Objective:To compare the outcomes of simultaneous versus staged nasal bone reduction and septoplasty in the treatment of traumatic nasal bone fractures with associated septal fractures. Methods:Patients with traumatic nasal bone fractures, with or without septal fractures, were recruited from two hospitals and divided into three groups. Group A underwent simultaneous nasal bone reduction and septoplasty, Group B underwent staged nasal bone reduction and septoplasty, and Group C underwent nasal bone reduction only. Nasal appearance scores and nasal congestion Visual Analogue Scale （VAS） scores were measured preoperatively, at 2 weeks postoperatively, and at 3 months postoperatively. For Group B, scores were also recorded at 2 weeks and 3 months after the second-stage surgery. Differences were analyzed using statistical software. Results:Two weeks post-surgery, the nasal appearance scores significantly decreased in all three groups compared to preoperative scores （P< 0.01）, with no statistically significant differences between the groups （P= 0.43, 0.71, 0.58）. In Group A, the VAS score for nasal congestion decreased significantly following simultaneous surgery （P<0.01）. In Group B, there were no significant differences in nasal congestion VAS scores between pre-surgery and post-first-stage, nor between three months post-first-stage and two weeks post-first-stage （P= 0.61, 0.13）. However, the VAS scores significantly decreased after the second-stage surgery compared to pre-surgery, and three months post-second-stage surgery compared to three months post-first-stage surgery （P<0.01）. The VAS scores for nasal congestion at two weeks post-surgery in Group A were lower than those in Group B after the first-stage surgery （P<0.01）. The incidence rates of nasal adhesions post-surgery in Groups A, B, and C were 0%, 6.9%, and 4.3%, respectively. Conclusion:For traumatic nasal bone fractures with associated septal fractures, performing simultaneous nasal bone reduction and septoplasty under general anesthesia using endoscopy is more time-efficient compared to staged surgery, and it results in a lower occurrence rate of post-surgical nasal adhesions.
Humans ; Nasal Bone/surgery* ; Nasal Septum/injuries* ; Treatment Outcome ; Rhinoplasty/methods* ; Male ; Female ; Adult ; Skull Fractures/surgery* ; Fractures, Bone/surgery* ; Middle Aged ; Adolescent

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION 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.
Male ; Female ; Humans ; Adult ; Rhinoplasty ; Cleft Lip/surgery* ; Retrospective Studies ; Nose/surgery* ; Nasal Septum/surgery* ; Nasal Cartilages/surgery* ; Silicones ; Treatment Outcome

Objective:To explore the relevant anatomical factors in the pathogenesis of chronic dacryocystitis based on CT radiomics. Methods:A retrospective analysis was conducted on the general data and sinus CT materials of 85 patients with chronic dacryocystitis（case group） admitted to our department from December 2020 to December 2023, and 85 individuals undergoing physical examination（control group） during the same period. The differences in anatomical parameters between the two groups were compared to study the morphological characteristics of the nasolacrimal duct in patients with chronic dacryocystitis. Univariate and multivariate logistic regression analyses were used to explore the relevant anatomical factors in the pathogenesis of chronic dacryocystitis. Results:There were statistically significant differences（P<0.05） in the proportion of combined nasal septal deviation, the distance between the anterior and posterior ridges of the lacrimal fossa, the angle between the long axis of the nasolacrimal duct and the projection on the midsagittal plane, the maximum transverse diameter of the bony nasolacrimal duct, the maximum cross-sectional area of the bony nasolacrimal duct, and the thickness of the frontal process of the maxilla between the two groups. There were no statistically significant differences（P>0.05） in whether there was a combined high-position nasal septal deviation, whether there was a combined non-high-position nasal septal deviation, and whether there was a combined pneumatized middle turbinate. Multivariate analysis showed that nasal septal deviation, the distance between the anterior and posterior ridges of the lacrimal fossa, the angle between the long axis of the nasolacrimal duct and the projection on the midsagittal plane, and the maximum cross-sectional area of the bony nasolacrimal duct are independent anatomical factors affecting the pathogenesis of chronic dacryocystitis. Conclusion:Nasal septal deviation, a large distance between the anterior and posterior ridges of the lacrimal fossa, a large angle between the long axis of the nasolacrimal duct and the projection on the midsagittal plane, and a small maximum transverse diameter of the bony nasolacrimal duct are important anatomical bases for the pathogenesis of chronic dacryocystitis, providing a basis for an in-depth understanding of the disease occurrence.
Humans ; Retrospective Studies ; Male ; Female ; Dacryocystitis/diagnostic imaging* ; Tomography, X-Ray Computed/methods* ; Nasolacrimal Duct/diagnostic imaging* ; Chronic Disease ; Nasal Septum/diagnostic imaging* ; Middle Aged ; Adult ; Radiomics

OBJECTIVE: To investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. METHODS: A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. RESULTS: Patients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points ( P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation ( P<0.05), but there was no significant difference between 7 days and 6 months after operation ( P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. CONCLUSION After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body's own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.
Humans ; Female ; Adult ; Male ; Rhinoplasty ; Retrospective Studies ; Reoperation ; Nasal Cartilages ; Nasal Septum ; Cicatrix

