Simultaneous Rhinoplasty Research Articles

Aesthetic and Functional Outcomes of Simultaneous Rhinoplasty and Lip Lift Surgery: A Systematic Review

Aesthetic and Functional Outcomes of Simultaneous Rhinoplasty and Lip Lift Surgery: A Systematic Review

Effect of a combination of rhinoplasty and septoplasty on the development of acute postoperative syndrome and cortisol secretion into blood plasma

Purpose of the study: to evaluate the effect of a combination of rhinoplasty and septoplasty on the development of acute postoperative syndrome and the secretion of cortisol into the blood plasma.Material and methods. A study was conducted in a group of 98 patients who underwent septoplasty, rhinoplasty or rhinoseptoplasty. Using a Digital Rating Scale, the intensity of pain was assessed 3, 6, 24, 48 hours after the end of surgery. The day before, immediately before and 6 hours after surgical interventions, all patients underwent blood sampling to determine the concentration of cortisol in the blood plasma. The data obtained were compared within groups over time, as well as between groups at the corresponding assessment points.Results. The intensity of pain 3 hours after surgery was significantly lower in the group of patients after rhinoplasty and significantly decreased after 6 (p < 0.001), 24 (p < 0.01), 48 (p < 0.001) hours after surgery, compared with patients who underwent septoplasty and rhinoseptoplasty. In the early postoperative period, patients from the rhinoplasty group had the lowest cortisol concentrations in the blood plasma, compared with patients after septoplasty (p < 0.001) and rhinoseptoplasty (p < 0.01). In patients who underwent rhinoseptoplasty, the level of cortisol in the blood was significantly higher compared with patients after septoplasty (p < 0.01).Conclusion. The assessment of acute pain using a digital rating scale after rhinosurgical interventions showed that septoplasty provokes the development of a stronger acute pain syndrome in the early postoperative period, which proves its trauma compared to rhinoplasty. Simultaneous rhinoplasty and septoplasty in the first days after surgery contributes to an increase in the concentration of cortisol in blood plasma, as well as an increase in pain syndrome.

Simultaneous Rhinoplasty and Septal Perforation Repair Using the Bone-Cartilaginous Unit.

Various techniques are employed for septal perforation repair but success rates still vary. Numerous mucosal flaps are used for septal perforation closure; however, a scaffold is essential for proper positioning and enhanced mucosal growth. The aim of this study was to assess the effectiveness of utilizing a septal bone/cartilage composite graft (BC unit) to close septal perforations in rhinoplasty patients and evaluate patient satisfaction. This case series included patients with septal perforation undergoing rhinoplasty and perforation repair between 2019 and 2023. BC units were used to cover the cartilaginous perforations in all patients. Patients were followed for a minimum of 1 year, assessing surgical results and postoperative satisfaction with the 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). In this study, 31 patients (22 female, 9 male), with a mean [standard deviation] age of 34.80 [10.31] years (range, 19-59 years), were enrolled. Nine had previousl undergone septoplasty, while four had undergone septorhinoplasty. The preoperative perforation size ranged from 6 to 27 mm (mean, 14.1 mm). At final follow-up, 26 cases (83.8%) achieved complete closure, while 3 had incomplete closures, and 2 experienced reperforation. Analysis revealed a notable mean decrease of 31.93 [26.47] in obstruction domain scores (SCHNOS-O) and a mean decrease of 44.19 [25.37] in cosmesis domain scores (SCHNOS-C). Septal perforation repair and rhinoplasty can be safely and effectively performed concurrently with BC units for suitable candidates.

Rhinoplasty and Le Fort I Maxillary Osteotomy in Cleft Patients.

