• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권4호
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• pp.350-355
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• 2005

There are various surgical methods for reconstruction of the nasal defect. Among them, there is some difference in the choosing the proper reconstruction method according to defect size and position. When the defect involved the tip, the columella, and the alar, the local flaps may be preferred, because they can provide sufficient amount of tissue. However, the composite grafts from the ear have been effectively used in reconstructions of smaller sized defects of the columella and ala. We excised total external nose because of squamous cell carcinoma on the nasal tip, columella, and nasal septum. We reconstructed the nasal tip, both alae, and columella with forehead flap. After division of the regional flap, we found partial necrosis of the columella and narrowness of the nostril. So, we used chondrocutaneous auricular composite grafts for reconstruction of the columella and both nostrils. We used the file-folder designed auricular composite graft for reconstruction of columella and the wedge shaped ear helical composite grafts for widening of nostrils. 6 months later, there were no significant problems, except some mismatched dark color in the grafted alar tissues. Here, we report a successful reconstruction of large nasal defect using combined two different reconstructive methods.

• 대한두개안면성형외과학회지
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• 제15권2호
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• pp.94-97
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• 2014

Unilateral nostril hypoplasia is an extremely rare congenital malformation of unknown etiology, and only a few cases have been reported in literature. Owing to variability and complexity of the deformity, surgical correction of unilateral nostril hypoplasia represents one of the most significant reconstructive challenges to reconstructive plastic surgeons. We report a 7-year-old Vietnamese child with nasal and periocular deformity resembling a craniofacial cleft. Grossly, the right nostril was patent but with alar rim deformity, and the left nostril was not readily identifiable. A dystopic medial canthus was present on the left side as well. Closer inspection and palpation of the left side of nose revealed a patency through the soft tissue and underlying bony structure, Thus, a new alar rim were reconstructed with an irregularly shaped Z-plasty to create patency on the involved side. Simulatneously, a second Z-plasty was performed to address the medial canthal deformity. Postoperative appearance and function was sastisfactory at one-year follow up visit. In the treatment of patients with nostril hypoplasia, a careful preoperative physical examination is a prerequisite, and Z-plasty can be a valuable option for surgical correction.

• Archives of Plastic Surgery
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• 제45권3호
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• pp.253-258
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• 2018

Background The nasolabial flap is ideal for reconstruction of the nasal alar subunit due to its proximity, color and contour match, and well-placed donor scar. When raised as a random-pattern flap, there is a risk of vascular compromise to the tip with increased flap length and aggressive flap thinning. Surgical delay can greatly improve the chances of tip survival, allowing the harvest of longer flaps with greater reach. Methods We describe our technique of lengthening the nasolabial flap through multiple delay procedures. A bipedicled flap was first raised and then transferred as a unipedicled flap with a 6:1 length-to-width ratio. During the delay process, the flap tip was thinned to the subdermal layer. Results In our case series of seven patients, defects as far as the medial canthal area and contralateral ala were reconstructed successfully with no incidence of tip necrosis or flap loss. The resultant flaps were thin enough to be folded over for the reconstruction of alar rim defects. Conclusions We highlight the success of our surgical technique in creating thin and robust nasolabial flaps for the reconstruction of full-thickness defects around the nose.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.102-105
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• 2020

Malignant skin tumors and precancerous lesions have a predilection to be located in the nasal dorsum or sidewall. Although invasive reconstructions have been presented, no simple and suitable method has yet been reported for this area. The flap presented herein, named the lateral nasal advancement flap, is designed on the adjacent lateral region of the sidewall or nasal dorsum and advanced in the medial direction. Two Burow's triangles are removed in the upper and lower portions of the flap: the upper triangle along the nasofacial sulcus and the lower triangle along the nasofacial sulcus and/or the alar groove. Excellent results were obtained in the two clinical cases described in this report. Neither a trap door deformity nor dog-ears developed in either case. The postsurgical scars followed the aesthetic lines and became inconspicuous. A distinct angle was formed in the nasofacial sulcus without anchor sutures. This surgical procedure is technically simple and is performed under local anesthesia. Although the flap is a cheek-based advancement flap, postsurgical scars do not remain in the cheek; instead, they are located in the nasofacial sulcus and alar groove. The lateral nasal advancement flap is recommended for reconstruction of the nasal sidewall and dorsum.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권6호
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• pp.360-367
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• 2013

Purpose: The purpose of this study was to perform three-dimensional (3D) assessment of facial soft tissue in patients with skeletal Class III and mandibular asymmetry after orthognathic surgery. Methods: Samples consisted of 3D facial images obtained from five patients with A point-nasion-B point angle less than 2 degrees, and more than 5 mm of menton deviation. All patients had been treated at Gangneung-Wonju National University Dental Hospital from 2009 to 2012. They had undergone orthognathic surgery of Lefort I, and sagittal split osteotomy for correction of skeletal deformity, and orthodontic treatment. Facial scanning was performed before treatment (T1) and post-surgical orthodontic treatment (T2). Linear and angle variables of soft tissue landmarks, antero-posterior facial depth, and facial volume were measured. Results: No significant differences in width of the alar base, mouth width, and nasal canting were observed between T1 and T2. However, lip deviation, menton deviation, alar canting, lip canting, and menton deviation angle were significantly reduced at T2. Antero-posterior facial depth on the axial plane parallel to the left cheilion was significantly reduced on the deviated side and significantly increased on the non-deviated side at T2. Volume of the lower lateral and lower medial parts of the face was reduced on the deviated side, and volume of upper lateral and lower lateral parts on the non-deviated side was significantly increased at T2. Conclusion: After orthognathic surgery, facial asymmetry of soft tissue was improved following skeletal changes, especially the mandibular region. Although the length of the alar base and mouth width did not change, lip and soft tissue menton were displaced to the medial side after treatment. Facial depth also became symmetric after treatment. Facial volume showed a decrease on the lower part of the deviated side and that on lateral parts of the non-deviated side showed an increase after treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.392-400
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• 2011

