Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients *

Size: px
Start display at page:

Download "Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients *"

Transcription

1 Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, 27e33 Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients * N. Chaithanyaa a, *, K.K. Rai b, H.R. Shivakumar b, Amarnath Upasi b a Department of Oral Maxillofacial and Reconstructive Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India b Department of Oral Maxillofacial and Reconstructive Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India Received 18 February 2010; accepted 16 March 2010 KEYWORDS Cleft nose; Nasal deformities; Open rhinoplasty; Conchal graft; Aesthetic and functional evaluation Summary Purpose: A definitive correction of nasal deformity is best performed by creating symmetry and addressing the nostril/tip/columella complex, which is more easily handled by direct vision. The main objective is to evaluate the nasal changes along with function and also to evaluate the satisfaction outcome of the patients following secondary rhinoplasty. Methods: Ten patients who were admitted to our unit for secondary rhinoplasty procedure involving the cleft lipepalate defects associated with nasal deformities were considered for the study. All the patients were evaluated pre- and postoperatively for aesthetics and function along with patient satisfaction and perception. Results: All the operated cases of cleft nasal deformity had a significant improvement in the facial aesthetics and function postoperatively. Clinical evaluation revealed that the post-nasal changes were significant with no nasal obstruction. Statistically, the results were significant (p < 0.05). Conclusion: Although our sample is small, this study would assist in some preliminary conclusions. From our present study, in the view of a distinct deformity of the internal and external nose associated with cleft lip/nose/palate in adolescents or adults, septal rhinoplasty or rhinoplasty alone provides good aesthetics and functional results. ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Nasal deformity associated with cleft lip has been viewed as one of the most challenging reconstructive s in rhinoplasty. The characteristic cleft lip nose represents a stigma of the cleft lip patient. This complexity results from a combination of altered anatomy, surgical scarring from previous reconstructive attempts and the inevitable * Work attributed to Bapuji Dental College and Hospital, Davangere, Karnataka, India. * Corresponding author. address: (N. Chaithanyaa) /$ - see front matter ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi: /j.bjps

2 28 N. Chaithanyaa et al. effects of growth, 1,2 and includes deformities of the septum, nasal pyramid, malformation of the nasal tip and malposition of ala on the cleft side. 3 The severity of the deformity varies with each case and is directly related to the extent of the lip deformity and particularly the alveolar cleft. 4 The maxillary cleft along with hypoplasia and malpositioning of the maxillary segments also contribute significantly to the facial asymmetry. The anatomic and functional deformity of the orbicularis muscle also contributes to the nasal deformity. 4 It is a fact that a significant number of patients who suffer from cleft lip and palate also suffer from airway obstruction, which might have significant implication on nasal physiology as well as the patients quality of life. Septal curvature and associated soft-tissue deviations are important components of the cleft lip nasal deformity. Deviated columella and nasal tip are as a result of a defective septum that would result in an aesthetic and functional deformity of the nose. 5,6 Definitive nasal correction is planned after completion of the nasal growth, typically after the age of 14e15 years. 7,8 The cleft lip nasal deformity is often retained during primary lip repair due to interference with nose growth, ineffective repair and resulting scars that make secondary correction difficult. 9 The main objective is to evaluate the nasal changes along with function and also to evaluate the satisfaction outcome of the patients following secondary rhinoplasty. Figure 2 Measurement in sagittal plane. Methods and methodology Patients reporting to the Department of Oral Maxillofacial and Reconstructive surgery, Bapuji Dental College and Hospital, Davangere, were selected for the study. Sample included three men and seven women, aged between 15 and 40 years with their mean age being 20.4 years. These patients were born with non-syndromic cleft lip palate (CLP) and were operated earlier for the cleft lip, alveolus and palate. Six patients had left defect, one patient had right and three patients had bilateral defects. Those who were operated for corrective rhinoplasty earlier were excluded from the study. On initial presentation, the patients were clinically and radiographically evaluated and photographs were taken using 8 megapixels, 3.5 x optical zoom camera. Pre- and post-operative photographs (Figures 4e9) were used for the evaluation of aesthetics in the vertical and horizontal planes (Figures 1,2) before and after the surgery. The mean results were calculated and confirmed by cephalometric values to avoid discrepancies following photographic evaluation. Cephalometrics values were calculated from the pre-operative (Figure 13) and post-operative (Figure 14) lateral cephalograms that were used to evaluate aesthetics in the sagittal plane (Figure 3). Extra-nasal clinical examination included (1) deviation of the dorsum from the midline; (2) presence of any irregularities along the dorsum; (3) examination of the tip; (4) position of the columella; (5) alar base width; (6) width of individual nostrils; and (7) skin. Intranasal examination included (1) position of the nasal septum; (2) vomers; (3) nasal valve; (4) turbinates; (5) upper lateral cartilages; (6) nasal spine; and (7) nasal floor. Six of the ten patients underwent orthognathic procedures for improvement of the facial profile prior to the rhinoplasty procedure as determined by the cephalometric analysis and clinical examination. Figure 1 Measurement in vertical plane. (a) Nasal axis deviation (b) Evaluation of the vertical position of the alar bases. Figure 3 Measurement in horizontal plane.

