1/29. Nasal angiocentric lymphoma: an entity that should be remembered.After four nasal aesthetic functional surgeries in a period of 18 months, a 46-year-old woman was evaluated who presented with moderate functional alteration, saddle-nose deformity, and total loss of the septal cartilage. Four months before presentation the patient sustained severe nasal trauma, resulting in depression of the nasal bridge without loss of function. Her problem was diagnosed initially as a consequence of an infected septal hematoma and loss of the septal cartilage. Based on this diagnosis, the patient was subjected, in an 18-month period, to four reconstructive surgeries by different specialists, without any improvement and with worsening of clinical presentation. During the authors' physical examination of the patient, she demonstrated marked nasal cutaneous retraction, atrophic nasal conchae with total loss of the septal cartilage, and a large loss of septal bone. Three nasal mucosa biopsies were acquired and the authors proceeded to carry out complete nasal reconstruction using external cranial table and rib cartilage. Histopathologically, a lesion was noted that was compatible with angiocentric lymphoma, for which treatment was administered according to this type of illness. The authors point out the importance of establishing an adequate diagnosis in the face of an apparently obvious clinical case, present cross-disciplinary treatment, and discuss the study protocol that should be used for this type of pathology. They present their reconstructive technique of the nasal structure using a combination of bone tissue and cartilage, the results, and the current state of the patient.- - - - - - - - - - ranking = 1keywords = cartilage (Clic here for more details about this article) |
2/29. The frontonasal flap for increased exposure in posttraumatic nasal deformity: a technical overview.Nasal reconstruction continues to be a surgical challenge. The prominent location of the nose, the unique quality and texture of its skin, and the intricacies of its cartilaginous and bony infrastructure demand careful attention to fine detail. Attempts to refine reconstructive techniques have resulted in a myriad of local flaps. The frontonasal flap is well-described and reliable, but it is infrequently used. A brief review of the literature is presented. The authors describe a unique case of a 64-year-old woman with posttraumatic nasal tip and dorsal deformity. The frontonasal flap provided soft tissue coverage for the nasal tip and allowed excellent exposure for reconstruction of the hard nasal framework with cartilage and bone grafts. It provides local tissue with excellent contour, color, and texture match, and can be performed in one stage.- - - - - - - - - - ranking = 0.2keywords = cartilage (Clic here for more details about this article) |
3/29. The use of lower turbinate bone grafts in the treatment of saddle nose deformities.Saddle nose reconstruction is based on the use of support grafts to manage aesthetic and functional problems. Bone (calvarial, iliac crest, costal, nasal hump, ulnar, and heterogeneous origin), cartilage (septal, costal, heterogeneous), and synthetic materials (silicon, silastic, polyethylene) were used as support grafts. Three patients have been included in this study to define the surgical management and long-term aesthetic and functional results of patients undergoing rhinoplasty with support grafts for a saddle nose deformity. Open rhinoplasty was employed. Both the lower turbinates were excised and the bone dissected from the soft tissues in two cases and in one case, only mucosa was removed. The amount of support needed was measured by using bone wax. The bone was used shaped in layers, according to the defect, and sutured to each other by vycril suture, and wrapped around by surgicell. The graft was then inserted in its place and fixed with external prolene sutures. Results were satisfactory in both function and aesthetics. Ten to 16-month follow-ups had no complications. Saddle nose surgery basically requires the use of a support graft to repair the nasal dorsum. A lower turbinate bone graft procedure has some advantages: it is cheap and safe, it is ready to use and not time-consuming, there is no donor area and no additional donor site morbidity, and it enlarges the airway and the passage to prevent nasal airway obstruction.- - - - - - - - - - ranking = 0.2keywords = cartilage (Clic here for more details about this article) |
4/29. Free temporoparietal fascial flaps and full-thickness skin grafts in aesthetic restoration of the nose.Free tissue transfers have been rapidly replacing distant flaps for use in nasal reconstruction. The temporoparietal fascial flap is a thin, broad, pliable, and well-vascularized flap. It can be used to drape over the cartilaginous and bony framework of the nasal skeleton and nourish the underlying primary cartilage grafts as well as the overlying full-thickness skin graft. The thin contour of the flap is aesthetically superior to thicker skin flaps and eliminates the need for secondary defatting or touch-up procedures. A large, single sheet of full-thickness skin graft, harvested from the supraclavicular region, can be applied over the fascial flap in the same session and provide a quite acceptable color match. The authors present a case whose alar margins and atrophic nasal skin were restored in one session by primary conchal cartilage grafts, a free temporoparietal fascial flap, and a full-thickness supraclavicular skin graft.- - - - - - - - - - ranking = 0.4keywords = cartilage (Clic here for more details about this article) |
5/29. Nasal reconstruction with a thin, free flap prefabricated with a silicone sheet: case report.When the reconstruction of facial tissue requires the use of a flap, this is best carried out with a thin flap that matches the texture of facial skin. For this reason, the authors often use postauricular and subclavicular donor sites. In the reported case, a prefabricated flap was created in the patient's subclavicular skin, by utilizing a silicone sheet and transferring the thoracodorsal vessels. Two weeks after the procedure, this prefabricated flap was transplanted with microsurgical techniques, to reconstruct the ala nasi, after a limited resection of a cavernous hemangioma that preserved the alar cartilage. A very favorable outcome was achieved.- - - - - - - - - - ranking = 0.2keywords = cartilage (Clic here for more details about this article) |
