, it may be very deteriorated or absent, so the costal cartilage is an essential support for very damaged noses or in case of secondary surgeries. Conclusions: the graft of choice is the septal cartilage due to its simple procurement and physical elastic properties, however its ration is scarce. Rib cartilage is a graft that provides a lot of material. The costal cartilage graft is a fruitful tool when facing complex surgeries or nasal reconstructions. Autologous rib cartilage graft is a viable alternative in reconstructive septorhinoplasty. The surgical technique is not complicated and has a low complication rate. KEY WORDS: autologous graft, rhinoplasty, nasal aesthetics, nasal deformity.

Complications Associated with Alloplastic Materials in Rhinoplasty and Their Operative Management.

Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound. LEVEL OF EVIDENCE: N/A.

Le Fort I and nasal fracture, primary reduction, and secondary revision saddle nose: A case report

Maxillofacial trauma is a common clinical situation in emergency rooms. Lesions involving the maxillofacial complex pose a significant public health challenge, not only due to their costs but also because of the potential functional and aesthetic issues that patients may experience. While some fractures are more suitable for delayed treatment, others necessitate immediate attention, requiring intervention within 24 hours of the trauma occurrence. Different types of reduction and fixation exist depending on the patient’s age, location, type of fracture, and the surgeon’s preferences. We reported a case of a 20-year-old female patient diagnosed with Le Fort I bilateral fracture and closed nasal fracture followed by saddle nose. The patient was managed with open reduction internal fixation and closed reduction nasal bone. The saddle nose in the patient was managed four months later by augmentation rhinoplasty with rib cartilage and pearl fat graft. Proper management of Le Fort I fracture and nasal fracture accompanied with saddle nose by open reduction internal fixation and augmentation rhinoplasty with rib cartilage and pearl fat graft can restore occlusion and improve symmetrical, proportional facial aesthetics, which is the indicators of a successful holistic maxillofacial trauma management.

Chondrocyte-laden gelatin/sodium alginate hydrogel integrating 3D printed PU scaffold for auricular cartilage reconstruction

Clinically, modified autologous rib cartilage grafts and commercial implants are commonly used for intraoperative repair of auricular cartilage defects caused by injuries. However, scaffold implantation is often accompanied by various complications including absorption and collapse, resulting in undesirable clinical outcomes. Three-dimensional printed auricular cartilage scaffolds have the advantage of individual design and biofunctionality, which attracted tremendous attention in this field. In this study, to better simulate the mechanical properties of auricular cartilage, we tested PU treated by ultrasonication and high temperature for 30 min (PU-30) or 60 min (PU-60). The results indicated that the compression modulus of PU-30 was 2.21–2.48 MPa, which similar to that of natural auricular cartilage (2.22–7.23 MPa) and was chosen for subsequent experiments. And the pores of treated PU were filled with a gelatin/sodium alginate hydrogel loaded with chondrocytes. In vivo analysis using a rabbit model confirmed that implanted PU-30 scaffold filled with chondrocytes contained hydrogel successfully integrated with normal auricular cartilage, and that new cartilage was generated at the scaffold-tissue interface by histological examination. These findings illustrate that this engineered scaffold represents a potential strategy for repair of ear cartilage damage in clinical.

Use of an autologous dermal flap and rib cartilage graft in the repair of a large tracheoesophageal fistula with tracheal stenosis.

Management of large tracheoesophageal fistulas complicated by tracheal stenosis remains challenging as it requires an ideal replacement for the membranous defect as well as a permanent buttress to reconstruct the stenotic segment. We present the successful use of an autologous free dermal flap reinforced with a pedicled pectoralis major muscle to repair the tracheal membranous wall and a rib cartilage graft to enlarge the tracheal lumen.

