Evaluating The Surgery Effect Of The Alar Cartilage Modification Techniques

BackgroundRhinoplasty has been a hot surgery in the Asia. Combined with the anatomy and the quality of cartilages, using the surgical techniques to improve the appearance, sculpture a beautiful nose, which is a long-cherished wish for plastic surgeons and each patient. Does the construction of the complex cartilages solve the defects of the nose? Thus still need clinical follow-up, and researching to draw the conclusions.The surgical methods to adjust the tip of the nose include suture, excision. transplantation.In 2003. Guyuron B summarized the suture methods:(1) The medial crural suture (2) The middle crural suture (3) The interdomal suture (4) Transdomal sutures (5) The lateral crural suture (6) The medial crural-septal suture (7) The tip rotation suture (8) The medial crural footplate suture (9) The lateral crural convexity control sutureKridel RWH. respectively proposed the lateral crural steal technique in 1989. and the lateral crural overlay technique in 1991. Guyuron B in 2003 made the tongue-in-groove technique adjust the tip of the nose. etc.Autogenous cartilage transplantations often choose the rib cartilage, the septal cartilage and the conchal cartilage. In 1997. Byrd et al. introduced the septal extension grafts which were described in three forms:paired spreader grafts, paired batten grafts extending diagonally across the caudal and dorsal septal L-strut, and direct extension grafts.From 1941 to 1951, Peer introduced using autologous nasal cartilage and auricular conchal cartilage to treat saddle nose and nasal tip deformities. In 1953. Goldman described the "floating graft", and in 1975, Sheen described the "shield graft",In 1979, Juri described the "anchor graft", In 1984 Peck described the "onlaygraft"" In this study, since July 2009,62 patients were received the primary nasal tip plasty. Now we collected the clinical data, summaried, analysised, evaluated the postoperative results, in order to provide an objective evidence for clinical operations.MethodsFrom July 2009 to September 2010,62 patients were received the primary nasal tip plasty. Patients were divided into four different surgical groups according to the different surgery method. Group 1:Placement of a columellar strut using autogenous cartilages, onlaygraft in nasal tip, the lateral crural transposition. Group 2: Onlaygraft in nasal tip, lateral crural partial resection. Group3: Placement of a columellar strut using autogenous cartilages, onlaygraft in nasal tip, lateral crural partial resection. Group 4:Placement of a columellar strut using autogenous cartilage, onlaygraft in nasal tip. Transdomal sutures, lateral crural steal. All patients were followed up for 1-6 months, were measured the line, angle in preoperative and postoperative photoes through the software. Calculated the preoperative and postoperative nasal tip protrusion, tip rotation, and the nasal tip tissue area to observe the morphological changing, and summarized.Results1 In these four methods, nasal tip protrusion, ala length and nasal tip protrusion /nasal width were increased after surgery. The inter-ala angle and the inter-axis angle, were decreased after surgery. 2 Comparison of four methods, In method 2 columella length and the Goode Ratio have no change, but in the other three methods these were increased postoperation.3 Comparison of four methods, In method 1 nasolabial angle were decreased postoperation than preoperation, contrary to the result in the other three methods.4 Exclude method 2, the nose tip area ratio was decreased after surgery in the other three methods.Conclusion1 Encountering the patients with low, flat nose, we can choose placement of a columellar strut using autogenous cartilage, onlaygraft in nasal tip, transdomal sutures to increase the nasaltip protrusion.2 Encountered the patients with droopy nose, we can choose lateral crural partial resection, lateral crural steal technique to rotate the nose tip upward.3 Encountered the patients with nasal tip upward, we can choose the lateral crural transposition to rotate the nose tip downwards.