6/29. Correction of the pinched nasal tip with alar spreader grafts.A pinched nasal tip is caused by collapsed alar rims secondary to weak lateral crura. The resulting deformity can be corrected with alar spreader grafts--autogenous grafts of septal or auricular cartilage that are inserted between and deep to the remaining lateral crura to force them apart, propping up the caved-in segment. We describe the surgical technique, indications, and variations in design of alar spreader grafts and present representative results from our series of 38 patients.- - - - - - - - - - ranking = 0.2keywords = cartilage (Clic here for more details about this article) |
7/29. Correction of atrophic nasal ala by sandwiching an auricular cartilage graft between para-alar and nasal floor retrogressive flaps.To correct atrophy of the nasal ala, combined flaps of the para-ala and the nasal floor were used. The flaps were pedicled on the alar base then slid in a retrograde fashion. Auricular cartilage harvested from the concha was placed in the original ala and between the para-alar and the nasal floor flaps to support the reconstructed nasal ala. The resulting skin defects in the nasal floor were covered with the skin grafts taken from postauricular regions. Postoperative scars were not conspicuous because suture lines were placed on the alar groove and the postauricular groove.- - - - - - - - - - ranking = 1keywords = cartilage (Clic here for more details about this article) |
8/29. Irradiated homologous costal cartilage: versatile grafting material for rhinoplasty.For most surgeons, nasal septal cartilage is the first choice in septoplasty. However, when this source is depleted, an alloplastic implant material might be preferable over other autogenous donor sites in order to avoid additional scars, morbidity, and lengthened operating time. In the alloplastic spectrum, irradiated costal cartilage (ICC) has certain advantages. Herein, we present our results with ICC in a wide range of septorhinoplasties to show its versatility and reliability. Sixty-five patients were included in the study. There were 42 male and 23 female patients. According to the indications, there were four groups of patients: (I) secondary septorhinoplasty (n = 24), (II) traumatic deformity (n = 21), (III) primary septorhinoplasty (n = 13), (IV) deformity due to previous septal surgery (n = 7). The mean follow-up period was 33 months. No significant resorption was detected in any of the patients. Minor complications developed in four cases (6%), including deformity in the dorsal graft, excessive graft length, and erythematous nasal tips. Aesthetic and functional results were satisfactory in the remaining cases. The low incidence of major complications and the versatility of ICC make it a safe and reliable source of cartilage graft for both primary and secondary septorhinoplasties when autogenous septal cartilage is either insufficient or unsuitable.- - - - - - - - - - ranking = 1.6keywords = cartilage (Clic here for more details about this article) |
9/29. Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection.BACKGROUND: It is accepted in rhinoplasty that complications are more common with alloplastic implants than with autografts. There is little guidance in the literature on how to deal with the cosmetic and/or functional problems that follow alloplastic implant rejection. The conventional advice has been to remove the allograft and not place any graft at the same time. The present article presents our experience treating allograft rejection and immediately repairing any structural defect with autografts. OBJECTIVE: To demonstrate that immediate nasal reconstruction using autogenous cartilage is a good technique when an alloplastic material has to be removed because of rejection, inflammation, or infection. DESIGN: A retrospective analysis of outcome for a case series. methods: A retrospective review of the management of 8 patients who presented to 2 tertiary referral centers with alloplastic implant rejection following rhinoplasty. In 7 cases, the alloplastic implant had to be removed because it had migrated and caused a foreign body reaction; in 1 case, the implant had caused a bacterial infection. RESULTS: In all 8 cases, the nasal deformity that followed the removal of the allograft was so marked that the nose was immediately reconstructed with autogenous cartilage. The patients all made a good recovery after immediate reconstruction, although skin changes associated with the alloplastic implant remained after a mean follow-up of 3 years 3 months. CONCLUSION: The use of autogenous cartilage is a good option for nasal augmentation immediately after the removal of an alloplastic implant.- - - - - - - - - - ranking = 1.4keywords = cartilage (Clic here for more details about this article) |
10/29. An absolute vascular milieu for primary bone graft in aesthetic nasal reconstruction.Restoration of a composite nasal defect with an aesthetically acceptable vascularized full-thickness soft tissue cover and a primary bone graft in a surgically unscarred area at the same stage requires that the flap have a complete formal inset from all the sides, for enhancement of the milieu interior. This article addresses such a situation, which required the use of a cantilever bone graft simultaneously with an interpolated midline forehead flap based on the supratrochlear vessel and transferred on a deepithelialized bridge segment, which allowed an absolute inset from all the sides. The eventual aesthetic outcome was satisfactory after a secondary surgery for nasal tip correction using conchal cartilage graft for tip framework. The procedure has allowed placement of the bone graft in an unscarred bed, with a complete inset of the vascularized full-thickness soft tissue cover. This provided the graft with the ideal vascular milieu for survival and consolidation and achieved an aesthetically acceptable soft tissue reconstruction of the nose with minimal donor-site morbidity. It obviated the need for the staged procedures and provided a secure vascular milieu for the primary bone graft.- - - - - - - - - - ranking = 0.2keywords = cartilage (Clic here for more details about this article) |
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