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O.028 Tip surgery in aesthetic rhinoplasty
8
Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1
recommend the new method for reconstruction of the temporomandibular joint in case of ankylosis.
Tuesday, 12 September 2006, 9.20−10.20
Hall 5
Aesthetic rhinoplasty O.027 Extracorporeal septoplasty for the management of rhinoseptal deviations J. Arias-Gallo, T. Gonz´alez-Otero, M.J. Mor´an-Soto, M. Burgue˜no-Garc´ıa. Servicio de Sirug´ıa Maxilofacial, Hospital Universitario La Paz, Madrid Introduction and Objectives: Septal deviation is one of the main causes of respiratory nasal insufficiency and external asymmetry. Septorhinoplasty either open or closed is sometimes unable to get good results, mostly due to a severe deviation of the anterior part of the septum. We show the advantages of extracorporeal septoplasty in the management of difficult cases of septonasal deviations. Material and Methods: The first author has performed 119 septorhinoplasties over the past 8 years. Extracorporeal septoplasy has been performed in 11 cases, always using an open approach. It consisted in a complete dissection of bony and cartilaginous septum followed by complete septal resection and reconstruction “on the table” of a new anterior “L strut”. This strut was then sutured to the K area, superior nasal cartilages and anterior nasal spine. Other rhinoplasty steps were done as necessary. We have reviewed the clinical charts and pre and post-op pictures. Results: Main indication for surgery has been a severe crocked nose (9 cases), followed by nasal sequelae of cleft lip and palate (2 cases). Two patients had a previous septorhinoplasty performed elsewhere. Comminute cartilage fracture was the most common intraoperative finding. All patients have reported a complete relief of their nasal obstruction, and a clear improvement of their esthetics. Pictures showed a significant improvement in nasal symmetry and enhancement of dorsal, tip and columelar projection when indicated. Conclusions: Extracorporeal septoplasty is very useful in difficult cases of septorhinoplasty, having few complications. Indications and technical details to avoid complications are described.
Abstracts, EACFMS XVIII Congress • the projection of the septum and the ULC; • the opening of the naso-labial angle, the relation of the alar rim to the columella and the nostril proportion; • the quality of skin, thick and oily skin or thin skin. The analysis of those deformities can lead to adopt a proper attitude on tip surgery. Conclusion: Tip surgery is an obligatory passage for remodelling the shape and the projection of the nose.
O.029 Modified forked flap for columellar length control in cleft-lip open rhinoplasty F. Carlino. Department of maxillo-facial surgery II, hospital “Galeazzi”, Milan, Italy Introduction and Objectives: Suturing the open rhinoplastycolumellar flap often causes a decrease of the obtained tip projecton, particularly in patients with cleft-lip sequences, where the columella is usually short and anelastic because of scar tissue. This paper proposes a modification of the classical forked flap to mantain the columellar length or, in certain cases, to increase it. Material and Methods: The inverted-V incision is extremely narrow and long; its arms go down beyond the columellar rims till the base of the vestibules, where they make other narrow angles and head vertically for the nostril tips, parallel to the columellar rims. Then, they continue in the nostrils as normal marginal incisions. Finally, we have designed a W, whose lateral arms lay in the nostrils and the central inverted-V in the columella. Difference from the classic ‘forked-flap’ is that none of the incisions lays in the lip skin. The suture is performed with three V-Y, one for each angle of the W, with consequent lengthening of the columella. Results: The technique lengthens the columella or, at least, it annuls the tension of the suture. It has been also used as simple columellar-lengthening procedure in cleft noses with extremely short columella; in these cases, a real open rhinoplasty was performed after 6 months. Conclusions: This technique, likewise the forked-flap procedure, can lengthen the columella, but avoids to involve the lip in the incisions; the scars have an inverted-Y instead of an inverted-V appearance. Technical difficulty is in flap width, in cases where skin and subcutaneous layer are thin and the medial crura lay just underneath.
