OBJECTIVES: Rhinoplasty is one of the most common cosmetic surgeries in China. Septal extension grafts (SEG) have been widely used in rhinoplasty, but there are few reports on SEG derived from ear cartilage. This study aims to explore the effectiveness and stability of auricular cartilage nasal SEG transplantation in Chinese rhinoplasty. METHODS: A retrospective analysis of 35 rhinoplasty patients admitted from September 2019 to March 2022 has been conducted. Among them, 29 patients underwent rhinoplasty for the first time and 6 patients underwent rhinoplasty with the age of 18-32 (average 22.4) years old. The postoperative follow-up was 3-28 (average 18.5) months. The improvement of the nose shape was observed. The changes of the nose tip angle, nasolabial angle, and nasofrontal angle were compared between before and after the operation, and the complications were recorded. RESULTS: All patients who underwent rhinoplasty with a septal extension grafts constructed from the concha cavity and concha cartilage showed significant improvement in nasal contour. The preoperative nasal tip angle, nasolabial angle, and nasofrontal angle were significantly improved compared with 3 months after operation (all P<0.001), and there was no significant difference between 3 months and 14 months after operation (all P>0.05). The appearance of nasal cavity was satisfactory in 32 patients after operation. Columella deviation occurred in 2 patients and 1 patient complained of downward rotation of the nasal tip, which was satisfied after readjustment of the graft. CONCLUSIONS The simplified SEG derived from auricular cartilage can provide stable support for the nasal tip, the nasal shape is natural after operation, and minimal trauma of unilateral auricle cartilage transplantation remains.
Humans ; Young Adult ; Adult ; Rhinoplasty ; Ear Cartilage/transplantation* ; Retrospective Studies ; Nasal Septum/transplantation* ; Plastic Surgery Procedures

BACKGROUND: Median cleft lip is a rare anomaly consisting of a midline vertical cleft through the upper lip. It can also involve the premaxillary bone, the nasal septum, and the central nervous system. In our current report, we present the clinical features of 6 patients with a median cleft lip and their surgical management according to the accompanying anomalies. METHODS: From December 2010 to January 2014, 6 patients with a median cleft lip were reviewed. Five of these cases underwent surgical correction; alveolar bone grafting was performed in a patient with a median alveolar cleft. The surgical technique included inverted-U excision of the upper lip and repair of the orbicularis oris muscle. The mean follow-up period was 20.4 months (range, 7.4-44.0 months). RESULTS: The study patients presented various anomalous features. Five patients received surgical correction, 4 with repair of the median cleft lip, and one with iliac bone grafting for median alveolar cleft. A patient with basal sphenoethmoidal meningocele was managed with transoral endoscopic surgery for repair of the meningocele. Successful surgical repair was achieved in all cases with no postoperative complications. CONCLUSIONS: Relatively mild forms of median cleft lip can be corrected with inverted-U excision with good aesthetic outcomes. In addition, there is a broad spectrum of clinical features and various anomalies, such as nasal deformity, alveolar cleft, and short upper frenulum, which require close evaluation. The timing of the operation should be decided considering the presence of other anomalies that can threaten patient survival.
Alveolar Bone Grafting ; Bone Transplantation ; Central Nervous System ; Cleft Lip* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Lip ; Meningocele ; Nasal Septum ; Postoperative Complications

OBJECTIVEAugmentation rhinoplasty is a commonly procedure in clinical work for a plastic surgeon. Autologous costal cartilage is widely used in aesthetic rhinoplasy because of the abundant in quality. However, the cartilage may warp, and it is not easy-handling for inexperienced plastic surgeons. We-used diced cartilage combined with thin strips as columellar struts, which can be easily shaped, and reduce the warping incidence.

METHODSFrom July 2012 to March 2014, 61 patients were performed diced costal cartilage for nasal augmentation via endonasal approach. Standardized photographs are obtained before and after surgery. Postoperative outcome is graded by patient's self-evaluation of the nasal appearance with a satisfaction scale.

RESULTSAmong the 61 cases, 25 were revision cases. The follow-up time was no less than 6 months, with an average time of 10.9 months. 28 patients reported improved or better nasal appearance. One patient required revision surgery because of overcorrection. Supratip step-off was observed in one patient and corrected by external reshaping. No warping, infection, irregularity, absorption, airway obstruction, or donor-site morbidity were observed. All patients were satisfied with the final appearance.

CONCLUSIONSDiced costal cartilage is a reliable option for nasal augmentation and revision rhinoplasty. Good outcomes can be achieved postoperatively, with aesthetically pleasing appearance and simple procedure.