3 Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients 29 Figure 6 Pre-operative left lateral profile. Figure 4 Figure 5 Pre-operative frontal profile. Post-operative frontal profile. Aesthetically, the nose was evaluated in the vertical, horizontal and sagittal planes. In the vertical plane, nasal deviations from the mid-sagittal plane were measured. The position of the alar bases relative to the interpupillary line was measured for vertical alar dystopia (Figure 1(A) and (B)). The nasolabial angle was measured in the sagittal plane and was considered excellent if it was between 95 and 105 (Figure 2). Horizontally, the distance from the mid-columella to the bucco alar groove on each side was measured. The alar tip angle on each side was measured. This way, the ala, the columella and the nasal tip were evaluated separately and as a complex (Figure 3). Table 3 gives a list of abbreviations used in the line figures. All these measurements were made on the cleft side; therefore, in the group with bilateral CLP, they were measured bilaterally. Nasal function was evaluated, both subjectively and objectively, for obstructed nasal passage using a nasal obstructive symptom evaluation scale (NOSE; Table 1). The parameters considered for nasal evaluation were nasal congestion or stuffiness, nasal blockage or obstructiveness, troublesome breathing through nose, troublesome sleeping and while inhaling air through nose while exercising and exertion. The overall trouble in breathing was evaluated pre- and postoperatively using a linear symptom evaluation scale. Qualitative analysis was performed to get the results. All the surgeries were carried out under general anaesthesia. Standard surgical procedures ( Figures 10e12) were carried out using open structure rhinoplasty and, in few cases, grafting was done using conchal and costochondral grafts as per the requirements. The patients were initially reviewed following the first week of surgery and then were reviewed regularly with 1-month intervals, followed by 3 and 6 months, for a total period of 1 year. Patients were examined for pain, any discomfort following the procedure and for function.

4 30 N. Chaithanyaa et al. Figure 7 Post-operative left lateral profile. Figure 9 Post-operative left lateral profile. Results The significance of the differences in the vertical, horizontal and sagittal planes with their pre- and postoperative data was analysed qualitatively. The patients studied completed the nasal obstructive symptoms evaluation scale and the linear symptom evaluation scale pre- and postoperatively, with a baseline of 0 indicating no existing, up to a score of 4 indicating very severe. Out of the 10 patients in the present study, eight were evaluated as having medium/moderate difficulty in breathing with two patients having severe difficulty while Figure 8 Pre-operative right lateral profile. Figure 10 Exposure of lower lateral cartilage.

5 Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients 31 Figure 11 Shield and Strut graft. breathing. Postoperatively, one patient, whose difficulty in breathing was severe as recorded preoperatively, had a considerable relief following a surgical intervention although the postoperative evaluation of the same parameter was considered moderate, while the remaining nine patients manifested with no breathing difficulty. Preoperatively, the patients perceived that their unequal alar positions were the most deformed part of their nasal anatomy, followed by their nasal tip, nostrils and finally their dorsum. Following surgical procedure, the alar base and nostril were the most improved site, followed by the nasal tip and finally the dorsum. The patients satisfaction with the postoperative outcome revealed highest visual analogue scale (VAS) scores at the nasal tip in most of the patients, followed by the dorsum, unequal alar bases and nostril. All patients were satisfied with the outcome of the surgery and even expressed they would undergo such a procedure a second time if necessary. Although the postoperative results were satisfactory, few patients required secondary surgical procedures (Table 2). Figure 13 Pre-operative cephalograpm. These patients present with a wide range of nasal deformities. Along with these abnormalities, this group of patients also frequently presents with alveolar arch malalignments and anterior fistulae. 12 Four of our patients in the Discussion It is universally acknowledged that the correction of a cleft lip nasal deformity continues to be a difficult. Figure 12 Closure. Figure 14 Post-operative cephalograpm.

6 32 N. Chaithanyaa et al. Table 1 NOSE scale 17 Sl. no. Conditions Not a Very mild Moderate Fairly 1 Nasal congestion or stiffness Nasal blockage or obstruction Trouble breathing through my nose Trouble sleeping Unable to get enough air through my nose while exercising or exertion Severe present study have presented with anterior fistulae, which was surgically corrected. Nasal surgery is the end result of an overall treatment programme for secondary cleft lip. These patients have associated facial skeletal deformities. Along with the clinical examination, radiographic and imaging modalities help us to know the severity of the deformity. Subperiosteal or subperichondrial correction of the perioral and perinasal muscle has to be done to maintain symmetry. One of the most important aspects of the cleft lip rhinoplasty is the creation of a symmetric and ideally positioned maxilla, without which the outcome of rhinoplasty will not be optimal. Six out of ten patients underwent orthognathic procedures for the improvement of the facial profile prior to the rhinoplasty procedure. All the orthognathic procedures were performed in our unit. Residual deformities exist in sagittal, horizontal and vertical planes that require correction. The operation may be performed by an endonasal or an open technique. Majority of the nasal deformities are corrected by an open technique and all our patients underwent open rhinoplasty. Few patients require augmentation of the radix and dorsum. Lateral osteotomies were done in two patients to correct the dorsal asymmetry. The alar basal width was reduced by the Weir wedge excision procedure. Reenforcement of the left ala with conchal cartilage was done in one of the patients. Columella strut for the tip projection, shield graft/tip graft for tip definition and dorsal graft for dorsal height were used to correct the asymmetries. Nasal obstruction is one of the most common complaints in the patient with cleft nasal deformity, and has been attributed to the altered nasal anatomy as well as physiology and to the reduced size of the nasal airway caused by the significant external nasal deformity, septal deviation, vomerine spurs and the deficit in maxillary growth. In the present study, six out of 10 patients underwent septorhinoplasty with correction of the hypertrophied inferior turbinates. Following the surgical procedure, two patients manifested with mild nasal obstruction. The symptoms of nasal blockage, nasal congestion or stuffiness had significantly improved following surgery. The evaluation of the outcome of rhinoplasty to treat secondary residual cleft lip nasal deformities has been the subject of numerous reports. 1,4,10e16 Patient satisfaction was evaluated at a 1-year follow-up visit. The data presented in this patient satisfaction survey indicate that the unilateral and bilateral cleft nasal deformities can be improved in the eyes of the patient using a combination of the external rhinoplasty approach, alar base relocation where necessary and augmentation of the nasal tip using an auricular cartilage graft. 10 The patients were satisfied with the postoperative outcome in terms of both aesthetics and function. Although our sample is small, this study would assist in some preliminary conclusions. Management of some of the important features seen in the case of cleft rhinoplasty has been emphasised here as follows: 1. The way in which the unilateral cases the alar cartilages are oriented as well as reduced to attain the required shape and form as observed on the opposite normal alar cartilage. 2. The downturned nasal tip, which is caudally moved by lengthening the foot end of the medial crura as well as reducing the caudal edge of alar cartilage on the cleft side. 3. Reinforcing of the medial crura with strut conchal cartilage graft. 4. Shield graft to be used in cases of deficient tip projection as well as in cases where debulking of thickskinned nasal lobule has been carried out. Table 2 Secondary surgical procedures Sl. no. Residual defects Number of patients Surgical correction performed 1 Extended columellar strut graft at the region 1 Trimming of the extruded graft of the septum 2 Increased alar width 1 Reduction of the alar base width by wier -wich excision 3 Notching of the alar bilaterally 1 Z-plasty 4 Stitch abscess at the base of the columella 1 Incision and drainage and removal the extruded suture material 5 Hypoplastic defect over the left perinasal area 1 Augmentation of the hypoplastic defect