Cleft patients often need orthognathic surgery to correct maxillary hypoplasia and rhinoplasty to correct nasal deformity. Rhinoplasty can be performed as a staged procedure after orthognathic surgery or simultaneously with maxillary osteotomy. The authors evaluated need for and complications of staged and simultaneous rhinoplasties in patients with different cleft types undergoing maxillary osteotomy. This retrospective study examined 99 (54 females) consecutive nonsyndromic patients with cleft lip/palate [23 bilateral cleft lip and palate (BCLP), 51 unilateral cleft lip and palate (UCLP), and 25 cleft palate (CP)] with a mean age of 17.8 (range: 11.5-45.3) years who had undergone Le Fort I maxillary advancement or bimaxillary osteotomy at the Cleft Palate and Craniofacial Center, Helsinki University Hospital, Finland, between 2002 and 2016. Medical charts were accessed through the hospital's archives and database. Of patients who underwent maxillary osteotomy, 45% (45/99) needed rhinoplasty (14 BCLP, 27 UCLP, and 4 CP). A significant difference ( P <0.01) existed in the need for rhinoplasty between different cleft types, those with BCLP and UCLP needing the most operations (60% and 53%). In 20 patients (20%), rhinoplasty was performed simultaneously with maxillary osteotomy, and in 25 patients (25%) in a second operation after osteotomy. The overall complication rate was 14%. No difference existed in complication rate in patients with or without simultaneous rhinoplasty. Of cleft patients who underwent maxillary osteotomy, 45% needed rhinoplasty. Patients with BCLP and UCLP needed rhinoplasty most often. Staged and simultaneous procedures were almost equally common with similar complication rates.

Correction of Cleft Lip Nose Deformity With Circular Shape Alar Graft and Block Costal Cartilage.

Secondary deformities of the cleft lip and nose are mainly caused by the long period of craniofacial development and the secondary scarring. Correction of the secondary cleft lip-nose deformity is a complex process that requires both the correction of the soft tissue and skeletal support. The purpose of this study was to present our experience in correcting the secondary unilateral cleft lip-nose deformities with autologous costal cartilage. A retrospective analysis of patients who underwent correction of unilateral cleft nasal deformity with simultaneous rhinoplasty by a senior surgeon from January 2015 to January 2022 was conducted. Preoperative and postoperative measurements of the columellar-labial angle and the inclination of nasal base were conducted to evaluate the surgical outcomes. A total of 54 patients were included in this study according to the inclusion criteria. The mean follow-up period was 4 years (range, 1-7 years). The mean values of the columellar-labial angle were 91.1 ± 9.2 degrees preoperatively and 101.0 ± 5.9 degrees postoperatively. The mean values of the inclination of nasal base were 4.5 ± 1.2 degrees preoperatively and 0.9 ± 0.4 degrees postoperatively. There was a considerable increase in the columellar-labial angle after the surgery (9.9 ± 6.0 degrees; P < 0.01). The inclination of nasal base decreased significantly (3.6 ± 1.1 degrees; P < 0.01). Our approach on correction the secondary clef lip nose through repositioning the muscles by Z-plasty and application of the block cartilage graft and circular shape alar graft has achieved long-term satisfactory results.

The effect of simultaneous rhinoplasty and septoplasty on the development of postoperative pain syndrome

