• Archives of Plastic Surgery
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• v.33 no.2
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• pp.135-143
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• 2006

The characteristics of the cleft lip nasal deformity is defined in this article in three planes. The alar flaring is explained in X axis, the lower positioning of the alar free margin is imagined in Y axis and the short hemicolumella is in Z axis. Most cleft surgeons have focused on the malposition of the lateral crus of alar cartilage while the author defined it in X and Y axises and tried to correct that deformity of short hemicolumella in Z axis. For the last 13 years the author applied that method in 818 cases of secondary cleft lip nose deformity. Through the columellar splitting incision extended to free margin of the alar not beyond the nasal dorsum, the skin and soft tissue of the webbing deformed the nasal tip was excised in crescent fashion. The dissected short hemicolumella including the medial crus was thus elevated and advanced into the space of the deformed nasal tip after the crescent excision. This procedure should be followed by the correction of the deformities in X and Y axis. The medial crus elevation is more effective and critical way to have the constant and nice outcome than the lateral crus reposition in secondary cleft lip nasal deformity

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.422-428
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• 2007

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of 1) lengthening the columella, 2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary, 3) nasal mucosal advancement, 4) alar base narrowing and 5) reconstruction of the orbicularis oris as required. In surgical repair of the cleft lip nose, the timing of the operation(during lip closure, before or after the puberty growth sput), and the operative technique play a key role in the final result. In this study, 13 cleft lip patients who had undergone a secondary cheilorhinoplasty at the Department of Oral and Maxillofacial Surgery, Pusan National University Hospital were evaluated to check the proper time and method of the operation.

• Archives of Plastic Surgery
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• v.51 no.5
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• pp.480-486
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• 2024

Many failures in total or subtotal nasal reconstruction result from an underestimation of the amount of skin required for an adequate result, especially for sufficient lining. Such planning errors usually lead to poor results, with exposure of structural grafts, infection, scar retraction, airway obstruction, and finally loss of projection and shape of the reconstructed nose. Reconstruction options for cases in which previous attempts have failed are always limited, as well as in cases of trauma or burns affecting the soft tissues of the forehead and face. In such complex situations, one may employ free flaps or tissue expansion, but such resources may not be always available. We describe a technique indicated for salvage surgeries in patients whose previous nasal reconstructions have failed, allowing a generous amount of tissue transfer for the nasal region. The technique combines the use of supraclavicular and submental flaps, with simple execution, not requiring microsurgical skills or devices such as tissue expanders. Done in three stages, the described technique provides enough skin for a total nasal reconstruction. The final result is obtained after subsequent refinements, and the total number of procedures is equivalent to when more sophisticated techniques are employed, such as tissue expansion or microsurgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.2
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• pp.167-173
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• 2007

The temporalis fascia graft has been widely used in the correction of nasal deformities. The fascia can be used alone or combined for augmentation rhinoplasty. The fascia graft provides adequate coverage, contour, and bulk on the profile of the nose, as well as an inconspicuous donor site. A depressed radix area can be successfully corrected by the fascia graft. We present two cases of nasal radix augmentation by using temporalis fascia graft. Two male patients presented with the skeletal class III malocclusion and the depressed radix. A planned orthognathic surgery and the temporalis fascia graft to the radix were performed. The malocclusion and the profile of the patients were markedly improved after the operation. Not only the radix but also the nose was improved in its size and length. There was no noticeable resorption or displacement of the radix area at follow-up. The temporalis fascia graft could be an appropriate surgical technique in radix augmentation and nose lengthening.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.243-249
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• 2007

Purpose: Posttraumatic nasal deformities might not be corrected adequately by conventional osteotomy techniques when the configuration of the nasal bone has been changed due to malunion. To consistently obtain good aesthetic and functional results, the anatomic reduction of malunion sites of the nasal bone is important. The purpose of this study is to present an osteotomy technique, including refracture along malunion sites and anatomical reduction of a malformed nasal bone, for the correction of a posttraumatic deviated nose. Methods: From March of 2003 to May of 2004, 27 patients, who underwent corrective rhinoplasty for the correction of bony pyramid deviation, were included in this study. Postoperative results of the technique were evaluated objectively at 1 year after surgery regarding nasal midline location, nose symmetry, and nasal contour. Results were rated as excellent, good, fair, or poor. All patients were also evaluated subjectively for cosmetic improvement, changes in breathing, and overall satisfaction. Results: Objective analysis of the outcomes revealed an excellent result in 17 patients(63%), good in 9(33%), and fair in 1 patient(4%). No case evaluated had a poor result. Regarding subjective analysis, 19 patients(70%) evaluated the cosmetic outcome as perfect. Among the 21 patients with preoperative airway problems, 19 patients(90%) reported improved breathing post-operatively. Patients' overall satisfaction levels were also very positive. No postoperative complications occurred during the 14 month mean follow-up period. Conclusion: The osteotomy technique presented in this study is simple, effective, and safe for correcting posttraumatic nasal deviation, and also produces consistent results.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.510-516
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• 2022