7 Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients 33 Table 3 List of abbrevations used A(Figure 2) Nasal tip projection A(Figure 3) Distance from right ala to mid columella IPL Interpupillary line AB-IPL Position of the alar base-relative to the inter pupillary line ABL Left alar base ABR Right alar base a (Figure 2) Ala-columella to FHP a (Figure 3) Angle formed between a tangent drawn to the right ala & the mid nasal tip line B Distance from left ala to mid columella b Same as angle alpha on the left side FHP Frankfurt horizontal plane NLA Naso-labial angle MSP Mid-sagittal plane NA Nasal axis NT Nasal tip HPA Highest point on the alar margin SS Stomion superior NTP Nasal tip projection The correction whistle deformity seen in the patient studied was reserved for the next surgical procedure. The soft triangle (towards the dome of the lateral crura) and the weak triangle (towards the intermediate crura) that is created on the cleft side can be eliminated with interdomal suture as well as a Tagima procedure, respectively, so that the cleft side of the nasal lobule can match with the noncleft side. Cleft rhinoplasty is a challenge because these are cases with high expectations and frustrations both, for having undergone multiple surgical procedures. To achieve near-normal architecture both with respect to form and function in cleft rhinoplasty cases is challenging but a daunting task. Conflict of interest The authors declare there is no conflict of interests or funding provided for the study. References 1. Wang TD, Madorsky SJ. Secondary rhinoplasty in nasal deformity associated with the unilateral cleft lip. Arch Facial Plast Surg 1999;1:40e5. 2. Shih Charles W, Sykes Jonathan M. Correction of the cleft-lip nasal deformity. Facial Plast Surg 2002;18:253e Hade DV, Peter JFML, editors. Textbook of Facial and Plastic Surgery; p McCarthy, editor. Textbook of Plastic Surgery 1990;4. p Gubisch Wolfgang, Reichert Heinz, Widmaier Werner. Six years experience with free septum replantation in cleft nasal correction. J Craniomaxillofac Surg 1989;17:31e3. 6. Blackwell Steven J, Parry Samuel W, Roberg Bradford C, et al. Onlay cartilage graft of the alar lateral crus for cleft lip nasal deformities. Plast Reconstr Surg 1985;76:395e Matukas VJ, Louis PJ. Secondary management of the nose in the cleft patient. Int J Oral Maxillofac Surg 1993;22:195e9. 8. Coghlan BA, Boorman JG. Objective evaluation of the Tajima secondary cleft lip nose correction. Br J Plast Surg 1996;49: 457e Ray Broadbent T, Woolf Robert M. Cleft lip nasal deformity. Ann Plast Surg 1984;12:216e Sandor GKB, Ylikontiola LP. Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate. Int J Oral Maxillofac Surg 2006;35:407e Beyoung YP, Chung Seum, Young HL. Three- layer corrections of secondary cleft lip nasal deformities. Cleft Palate Craniofac J 1996;33:169e Ahuja Rajeev B. Radical correction of secondary nasal deformity in unilateral cleft lip patients presenting late. Plast Reconstr Surg 2001;108:1127e Stal Samuel, Hollier Larry. Correction of secondary deformities of the cleft lip nose. Plast Reconstr Surg 2002;109:1386e Cohen Mimis, Smith Bonnie E, Daw Joseph L. Secondary unilateral cleft lip nasal deformity: functional and esthetic reconstruction. Plast Reconstr Surg 2003;14:584e Guyuron Bahman. Late cleft lip nasal deformity. Plast Reconstr Surg 2008;121:1e Anastassov GE, Joos U, Zollner B. The evaluation of the results of the delayed rhinoplasty in cleft lip and palate patient: functional and aesthetic implications and factors that affect successful nasal repair. Br J Oral Maxillofac Surg 1998;36:416e Sam PM. Analysis of outcome after functional rhinoplasty using a disease specific quality of life instrument. Arch Facial Plast Surg 2006;8:306e9.

Revision of the Cleft Lip Nose

Revision of the Cleft Lip Nose Revision of the Cleft Lip Nose Tom D. Wang, MD, FACS* Professor and Chief of Facial Plastic & Reconstructive Surgery Department of Otolaryngology / Head & Neck Surgery Oregon Health & Science University

More information

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Original Article Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Yoon Seok Lee 1, Dong Hyeok Shin 1, Hyun Gon Choi 1, Jee Nam Kim 1, Myung Chul

More information

Cairo Dental Journal (24) Number (I), 77:84 January, Haitham Sayed Attia 3, Mohamed Saied Hamed 1 and Monteser El Koutobey 2

Cairo Dental Journal (24) Number (I), 77:84 January, Haitham Sayed Attia 3, Mohamed Saied Hamed 1 and Monteser El Koutobey 2 Cairo Dental Journal (24) Number (I), 77:84 January, 2008 Anthropometric Analysis of cases of Unilateral Cleft Lip Versus cases of Complete Unilateral Cleft Lip and Palate Haitham Sayed Attia 3, Mohamed

More information

Use of tent-pole graft for setting columella-lip angle in rhinoplasty

Use of tent-pole graft for setting columella-lip angle in rhinoplasty Agrawal et al. Plast Aesthet Res 2018;5:13 DOI: 10.20517/2347-9264.2018.17 Plastic and Aesthetic Research Letter to Editor Open Access Use of tent-pole graft for setting columella-lip angle in rhinoplasty