Introduction. One of the most difficult goals in facial reconstructive surgery is to eliminate defects in the external nose. Difficulties may arise with simultaneous septo- and rhinopalasty, as there is a need to restore and preserve the structures of the nasal cavity. To date, there are not many studies that would be aimed at assessing the pain syndrome after surgery on the structures of the nose, which was the impetus for studying this problem. The purpose of the study. The purpose of this study was to study the severity of acute pain syndrome after septoplasty, rhinoplasty and rhinoseptoplasty. Materials and methods. A total of 98 patients, 19 men and 79 women, aged from 18 to 45 years, were examined and operated on. The open rhinoplasty group (group 1) included 6 men and 27 women, the open rhinoseptoplasty group (group 2) – 7 men and 26 women, and the septoplasty group (group 3) included 6 men and 26 women. To ensure premedication, all patients were prescribed 2 ml of 0.4% dexamethasone solution, 4 ml of 0.2% ondacetron solution. Preoxygenation of 100% O2 5-6 l/min was carried out with the help of an anesthetic mask. Induction of anesthesia was carried out with 20 ml (200 mg) of 1% propofol emulsion. To achieve myoplegia, a solution of ridelate C (50 mg) was administered. For anesthesia purposes, 2 ml of 0.005% fentanyl solution (0.1 mg) was administered intravenously. Infiltration anesthesia during rhinoplasty was carried out using a 2% solution. Local anesthesia was performed by intramuscular administration of a 50 mg ketoprofen solution before surgery, 24 and 48 hours after manipulation, as well as for 3 days after it, taking into account the severity of the pain syndrome. After performing rhinoplasty, septoplasty and rhinoseptoplasty, the severity of the pain syndrome was assessed using a visual analog scale (VAS), a digital rating scale (DRS) and facial pain scale (FPS 3, 6, 24, 48 hours after the end of surgery. Results. According to the VAS pain syndrome assessment, the pain intensity in group 1 was maximal one hour after rhinoplasty and subsequently had negative dynamics: on the 3rd, 6th (p&lt;0.001), 24th (p&lt;0.05) and 48th (p&lt;0.001) hours after surgery. In groups 2 and 3, the highest pain intensity was recorded at the 3rd hour after surgery (p&lt;0.001), compared with the hour after surgery. According to the DRS, the intensity of pain 3 hours after rhinoplasty in group 1 decreased, compared with his assessment 1 hour after surgery, and continued to decrease on the 3rd, 6th (p&lt;0.001), 24th (p&lt;0.01) and 48th hours (p&lt;0.001). In group 2, 3 hours after surgical manipulation, the intensity of the pain syndrome increased significantly compared to the previous period of its assessment (p&lt;0.05), which was also found in the group of patients after rhinoseptoplasty (p&lt;0.05) at the same time. Assessing the severity of the pain syndrome according to FPS, in group 1, the pain syndrome was insignificant and did not cross the threshold. In patients of groups 2 and 3, compared with the 1st hour after the interventions, pain syndrome significantly increased after 3 hours (p&lt;0.001), but subsequently decreased. Conclusion. Based on the analysis of acute postoperative pain syndrome, this study confirms that septoplasty is a more traumatic intervention compared to rhinoplasty, and surgical operations in the area of the external nose and on the nasal septum in the early postoperative period entail excalation of stress reactions, relative to rhinoplasty and septoplasty.

Rhinoplasty as an Adjunct to Orthognathic Surgery:: A Review.

Orthognathic surgery is a well-recognized method to correct dentofacial deformities. The main goal of orthognathic surgery is to improve soft tissue change. Soft tissue changes to the nose have been well documented. Simultaneous rhinoplasty during orthognathic surgery can be performed to correct existing inherent nasal deformities and also the unfavorable changes that arose from the maxillary surgery. Challenges for concurrent nasal surgery with jaw surgery include preoperative, perioperative, and postoperative which can be overcome with meticulous planning and experience. In complex cases, rhinoplasty can be staged in the last 6months after the orthognathic surgery.

Facial masculinization surgery

Facial masculinization surgery

Concurrent management of nasal bone expansion from nasal polyposis (Woakes' disease).

BackgroundWoakes' disease is the eponymous name for severe chronic rhinosinusitis with nasal polyposis (CRSwNP) leading to thinning and expansion of the nasal pyramid. The endoscopic treatment of the sinus disease, while extensive, is standard practice for the rhinologist. Management of their external nasal deformities, for many, is not. Simultaneous closed rhinoplasty in these patients is straightforward, easy to perform and achieves an excellent esthetic outcome.MethodsThree patients with CRSwNP and notable nasal pyramid expansion are reviewed. All patients had eosinophilic disease, with two having NSAID‐exacerbated respiratory disease (N‐ERD). All three patients underwent full house endoscopic sinus surgery from May 2018 to September 2019 along with simultaneous closed rhinoplasty. Two of these patients required only external digital pressure to fracture the nasal bones for gentle Boies elevator repositioning, while the third had osteotomies with minimal force to aid reduction.ResultsPostoperatively, patients had excellent nasal airway symptom improvement, and the cosmetic results following rhinoplasty demonstrated normalization of symmetry, profile, and contour of the nose with high‐patient satisfaction.ConclusionBased on our experience, simultaneous rhinoplasty on the thinned nasal bones of Woakes' Disease patients is not only easy to perform, but provides excellent cosmetic and functional results by allowing bone to remodel in the appropriate position, and avoids a second‐stage rhinoplasty.

