Background:The nasal alar defect in Asians remains a challenging issue,as do clear classification and algorithm guidance,despite numerous previously described surgical techniques.The aim of this study is to propose a ...Background:The nasal alar defect in Asians remains a challenging issue,as do clear classification and algorithm guidance,despite numerous previously described surgical techniques.The aim of this study is to propose a surgical algorithm that addresses the appropriate surgical procedures for different types of nasal alar defects in Asian patients.Methods:A retrospective case note review was conducted on 32 patients with nasal alar defect who underwent reconstruction between 2008 and 2022.Based on careful analysis and our clinical experience,we proposed a classification system for nasal alar defects and presented a reconstructive algorithm.Patient data,including age,sex,diagnosis,surgical options,and complications,were assessed.The extent of surgical scar formation was evaluated using standard photography based on a 4-grade scar scale.Results:Among the 32 patients,there were 20 males and 12 females with nasal alar defects.The predominant cause of trauma in China was industrial factors.The majority of alar defects were classified as type Ⅰ C(n=8,25%),comprising 18 cases(56.2%);there were 5 cases(15.6%)of type Ⅱ defect,7(21.9%)of type Ⅲ defect,and 2(6.3%)of type Ⅳ defect.The most common surgical option was auricular composite graft(n=8,25%),followed by bilobed flap(n=6,18.8%),free auricular composite flap(n=4,12.5%),and primary closure(n=3,9.4%).Satisfactory improvements were observed postoperatively.Conclusion:Factors contributing to classifications were analyzed and defined,providing a framework for the proposed classification system.The reconstructive algorithm offers surgeons appropriate procedures for treating nasal alar defect in Asians.展开更多
The aim of this study was to determine the relationship between inter canine width (ICW) and inter alar width (IAW), inter commissural width (ICoW), and inter canthal distance (ICaD) in Bantu population. Materials and...The aim of this study was to determine the relationship between inter canine width (ICW) and inter alar width (IAW), inter commissural width (ICoW), and inter canthal distance (ICaD) in Bantu population. Materials and Methods: It was a pilot study included all participants who were aged at least 18 years, without a history of orthodontics treatment from Prosthodontics Department, Faculty of Dental Medicine, University of Kinshasa. The Ethics committee of the National Center of Research for Dental Sciences in DR Congo approved the study protocol (CNRSB 1504.218). The participants medical records were obtained from the interview and dental examination. Nature of the study was explained with participant information sheet, and an informed consent of all participants was obtained. The inclusion criteria were no missing maxillary and mandibular teeth, no diastema, and no anterior restorations, 18 years old before enrollment in the study. The exclusion criteria were inability to meet the above requirements, pregnancy, and refusal to participate in the study. The inter-canine width (ICW), inter alar width (IAW), inter canthal distance (ICaD) and inter-commissural width (ICoW) of each participant were measured with a digital Vernier caliper (Mitutoyo, UK Ltd.,) (0.01 mm) three times and the average value was recorded. The inter canthal distance (ICaD) was measured without applying pressure by bringing the recording parts of the caliper just in contact with the medial angle. The inter alar width (IAW) was marked with a fine marked pencil on the widest outer surface of the alae of the nose on either side or width. Those two points were measured without applying pressure by bringing the recording parts of the caliper just in contact with the outer surface. The participant was told to stop breathing shortly to avoid any change in shape of the nose. The inter-commissural width (ICoW) was determined by measuring the maxillary lip vermilion from commissure to commissure without the application of pressure on the tissue in the relaxed state. The inter-canine width (ICW) was measured indirectly using a dental floss. A dental floss was marked on one end prior to placement in the mouth. Using that point as reference, the dental floss was circumference along the curvature of the anterior dentition such that it passed along the contact point of all the teeth. The distal end of the canine teeth on both sides was then marked on the floss while it was stretched in the patients mouth. Floss was marked on both sides with the marker pencil. The distance between the two proximal contact points was measured and recorded. Data, analysis and validation were performed by the SPSS software (version 22.0, IBM SPSS Statistics, Chicago, IL, USA). Unpaired t-test was used, of Kolmogorov-Smirnov test. Analysis of variance (ANOVA) test was used to test for comparability between socio-demographic characteristics dental measurements. Pearsons correlation coefficients test was calculated to determine the relationship between facial and dental parameters. Significance was set at P 0.01. Results: Of 314 participants enrolled, 202 were included. The age ranged from 18 to 