More information

Scientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim

Scientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the lar Rim Richard Ellenbogen, MD; and Greg azell, MD ackground: lthough the alar rim has frequently been neglected in correction

More information

Correction of Secondary Deformities of the Cleft Lip Nose

Correction of Secondary Deformities of the Cleft Lip Nose CME Correction of Secondary Deformities of the Cleft Lip Nose Samuel Stal, M.D., and Larry Hollier, M.D. Learning Objectives: After studying this article, the practitioner should be able to: 1. Describe

More information

The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty

The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty British Journal of Plastic Surgery (2003), 56, 218 223 q 2003 The British Association of Plastic Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/s0007-1226(03)00117-6 The

More information

Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate

Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate Fernando D. Burstein MD, FACS, FAAP Atlanta, Georgia, USA Rather than treating nasal, maxillary, and soft tissue

More information

UCL Repair: Emphasis on Muscle Dissection and Reconstruction

UCL Repair: Emphasis on Muscle Dissection and Reconstruction UCL Repair: Emphasis on Muscle Dissection and Reconstruction Unilateral cleft lip repair is performed using rotation-advancement technique. Markings are made on columella base, redlines, Cupid s bow on

More information

Advances of Plastic & Reconstructive Surgery

Advances of Plastic & Reconstructive Surgery Chapter 1 Advances of Plastic & Reconstructive Surgery Cleft lip nasal deformity: Analysis and treatment Martínez-Capoccioni Gabriel*; Martín-Martín Carlos Servizo Galego de Saúde, Service of ENT Head

More information

Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear

Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear The British Association of Plastic Surgeons (2004) 57, 238 244 Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear Yong Oock Kim*, Beyoung Yun Park, Won Jae Lee Institute

More information

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities Free full text on www.ijps.org Review Article DOI: 10.4103/0970-0358.57195 Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities Mimis Cohen, David E. Morris, Aisha D.

More information

Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series

Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series DOI: 10.7860/IJARS/2017/28759:2331 Surgery Section Case Series Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series JACOB JOHN, ARJUN MADHU USHA, MUBARAK AZIZ, VINIT RENKAN

More information

Unilateral Cleft Lip Repair by using White-skin-roll Flap from Cleft Side of Lip

Unilateral Cleft Lip Repair by using White-skin-roll Flap from Cleft Side of Lip Unilateral Cleft Lip Repair by using White-skin-roll Flap from Cleft Side of Lip Background: With all due consideration to the restoration of function, post-operative aesthetic appearance of the cleft

More information

Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N.

Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N. CME Cleft Rhinoplasty Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N. Edina and Minneapolis, Minn. Learning Objectives: After studying this article, the participant should

More information

Unilateral cleft nasal deformity is a clinical term referring to a nose

Unilateral cleft nasal deformity is a clinical term referring to a nose ORIGINAL ARTICLE Assessment of Secondary Cleft Rhinoplasty Using Resorbable Plates at the Age of Primary School Arun K. Gosain, MD and Amir H. Fathi, MD Background: Secondary rhinoplasty after a cleft

More information

Plastic Surgeon, Middlesbrough General Hospital, Stockton Children's Hospital, Newcastle Regional Hospital Board

Plastic Surgeon, Middlesbrough General Hospital, Stockton Children's Hospital, Newcastle Regional Hospital Board THE NASAL TIP IN BILATERAL HARE LIP By J. POTTER, F.R.C.S.Ed. Plastic Surgeon, Middlesbrough General Hospital, Stockton Children's Hospital, Newcastle Regional Hospital Board IN the problem of the bilateral

More information

The overprojected ( Pinocchio ) tip and the ptotic

The overprojected ( Pinocchio ) tip and the ptotic Featured Operative Technique Management of the Overprojected Nose and Ptotic Nasal Tip William E. Silver, MD, FCS; and Giancarlo F. Zuliani, MD The overprojected ( Pinocchio ) tip and the ptotic tip are

More information

Fundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty.

Fundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty. COSMETIC Classifying Deformities of the Columella Base in Rhinoplasty Michael R. Lee, M.D. Georges Tabbal, M.D. T. Jonathan Kurkjian, M.D. Jason Roostaeian, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background:

More information

Nasal Soft-Tissue Triangle Deformities

Nasal Soft-Tissue Triangle Deformities 339 Hossam M.T. Foda, MD 1 1 Division of Facial Plastic Surgery, Otolaryngology Department, Alexandria Medical School, Alexandria, Egypt Facial Plast Surg 2016;32:339 344. Address for correspondence Hossam

More information

There are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE

There are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE ORIGINAL ARTICLE Erdem Tezel, MD, and Ayhan Numanoğlu, MD Abstract: Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of

More information

UNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1

UNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1 Journal of Plastic, Reconstructive & Aesthetic Surgery (2006) -, -e- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

More information

Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report

Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report 220 Nasal septal reconstruction Case Report Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report Yakup Cil1* Diyarbakır Military Hospital, Department of Plastic Surgery 21000 Diyarbakır, Turkey

More information

Secondary rhinoplasty

Secondary rhinoplasty Free full text on www.ijps.org Secondary rhinoplasty Gaith Shubailat American Board of Plastic Surgery Address for correspondence: Gaith Shubailat, P. O. Box 5180, Amman, Jordan 11183. E-mail: gaith@shubailat.com

More information

INTRODUCTION. Typical secondary bilateral cleft lip nasal deformities present a short columella, a laterally-spreading dome of the alar cartilages

INTRODUCTION. Typical secondary bilateral cleft lip nasal deformities present a short columella, a laterally-spreading dome of the alar cartilages The Correction of a Secondary ilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

More information

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery DOI 10.1007/s00266-010-9562-2 ORIGINAL ARTICLE The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery Hani Abou Mayaleh Received: 11 April 2010 / Accepted: 15 July 2010 Ó Springer Science+Business

More information

Component Rhinoplasty

Component Rhinoplasty 18 Original Article Component Rhinoplasty Muhammad Humayun Mohmand*, Muhammad Ahmad Cosmetic Plastic Surgeon, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan ABSTRACT BACKGROUND According