The septal extension graft is a very useful method of controlling nasal lengthening and tip projection, rotation, and shape by fixing a graft to the septum, which leads to a strong supporting structure. Enhancing graft stability is important for better long-term outcomes and minimizing complications or relapse, and even more efficient application of these methods is needed for East Asians who lack enough cartilage to be harvested in addition to possessing a weak cartilage framework. In this paper, the methods for overcoming the drawbacks of the septal extension graft, such as instability, a fixed tip, and insufficiency of cartilage, are presented, and the applications of each method for greater satisfaction with surgical outcomes are also discussed.
Asian Continental Ancestry Group ; Cartilage ; Humans ; Methods ; Nasal Septum ; Recurrence ; Rhinoplasty ; Transplantation, Autologous ; Transplants*

OBJECTIVE: To observe the efficacy of rhinoplasty with autogenous nasal septal cartilage for saddle nose caused by nasal bone and nasal septum fracture after trauma. METHOD: During the treatment process of 30 cases of nasal trauma, simple nasal bone fracture reposition and nasal septum correction was done, and rhinoplasty was done using the nasal septal cartilage. All the patients were followed up to evaluate subsequent effect. RESULT: All the patients were satisfied with the result of one stage repairment. After following-up for 3-42 months, 28 cases (93.3%) were of long-term satisfaction. CONCLUSION Rhinoplasty with autogenous nasal septal cartilage for saddle nose was an effective method to repair the nasal trauma.
Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Nasal Cartilages ; transplantation ; Nasal Septum ; surgery ; Nose Deformities, Acquired ; surgery ; Rhinoplasty ; methods ; Transplantation, Autologous ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the nasal functional reconstructive methods for post-traumatic external nasal deformity and nasal septal deviation, and to evaluate the efficacy of surgical treatment. METHOD: (1) Twelve patients with C-type external nasal deviation were choose undertaking L-shaped incision of the interface of left nasal septal skin and mucosa as well as bilateral inter-cartilaginous incision using endoscopy which named close group; (2) 5 patients with S-type and 10 patients with side-skew-type external nasal deviation patients were choose undertaking trans-columella inversed-V incision as well as bilateral infra-cartilaginous incision viewing directly which named open group. Both of the groups undertook nasal septal reconstruction surgery and rhinoplasty with autologous nasal septal cartilage grafts. RESULT: During the follow-up period, both groups were satisfied with the functional and aesthetic outcome, while with no recurrence of symptoms and complications. No significant differences were found between the two groups. CONCLUSION Autologous nasal septal cartilage and bone are the best filling grafts for cosmetic rhinoplasty. Rhinoplasty with simultaneous nasal septum surgery can reconstruct nasal function and appearance.
Adolescent ; Adult ; Female ; Humans ; Male ; Nasal Cartilages ; transplantation ; Nasal Septum ; abnormalities ; surgery ; Nose ; abnormalities ; surgery ; Rhinoplasty ; methods ; Treatment Outcome ; Young Adult

OBJECTIVE: The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed. The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success. METHOD: The surgical procedures were demonstrated on cadaver heads specimens. Then 20 adult CT scans of sinus and skull base were calculated by workstations. The dimensions of three different skull base (the defect of anterior skull base/cribriform plate approach, sellar region/planum sphenoidale region and clivus region) of maximum areas, length and width, were measured. And with these data the nasoseptal flap were designed for providing enough area to cover the defect. The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap. RESULT: The mean length from the projection of sphenopalatine to the anterior skull base, planum/sella area and clivus were 49.56 mm, 57.47 and 67.19 mm, respectively. The means of areas of anterior dural defect, transsellar defect and panclivectomy were 16.13 cm2, 14.03 cm2 and 13.12 cm2, respectively. The average length of the nasoseptal flap ranged between 64.71-65.93 mm, the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2. CONCLUSION One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area. In some cases, the flap can not completely cover the area of clivus region because of the limitation of its length.
Adult ; Endoscopy ; methods ; Humans ; Nasal Septum ; anatomy & histology ; diagnostic imaging ; transplantation ; Skull Base ; diagnostic imaging ; surgery ; Surgical Flaps ; Tomography, X-Ray Computed