Algorithmic Elementary-Age Nasal Reconstruction for Binder Syndrome

Background: Nasomaxillary hypoplasia, or Binder syndrome, is conventionally treated at skeletal maturity (SKM). However, our institution has employed a stratified treatment algorithm, treating severe patients with serial nasal expansion beginning at elementary school age (5-11 years) to expand the soft tissues and improve appearance prior to definitive rhinoplasty at SKM. This study evaluates the treatment patterns and outcomes of Binder syndrome employing this pathway. Methods: Eight cases of nasomaxillary hypoplasia were identified from a database of rhinoplasties performed between 2006 and 2020 at a tertiary children’s hospital. Photomorphometric analyses were conducted on basal, frontal, and lateral photographs. Goode’s ratio was used to assess change in projection, and pronasale to ala distance was measured bilaterally as a proxy of symmetry. Changes in symmetry were calculated using bilateral nasal width ratio. Results: In our sample, 6 patients (75.0%) had initial rhinoplasty prior to SKM, with 3 undergoing serial silastic implant placement, one with complicated implant placement followed by autologous reconstruction, and 2 undergoing serial expansion with allograft rib cartilage grafts. Average age at initial rhinoplasty was 6.3 (range 5.2-8.8) years for the pre-SKM group and 15.6 (range 14.1-17.1) years for the post-SKM group. Patients in the pre-SKM rhinoplasty group underwent more procedures than those at SKM (2.3 vs 1.5, respectively). The average change in nasal parameters was −0.029 for Goode’s ratio and −9.5° for nasolabial angle. The average post-operative nasal symmetry index was 0.98 representing near perfect symmetry. There was no significant difference in the degree of improvement in nasolabial angle, Goode’s ratio, or nasal symmetry between SKM and pre-SKM cohorts (all P &gt; .05). Conclusion: Among patients with Binder syndrome, those treated initially at elementary-age were able to achieve similar improvements in nasal indices to those treated at SKM. This approach allows patients to live their key developmental years with less stigmata of their facial difference but requires more surgical intervention.

Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with Three-Dimensional Planning.

Progressive hemifacial atrophy (PHA) is a rare disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures. For severe PHA patients with obvious bone deformities, skeletal framework reconstruction is needed in addition to soft-tissue augmentation. The authors propose a new combinatorial surgical method using rib cartilage graft and free adipofascial flap for restoring facial symmetry. To improve the surgical accuracy, preoperative three-dimensional planning and printing was used. Twelve patients with severe facial atrophy were included in the authors' study. Three-dimensional facial image analyses were performed preoperatively to quantify the facial asymmetry. Rib cartilages were harvested and sculptured to the appropriate shape created by three-dimensional planning and fixed to the atrophic bone. The circumflex scapular artery-based adipofascial flap was transplanted to repair soft-tissue deficiency. A residual small monitor flap was left with the adipofascial flap. A revision surgery was performed to perfect the repair if the contour was suboptimal 6 months postoperatively. The adipofascial flaps survived in all 12 patients. All patients achieved good healing without complications. At 1 more year after surgery, the rib cartilage was still in position and rarely absorbed. The morphologic and volumetric difference between the affected side and the unaffected side was improved significantly postoperatively. All patients were satisfied with the results, and no more additional operations were required. The combinatorial surgery of rib cartilage graft and free adipofascial flap in the setting of three-dimensional planning and printing can be a good choice in restoring facial symmetry in severe cases of PHA. Therapeutic, IV.

A Unique Case of Modifying an Old Extended Spreader Costal Graft into a Supportive Structure in a Nasal Alar Reconstructive Surgery – A Case Report

A ten-year-old reconstruction surgery of a total nasal dorsum defect on the right nose involves a medial arm flap and self-rib cartilage, complicated into fibrous tissue retraction, which caused nostril narrowing and asymmetry. This complication was corrected using a combination of a nasolabial flap for a skin coverage and a modified, old rib cartilage graft to create a supportive rim for the newly reconstructive right nasal ala. There is controversy about the advantage of auricular cartilage versus costal cartilage with a gap in academic studies. However, in this case, costal cartilage has shown significant benefits that helped patients to gain the best functional and aesthetic results. In addition, the modification of an old nasal graft for another function is a unique spotlight in our case. Therefore, we report a case about using an old nasal graft for an alternative function, as well as the observed results from the first-stage of this procedure.