More information

Vancouver, B.C., Canada

Vancouver, B.C., Canada THE "ALAR SHIFT" REVISITED By THEODORE F. WILKIE, B.A., M.D., F.R.C.S.(C), F.A.C.S. Vancouver, B.C., Canada IN the hands of many plastic surgeons certain procedures have an evanescent history. Usually

More information

BONE GRAFTING IN TREATMENT OF CLEFT LIP AND PALATE 337

BONE GRAFTING IN TREATMENT OF CLEFT LIP AND PALATE 337 PRIMARY BONE GRAFTING IN THE TREATMENT OF CLEFT LIP AND PALATE WITH SPECIAL REFERENCE TO ALVEOLAR COLLAPSE By FRANK ROBINSON, F.R.C.S., and BARRIE WOOD, L.D.S. Burns and Plastic Surgery Unit, Booth Hall

More information

Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses

Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Ahmed Elshahat, MD Plastic Surgery Department, Faculty of Medicine, Ain Shams University; and Eldemerdash Hospital, Cairo, Egypt

More information

The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty

The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty IJMS Vol 36, No 3, September 2011 Original Article The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty Behrooz Gandomi 1, Mohammad Hossein Arzaghi

More information

LATERAL CEPHALOMETRIC EVALUATION IN CLEFT PALATE PATIENTS

LATERAL CEPHALOMETRIC EVALUATION IN CLEFT PALATE PATIENTS POLSKI PRZEGLĄD CHIRURGICZNY 2009, 81, 1, 23 27 10.2478/v10035-009-0004-2 LATERAL CEPHALOMETRIC EVALUATION IN CLEFT PALATE PATIENTS PRADEEP JAIN, ANAND AGARWAL, ARVIND SRIVASTAVA Department of Plastic

More information

Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length

Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Research Original Investigation Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Yan Ho, MD; Robert Deeb, MD; Richard Westreich, MD; William Lawson, MD, DDS IMPORTANCE Resection of

More information

Rhinoplasty - Tip Augmentation by Extended Columellar Strip

Rhinoplasty - Tip Augmentation by Extended Columellar Strip World Articles of Ear, Nose and Throat ---------------------Page 1 Rhinoplasty - Tip Augmentation by Extended Columellar Strip Authors: Vikas Sinha*, Viral A. Chhaya**, Dilavar A. Barot***, Keyur Mehta****,

More information

SEMI- ANNUAL FELLOWSHIP REPORT June 2015 to December 2015

SEMI- ANNUAL FELLOWSHIP REPORT June 2015 to December 2015 SEMI- ANNUAL FELLOWSHIP REPORT June 2015 to December 2015 Submitted by, Dr.Arun Ramaiah., Resident fellow, St.Thomas Cleft and Craniofacial centre. Letter to CCI To start with I would like to thank Cleft

More information

The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation

The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation Med. J. Cairo Univ., Vol. 83, No. 1, September: 585-589, 2015 www.medicaljournalofcairouniversity.net The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation

More information

Compared with other ethnicities, Asians have

Compared with other ethnicities, Asians have Original Article Correction of Asian Short Nose with Lower Lateral Cartilage Repositioning and Ear Cartilage Grafting Jin Suk Byun, MD, PhD* Kenneth K. Kim, MD, FACS, Background: Asians with short nose

More information

Achieving a consistent functional and aesthetic

Achieving a consistent functional and aesthetic Special Topic Simplifying the Management of Caudal Septal Deviation in Rhinoplasty Fadi C. Constantine, M.D. Jamil Ahmad, M.D. Palmyra Geissler, M.D. Rod J. Rohrich, M.D. Dallas, Texas; and Mississauga,

More information

ORIGINAL ARTICLE. Quantitative Study of Nasal Tip Support and the Effect of Reconstructive Rhinoplasty. accomplish both an excellent

ORIGINAL ARTICLE. Quantitative Study of Nasal Tip Support and the Effect of Reconstructive Rhinoplasty. accomplish both an excellent ORIGINAL ARTICLE Quantitative Study of and the Effect of Reconstructive Rhinoplasty Holger G. Gassner, MD; William J. Remington, MD; David A. Sherris, MD Objectives: To develop a method to quantify nasal

More information

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY THE NASAL SEPTUM IN RHINOPLASTY: BASIC SEPTOPLASTY TECHNIQUES FWA Otten Introduction Septal corrections form an important step in rhinoplastic

More information

Nose Reshaping (Rhinoplasty)

Nose Reshaping (Rhinoplasty) Nose Reshaping (Rhinoplasty) Are you interested in improving the appearance of your nose? If so, you re not alone. Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed

More information

Analyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection

Analyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection COSMETIC A Multivariate Analysis of Nasal Tip Deprojection Jacob G. Unger, M.D. Michael R. Lee, M.D. Robert K. Kwon, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background: Projection of the nasal tip is a

More information

Rotation-Advancement Principle. in Cleft Lip Closure. D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida

Rotation-Advancement Principle. in Cleft Lip Closure. D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida Rotation-Advancement Principle in Cleft Lip Closure D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida Correction of prealveolar, alveolar, and postalveolar clefts poses a fivefold project: natural appearance,

More information

MedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications:

MedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications: MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.038.MH Septoplasty-Rhinoplasty This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar CareFirst

More information

Correction of the Retracted Alar Base

Correction of the Retracted Alar Base 218 William D. Losquadro, M.D. 1 Anthony Bared, M.D. 2 Dean M. Toriumi, M.D. 2 1 Mount Kisco Medical Group, Katonah, New York 2 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology

More information

Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide

Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide 537643AESXXX10.1177/1090820X14537643Aesthetic Surgery JournalÇakır et al research-article2014 INTERNATIONAL CONTRIBUTION Featured Operative Technique Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step

More information

Closed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas.

Closed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas. Operative Techniques in Otolaryngology (2007) 18, 233-242 Closed rhinoplasty Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD From the Center for Aesthetic Surgery, Colleyville, Texas. KEYWORDS

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our

More information

ORIGINAL ARTICLE. Reconstruction of the Nasal Columella. David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A.

