OBJECTIVES: This study aimed to explore the relationship between alveolar cleft and secondary nasal deformity post unilateral cleft lip repair in adults. METHODS: A total of 27 patients aged 16-30 years old with unilateral secondary nasal deformity and alveolar cleft were included, 13 of whom underwent bone grafting. Spiral CT data of all preoperative and postoperative patients who had alveolar bone grafting were collected. Then, Mimics software was used for three-dimensional reconstruction to evaluate the correlation between the width, height, and volume of the alveolar cleft and those of the nasal deformity. The difference in nasal deformity before and after alveolar bone grafting was also explored. RESULTS: The width of the alveolar cleft was positively correlated with the difference in bilateral nostril floor width (P<0.05). As the effective depth of the alveolar cleft increased, the sub-alare inclination angle largened (P<0.05). However, no significant difference was found in the nasal deformity between before and after alveolar bone grafting. CONCLUSIONS Alveolar cleft is closely related to secondary nasal deformities post unilateral cleft lip repair, especially nasal floor deformities. Alveolar bone grafting benefits adult patients for the improvement of secondary nasal deformities post unilateral cleft lip repair.
Humans ; Adult ; Adolescent ; Young Adult ; Nose/surgery* ; Cleft Lip/surgery* ; Rhinoplasty/methods* ; Imaging, Three-Dimensional ; Treatment Outcome ; Cleft Palate/complications*

OBJECTIVES: The long-term effect of muscular force balance reconstruction technique combined with intranasal fixation for correcting secondary nasolabial deformity after unilateral cleft lip was evaluated. The aim was to provide a basis for further improving the surgical treatment effect of secondary nasolabial deformity of acleft lip. METHODS: A total of 40 patients aged 4-28 years with secondary nasal deformity and unilateral cleft lip were selected as research subjects. The two-dimensional photo measurement analysis method was used in comparing the surgical results before and immediately after the operation (7 d) and 1 year after the operation. RESULTS: Columellar angle, nostril height ratio (NHR), alar rim angle, alar rim angle ratio, and nostril shape (NS) increased dimmediately after the operation, whereas alar base width ratio (ABWR) and nostril width ratio decreased (NHR) immediately after the operation (P<0.01). The ABWR, NHR, and NS immediately after the operation were not significantly different from those 1 year after the operation (P>0.05). CONCLUSIONS Muscular force balance reconstruction technique combined with intranasal fixation is effective in the repair of unilateral secondary nasolabial deformity, and stable results can be obtained 1 year after surgery.
Humans ; Cleft Lip/surgery* ; Nose/abnormalities* ; Rhinoplasty/methods* ; Treatment Outcome

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*

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the effectiveness of percutaneous and endonasal lateral osteotomy for the correction of deviated nose. SUBJECTS AND METHOD: Medical records of 60 patients who underwent rhinoplasty to correct deviated nose were reviewed retrospectively. Patients with unilateral osteotomy, revision rhinoplasty, spreader graft, or who had no preoperative or postoperative photos were excluded from the study. The patients were categorized into two groups, which either had C-shaped deviation or I-shaped deviation. Preoperative and postoperative deviation angles were measured and their differences were analyzed according to the approach methods. RESULTS: In the percutaneous approach group, 26 patients had C-shaped deviation and 10 patients had I-shaped deviation, whereas in the endonasal approach group, 17 patients had C-shaped deviation and 7 patients had I-shaped deviation. In the percutaneous approach, the deviation angle was statistically improved in the C-shaped deviation, but in the endonasal approach, it was statistically improved in the C-shaped and I-shaped deviation after surgery. In the C-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 5.2°±3.6° and 7.9°±5.3°, respectively, which showed significant difference. However, in the I-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 2.9°±1.3° and 2.9°±1.0°, respectively, with no significant difference. CONCLUSION: The improvement of deviation angle following osteotomy may be different according to the approach methods for deviated nose. Endonasal approach was more suitable than percutaneous approach in the correction of I-shaped deviated nose.
Humans ; Medical Records ; Methods ; Nose Deformities, Acquired ; Nose ; Osteotomy ; Retrospective Studies ; Rhinoplasty ; Surgical Procedures, Operative ; Transplants