Nasal spine implant to correct nasal asymetry and to enable nose correction accompanying orthognathic surgery

ObjectivesOrthognathic surgery is gaining importance as an aesthetic procedure. The aim of this work is the first case report of a simultaneous rhinoplasty and orthognathic surgery, using a nasal spine implant. Case reportThis is a retrospective study based on the CARE guideline. A nasal spine implant was virtually planned and printed in polyetheretherketone (PEEK) to correct a nasal deviation and enable a rhinoplasty in the same surgical time. Both the surgeon and the patient were very satisfied with the clinical result. ConclusionsVirtually planned and printed nasal spine implant is feasible. A helpful method to support rhinoplasty in orthognathic surgery to avoid deviations in the tip of the nose or asymmetries in the nostrils.

Clinical Practice Trends and Postoperative Outcomes in Primary Cleft Rhinoplasty.

Optimal correction of the cleft nasal deformity remains challenging. The purpose of this study was to examine the practice patterns and postoperative course of patients undergoing cleft lip repair with rhinoplasty compared to those who have primary lip repair without rhinoplasty. A retrospective cohort study was conducted based on the Kids' Inpatient Database. Data were collected from January 2000 to December 2011 and included infants aged 12 months and younger who underwent cleft lip repair. The predictor variable was the addition of rhinoplasty at primary cleft lip repair. Primary outcome variables included hospital setting, year, and admission cost, while secondary outcome variables included length of stay and postoperative complication rate. Independent t-tests and chi-squared tests were performed. Continuous variables were analyzed by multiple linear regression models. The study sample included 4559 infants with 1422 (31.2%) who underwent primary cleft rhinoplasty. Over time, there was a significant increase in the proportion of cleft lip repairs accompanied by a rhinoplasty (p < .01). A greater proportion of patients with unilateral cleft lips received simultaneous rhinoplasty with their lip repairs (33.8 vs 26.0%, p < .01). This cohort had a significantly shorter length of stay (1.6 vs 2.8 days, p < .01) when compared to children that underwent cleft lip repair alone. Performing primary cleft rhinoplasty is becoming more common among cleft surgeons. Considering comparable costs and complication rates, a rhinoplasty should be considered during the surgical treatment planning of patients with cleft nasal deformities.

Costal Cartilage and Costal Perichondrium Sandwich Graft in Septal Perforation Repair.

Repair of the septal perforation is a challenging procedure and there are many different surgical techniques. In this study, the authors present a novel method which the authors use costal cartilage and costal perichondrium sandwich graft as an interposition graft with bilateral opposing mucoperichondrial flaps. Fourteen patients (5 females, 9 males) underwent septal perforation repair. All surgeries were performed through an open approach septoplasty technique. The edges of the perforation were incised to excise the mucosa with a thickness of 2 mm. Bilateral mucoperichondrial flaps were raised. Then costal cartilage and costal perichondrium were harvested from the rib. The cartilage was divided into a smaller piece which is 2 mm thick and 1 cm wider than perforation size. The prepared cartilage was wrapped with perichondrium to obtain a sandwich graft. This sandwich graft was placed between the mucoperichondrial flaps, corresponding to the perforation. After 9 months of follow-up, 11 (78%) of the 14 perforations were completely closed. Failure of the repair was observed in 3 patients; 2 of the perforations were medium size and one perforation was large size. No complications occurred. Using costal cartilage and costal perichondrium sandwich graft is a novel and useful technique especially in large septal perforations. Considering that septum surgery has an important role in the etiology of septum perforation, this method provides a good graft source for both perforation closure and simultaneous rhinoplasty surgery.

S4B-22 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS SIMULTANEOUS RHINOPLASTY IN ORTHOGNATHIC SURGERY IN CLEFT PATIENTS