ORIGINAL ARTICLE. Reconstruction of the Nasal Columella. David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A. ORIGINAL ARTICLE Reconstruction of the Nasal Columella David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A. Hilger, MD Objective: To report techniques successful for nasal columella

More information

Figure 1. Basic anatomy of the palate

Figure 1. Basic anatomy of the palate CHAPTER 10 CLEFT LIP AND PALATE Chen Yan, MD and Sanjay Naran, MD I. ANATOMY AND DEFINITIONS A. Cleft Lip (CL) alone, Cleft Lip with Cleft Palate (CLP), and Cleft Palate (CP) alone 1. CL alone and CLP

More information

Spreader Graft in Closed Rhinoplasty: The Rail Spreader

Spreader Graft in Closed Rhinoplasty: The Rail Spreader Original Article 515 Spreader Graft in Closed Rhinoplasty: The Rail Spreader Alberto Scattolin, MD 1 Niana Orlando, MD 1 Luca D Ascanio, MD 2 1 Department of Otolaryngology, Villa Donatello Clinic, Piazzale

More information

ORIGINAL ARTICLE. patients with impaired nasalbreathingandaestheticdiscomfortduetostenosisofthenasalvestibule.

ORIGINAL ARTICLE. patients with impaired nasalbreathingandaestheticdiscomfortduetostenosisofthenasalvestibule. ORIGINAL ARTICLE Postoperative Management of Nasal Vestibular Stenosis The Custom-made Vestibular Device Dirk-Jan Menger, MD; Peter J. F. M. Lohuis, MD, PhD; Steven Kerssemakers, MD; Gilbert J. Nolst Trenité,

More information

Hospital das Clinicas, Brazil

Hospital das Clinicas, Brazil THE IMPORTANCE OF THE CARTILAGINOUS FRAMEWORK IN PLASTIC SURGERY OF THE NOSE By ROBERTO FARINA, M.D., OSVALDO DE CASTRO, and RICARDO BAROUDI, M.D. Hospital das Clinicas, Brazil As far as plastic surgery

More information

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Primary Repair of Unilateral Cleft Lip Nasal Deformity CLEFT THE IRAQI LIP POSTGRADUATE NASAL DEFORMITY MEDICAL JOURNAL VOL.8, NO.3, 2009 Primary Repair of Unilateral Cleft Lip Nasal Deformity Zakaria Y.Arajy*, Ahmed A.M.Nawres** ABSTRACT: BACKGROUND: There

More information

implementation of modern rhinoplasty techniques to yield an aesthetic result well balanced with other facial components.

implementation of modern rhinoplasty techniques to yield an aesthetic result well balanced with other facial components. : J Dentistry and Otolaryngology Volume 14 Issue 3 Version 1.0 Year 2014 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Inc. (USA) Online ISSN: 2249-4618 & Print

More information

Despite a multiplicity of surgical approaches to PEDIATRIC/CRANIOFACIAL. Primary Septoplasty in the Repair of Unilateral Complete Cleft Lip and Palate

Despite a multiplicity of surgical approaches to PEDIATRIC/CRANIOFACIAL. Primary Septoplasty in the Repair of Unilateral Complete Cleft Lip and Palate PEDIATRIC/CRANIOFACIAL Primary Septoplasty in the Repair of Unilateral Complete Cleft Lip and Palate Srinivas Gosla-Reddy, M.B.B.S., M.D.S. Krisztian Nagy, M.D., D.D.S. Maurice Y. Mommaerts, M.D., D.M.D.,

More information

Construction of the congenitally missing columella in midline clefts

Construction of the congenitally missing columella in midline clefts Construction of the congenitally missing columella in midline clefts Kurt-Wilhelm BÜTOW Department of Maxillo-Facial and Oral Surgery (Head: Prof. Kurt-W. Bütow, MChD(OMFSurg), DMD, PhD, DSc(Odont), FCMFOS),

More information

The Crooked Nose and its Functional Surgical Correction

The Crooked Nose and its Functional Surgical Correction The Crooked Nose and its Functional Surgical Correction Armando González Romero Introduction The nose is a highly specialized organ of the respiratory system and is essential for homeostasis. The pathological

More information

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective Plastic Surgery International, Article ID 202560, 7 pages http://dx.doi.org/10.1155/2014/202560 Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective William

More information

1 The nasal bones are deeper and are therefore MATERIAL AND METHODS. At the Department of Plastic and Reconstructive

1 The nasal bones are deeper and are therefore MATERIAL AND METHODS. At the Department of Plastic and Reconstructive Technical Experiences Reconstruction of the Nasal Tip Valerio Cervelli, MD, DJ Bottini, PhD, Pietro Gentile, MD Rome, Italy Defects of the nasal tip present complex problems in terms of reconstruction,

More information

Proboscis lateralis: report of two cases

Proboscis lateralis: report of two cases The British Association of Plastic Surgeons (2003) 56, 704 708 CASE REPORT Proboscis lateralis: report of two cases Lütfi Eroğlu a, *, Osman Ata Uysal b a Faculty of Medicine, Department of Plastic and

More information

SURGICAL - ORTHODONTIC TREATMENT OF CLASS II DIVISION 1 MALOCCLUSION IN AN ADULT PATIENT: A CASE REPORT

SURGICAL - ORTHODONTIC TREATMENT OF CLASS II DIVISION 1 MALOCCLUSION IN AN ADULT PATIENT: A CASE REPORT Case Report International Journal of Dental and Health Sciences Volume 02, Issue 02 SURGICAL - ORTHODONTIC TREATMENT OF CLASS II DIVISION 1 MALOCCLUSION IN AN ADULT PATIENT: A CASE REPORT Amit Dahiya 1,Minakshi

More information

Surgical Treatment of Short Nose

Surgical Treatment of Short Nose Surgical Treatment of Short Nose Dr. Otto YT Au MD (JEFFERSON, USA) 1957, MCPS (MANITOBA) 1963, FHKAM (SURGERY) 1995 Diplomate American Board Plastic Surgery Plastic Surgery Specialist Dr.OttoYTAu A nice