OBJECTIVE: To explore the significance of MR and endoscopy in the postoperative management of skull base reconstruction with a vascular pedicle nasoseptal mucoperiosteal flap. METHOD: The immediate, and delayed postoperative MR imaging scans and endoscopic data of 8 patients who underwent endonasal endoscopic reconstruction of skull base dural defects with a vascular pedicle nasoseptal mucoperiosteal flap were retrospectively studied. Among the 8 patients, 7 cases have integrated immediate, delayed postoperative MR and synchronous endoscopic data which were harvest at the first week and at a 3- to 7-month interval respectively. One case was followed up by CT and endoscopy. The intracranial parenchymal changes, local situation of skull base defect site, the septal flap, healing of flap donor site and the transition of naso sinus mucosa were fully evaluated to explore the healing process and to improve the success rate of the reconstruction. RESULT: We can obtain the key postoperative information of intracranial and the skull base reconstruction site with MR and endoscopy. The MR can exclude the intracranial complications such as postoperative intracranial hematoma, cerebral edema, or pneumocephalus, and clearly show the location and extent of skull base defects, the position of the flap, the overlapping manner between the dural defect margin and the flap and the postoperative cerebrospinal fistula. In immediate and postoperative follow-up with MR, the septal flap had homogeneous enhanced image with a roughly "C" figure under the skull base, indicating stable blood supplement. The synchronous endoscopic examination also proved the survival of the septal flaps in 7 cases , the cerebrospinal fluid leakage in 1 case. One case flap necrosis. The septal flaps presented edema and congested in the immediate postoperative endoscopy, and returned to normal in the delayed examination. The non-vascular materials such as gelatin sponge and fat tissue had the different characteristics signal. Nasal mucosal edema and sinus ventilation continually recovered during the follow up and the exposed septal cartilage on the donor site resurfaced by mucosa in 2 months. CONCLUSION MR and endoscopy could provide the critical postoperative information about the vascular pedicle septal flap reconstruction. MR combined with endoscopy not only could rule out the complications, but also could gain the information such as the position, blood supply and healing of the flap, at the same time detected the cerebrospinal fluid leakage to provide accurate information for the secondary stage reconstruction. The information got from MR and endoscopy were important for the surgeon and the radiologist to recognize the flap and to evaluate for variations that may suggest potential flap failure.
Adult ; Cerebrospinal Fluid Rhinorrhea ; Endoscopy ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Nasal Mucosa ; transplantation ; Nasal Septum ; Periosteum ; transplantation ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skull Base ; surgery ; Surgical Flaps ; blood supply

The nasal manifestations of the Wegener's granulomatosis commonly results in destruction of the cartilaginous support of the nose and a severe saddle nose deformity. It is so difficult to correct the saddle nose deformity because surgeons have fear about relapse of the Wegener's granulomatosis and cannot use the septal cartilage as a donor site. However we reconstructed the deformity with chondro-osseous rib graft successfully. A 49-year-old woman had a saddle nose deformity after resecting Wagener's granulomatosis, and suffered from not only aesthetic problem but also dyspnea and nasal airway obstruction while physical exercise. She underwent a rhinoplasty with rib graft. The correction came out to be successful and the nasal airway complaint was resolved. She had a recurrence of Wegener's granulomatosis at postoperative 6 months and was admitted for medical treatment of the inflammation at the nasal septum. The follow-up computed tomographic image study revealed good maintenance of the graft. Saddle nose deformity that arises from Wagener's granulomatosis should be reconstructed with chondro-osseous rib graft. Even though the disease might recur, influence to the grafted cartilage is minimal. Active treatment with plastic surgery is thought to be no problem for reconstruction.
Bone Transplantation ; Cartilage ; Congenital Abnormalities ; Dyspnea ; Exercise ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Middle Aged ; Nasal Obstruction ; Nasal Septum ; Nose ; Nose Deformities, Acquired ; Porphyrins ; Recurrence ; Rhinoplasty ; Ribs ; Surgery, Plastic ; Tissue Donors ; Transplants ; Wegener Granulomatosis

OBJECTIVE: To investigate the neoplasia of fossa orbitalis, hard palate and the anterior skull base defect by making use of mucoperiosteal flap of nasal septum. METHOD: A retrospective study was reviewed in 12 patients with tumors in nasal cavity and nasal sinuses. According to tumor character and range, by partial or total maxillectomy and ethmoidectomy, fossa orbitalis, hard palate and the anterior skull base defects were repaired synchronously on the heels of resection of the tumors which damaged fossa orbitalis, hard palate and the anterior skull base. RESULT: Among the 12 patients there were 5 patients with the destructions on ethmoidal horizontal plate, 2 patients with the destructions on hanging wall of ethmoid, 1 patient with the destruction on hanging wall of fossa orbitalis, 1 patient with the destruction on medial wall of fossa orbitalis and on floor of orbit respectively, 2 patients with the destructions on hard palate and all the destructions were repaired following detection synchronously. There were no complications of surgical death, cerebrospinal fluid leaks, encephalomeningocele. CONCLUSION During the operation of tumor in nasal cavity and/or nasal sinuses when defect of fossa orbitalis, hard palate and anterior skull base were found and the defects need repair, we can take advantages of mucoperiosteal flap of nasal septum to perform the transplantation of mucoperiosteal flap in order to avoid forming local defect.
Adult ; Female ; Humans ; Male ; Middle Aged ; Nasal Septum ; surgery ; Orbit ; surgery ; Palate, Hard ; surgery ; Periosteum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skull Base ; surgery ; Surgical Flaps