Background Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. Many surgical techniques and conservative devices have been offered for the early management of bilateral cleft lip in infants. The purpose of this study was to evaluate the effect of lip adhesion on the lip and nose of patients with bilateral cleft lip. Methods A retrospective review of 13 patients with bilateral cleft lip was performed and compared with age-matched noncleft children. Patients underwent lip adhesion at a mean age of 2.8 months, and cheiloplasty at 6.6 months of age using a modification the Mulliken method. Secondary rhinoplasty was performed at the age of 6 in 13 patients. The surgical results were analyzed using photographic records obtained at the age of 1 and 7 years. Twelve length measurements and one angle measurement were obtained. Results All measurements were not statistically different from those of the noncleft age-matched control group at the age of 1. At 7 years of age, upper lip height and vermilion mucosal height were shorter (p < 0.05) than in the control group. Nasal tip protrusion and the nasolabial angle were greater (p < 0.05) than in the control group. Conclusion Lip adhesion followed by secondary rhinoplasty resulted in an acceptable lip and nasal appearance. Although nasoalveolar molding is now widely used, lip adhesion can be an appropriate alternative if an orthodontist is not available due to geographical or economic constraints.

• Journal of the Korean Burn Society
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• v.24 no.1
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• pp.14-17
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• 2021

The nose is a complex three-dimensional structure and represents a major aesthetic focus of the face. As a gold standard for nasal soft tissue reconstruction, the 'forehead flap' provides reconstructive surgeons a robust pedicle and large amount of tissue to reconstruct almost any defect. However, during this process, some hair can be unintentionally introduced to the nose. Accordingly, laser hair removal is sometimes needed, but blood circulation and flap survival should be carefully monitored. Despite careful evaluation, a third-degree burn occurred in our patient that required eight weeks to heal. Here, we report on a burn resulting from epilation conducted 2 weeks after forehead flap for nasal reconstruction.

• Korean Journal of Cleft Lip And Palate
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• v.3 no.1
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• pp.17-22
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• 2000

While in endonasal rhinoplasty transection and resection of nasal structures is primarily used for correction of nasal deformities, open rhinoplasty is performed using stures and repositioning of nasal structures in the repair of severe nasal deformities. We reviewd our experiences in the repair of cleft nasal deformities from 1991 to 1999 year in our institute, and compared the results of open rhinoplasty with endonasal rhinoplasty. In overall 164 cases of rhinoplasty in cleft nasal repair, open rhinoplasty was done in 13 cases. Male patients were 10, female 3(age between 6 to 34 years old). In this article, our experience, together with review of literatures of open rhinoplasty in the cleft nasal deformities are reported.

• The korean journal of orthodontics
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• v.51 no.6
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• pp.428-434
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• 2021

Craniofacial clefts are extremely rare deformities. Tessier's classification is a widely accepted system that is based on clinical, radiographical, and surgical observations. The Tessier No. 0 cleft most commonly affects the upper lip, nose, and palate. This case presentation aims to report the outcome of a modified presurgical alveolar molding (PAM) appliance used in the treatment of an infant with Tessier No. 0 cleft as an alternate approach to mold such defects before surgery. The modified PAM appliance consisted of reciprocal parts connected by a helix. The segments were approximated by stripping the appliance at the midline in a V-shaped manner and the force was exerted by the extraoral elastics. The procedure gave results in 8 weeks, which may be regarded as a reasonable duration. The anterior cleft gap, which was 13 mm before the treatment, was reduced to 3 mm after the treatment by using modified PAM appliance. On a 21-month follow-up period, oral reshaping was regarded successful due to stability of the improved oral mold.

• Journal of Medicine and Life Science
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• v.15 no.2
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• pp.105-107
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• 2018

The reconstruction method of nasal area can be used differently depending on the location, size, age. In this elderly female patient case, without using the forehead medial flap, good results can be obtained by using an advancement flap considering the nasal aesthetic unit.