More information

Surgical correction of septal deviation after Le Fort I osteotomy

Surgical correction of septal deviation after Le Fort I osteotomy Shin et al. Maxillofacial Plastic and Reconstructive Surgery (2016) 38:21 DOI 10.1186/s40902-016-0067-z Maxillofacial Plastic and Reconstructive Surgery CASE REPORT Open Access Surgical correction of septal

More information

The anatomical basis for a cleft lip defect is far

The anatomical basis for a cleft lip defect is far PEDIATRIC/CRANIOFACIAL Comparison of Three Incisions to Repair Complete Unilateral Cleft Lip Srinivas Gosla Reddy, M.D.S., M.B.B.S. Rajgopal R. Reddy, B.D.S., M.B.B.S. Ewald M. Bronkhorst, Ph.D. Rajendra

More information

Augmentation Rhinoplasty with Autologous Grafts

Augmentation Rhinoplasty with Autologous Grafts Aesth Plast Surg (2008) 32:136 142 DOI 10.1007/s00266-007-9052-3 REVIEW Augmentation Rhinoplasty with Autologous Grafts D. J. Bottini Æ P. Gentile Æ A. Donfrancesco Æ L. Fiumara Æ V. Cervelli Published

More information

There is no uniform grading system for nasal dorsal deformities currently in general use

There is no uniform grading system for nasal dorsal deformities currently in general use ORIGINAL ARTICLE A Grading System for Nasal Dorsal Deformities Matthew A. Kienstra, MD; Holger G. Gassner, MD; David A. Sherris, MD; Eugene B. Kern, MD There is no uniform grading system for nasal dorsal

More information

RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland

RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP By MICHAL KRAUSS Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION of the nose is one of the composite procedures in

More information

RHINOPLASTY (NOSE RE-SHAPING)

RHINOPLASTY (NOSE RE-SHAPING) PROCEDURE FACT SHEET PLASTIC SURGERY RHINOPLASTY (NOSE RE-SHAPING) This is a guide for people who are considering having a nose re-shaping (Rhinoplasty) operation. We advise that you talk to a plastic

More information

Journal of Cranio-Maxillo-Facial Surgery

Journal of Cranio-Maxillo-Facial Surgery Journal of Cranio-Maxillo-Facial Surgery 41 (2013) 147e152 Contents lists available at SciVerse ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com Assessment of nostril

More information

Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty

Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty Niveditha J Sagar, Chidananda R Devasamudra Original article 10.5005/jp-journals-10013-1254 Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty 1 Niveditha J Sagar, 2 Chidananda

More information

Intraoral mandibular distraction osteogenesis in facial asymmetry patients with unilateral temporomandibular joint bony ankylosis

Intraoral mandibular distraction osteogenesis in facial asymmetry patients with unilateral temporomandibular joint bony ankylosis Int. J. Oral Maxillofac. Surg. 2002; 31: 544 548 doi:10.1054/ijom.2002.0297, available online at http://www.idealibrary.com on Intraoral mandibular distraction osteogenesis in facial asymmetry patients

More information

CLINICAL NOTE. Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken s Method

CLINICAL NOTE. Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken s Method CLINICAL NOTE Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken s Method Seok-Kwun Kim, MD, PhD, Myung-Hoon Kim, MD, Yong-Seok Kwon, MD, and Keun-Cheol Lee, MD, PhD Purpose: To evaluate long-term

More information

ORTHOGNATHIC SURGERY

ORTHOGNATHIC SURGERY ORTHOGNATHIC SURGERY MEDICAL POLICY Effective Date: February 1, 2017 Review Dates: 1/93, 7/95, 10/97, 4/99, 10/00, 8/01, 12/01, 4/02, 2/03, 1/04, 1/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11,

More information

Changes in soft tissue thickness after Le Fort I osteotomy in different cleft types

Changes in soft tissue thickness after Le Fort I osteotomy in different cleft types Arja Heliövaara, DDS, PhD Orthodontist Jyri Hukki, MD, PhD Senior Consultant in Plastic Surgery Reijo Ranta, DDS, PhD Docent and Senior Orthodontist Aarne Rintala, MD, PhD Assistant Professor of Plastic

More information

Residual deformities after repair of clefts of the lip and palate

Residual deformities after repair of clefts of the lip and palate Clin Plastic Surg 31 (2004) 331 345 Residual deformities after repair of clefts of the lip and palate Mimis Cohen, MD, FACS, FAAP a,b, * a Divisions of Plastic, Reconstructive, and Cosmetic Surgery, The

More information

Regina Rodman, MD Faculty Mentor: Tamara Watts, MD PhD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds

Regina Rodman, MD Faculty Mentor: Tamara Watts, MD PhD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds Regina Rodman, MD Faculty Mentor: Tamara Watts, MD PhD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds Presentation March 29, 2012 Anatomic landmarks Photography

More information

What is Hemifacial Microsomia? By Pravin K. Patel, MD and Bruce S. Bauer, MD Children s Memorial Hospital, Chicago, IL

What is Hemifacial Microsomia? By Pravin K. Patel, MD and Bruce S. Bauer, MD Children s Memorial Hospital, Chicago, IL What is Hemifacial Microsomia? By Pravin K. Patel, MD and Bruce S. Bauer, MD Children s Memorial Hospital, Chicago, IL 773-880-4094 Early in the child s embryonic development the structures destined to

More information

Surgical Management of Nasal Airway Obstruction

Surgical Management of Nasal Airway Obstruction Surgical Management of Nasal Airway Obstruction John F. Teichgraeber, MD a, Ronald P. Gruber, MD b, Neil Tanna, MD, MBA c, * KEYWORDS Nasal obstruction Nasal breathing Septal deviation Nasal valve narrowing

More information

Essentials of Septorhinoplasty

Essentials of Septorhinoplasty Essentials of Septorhinoplasty von Hans Behrbohm, Eugene Tardy 1. Auflage Essentials of Septorhinoplasty Behrbohm / Tardy schnell und portofrei erhältlich bei beck-shop.de DIE FACHBUCHHANDLUNG Thematische