68 years, with a mean age of 40.62 12.99 years. Although the Pearsons correlation coefficients were negative. Ninety-three participants (46%) were men and one hundred and nine (54%) were women. The overall mean age was 40.62 12.99 years. Facial and dental measurements were greater in women than men with significant differences for ICW (p = 0.04). However, no significant difference was seen between men and women for IAW, ICaD and ICoW (p = 0.44, p = 0.23, p = 0.31 respectively). The correlation including Pearsons correlation coefficient and P-values for all participants is not demonstrated. Conclusion: Within the limitations of this study, the results suggest that IAW, ICaD and ICoW cannot be used as a preliminary method for determining the width of the maxillary for anterior teeth for edentulous patients.展开更多
This report describes a two-step surgical correction of an isolated left-sided congenital alar cleft in a 21-year-old male patient presenting with a 9×6.5 mm^(2)-sized cleft.Malformations of the alar structure an...This report describes a two-step surgical correction of an isolated left-sided congenital alar cleft in a 21-year-old male patient presenting with a 9×6.5 mm^(2)-sized cleft.Malformations of the alar structure and displacement of the lower lateral cartilage were observed.All flaps survived,and the patient was completely satisfied with the surgical results.This surgical treatment is simple and reliable,can greatly improve the nasal appearance of patients with alar clefts,and may be an alternative to the current surgical treatment.展开更多
Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only i...Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.展开更多
Background: The repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities.Methods: In this report, we describe an alar...Background: The repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities.Methods: In this report, we describe an alar spiral advancement flap with a subcutaneous pedicle combined with postoperative nasal stent therapy for the repair of alar defects.Results: All cases showed slight asymmetry immediately after surgery, but at a median follow-up of 24 months, no cases of dissatisfaction with the nose shape or abnormal respiratory function were found. Almost all incision scars subsided within 12 months. In addition, all flaps that were dissected and rotated during the surgeries healed, and no signs of necrosis or development of vascular compromise were observed.Conclusion: Our preliminary experience suggests that the alar spiral flap followed by nasal stent therapy provides stable recovery of appearance and function for alar defects during follow-ups and shows promise for future therapies.展开更多
Background Nasal alarplasty is an important component of esthetic rhinoplasty in Asians.The two main surgical techniques that correct alar hypertrophy by reducing the height or length often leave external scars and ar...Background Nasal alarplasty is an important component of esthetic rhinoplasty in Asians.The two main surgical techniques that correct alar hypertrophy by reducing the height or length often leave external scars and are associated with a high relapse rate.Methods We developed a new technique,called three-dimensional(3D)M-shaped resection,which corrects both the nasal alar height and length and simultaneously minimizes external scarring.We performed this procedure from January 2013 to September 2016 in 49 consecutive female patients diagnosed with saddle nose and nasal alar hypertrophy.Their mean age was 28.6(range,18–40)years.All patients had previously undergone simple rhinoplasty.Nasal alar length and height,nostril length and width,and maximal nose width were analyzed preoperatively and postoperatively from photographs.Results After a mean of 9(range,3–24)months of follow-up,surgery was considered successful in 46 women(94%)with good cosmetic effects.In three patients,nasal alar hypertrophy recurred(6 months postoperatively).There were no early complications such as hematomas,infections,skin or mucosal necrosis,or wound dehiscence.The mean reductions postoperatively were 1.7 mm and 0.9 mm for nasal alar length and height,respectively,1.6 mm for both nostril length and width,and 3.5 mm for nose width.Conclusion The 3D M-shaped resection for nasal alar hypertrophy effectively reduced hypertrophy in 94%of patients for up to 24 months,producing minimal external scars and good cosmetic effects.It is a simple and convenient technique that is an effective and safe option for nasal alarplasty.展开更多
上颌Le Fort Ⅰ型截骨术是正颌外科中矫治上颌骨畸形最常采用术式之一。但是,上颌骨的移动、肌肉的剥离会影响周围软组织的形态,其中鼻形态的改变越来越受到重视。已有研究报道,正颌手术后鼻形态的不利改变是降低患者手术满意度的主要...上颌Le Fort Ⅰ型截骨术是正颌外科中矫治上颌骨畸形最常采用术式之一。但是,上颌骨的移动、肌肉的剥离会影响周围软组织的形态,其中鼻形态的改变越来越受到重视。已有研究报道,正颌手术后鼻形态的不利改变是降低患者手术满意度的主要原因之一。明确上颌Le Fort Ⅰ型截骨术对鼻形态的影响能够帮助医生更准确地预测术后鼻形态的变化,从而优化手术设计、提高医患沟通效率。本文将对上颌Le Fort Ⅰ型截骨术后鼻部形态变化的研究进展作一综述,旨在为临床实践提供相应的参考。展开更多