Introduction: Thirty five percent of clef and lip patient need an orthognathic surgery to improve the function and aesthetic structure of the face. Considering the proximity between the nose and the maxilla, when a Lefort I osteotomy is performed, nose structure can change, making it difficult for the surgeon to predict the surgical result. Some reports have described the changes seen in non cleft and lip patients. Cleft and lip patients are often seeking to improve their facial structure aesthetically, most of them require a rhinoplasty in order to achieve that. A detailed and careful planning of the surgery as well as an accurate knowledge of the nasal anatomy in these type of patients allows the surgeon to correct and prevent some of the changes made with the osteotomy. The purpose of this study was to evaluate nasal changes in orthognathic patients with cleft and lip, describe surgical considerations made in order to correct and prevent nasal deformities and analyze the aesthetic outcomes and prevalence over time. Methods: A retrospective study over a 5 years period was perform. Two main groups where identify, (1) patients with maxillo mandibular discrepancies and cleft lip and palate and (2) patients with maxillo mandibular discrepancies with out cleft lip and palate. Clinical photographs and CT Scans where analyzed through time, 1 year, 3 years and 5 years. Patient demographic information, medical record, surgical plan and follow up record were compiled. Results: 220 patients undergoing orthognathic surgery with simultaneous rhinoplasty where analyzed. 82 percent of the patients underwent a Lefort I osteotomy. Of this 82 percent, 40 percent were combined maxillo mandibular osteotomies and 60 percent were only lefort I osetomies. The patients were dived into two groups, 37 patients were cleft lip and palate patients and 63 were not. 38 percent of the lefort I osteotomy patients underwent a maxillar advancement of 5mm or more. During surgery 95 percent of the patients with cleft lip needed to correct base widening, where as in the control group 60 percent of the cases needed it. 1 percent of the patients needed a minor nose correction. All of our patients refer a satisfactory aesthethic and functional result. Conclusion: We present our long term results of simultaneous rhinoplasty with orthognathic surgery, in patients with cleft lip and palate, and in patients with out. We observed that the main anatomic changes in patients with cleft and lip were base widening, lost of tip support and lack of tip projection, surgical modifications and recommendations were made for each group of patients. After analyzing our results we conclude that simultaneous rhinoplasty in orthognathic surgery in cleft and lip patients should be performed obtaining satisfying functional and aesthetic results that endure overtime.

Bilateral cleft lip repair with simultaneous premaxillary setback and primary limited rhinoplasty

BackgroundFunctional closure of the orbicularis oris muscle and esthetic reconstruction of nasolabial components are impossible in patients with severely deformed premaxilla. Here, we review a surgical strategy for patients with unremedied premaxilla retrospectively.ResultsVomerine ostectomy and premaxillary setback with nasolabial repair were performed in 12 patients with bilateral cleft lip and palate. The mean age of patients was 21.7 months. The extent of ostectomy varied between 3 and 11 mm. There were no serious complications from defective perfusion to the premaxilla or the philtral flap. The follow-up period ranged from 2 to 25 months. Proper positioning of the premaxilla and satisfactory nasolabial esthetics were achieved in all patients.ConclusionsWe performed nasolabial repair after premaxillary setback without jeopardizing the premaxillary segment or the philtral flap. Our surgical strategy could be recommended in poor socio-economic circumstances due to the cost effectiveness of limiting the number of surgeries.

Improvement of Aesthetic and Nasal Airway in Patients With Cleft Lip Nasal Deformities: Rhinoplasty With Septal Cartilage Graft and Septoplasty.

To assess the improvement of nasal morphologies and ventilation after septal cartilage graft and septoplasty of patients with unilateral cleft lip and palate (UCLP). Retrospective case-control study. Tertiary stomatology hospital. In total, 118 patients with UCLP who had been diagnosed with a secondary nasal deformity and had reconstructive rhinoplasty and/or septoplasty between 2010 and 2015. Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, septum deviated angle, rhinoplasty satisfaction questionnaire, and 3-dimensional photographs. Average follow-up period was approximately 12 months for both groups. NOSE and 3-dimensional computed tomography (3DCT) analysis demonstrated postoperative improvement in nasal airway function of those patients who underwent rhinoplasty and septoplasty simultaneously ( P < .05). Subjective assessment by patients' visual analog scale (VAS) and objective assessment by 3-dimensional stereophotography demonstrated postoperative improvement in nasal morphologies, particularly the columella deviation angle and nasal depth (representing nasal tip height), which are crucial parameters of nasal aesthetics ( P < .05). In patients who underwent simultaneous rhinoplasty and septoplasty, nasal symmetry and ventilation function were significantly improved compared to the control group. Septum grafts could provide nasal tip support for patients with cleft lip. Three-dimensional stereophotogrammetry helped us to better visualize the surgical results. Although the septal cartilage of Asian patients is sometimes insufficient for simultaneous use for multiple grafts, septum grafts in rhinoplasty of patients with cleft lip nasal deformities could give support for nasal tips.