BACKGROUND: Abbé flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional Abbé flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. METHODS: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. RESULTS: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional Abbé flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. CONCLUSION: A new modified Abbé flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.
Cicatrix ; Cleft Lip* ; Congenital Abnormalities* ; Ectropion ; Esthetics ; Humans ; Lip ; Methods ; Rhinoplasty ; Skin ; Surgical Flaps ; Wounds and Injuries

BACKGROUND: Millard’s rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. METHODS: We retrospectively reviewed 82 patients’ medical records and presented surgical technique and outcomes. The main features of the authors’ strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients’ nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen’s kappa statistics. RESULTS: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. CONCLUSION: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.
Cleft Lip* ; Follow-Up Studies ; Hope ; Humans ; Lip ; Medical Records ; Methods ; Nose ; Recurrence ; Retrospective Studies ; Rhinoplasty ; Surgeons ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Various techniques have been reported for the correction of deviated nasal septum, most of them for caudal septal cartilage. For deviated posterior septal cartilage, the typical method of the day is the resection of deviated portion. However, we developed a bone anchoring technique that conservatively corrects deviated posterior septal cartilage. The aim of the current study is to determine the efficacy of this bone anchoring technique. SUBJECTS AND METHOD: The patients who had undergone septoplasty using bone anchoring technique by a single surgeon (J.S.K) between October 2015 and June 2016 were enrolled in this study. The result of the surgery was evaluated using a visual analogue scale (VAS, ranged 0– 10) for nasal obstruction, acoustic rhinometry, and assessment of surgeon. RESULTS: A total of 44 patients were included in this study. The VAS of nasal obstruction was significantly decreased after surgery from 7.5±1.7 to 2.4±1.4. In acoustic rhinometry, minimal cross-sectional area and volume were increased after surgery from 0.35±0.18 to 0.52±1.40 cm2 and from 3.6±1.1 to 5.8±1.5 cm3, respectively. Most of the deviated septum was well corrected, and complication or recurrence did not developed. CONCLUSION: Bone anchoring technique is easy to perform. It enables the preservation of septal cartilage, which is useful in revision septoplasty or rhinoplasty. We conclude that this technique is a good method for the correction of deviated posterior septal cartilage.
Cartilage ; Humans ; Methods ; Nasal Obstruction ; Nasal Septum* ; Reconstructive Surgical Procedures ; Recurrence ; Rhinometry, Acoustic ; Rhinoplasty ; Suture Anchors*

OBJECTIVES: Middle vault deviation has a significant effect on the aesthetic and functional aspects of the nose, and its management continues to be a challenge. Spreader graft and its modification techniques have been focused, but there has been scarce consideration for removing surplus portion and balancing the upper lateral cartilage (ULC). This study aimed to report the newly invented triangular-shaped resection technique (“triangular resection”) of the ULC and to evaluate its efficacy for correcting middle vault deviation. METHODS: A retrospective study included 17 consecutive patients who presented with middle vault deviation and underwent septorhinoplasty by using triangular resection at a tertiary academic hospital from February 2014 and March 2016. Their outcomes were evaluated pre- and postoperatively including medical photographs, acoustic rhinometry and subjective nasal obstruction using a 7-point Likert scale. RESULTS: The immediate outcomes were evaluated around 1 month after surgery, and long-term outcomes were available in 12 patients; the mean follow-up period was 9.1 months. Nasal tip deviation angle was reduced from 5.66° to 2.37° immediately (P < 0.001). Middle vault deviation also improved from 169.50° to 177.24° (P < 0.001). Long-term results were 2.49° (P=0.015) for nasal tip deviation and 178.68° (P=0.002) for middle vault deviation. The aesthetic outcome involved a complete correction in eight patients (47.1%), a minimally visible deviation in seven patients (41.2%) and a remaining residual deviation in two patients (11.8%). Pre- and postoperative minimal cross-sectional areas (summation of the right and left sides) were 0.86 and 1.07, respectively (P=0.021). Fifteen patients answered about their nasal obstruction symptoms and the median symptom score had alleviated from 6.0 to 3.0 (P=0.004). CONCLUSION: Triangular resection of the ULC is a simple and effective method for correcting middle vault deviation and balancing the ULCs without complications as internal nasal valve narrowing.
Cartilage* ; Follow-Up Studies ; Humans ; Methods ; Nasal Cartilages ; Nasal Obstruction ; Nose ; Nose Deformities, Acquired ; Retrospective Studies ; Rhinometry, Acoustic ; Rhinoplasty ; Transplants