A case report of rib cartilage graft dropped on the operating room floor during nose reconstruction surgery

Background: Most of the available literature on grafts being contaminated by dropping them on operating room floors has focused on bones and tendons. By contrast, few studies concern skin grafts, with no existence of rib cartilage grafts. However, due to the lack of protocols when such an incident occurs, the results in the literature are incompatible. Most of the studies recommend managing the situation by sterilizing the graft with antiseptic agents and completing the surgery as well as avoiding obtaining another graft, which might increase morbidity. Case Presentation: Here, we report a case at the rhinoplasty clinic at King Abdullah Medical City in Makkah, Saudi Arabia. The case is of a 30-year-old male patient who complained of a saddle nose with a loss of tip support and severely deviated septum grade 5 caused by a history of trauma. The patient also had symptom-free pectus excavatum that had not been corrected surgically. Otherwise, the patient had a good body build with no family history or past medical/surgical history. Conclusion: The patient underwent reconstructive surgery to the nose using rectus muscle fascia and a rib cartilage graft. During the operation, the cartilage was accidentally dropped on the floor. Due to the patient&amp;apos;s chest configuration, harvesting a new graft was difficult. Thus, the same graft was used after decontamination. Clinicians who treat patients in similar clinical circumstances in the future may benefit from our experience.

Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft

A 1-2-mm thin rib cartilage graft was used as a septal extension graft to overcome the drawbacks of traditional rib cartilage rhinoplasty, which often results in a stiff nasal tip. The remaining rib cartilage was placed on the nasal dorsum as an ultrafine diced cartilage wrapped in fascia (UDCWF) graft. This study aimed to assess the stability of thin rib cartilage grafts and measure the resorption rate of the UDCWF graft. This retrospective study included 53 patients who underwent rhinoplasty with septal extension grafting and nasal dorsum augmentation using a septal cartilage (SC group) or rib cartilage (RC group) graft between June 2017 and June 2020. The nasal length, tip height, sellion height, and nasolabial angle in the preoperative, immediate postoperative, and long-term postoperative periods were analyzed using three-dimensional photogrammetry. A total of 26 patients received rib cartilage grafts and 27 patients received septal cartilage grafts. The RC group showed greater maintenance of tip height, nasal length, and tip derotation over time. The relapse ratio in tip height was -3.3±1.6% and -8.4±4.3% in the RC and SC groups, respectively (p=0.001). The resorption rate of the UDCWF graft was -7.5±3.6% and -7.8±2.3% at the sellion and rhinion, respectively. The thin rib cartilage provided sufficient intrinsic strength to maintain tip height and tip rotation. It can be an effective alternative to rhinoplasty in Asians with features such as thick skin and a short nose. Moreover, the UDCWF graft exhibited an approximately 7.5% resorption rate, leading to lower probabilities of dorsal irregularity and stepping deformity.

Cleft Rhinoplasty: Does Timing and Utilization of Cartilage Grafts Affect Perioperative Outcomes?

The purpose of this study was to evaluate the epidemiology and perioperative complications of different reconstructive strategies to correct cleft nasal deformity, with particular attention paid to type and timing of cartilage grafting. Retrospective cohort study was conducted of cleft rhinoplasty performed between 2012 and 2017 in North America utilizing the American College of Surgeons National Surgical Quality Improvement Program- Pediatric hospital network. Medical/surgical complications, reoperations, and readmissions within 30 days postoperatively were analyzed with appropriate statistics. During the study interval, 3317 pediatric patients underwent cleft rhinoplasty, with 8.0% involving the use of cartilage grafts. Ear cartilage was significantly more commonly used for intermediate repair, whereas rib cartilage was more commonly used for late repair (P=0.006). Overall, rhinoplasties with ear cartilage grafts had shorter procedure durations than those without cartilage grafts (P=0.005), whereas those with rib cartilage grafts had increased procedure duration (P<0.001). The use of cartilage grafts was not associated with increased complications in either intermediate or late cleft rhinoplasty. Patients with bilateral clefts were more likely to undergo rhinoplasty with cartilage grafts overall (P=0.047) and with cartilage grafts for late reconstruction (P=0.039). Ear cartilage is most frequently utilized for intermediate repair, whereas rib cartilage is most frequently utilized for late repair during cleft rhinoplasty. Ear cartilage grafts are associated with significantly decreased procedure duration, whereas rib cartilage grafts are associated with significantly increased procedure duration. Not surprisingly, cleft rhinoplasty is relatively safe, with a 2% overall short-term complication rate.

Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A 9-Year Experience.

Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax. A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection. The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent). The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft. Therapeutic, IV.

Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction

Background:There is minimal information describing the common characteristics among patients seeking primary/revision rhinoplasty. Success is traditionally interpreted from the surgeon's viewpoint, without considering the patient's perspective. The study's aims were to (1) identify/compare anatomic and functional characteristics commonly found in patients seeking primary and revision rhinoplasties; (2) assess patient satisfaction using a survey; and (3) explore whether graft choice (auricular cartilage versus rib cartilage) affects patient satisfaction and outcome in revision rhinoplasty.Methods:A retrospective review of all rhinoplasties by a single surgeon from June 2016 to January 2020 was performed, focusing on preoperative anatomic/functional characteristics and operative interventions performed. A survey was then used to assess patient satisfaction. Finally, survey outcomes were compared between patients who received auricular and rib cartilage grafts in revision rhinoplasty.Results:A total of 102 rhinoplasties (53 primary and 49 revisions) were included. Primary rhinoplasties were noted to have more patients with “big” noses (P = 0.015) or humps (P < 0.010). Patients undergoing revision rhinoplasties more commonly exhibited middle vault collapse (P = 0.022). The survey response rate was 60%. Revision rhinoplasty patients had a higher incidence of dissatisfaction with their outcomeConclusions:Several features among patients seeking revision rhinoplasties could have been created in the primary operation. The rhinoplasty surgeon should be careful to not introduce new issues or create worse deformities than those seen following the initial operation. Survey-based outcome analysis demonstrated that revision rhinoplasty patients are more likely to have a greater rate of dissatisfaction following their operation.

Tissue Engineering Auricular Cartilage: A Review of Auricular Cartilage Characteristics and Current Techniques for Auricular Reconstruction

Microtia and anotia are congenital auricular anomalies that negatively impact the psychosocial development of those affected. Because the auricular cartilage is a type of elastic cartilage that lacks regenerative capacity, any notable defect in its structure requires a surgical approach to reconstruct the auricle. While there are several reconstructive options available between alloplastic and prosthetic implants, autologous rib cartilage grafts remain the most commonly used treatment modality. Still, this widely used technique is accompanied by significant patient discomfort in a young child, and it carries additional risks secondary to the traumatic process of rib cartilage extraction, such as pneumothorax, chest wall deformities, and the final aesthetic results may not be ideal. To circumvent these limitations, tissue-engineering approaches have been employed to create a realistic-looking ear that mirrors the complex anatomy of the normal ear. This article provides an overall description of the ear’s anatomy and reviews the traditional management options for auricular reconstruction. The biochemical and biomechanical properties of human auricular cartilage are detailed as they relate to design criteria. In addition, a variety of cell sources, biocompatible scaffolds, scaffold-free techniques, mechanical and biological stimuli have been discussed. This review aims to identify knowledge gaps in the literature related to auricular cartilage characteristics and make recommendations to drive the field of auricular tissue engineering.

Utility of 3D CT Rib Study in Presurgical Planning of Autologous Ear Graft for Pinna Reconstruction in Microtia