The substantiation for simultaneous rhinoplasty and correction of the intranasal structures in the patients presenting with the combination of pathology of the nasal cavity and disfigurement of the shape of the nose

The objective of the present work was to evaluate the effectiveness of rhinoplasty performed in the combination with the correction of the intranasal structures. The study included the comparison of intra- and post-operative characteristics of rhinoplasty carried out with and without correction of the intranasal structures in 374 patients presenting with the combination of pathology of the nasal cavity and disfigurement of the shape of the nose. It was shown that the simultaneous surgical interventions are not accompanied by a significant increase in the frequency of intra- and post-operative complications in comparison with rhinoplastic surgery alone; nor do they require additional time expenditures. At the same time, the absence or the inadequate performance of septoplasty and/or the correction of the inferior turbinated bone during rhinoplasty in the patients presenting with the combination of pathology of the nasal cavity and disfigurement of the shape of the nose is fraught with the poor aesthetic outcome of the treatment and persistent disturbances of the respiratory function.

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation. To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements. This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images. Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically. Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002). This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.

Alveolar bone grafting with simultaneous cleft lip rhinoplasty

Optimal timing for cleft lip rhinoplasty is controversial. Definitive rhinoplasty is deferred until facial skeletal growth is completed. Intermediate rhinoplasty is performed after stabilization of the grafted alveolar bone, because the grafted bone tends to be absorbed over several months postoperatively, distorting the nasal profile. Here, we report our experience with simultaneous rhinoplasty during alveolar bone grafting for indicated patients, describe our surgical technique that ensures long-term bone graft survival, and report graft take rates and nasal profile changes. This retrospective chart review included a total of 54 patients; 44 underwent alveolar bone grafting only, and 10 underwent simultaneous cleft lip rhinoplasty. All surgeries were conducted with a judicious mucosal incision for tensionless wound closure. Bone graft take was evaluated with dental radiographs by the Bergland classification. Further, nasal aesthetic outcome was evaluated with medical photographs, based on nostril height and width and alar base width. In total, 96.3% of clefts showed graft success with Type I (66.7%) or Type II (27.8%) classifications; only 3.7% of clefts showed unfavorable results classified as Type III, and no clefts showed Type IV failure. The nasal shape was flatter with a decreased nostril height and increased nostril width after alveolar bone grafting, while nostril height was increased and nostril width was decreased in patients who underwent simultaneous rhinoplasty. With surgical techniques ensuring alveolar bone graft survival, simultaneous cleft lip rhinoplasty can result in nasal aesthetic improvement for patients with severe nasal deformities, decreasing the number of operations.

Evaluation of the results of simultaneous open rhinoplasty and Abbe flap for the reconstruction of the secondary bilateral cleft and nasal deformity

We aimed to evaluate the results of simultaneous rhinoplasty and Abbe flap for the reconstruction of the secondary bilateral cleft and nasal deformity by means of a newly developed software-based method. A total of 16 patients with the bilateral cleft lip nasal deformity received Abbe flap and simultaneous open rhinoplasty between 2004 and 2010. The mean age of the patients was 21 years, and the average follow-up time was 2.4 years. After the open rhinoplasty procedure, the upper lip was reconstructed with the Abbe flap. Preoperative and postoperative photographs that had been taken laterally were evaluated by using Adobe Photoshop(®) CS4 and Adobe InDesign(®) software. The length of the columella and the relative changes of the most anterior point of the upper lip to the vertical plane tangent to the most anterior point of the lower lip were measured in pixels on standardized preoperative and postoperative images. The differences were calculated and compared as a percentage (%). There was no flap loss and associated problems. The measurements of columellar length revealed an average increase of 51.8±11.3%, while the relative change of the most anterior point of the upper lip revealed an average increase of 68.6±11.2%. The results of the treatment modality were successfully evaluated by a newly developed software-based method.

Simultaneous orthognathic surgery and rhinoplasty

Simultaneous orthognathic surgery and rhinoplasty