O.028 Tip surgery in aesthetic rhinoplasty J. Khoury1 , S. Abdul Samad2 . 1 Department of ENT & HNS, St. George Hospital-University Medical Center, School of Medicine, University of Balamand, Beirut, Lebanon; 2 Hopital Ambroise Pare Marseille, France Introduction and Objectives: An attractive and natural looking nasal tip is not just a small tip. At it sometimes happens after rhinoplasty, the nasal tip may become small in size but illdefined, artificial, and carrying an operated look on. Since we are practicing rhinoplasty, surgery of the nasal tip is considered to be the most delicate procedure and therefore many corrective surgical techniques were published. Materials and Methods: In this presentation, we are going to present to you our personnel attitude which has been adopted on about 2000 rhinoplasties in the management of tip deformities (21% male). Certainly, there are other possible procedures and other techniques, which may be subjects for discussion. Results: The secret of an attractive nasal tip lies in the analysis of tip deformities: • the shape, volume and the length of caudal and lateral borders of the LLC;
O.030 Pull up spreader grafts M. Albanese, G. Vismara, A. D’Agostino. 1 Maxillofacial Department, University of Verona, Italy; 2 Eeuwfeestkliniek, Antwerp, Belgium Introduction: The purpose of the author is a new technique of simultaneous spreader grafting of the nasal vault and the rotation of the tip in the desired position. Material and Methods: Ten patients affected by vere (6) nasal obstruction were treated from 2001 to 2003 with a new technique of nasal spreading. We selected patients presenting thin skin with no previous deviation of the nasal dorsum. This technique is performed with an open approach. The upper part of the lateral crus is splitted and rotated medially and therefore inserted in a precise pocket between the nasal septum and the upper lateral. Results: All 10 patients had an improvement in nasal airway (scale 1–10), 6 patients with a score of 7 and 4 patients with a score of 10. Nobody complained for the open approach scarring and all had a good aesthetic result, with a stable upward rotation of the tip after 2 years.
Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1
recommend the new method for reconstruction of the temporomandibular joint in case of ankylosis.
Tuesday, 12 September 2006, 9.20−10.20
Hall 5
Aesthetic rhinoplasty O.027 Extracorporeal septoplasty for the management of rhinoseptal deviations J. Arias-Gallo, T. Gonz´alez-Otero, M.J. Mor´an-Soto, M. Burgue˜no-Garc´ıa. Servicio de Sirug´ıa Maxilofacial, Hospital Universitario La Paz, Madrid Introduction and Objectives: Septal deviation is one of the main causes of respiratory nasal insufficiency and external asymmetry. Septorhinoplasty either open or closed is sometimes unable to get good results, mostly due to a severe deviation of the anterior part of the septum. We show the advantages of extracorporeal septoplasty in the management of difficult cases of septonasal deviations. Material and Methods: The first author has performed 119 septorhinoplasties over the past 8 years. Extracorporeal septoplasy has been performed in 11 cases, always using an open approach. It consisted in a complete dissection of bony and cartilaginous septum followed by complete septal resection and reconstruction “on the table” of a new anterior “L strut”. This strut was then sutured to the K area, superior nasal cartilages and anterior nasal spine. Other rhinoplasty steps were done as necessary. We have reviewed the clinical charts and pre and post-op pictures. Results: Main indication for surgery has been a severe crocked nose (9 cases), followed by nasal sequelae of cleft lip and palate (2 cases). Two patients had a previous septorhinoplasty performed elsewhere. Comminute cartilage fracture was the most common intraoperative finding. All patients have reported a complete relief of their nasal obstruction, and a clear improvement of their esthetics. Pictures showed a significant improvement in nasal symmetry and enhancement of dorsal, tip and columelar projection when indicated. Conclusions: Extracorporeal septoplasty is very useful in difficult cases of septorhinoplasty, having few complications. Indications and technical details to avoid complications are described.