Objective: To present a rare case of nasal tip schwannoma and describe its resection and reconstruction using combined cartilage grafts. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 13-year-old boy presented with a progressively enlarging nasal tip and severe left nasal obstruction causing breathing difficulties and psychosocial distress. There was a bulging septal mass obstructing 90% of the left nasal cavity. Septal incision biopsy revealed schwannoma and definitive surgery via open rhinoplasty approach was done. The non-encapsulated schwannoma extended from the subcutaneous nasal tip to the left septal mucosa. There was no evidence of skin or cartilage invasion, but prolonged pressure from the expansile schwannoma caused severe lower lateral cartilage and anterior septal atrophy leading to a collapsed and expanded nasal tip after resection. To correct this, a total reconstruction of the anterior tip complex was done using combined ear cartilage seagull wing graft, shield graft and septal extension graft. Conclusion Nasal tip and septal schwannoma is rare and can cause significant nasal obstruction and deformity. Complete excision is vital to avoid recurrence. Total reconstruction of the lower lateral cartilages using autologous septal and ear cartilage grafts may be a safe and effective technique that yields acceptable aesthetic results.
nasal septum ; schwannoma ; ear cartilage ; rhinoplasty ; nasal cartilages ; esthetics ; neurilemmoma ; adolescent

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

Humans ; Nasal Obstruction/surgery* ; Nasal Septum/surgery* ; Rhinoplasty

Objective: To explore the methods for the accurate resection of malignant tumors of the external nose, and the accurate evaluation and repair of tissue defects. Methods: We collected 48 cases with nasal malignant tumors treated in 980 Hospital, Joint Support Force of the People's Liberation Army from January 2010 to June 2020, including 28 males and 20 females, aged 36-86 years. The pathological types of tumors included basal cell carcinomas (n=29), squamous cell carcinomas (n=11), trichilemmal carcinomas(n=6), denoid cystic carcinoma (n=1) and non-Hodgkin lymphoma (n=1). Tumor resection was mainly based on the traditional extended resection determined by the safety margin, and Mohs surgery was used to minimize the scope of resection, for the margin that significantly affected the repairing results, such as the lesion adjacent to the nasal alar margin, nasal columella or deep easy-penetrating margin. All cases obtained tumor resection and primary/secondary defect reconstruction. Results: According to the pathological type and tumor size, the safe resection margin was mainly 4-10 mm, and Mohs surgery was used in 24 cases. Limited-size defects in 38 cases were repaired with double-leaf flaps, kite flaps, nasal dorsum brow flaps, nasolabial flaps or free tissues. Among 10 cases with compound defects, 8 cases were repaired with frontal flaps, including 4 cases with single frontal flaps, 2 cases with additional titanium mesh stent reconstruction and 2 cases with over and out frontal flaps. During follow-up of 1 to 10 years, all the flaps survived without flap necrosis, and the postoperative nasal contour and ventilation were satisfactory. One patient had tumor recurrence 18 months after operation, 2 patients died of cardiovascular and cerebrovascular diseases, and other patients survived without tumors. Conclusions: Mohs surgery can basically meet the requirements for precise resection of external nasal malignant tumors. Individualized application of adjacent tissue flaps and various frontal flaps is a reasonable choice to achieve the satisfactory outcome of external nasal repair and to take into account the complexity of operation.
Carcinoma, Basal Cell/surgery* ; Female ; Humans ; Male ; Nasal Septum ; Nose Neoplasms/surgery* ; Skin Neoplasms ; Surgical Flaps

At present, nasal abnormalities is often classified from different perspectives, such as the alar-columella relationship, nasal base width, and the condition of alar hyperplasia. However, due to the impact of race and region, different people may be applied to different classification methods, resulting in different clinical diagnosis and treatments. So far, there is no unified standard for alar deformity classification to guide clinical treatment. In alar-columella relationship, the retracted ala and the hanging columella, hanging ala and retracted columella are easily confused. According to the classification of nasal base width, it is easy to confuse the alar flare with wide alar base. Therefore, the accurate preoperative evaluation of the nasal ala and the selection of appropriate clinical treatments for different abnormalities are beneficial for surgeons to achieve perfect rhinoplasty results.
Cleft Lip ; Humans ; Hyperplasia ; Nasal Septum/surgery* ; Nose ; Preoperative Care ; Rhinoplasty/methods*

OBJECTIVES: To compare the operation time, subjective and objective outcomes of septoplasty with three high-tension line resection and two high-tension line resection. METHODS: A prospective randomized controlled study was conducted to identify patients with septal deviation and symptomatic nasal obstruction. The patients were classified into a three high-tension line resection and senior physician group (Group A), a two high-tension line resection and senior physician group (Group B), a three high-tension line resection and junior physician group (Group C), a two high-tension line resection and junior physician group (Group D). In addition, according to whether there were the anterior deviation, some of patients were also divided into a three high-tension line resection and anterior deviation group (Group E) and a two high-tension line resection and anterior deviation group (Group F). The operation time was recorded. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) Scale (subjective symptom), nasal endoscopy (bodily sign) and rhinomanometry (objective examination) before and 6 months after septoplasty. The operation time and the efficacy were compared between three high-tension line resection operation and two high-tension line resection operation. RESULTS: There was no significant difference in the operation time between the Group A and the Group B ( CONCLUSIONS The effect of septoplasty with two high-tension line resection is as good as septoplasty with three high-tension line resection. The septoplasty with two high-tension line resection is more suitable to junior physician because it is easier and the operation time is shorter.
Humans ; Nasal Obstruction/surgery* ; Nasal Septum/surgery* ; Prospective Studies ; Rhinoplasty ; Treatment Outcome