文摘Background:The nasal alar defect in Asians remains a challenging issue,as do clear classification and algorithm guidance,despite numerous previously described surgical techniques.The aim of this study is to propose a surgical algorithm that addresses the appropriate surgical procedures for different types of nasal alar defects in Asian patients.Methods:A retrospective case note review was conducted on 32 patients with nasal alar defect who underwent reconstruction between 2008 and 2022.Based on careful analysis and our clinical experience,we proposed a classification system for nasal alar defects and presented a reconstructive algorithm.Patient data,including age,sex,diagnosis,surgical options,and complications,were assessed.The extent of surgical scar formation was evaluated using standard photography based on a 4-grade scar scale.Results:Among the 32 patients,there were 20 males and 12 females with nasal alar defects.The predominant cause of trauma in China was industrial factors.The majority of alar defects were classified as type Ⅰ C(n=8,25%),comprising 18 cases(56.2%);there were 5 cases(15.6%)of type Ⅱ defect,7(21.9%)of type Ⅲ defect,and 2(6.3%)of type Ⅳ defect.The most common surgical option was auricular composite graft(n=8,25%),followed by bilobed flap(n=6,18.8%),free auricular composite flap(n=4,12.5%),and primary closure(n=3,9.4%).Satisfactory improvements were observed postoperatively.Conclusion:Factors contributing to classifications were analyzed and defined,providing a framework for the proposed classification system.The reconstructive algorithm offers surgeons appropriate procedures for treating nasal alar defect in Asians.
文摘The aim of this study was to determine the relationship between inter canine width (ICW) and inter alar width (IAW), inter commissural width (ICoW), and inter canthal distance (ICaD) in Bantu population. Materials and Methods: It was a pilot study included all participants who were aged at least 18 years, without a history of orthodontics treatment from Prosthodontics Department, Faculty of Dental Medicine, University of Kinshasa. The Ethics committee of the National Center of Research for Dental Sciences in DR Congo approved the study protocol (CNRSB 1504.218). The participants medical records were obtained from the interview and dental examination. Nature of the study was explained with participant information sheet, and an informed consent of all participants was obtained. The inclusion criteria were no missing maxillary and mandibular teeth, no diastema, and no anterior restorations, 18 years old before enrollment in the study. The exclusion criteria were inability to meet the above requirements, pregnancy, and refusal to participate in the study. The inter-canine width (ICW), inter alar width (IAW), inter canthal distance (ICaD) and inter-commissural width (ICoW) of each participant were measured with a digital Vernier caliper (Mitutoyo, UK Ltd.,) (0.01 mm) three times and the average value was recorded. The inter canthal distance (ICaD) was measured without applying pressure by bringing the recording parts of the caliper just in contact with the medial angle. The inter alar width (IAW) was marked with a fine marked pencil on the widest outer surface of the alae of the nose on either side or width. Those two points were measured without applying pressure by bringing the recording parts of the caliper just in contact with the outer surface. The participant was told to stop breathing shortly to avoid any change in shape of the nose. The inter-commissural width (ICoW) was determined by measuring the maxillary lip vermilion from commissure to commissure without the application of pressure on the tissue in the relaxed state. The inter-canine width (ICW) was measured indirectly using a dental floss. A dental floss was marked on one end prior to placement in the mouth. Using that point as reference, the dental floss was circumference along the curvature of the anterior dentition such that it passed along the contact point of all the teeth. The distal end of the canine teeth on both sides was then marked on the floss while it was stretched in the patients mouth. Floss was marked on both sides with the marker pencil. The distance between the two proximal contact points was measured and recorded. Data, analysis and validation were performed by the SPSS software (version 22.0, IBM SPSS Statistics, Chicago, IL, USA). Unpaired t-test was used, of Kolmogorov-Smirnov test. Analysis of variance (ANOVA) test was used to test for comparability between socio-demographic characteristics dental measurements. Pearsons correlation coefficients test was calculated to determine the relationship between facial and dental parameters. Significance was set at P 0.01. Results: Of 314 participants enrolled, 202 were included. The age ranged from 18 to 68 years, with a mean age of 40.62 12.99 years. Although the Pearsons correlation coefficients were negative. Ninety-three participants (46%) were men and one hundred and nine (54%) were women. The overall mean age was 40.62 12.99 years. Facial and dental measurements were greater in women than men with significant differences for ICW (p = 0.04). However, no significant difference was seen between men and women for IAW, ICaD and ICoW (p = 0.44, p = 0.23, p = 0.31 respectively). The correlation including Pearsons correlation coefficient and P-values for all participants is not demonstrated. Conclusion: Within the limitations of this study, the results suggest that IAW, ICaD and ICoW cannot be used as a preliminary method for determining the width of the maxillary for anterior teeth for edentulous patients.
