The anchor of the nasal ala in cleft lip-nose patients: a morphological description and a new surgical approach.

OBJECTIVE: The purpose of this article is to describe a morphological condition that is readily seen in both primary and secondary deformed noses of cleft patients and to present a new surgical technique to correct this specific deformity that afflicts the alar dome. This anomaly resembles a taut cord-like tissue that runs vertically from the pyriform aperture and is anchored onto the alar cartilage, thus impeding the cartilage's normal growth process. This new surgical technique releases the anchor and corrects the deformity of the nasal rim by using a triangular flap V-Y advancement technique. RESULTS: From 1994 to 1997, 88 cleft lip-nose cases were operated on by the author using the triangular flap V-Y advancement technique for releasing the anchor. Forty-two cases were primary repairs and 46 were secondary repairs. CONCLUSIONS: By studying the normal and pathological anatomy of the nose and its proportions, the surgeon can obtain ideas for new surgical corrective techniques that can be used to restore anatomical balance and harmony between the nose and the face. Only in the last 15 to 20 years has the plastic surgeon begun to be interested in primary rhinoplasty in cleft lip-nose patients. Within this time, many different techniques have been proposed. All primary and secondary cases that have undergone this specific technique for release of the anchor have shown good results for restoring the height of the alar dome's affected side to that of the noninvolved side, thus establishing a more anatomically balanced nose.     

Correction of the skeletal nasal base in rhinoplasty.

The anatomic abnormalities responsible for the unesthetic nose have been rather extensively described and detailed in clinical studies, applied clinical research (anthropometric) evaluations, and laboratory investigations. These include alterations in the nasal bones, septum, upper lateral cartilage, lower lateral cartilages, skin, nerves, and vessels. However, little attention has been directed to the nasal base, which is frequently deficient and/or asymmetrical in people with nasal deformities. The importance of recognizing this deformity when evaluating patients for rhinoplasty and its subsequent correction as part of the procedure are discussed.     

Application of nasal clip in the one-stage repair of unilateral cleft lip nasal deformity

目的 探讨鼻夹在单侧唇裂鼻畸形一期整复术后的应用效果。方法 选取2017年1月—2018年6月在四川大学华西口腔医院唇腭裂外科行单侧唇裂鼻畸形一期整复术的患者60例,分为鼻夹组、鼻模组和对照组。3组患者均在术后6~12个月复诊,并对鼻外形进行评价。结果 鼻夹组患者的鼻外形发育及美学效果较对照组有明显改善,差异有统计学意义（P<0.05）。结论 鼻夹对于唇裂鼻畸形患者矫正术后鼻外形的改善有良好的效果,而且鼻夹操作简单,患者依从性较好,值得临床推广使用。     

The collagen-apatite implant and repair of jaw bone tissue defects

The calcified material (the collagen and calcium hydroxyphosphate--base material) has been used for the first time with a high degree of the structural integrability of components. This material has been obtained according to an unique technology. The material was implanted in 17 patients: after cystectomy--12, after root apex resection--5. The teeth which were in the defective region were preimmobilized by means of archbar structures. The material biotransformation was checked by scintigraphy, roentgenography. According to the obtained data forming of bone tissue was registered on day 20-21 after the operation, after 2-2.5 months this process ended.     

Immediate repair of labial bone defects

In this paper some surgical techniques are described to prevent or restore the characteristic and esthetically disturbing resorption defect in the anterior alveolar process as a result of tooth loss. One-stage approaches are described. Submucosal implants are used in combination with conventional fixed prosthodontics. If a single tooth replacement by means of an implant is aimed at, the split-crest technique may be a valuable alternative for an autologous bone graft or guided bone regeneration procedure.     

A review of the effects of expansion of the nasal base on nasal airflow and resistance.

PURPOSE: The purpose of this article is to inform the reader of the current literature regarding nasal airflow resistance. The anatomy and physiology of nasal airflow resistance will be examined and the known effects of widening of the nasal airway upon airflow will be described. MATERIALS AND METHODS: This article is a review of the current literature regarding nasal airflow and resistance and the effects of widening of the nasal base. No patient data were collected. RESULTS: The literature shows that nasal airflow resistance can be changed by surgical manipulation and by rapid palatal expansion, but that the effects on airflow resistance and future growth and development are unpredictable. CONCLUSION: Patients with a maxilla that is constricted in the transverse dimension and nasal airflow problems may benefit from expansion of the nasal base. The resultant effects upon nasal airflow resistance and subsequent growth and development are unpredictable and therefore airflow issues alone may not be a primary reason to increase the transverse dimension of the nasal base.     

Healing and repair of osseous defects

This article has discussed most of the modalities currently in use for the filling of bony defects. No one modality or combination of methods or materials has yet surfaced as the definitive means of treatment for filling these defects.     

History of cleft lip nasal repair.

Surgery of the cleft lip nasal tip has lagged behind cleft lip surgery. In fact, in most early illustrations it was not even noted. Since the development of cosmetic rhinoplasty an endless array of techniques have been published. Unfortunately there are few studies of the gross anatomy.     

Airway management in the repair of craniofacial defects.

The operative repair of craniofacial defects presents the surgeon with critical problems regarding airway management. Thirty-seven per cent of our series of 100 children operated upon for a variety of cranofacial deformities had some difficulty in airway management. Those patients with mandibular dysostoses and those requiring midface advancement (Le Fort III) had the highest incidence of airway problems. Our suggested management of the airway is described with emphasis upon the importance of close cooperation between the plastic surgeon, otolaryngologist and anesthesiologist.     

Osseous repair in infrabony periodontal defects

The present investigation was undertaken to quantitate the osseous changes which occur throughout the entire circumferential extent of infrabony periodontal defects in patients with optimal plaque control. Fifteen defects were selected in nine patients. Periodontal surgery was scheduled after each patient had shown an ability to practice efficient plaque removal. Muco-periosteal flaps were raised and the osseous defects debrided. The dimensions of each defect were measured at several specific location points within the defect. The flaps were replaced at their original location and, post-operatively, optimal plaque control was maintained in the area (Mean Plaque Index 0.04). Six to 8 months after the initial surgery all areas were re-operated and the osseous defects were remeasured at the same specific location points. Each defect showed osseous regeneration at every location point. The mean initial osseous defect depth at a location point was 3.5 mm and the mean amount of bone regeneration which occurred was 2.5 mm. Crestal alveolar bone resorption occurred at almost half of the location points and averaged 0.7 mm. Eleven of the 15 defects had resolved completely. There were isolated areas where a shallow defect persisted in the remaining four defects. The behavior of an osseous defect throughout its circumferential extent was characterized by a combination of coronal bone regeneration (mean 77%) and marginal bone resorption (mean 18%). Infrabony periodontal defects may predictably remodel after surgical debridement and establishment of optimal plaque control.     

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Park等[1]在行二期唇裂鼻畸形整复术时,发现患侧鼻翼软骨有着正常同样的大小和厚度,只是附着和形状发生了异常。基于这一发现,鼻软骨畸形被认为是源于唇裂形成后产生的异常肌肉应力的分布,而不是由于原发的软骨畸形。