Abstracts, EACFMS XVIII Congress • the projection of the septum and the ULC; • the opening of the naso-labial angle, the relation of the alar rim to the columella and the nostril proportion; • the quality of skin, thick and oily skin or thin skin. The analysis of those deformities can lead to adopt a proper attitude on tip surgery. Conclusion: Tip surgery is an obligatory passage for remodelling the shape and the projection of the nose.
O.029 Modified forked flap for columellar length control in cleft-lip open rhinoplasty F. Carlino. Department of maxillo-facial surgery II, hospital “Galeazzi”, Milan, Italy Introduction and Objectives: Suturing the open rhinoplastycolumellar flap often causes a decrease of the obtained tip projecton, particularly in patients with cleft-lip sequences, where the columella is usually short and anelastic because of scar tissue. This paper proposes a modification of the classical forked flap to mantain the columellar length or, in certain cases, to increase it. Material and Methods: The inverted-V incision is extremely narrow and long; its arms go down beyond the columellar rims till the base of the vestibules, where they make other narrow angles and head vertically for the nostril tips, parallel to the columellar rims. Then, they continue in the nostrils as normal marginal incisions. Finally, we have designed a W, whose lateral arms lay in the nostrils and the central inverted-V in the columella. Difference from the classic ‘forked-flap’ is that none of the incisions lays in the lip skin. The suture is performed with three V-Y, one for each angle of the W, with consequent lengthening of the columella. Results: The technique lengthens the columella or, at least, it annuls the tension of the suture. It has been also used as simple columellar-lengthening procedure in cleft noses with extremely short columella; in these cases, a real open rhinoplasty was performed after 6 months. Conclusions: This technique, likewise the forked-flap procedure, can lengthen the columella, but avoids to involve the lip in the incisions; the scars have an inverted-Y instead of an inverted-V appearance. Technical difficulty is in flap width, in cases where skin and subcutaneous layer are thin and the medial crura lay just underneath.
O.028 Tip surgery in aesthetic rhinoplasty J. Khoury1 , S. Abdul Samad2 . 1 Department of ENT & HNS, St. George Hospital-University Medical Center, School of Medicine, University of Balamand, Beirut, Lebanon; 2 Hopital Ambroise Pare Marseille, France Introduction and Objectives: An attractive and natural looking nasal tip is not just a small tip. At it sometimes happens after rhinoplasty, the nasal tip may become small in size but illdefined, artificial, and carrying an operated look on. Since we are practicing rhinoplasty, surgery of the nasal tip is considered to be the most delicate procedure and therefore many corrective surgical techniques were published. Materials and Methods: In this presentation, we are going to present to you our personnel attitude which has been adopted on about 2000 rhinoplasties in the management of tip deformities (21% male). Certainly, there are other possible procedures and other techniques, which may be subjects for discussion. Results: The secret of an attractive nasal tip lies in the analysis of tip deformities: • the shape, volume and the length of caudal and lateral borders of the LLC;
O.030 Pull up spreader grafts M. Albanese, G. Vismara, A. D’Agostino. 1 Maxillofacial Department, University of Verona, Italy; 2 Eeuwfeestkliniek, Antwerp, Belgium Introduction: The purpose of the author is a new technique of simultaneous spreader grafting of the nasal vault and the rotation of the tip in the desired position. Material and Methods: Ten patients affected by vere (6) nasal obstruction were treated from 2001 to 2003 with a new technique of nasal spreading. We selected patients presenting thin skin with no previous deviation of the nasal dorsum. This technique is performed with an open approach. The upper part of the lateral crus is splitted and rotated medially and therefore inserted in a precise pocket between the nasal septum and the upper lateral. Results: All 10 patients had an improvement in nasal airway (scale 1–10), 6 patients with a score of 7 and 4 patients with a score of 10. Nobody complained for the open approach scarring and all had a good aesthetic result, with a stable upward rotation of the tip after 2 years.