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Plastic and Reconstructive Surgery Jul 2021Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth... (Review)
Review
BACKGROUND
Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity.
METHODS
The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty.
RESULTS
The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided.
CONCLUSION
Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.
Topics: Cleft Lip; Esthetics; Humans; Nasal Cartilages; Nasal Septum; Reoperation; Rhinoplasty; Treatment Outcome
PubMed: 34076624
DOI: 10.1097/PRS.0000000000008124 -
Brazilian Journal of Otorhinolaryngology 2017Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years...
INTRODUCTION
Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years later.
OBJECTIVE
To report the surgical experience in treating children with nasal septum and/or nasal pyramid deviation.
METHODS
Review of medical records of 202 children, 124 (61.4%) males and 78 (38.6%) females, between 4 and 16 years of age (M=11 years) who underwent rhinoplasty and/or septoplasty in a Pediatric Otolaryngology Service of the Dept. of Otolaryngology and Head and Neck Surgery between January 1994 and January 2010.
RESULTS
Septoplasty performed in 157 cases (77.7%); rhinoseptoplasty in 23 cases (11.4%), and rhinoplasty in 22 cases (10.9%).
CONCLUSION
Nasal changes should be corrected in children, in order to provide harmonious growth, and prevent severe sequelae found in mouth breathers.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Nasal Septum; Rhinoplasty
PubMed: 27339699
DOI: 10.1016/j.bjorl.2016.04.019 -
Otolaryngologic Clinics of North America Jun 2019Nasal airway obstruction is a common complaint encountered by the otolaryngologist. In-office nasal procedures are becoming increasingly popular and should be considered... (Review)
Review
Nasal airway obstruction is a common complaint encountered by the otolaryngologist. In-office nasal procedures are becoming increasingly popular and should be considered for patients desiring immediate treatment without the adverse effects of general anesthesia, operating room costs, or scheduling delays. This article discusses the factors in patient selection, room setup, and other considerations. The options available for in-office treatment of nasal valve repair are discussed, including turbinoplasty, septoplasty, and nasal valve repair/functional rhinoplasty-type techniques described in the literature.
Topics: Ambulatory Surgical Procedures; Anesthesia, Local; Humans; Nasal Obstruction; Nasal Septum; Patient Selection; Rhinoplasty
PubMed: 30905568
DOI: 10.1016/j.otc.2019.02.010 -
European Annals of Otorhinolaryngology,... Nov 2020The difficulty of correcting nasal septum deformities using the classical Killian or Cottle techniques or derivatives has led in recent years to new suggestions such as...
The difficulty of correcting nasal septum deformities using the classical Killian or Cottle techniques or derivatives has led in recent years to new suggestions such as extracorporeal septoplasty or various apposition grafts to counteract refractory deformity of the quadrangular cartilage. Naturally occurring septal deformities result from conflicts in growth between the quadrangular cartilage, perpendicular ethmoidal plate and vomer, which each have their own different evo-devo origin. Septoplasty by disarticulation consistently restores a level septum by completely resolving the growth conflicts. Conserving the quadrangular cartilage is essential for the stability of the nasal pyramid on condition that 1) the lateral flare of the superior edge of both the component septolateral cartilages that suspend it at the roof of the piriform orifice and 2) the height of its anterior edge are respected. The anterior edge is always high enough (except in case of fracture or malformation to project the retrolobular nasal dorsum in proportion to the height of the alar cartilage when it is repositioned on its natural premaxillary base.
Topics: Disarticulation; Humans; Nasal Cartilages; Nasal Septum; Rhinoplasty; Vomer
PubMed: 33020044
DOI: 10.1016/j.anorl.2020.07.014 -
The Journal of Craniofacial SurgeryDermoid cyst is a congenital and benign disease with most occur on the head and neck. It is rarely that occur on the nasal tip and nasal septum at same time and rarely...
Dermoid cyst is a congenital and benign disease with most occur on the head and neck. It is rarely that occur on the nasal tip and nasal septum at same time and rarely repair of using nasal septum mucosa. The authors treated a child with dermoid cyst in the nasal tip and septum. Only the dermoid cyst at the tip of the nose caused the change of appearance. Dermoid cyst of nasal septum did not cause any clinical symptoms. She underwent excision of the dermoid cyst at the tip of the nose and endoscopic surgery for the dermoid cyst in the nasal septum and used the nasal septum mucosa for repair at the same time. After 6 months of recovery, the appearance of the nasal tip recovered well without obvious scar, the nasal septum area recovered well, and the local stoma was unobstructed without recurrence. The authors found that this kind of nasal septal cyst with no clinical symptoms can achieve good therapeutic effect through endoscopic surgery and repair of using nasal septum mucosa, with less damage, rapid recovery, and good prognosis.
Topics: Child; Dermoid Cyst; Endoscopy; Female; Humans; Nasal Septum; Nose Diseases; Nose Neoplasms
PubMed: 34690325
DOI: 10.1097/SCS.0000000000008281 -
Ugeskrift For Laeger Sep 2023Injuries to the cartilaginous structures of the nose can arise after minor trauma and without a concomitant nasal fracture. They are diagnosed with a thorough clinical... (Review)
Review
Injuries to the cartilaginous structures of the nose can arise after minor trauma and without a concomitant nasal fracture. They are diagnosed with a thorough clinical examination and can, if not diagnosed and treated in the acute phase, result in nasal/septal deformation, saddle nose or abscess formation with subsequent intracranial spreading of the infection. Even with proper treatment in the acute phase, the cartilage often heals with deviation. This can result in functional and cosmetic problems which may require later reconstructive surgery, as argued in this review.
Topics: Humans; Rhinoplasty; Nose Deformities, Acquired; Nasal Septum; Cartilage; Nose Diseases
PubMed: 37873992
DOI: No ID Found -
Brazilian Journal of Otorhinolaryngology 2022The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored.