More information

Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study

Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study Original Article Young Chul Kim, Woo Shik Jeong, Tae Suk Oh, Jong Woo Choi,

More information

ORTHOGNATHIC SURGERY

ORTHOGNATHIC SURGERY Status Active Medical and Behavioral Health Policy Section: Surgery Policy Number: IV-16 Effective Date: 10/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should

More information

Cleft Lip and Palate: The Effects on Speech and Resonance

Cleft Lip and Palate: The Effects on Speech and Resonance Ann W. Kummer, PhD, CCC-SLP Cincinnati Children s Cleft lip and/or palate can have a negative impact on both speech and resonance. The following is a summary of normal anatomy, the types and causes of

More information

The correction of nasal septal deviations in rhinoplasty

The correction of nasal septal deviations in rhinoplasty Page 1 of 9 Aesthetic Surgery & Medicine The correction of nasal septal s in rhinoplasty P Persichetti 1 *, V Toto 1, M Signoretti 1, R Del Buono 1, B Brunetti 1, F Segreto 1, D Lazzeri 2, GF Marangi 1

More information

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods Plastic Surgery International Volume 0, Article ID 4578, 4 pages doi:0.55/0/4578 Clinical Study Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with

More information

In the United States, cleft lip with or without PEDIATRIC/CRANIOFACIAL

In the United States, cleft lip with or without PEDIATRIC/CRANIOFACIAL PEDIATRIC/CRANIOFACIAL Comparison of the Rotation-Advancement and Philtral Ridge Techniques for Unilateral Cleft Lip Repair Jay M. Cline, M.D. Samuel L. Oyer, M.D. Hedyeh Javidnia, M.D. Shaun A. Nguyen,

More information

19, 2006 RESIDENT PHYSICIAN:

19, 2006 RESIDENT PHYSICIAN: TITLE: Rhinoplasty SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: April 19, 2006 RESIDENT PHYSICIAN: Alan L. Cowan, M.D. FACULTY ADVISOR: David C. Teller, M.D. SERIES EDITORS: Francis

More information

Guide to Writing Oral Protocols

Guide to Writing Oral Protocols Guide to Writing Oral Protocols CONTENTS PAGE Structure and Purpose of the Oral Examination 2 When Planning a Protocol 2 Selecting Photos, Illustrations, and Other Art 2 Standard Views for Major Facial

More information

Bony hump reduction is an integral part of classic

Bony hump reduction is an integral part of classic Rhinoplasty Nasal Hump Reduction With Powered Micro Saw Osteotomy INTERNATIONAL CONTRIBUTION Yakup Avşar, MD Background: Hump reduction with manual osteotomy is an invasive procedure in aesthetic rhinoplasty.

More information

Bilateral cleft lip repair with simultaneous premaxillary setback and primary limited rhinoplasty

Bilateral cleft lip repair with simultaneous premaxillary setback and primary limited rhinoplasty Park and Kim Maxillofacial Plastic and Reconstructive Surgery (2018) 40:43 https://doi.org/10.1186/s40902-018-0182-0 Maxillofacial Plastic and Reconstructive Surgery RESEARCH Bilateral cleft lip repair

More information

Kevin T. Kavanagh, MD

Kevin T. Kavanagh, MD Kevin T. Kavanagh, MD Axial Based upon a named artery. Survival length depends upon the artery not the width of the flap. Random Has random unnamed vessels supplying it. Survival length is directly proportional

More information

Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique

Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique Archives of Craniofacial Surgery Arch Craniofac Surg Vol.19 No.1, 3-12 https://doi.org/10.7181/acfs.2018.19.1.3 Personal technique for definite repair of complete unilateral cleft lip: modified Millard

More information

Index. Blunt perichondrium elevator, 164 Bone paste, 85 Bone scissors, 35 36, 128, 328

Index. Blunt perichondrium elevator, 164 Bone paste, 85 Bone scissors, 35 36, 128, 328 A Alar rim edge excision incision, 311 marking, 311 resection, 312 suture, 312 317 Arkansas stone, 254 Autorim flap technique ala retractions, 145 alar support, 158 bulbous cartilage, 150 cartilage surface,

More information

Anatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC

Anatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC Anatomy of External NOSE By Dr Farooq Aman Ullah Khan PMC 24 th Nov. 2017 The External Nose Descriptions of the nose always begin with that part of it which is covered by the skin, i.e., the EXPOSED PART

More information

A new classification system of nasal contractures

A new classification system of nasal contractures Original Article J Cosmet Med 2017;1(2):106-111 https://doi.org/10.25056/jcm.2017.1.2.106 pissn 2508-8831, eissn 2586-0585 A new classification system of nasal contractures Geunuck Chang 1, Donghak Jung

More information

Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D.

Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Techniques in Cosmetic Surgery Rhinoplasty with Advancing Age Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Houston and Dallas, Texas Rhinoplasty in the

More information

Combined tongue flap and V Y advancement flap for lower lip defects

Combined tongue flap and V Y advancement flap for lower lip defects British Journal of Plastic Surgery (2005) 58, 258 262 CASE REPORTS Combined tongue flap and V Y advancement flap for lower lip defects Kenji Yano*, Ko Hosokawa, Tateki Kubo Department of Plastic and Reconstructive

More information

Surgical Treatment of Nasal Obstruction

Surgical Treatment of Nasal Obstruction Surgical Treatment of Nasal Obstruction P. Daniel Knott, MD FACS Director, Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology/Head and Neck Surgery UCSF Medical Center Nothing

More information

24 EARLY ACCEPTANCE IN

24 EARLY ACCEPTANCE IN IN COMPLETE CLEFTS 24 EARLY ACCEPTANCE IN IN COMPLETE CLEFTS OFTEN IT HAS BEEN SAID EEAN INCOMPLETE CLEFT CAN BE MORE DIFFICULT THAN COMPLETE ONE YET WITH LESS TISSUE MISSING LESS NASAL DISTORTION AND

More information