BACKGROUND AND OBJECTIVES: The demand for rhinoplasty has been high for both men and women over the years; recently, however, it is rapidly increasing for men as their interest in aesthetics has heightened. This study investigated the psychological characteristics of male patients who underwent rhinoplasty through questionnaire-guided consultation. In addition, we investigated the difference between patients and surgeons regarding their aesthetic concerns for rhinoplasty. SUBJECTS AND METHOD: Of the male patients who underwent rhinoplasty from January 2006 to December 2012, 124 patients who had completed the questionnaires were included. The questionnaire for rhinoplasty asked about the basic personality traits of patients, patients' complaints about their nose, reasons for receiving the operation and expectation for postoperative change. RESULTS: Patients responded most to the item, “I have high expectations for the surgery” for the question regarding personality characteristics, followed by the response, “I am concerned about my health.” Regarding questions about reasons for rhinoplasty, complaints about their dorsum were high; among these patients, they were most concerned about the appearance of the ‘crooked nose’ when viewed from the front. On the other hand, the concern for the ‘poorly defined nasal tip’ was not high, whereas it was defined as one of the problems mentioned by the surgeons. CONCLUSION: These results show differences regarding aesthetic concerns between the patients and the surgeon, especially regarding the nasal tip. It would be helpful for both patient and surgen to plan the surgery after careful consultation based on the questionnaire, accurate understanding of the patients' complaints and expectations to obtain satisfactory results for both.
Anxiety ; Esthetics ; Female ; Hand ; Humans ; Male* ; Methods ; Nose ; Psychology ; Rhinoplasty* ; Surgeons

BACKGROUND AND OBJECTIVES: Since rhinoplasty techniques require meticulous and delicate manipulation, proper anesthesia is essential. The aim of the current study is to compare patient satisfaction and complication of rhinoplasty performed under local anesthesia against general anesthesia. SUBJECTS AND METHOD: Patients who underwent rhinoplasty by a single surgeon between March 2014 and January 2017 were enrolled in this study. Midazolam was utilized to sedate the patient during local anesthesia. Pain and memory of surgery under local anesthesia, satisfaction of anesthesia, and willingness to undergo the surgery with the same anesthesia method again were evaluated. Cardiopulmonary events, nausea, and vomiting were assessed as complications. Aesthetic satisfaction of patients and the doctor was evaluated 6 month after the surgery. The parameters were compared between local and general anesthesia. RESULTS: A total 120 patients were included in this study. The degree of pain was low during surgery under local anesthesia. Although most of patients remembered the process of surgery during local anesthesia, satisfaction of local anesthesia was high. The satisfaction of anesthesia and willingness to undergo surgery with same anesthesia were not signifcantly different between local and general anesthesia. No serious complications developed during local anesthesia and there were no signifcant differences of aesthetic satisfaction between local and general anesthesia. CONCLUSION: Patient satisfaction and aesthetic results of rhinoplasty performed under local anesthesia were comparable to general anesthesia, indicating that surgeons do not need to be afraid of applying local anesthesia in rhinoplasty.
Anesthesia ; Anesthesia, General* ; Anesthesia, Local ; Humans ; Memory ; Methods ; Midazolam ; Nausea ; Patient Satisfaction* ; Rhinoplasty* ; Surgeons ; Vomiting