Purpose The aim of this study was to demonstrate the utility of three-dimensional computed tomography (3D) CT rib study in presurgical planning to select the autologous rib cartilage graft for pinna reconstruction. Materials and Methods Total of 35 patients of microtia for autologous rib graft from April 2017 to February 2020 were evaluated in this study. All patients had a plain low-dose multislice CT chest. The length of costal cartilages of sixth to ninth ribs bilaterally and width and height of sixth and seventh rib costal cartilage synchondrosis were measured in 3D reconstructed true size coronal images with best possible length displayed. All patients had high-resolution computed tomography (HRCT) temporal studies done to evaluate for associated anomalies in external canal, middle ear cavities, and inner ear structures. Eleven patients had simultaneous HRCT temporal bone done after plain CT chest and rest who had done recent prior study were reviewed without repetition of study. Results There were 19 males and 16 females for 3D CT rib study. Average age of the participants was 16.5 years. The average width of synchondrosis of sixth and seventh rib was 15.4 mm on right side and 14.7 mm on left side, average height of synchondrosis was 28.5 mm on right side and 30.7 mm on left side. Average length of the eighth rib costal cartilage was 88.6 mm on the right side and 90.5 mm on the left side. Average length of the ninth rib was 63.2 mm on the right side and 58.2 mm on the left side. Costal cartilage calcifications were present in 9 patients. Conclusion Preoperative 3D CT rib study provides accurate measurements of rib stock for sculpting autologous ear graft.

Anaplastic thyroid cancer with long-term survival with lenvatinib therapy and preservation of laryngeal function after one-stage reconstruction: A case report.

Laryngotracheal reconstruction is performed to treat locally advanced thyroid carcinoma invading the larynx and/or trachea. The reconstructive technique varies. The present report describes the case of a 71-year-old female patient who underwent surgery for thyroid carcinoma involving the larynx. Reconstructive surgical techniques were employed to maintain laryngeal structure and function. An anterolateral thigh flap with free rib cartilage grafts was used to compensate for laryngeal defects. Although a temporary tracheal stoma was constructed, it closed spontaneously after decannulation. Therefore, one-stage laryngeal reconstruction was accomplished. Post-operative histopathological examination revealed focal anaplastic changes in the lesion, which mainly consisted of papillary components. Post-operative positron emission tomography/computed tomography indicated early recurrence in the left side of the neck. Therefore, lenvatinib was started as adjuvant therapy. Complete response was observed with lenvatinib therapy. The patient was alive and had good laryngeal function 26 months after the operation. One-stage laryngeal reconstruction can reduce burden and improve quality of life in patients with thyroid carcinoma involving the larynx. Lenvatinib may be useful for treating early recurrence of anaplastic thyroid carcinoma after reconstructive surgery with a free flap.

Complications After Inadequate Treatment of Nasal Bone Fracture Combined With Septal Fracture: A Case Report

In treating a nasal bone, an incomplete nasal bone reduction can result in nasal deformity, both aesthetic and functional, requiring a secondary operation. A 60-year-old female with a traumatic comminuted nasal bone fracture with septal fracture was initially treated with closed reduction, which later resulted in a saddle nose and a completely occluded nasal cavity. Later, the patient underwent a revision operation of extracorporeal septorhinoplasty with rib cartilage graft, and the postoperative course was uneventful. Herein, we present a case of complications occurring after inadequate treatment of septal fracture. Physicians should thoroughly evaluate the extent of the nasal bone fracture, including the integrity of the nasal septum, and manage accordingly.

Midfacial Degloving Technique for Free Flap Reconstruction of Nasal and Anterior Skull Base Defects.

Traditionally, surgical access for extirpation and reconstruction of midfacial tumors requires external incisions that can cause a myriad of complications, especially in irradiated patients. The modern midfacial degloving approach involves hidden, sublabial and intranasal incisions that provide reliable access for free flap reconstruction of nasal and maxillofacial tumors. Seven patients with a history of radiation therapy underwent free flap reconstruction of the midface. Five patients underwent the technique in a delayed manner, and the remaining two underwent reconstruction immediately at the time of resection. Five patients underwent free radial forearm fasciocutaneous free flaps and two underwent reconstruction with anterolateral thigh perforator flaps. Bone and/or rib cartilage grafting was used in all patients. All patients underwent successful free flap reconstruction of the midface without external incisions. The most common complication was postoperative infection requiring oral or intravenous antibiotics. No patients sustained loss of their grafts or hardware in the postoperative period. The midfacial degloving technique provides satisfactory exposure to the nasal cavity, midface, orbits, and skull base for free flap reconstruction, without disrupting the external soft tissue. The authors describe a novel use of the midfacial degloving technique to provide safe and reliable results with improved cosmetic outcome.