Purpose: Cleft lip and palate is one of the most frequent hereditary deformities of the maxillofacial region which can arise in facial and jaw abnormalities as well as malocclusion and speech problems. In particular, unilateral cleft lip and palate is characterized by midface deformity resulting in maxillary anterior nasal septal deviation and nasal deformity. The aim of this study is to analyze the facial deformity of untreated unilateral cleft lip patients for contribution to primary cheiloplasty. Methods: Thirty-three patients with unilateral cleft lip and palate were impressioned before operation and facial casts were made. The casts were classified into complete cleft lip and incomplete cleft lip groups and each group were classified into affected side and normal side. Anthropometric reference points and lines were setted up and analysis between points and lines were made. Results and Conclusion: The obtained results were as follows: 1. The intercanthal width had no significant difference between the incomplete and complete cleft lip groups. 2. Cleft width and alar base width were greater in the complete group, and nasal tip protrusion was greater in the incomplete group. 3. Involved alar width and nostril width were greater in the complete group and in both complete and incomplete groups, involved alar width and nostril width were greater than the non-involved side. 4. The lateral deviation of the subnasale was greater in the complete group in both involved and non-involved sides. 5. The nasal laterale was placed inferiorly in both cleft groups. 6. The subnasale was deviated to the non-involved side in both cleft groups. 7. The nose tip was deviated to the non-involved side in both cleft groups and had greater lateral deviation in the complete cleft group. 8. The midpoint of cupid's bow had no vertical difference between complete and incomplete groups, but had a greater lateral deviation in the complete group. 9. In the complete cleft group, correlation between differences in cleft width and nostril width and columella height difference were obtained.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.205-213
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• 2005

There are several characteristics of the nose of orientals. The dorsum of nose is flat and low, the skin is thick with severe tension, the nasal tip is bulbous, the nostril is wide, and the projection of the nose is limited due to a poorly developed alar cartilage with a short columella. In order to improve these untoward characteristics of the nose of Orientals aesthetically, plain augmentation of the dorsum and tip-plasty with conventional methods has been performed by many plastic surgeons. However these conventional rhinoplasty is not enough to obtain satisfactory results when transforming into a more beautiful and aesthetically charming appearance. In order to produce the optimal nasal shape and profile, it is extremely important to consider the aesthetic surgical factors, which are; the position of the nasion, the optimal nasolabial angle(95-100 degree in Orientals), the natural exposure of infra-tip lobule with and columella, the position of the tip defining point in harmony with the dorsal profile and the smooth and natural silhouette of the lateral nasal profile as it descends into the inferior portion of the nose. From April, 2003 to August, 2004, a total of 52 patients underwent open rhinoplasty, adhering to the strict aesthetic principles considered and described priorly. Surgical approach was done through a transcolumella incision and an alar rim incision. The nasal dorsum was augmented with a silicone implant and the shape of the columella and the nasolabial angle were finessed with a silicone strut implant which was placed in between the medial crurae in a manner of a non-visible graft. The nasal tip was corrected by alar cartilage suture technique and onlay graft of shield shaped Alloderm and Gore-Tex. Author obtained the optimal nasal shape and profile aesthetically, and the results, considered satisfactory in all patients without any complications, are as follows; 1. the average increase in nasal length was 2.5 mm, 2. the average decrease in nasal width was 2.1 mm, 3. the average increase in nasal tip projection was 3.2 mm, 4. the changes of nasolabial angles were from 85.5 degree to 94.7 degree, 5. the changes of the angle between the long axis of the external naris was from 101.3 degree to 89.5 degree. In conclusion, this surgical procedure is an effective, reliable and a valuable method in improving the nasal shape, tip projection, nasolabial angle and especially, the lateral facial profile of Orientals aesthetically.

• 대한구순구개열학회지
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• 제2권1_2호
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• pp.23-28
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• 1999

The author presents Bardach' s technique for the residual unilateral cleft lip nasal deformity, The key to a successful and stable correction of the nasal deformity is to lengthen the columella on the cleft side and to mobilize alar cartilage from its surrounding tissue, creating a symmetric shape and length, The major advantages of the technique are lengthening of the cleft columella and creation of a symmetric and well-projected nasal tip.

• 대한두개안면성형외과학회지
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• 제11권1호
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권1호
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• pp.64-68
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• 2002

저자등은 치조열이 있는 성인 환자의 골결손에서 회복이 어려운 비익기저부의 지지와 구개비강누공(oronasal fistula)의 폐쇄등을 위하여, 형성된 defect 부위의 비강쪽 점막을 이용하여 nasal layer 형성하고 장골의 피질골과 해면골을 채취하여 파열된 piriform aperture 좌,우측 골에 fissure bur를 이용하여 양쪽에 수평홈을 형성하고, 채취한 피질골을 양측 홈사이에 설합과 같이 밀어 넣어 piriform aperture를 재건하여 연결시키고, 그 아래로 해면골을 이식된 피질골에 누르며 다져 충전하는 방법을 사용하여 비익기저부의 회복에 양호한 결과를 얻었기에 문헌고찰과 함께 증례들을 보고하는 바이다.