INTRODUCTION
The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored.
OBJECTIVE
This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity.
METHODS
The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients.
RESULTS
The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles.
CONCLUSION
Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.
Topics: Humans; Nasal Obstruction; Nasal Septum; Nasal Surgical Procedures; Nose Deformities, Acquired; Tomography, X-Ray Computed
PubMed: 33132090
DOI: 10.1016/j.bjorl.2020.09.004 -
HNO Feb 2022Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific...
BACKGROUND
Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific implants or surgery. Implants are created either under anesthesia using silicone impressions or using 3D models from CT data. Disadvantages for patient safety are the increased risk of morbidity or radiation exposure.
MATERIALS AND METHODS
In the context of otorhinolaryngologic surgery, we present a gentle approach to treating NSP with a new image-based, contactless, and radiation-free measurement method using a 3D endoscope. The method relies on image information only and makes use of real-time capable computer vision algorithms to compute 3D information. This endoscopic method can be repeated as often as desired in the clinical course and has already proven its accuracy and robustness for robotic-assisted surgery (RAS) and surgical microscopy. We expand our method for nasal surgery, as there are additional spatial and stereoperspective challenges.
RESULTS
After measuring 3 relevant parameters (NSP extension: axial, coronal, and NSP circumference) of 6 patients and comparing the results of 2 stereoendoscopes with CT data, it was shown that the image-based measurements can achieve comparable accuracies to CT data. One patient could be only partially evaluated because the NSP was larger than the endoscopic field of view.
CONCLUSION
Based on the very good measurements, we outline a therapeutic procedure which should enable the production of patient-specific NSP implants based on endoscopic data only.
Topics: Endoscopy; Humans; Nasal Septal Perforation; Nasal Septum; Quality of Life; Robotic Surgical Procedures
PubMed: 34633475
DOI: 10.1007/s00106-021-01102-4 -
European Annals of Otorhinolaryngology,... May 2021Septorhinoplasty by disarticulation is an esthetic and functional solution for naturally occuring nasal pyramid dysmorphia, releasing the anatomic traces of...
Septorhinoplasty by disarticulation is an esthetic and functional solution for naturally occuring nasal pyramid dysmorphia, releasing the anatomic traces of growth-related stresses. Disarticulating the septolateral cartilage from its bony framework via a closed approach to the septal pocket is associated to Rethi's external approach in order to disarticulate the fibrocartilaginous nasal dorsum, while conserving its integrity, under the bony dorsum. The bony pyramid is then disarticulated down to the nasion, after resecting any bone hump, by 2 paramedian and 2 low lateral osteotomies in the basal groove. The lateral sides of the bony pyramid are then fractured at their posterior edges by percutaneous pinching to close the open roof and realign them along the midline. The septolateral cartilage, reduced as necessary at the inferior and anterior edges, is thereafter repositioned on the premaxillary bone. Traction on its anterior edge restores rectilinear frontal and lateral tension in the fibrocartilaginous dorsum, fully conserved from its attachment to the nasion. This technique corrects any septal deformity and restores frontal and lateral dorsum straightness.
Topics: Cartilage; Disarticulation; Esthetics; Humans; Nasal Septum; Nose; Rhinoplasty
PubMed: 32718850
DOI: 10.1016/j.anorl.2020.06.018 -
Journal of Anatomy Mar 2021The nasal septum is a cartilaginous structure that serves as a pacemaker for the development of the midface. The septum is a hyaline cartilage which is surrounded by a...
The nasal septum is a cartilaginous structure that serves as a pacemaker for the development of the midface. The septum is a hyaline cartilage which is surrounded by a perichondrium and epithelium. It remains cartilaginous anteriorly, but posteriorly it undergoes endochondral ossification to form the perpendicular plate of the ethmoid. Understanding of hyaline cartilage differentiation stems predominantly from investigations of growth plate cartilage. It is currently unclear if the morphological and molecular properties of the differentiating nasal septum align with what is known from the growth plate. In this study, we describe growth, molecular, and cellular characteristics of the nasal septum with reference to hyaline cartilage differentiation. The nasal septum grows asynchronous across its length with phases of rapid growth interrupted by more stagnant growth. Growth appears to be driven predominantly by acquisition of chondrocyte hypertrophy. Similarly, cellular differentiation is asynchronous, and differentiation observed in the anterior part precedes posterior differentiation. Overall, the nasal septum is structurally and molecularly heterogeneous. Early and extensive chondrocyte hypertrophy but no ossification is observed in the anterior septum. Onset of hypertrophic chondrocyte differentiation coincided with collagen fiber deposition along the perichondrium. Sox9, Col2, Col10, Mmp13, Sp7, and Runx2 expression was heterogeneous and did not always follow the expected pattern established from chondrocyte differentiation in the growth plate. The presence of hypertrophic chondrocytes expressing bone-related proteins early on in regions where the nasal septum does not ossify displays incongruities with current understanding of hyaline cartilage differentiation. Runx2, Collagen II, Collagen X, and Sp7 commonly used to mark distinct stages of chondrocyte maturation and early bone formation show wider expression than expected and do not align with expected cellular characteristics. Thus, the hyaline cartilage of the nasal septum is quite distinct from growth plate hyaline cartilage, and caution should be taken before assigning cartilage properties to less well-defined cartilage structures using these commonly used markers. Beyond the structural description of the nasal cartilage, this study also provides important information for cartilage tissue engineering when using nasal septal cartilage for tissue regeneration.
Topics: Animals; Cell Differentiation; Chondrocytes; Growth Plate; Hyaline Cartilage; Mice; Nasal Septum
PubMed: 33043993
DOI: 10.1111/joa.13332