基金the Ethics Committee at the Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(approval no.SH9H-2021-T242)。
文摘This report describes a two-step surgical correction of an isolated left-sided congenital alar cleft in a 21-year-old male patient presenting with a 9×6.5 mm^(2)-sized cleft.Malformations of the alar structure and displacement of the lower lateral cartilage were observed.All flaps survived,and the patient was completely satisfied with the surgical results.This surgical treatment is simple and reliable,can greatly improve the nasal appearance of patients with alar clefts,and may be an alternative to the current surgical treatment.
文摘Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.
基金supported by the National Natural Science Foundation of China(grant nos.81701901 and 81801946)Natural Science Foundation of Shanghai Committee of Science and Technology(grant no.19ZR1430100)Shanghai Municipal Key Clinical Specialty(grant no.shslczdzk00901)。
文摘Background: The repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities.Methods: In this report, we describe an alar spiral advancement flap with a subcutaneous pedicle combined with postoperative nasal stent therapy for the repair of alar defects.Results: All cases showed slight asymmetry immediately after surgery, but at a median follow-up of 24 months, no cases of dissatisfaction with the nose shape or abnormal respiratory function were found. Almost all incision scars subsided within 12 months. In addition, all flaps that were dissected and rotated during the surgeries healed, and no signs of necrosis or development of vascular compromise were observed.Conclusion: Our preliminary experience suggests that the alar spiral flap followed by nasal stent therapy provides stable recovery of appearance and function for alar defects during follow-ups and shows promise for future therapies.
文摘Background Nasal alarplasty is an important component of esthetic rhinoplasty in Asians.The two main surgical techniques that correct alar hypertrophy by reducing the height or length often leave external scars and are associated with a high relapse rate.Methods We developed a new technique,called three-dimensional(3D)M-shaped resection,which corrects both the nasal alar height and length and simultaneously minimizes external scarring.We performed this procedure from January 2013 to September 2016 in 49 consecutive female patients diagnosed with saddle nose and nasal alar hypertrophy.Their mean age was 28.6(range,18–40)years.All patients had previously undergone simple rhinoplasty.Nasal alar length and height,nostril length and width,and maximal nose width were analyzed preoperatively and postoperatively from photographs.Results After a mean of 9(range,3–24)months of follow-up,surgery was considered successful in 46 women(94%)with good cosmetic effects.In three patients,nasal alar hypertrophy recurred(6 months postoperatively).There were no early complications such as hematomas,infections,skin or mucosal necrosis,or wound dehiscence.The mean reductions postoperatively were 1.7 mm and 0.9 mm for nasal alar length and height,respectively,1.6 mm for both nostril length and width,and 3.5 mm for nose width.Conclusion The 3D M-shaped resection for nasal alar hypertrophy effectively reduced hypertrophy in 94%of patients for up to 24 months,producing minimal external scars and good cosmetic effects.It is a simple and convenient technique that is an effective and safe option for nasal alarplasty.
文摘上颌Le Fort Ⅰ型截骨术是正颌外科中矫治上颌骨畸形最常采用术式之一。但是,上颌骨的移动、肌肉的剥离会影响周围软组织的形态,其中鼻形态的改变越来越受到重视。已有研究报道,正颌手术后鼻形态的不利改变是降低患者手术满意度的主要原因之一。明确上颌Le Fort Ⅰ型截骨术对鼻形态的影响能够帮助医生更准确地预测术后鼻形态的变化,从而优化手术设计、提高医患沟通效率。本文将对上颌Le Fort Ⅰ型截骨术后鼻部形态变化的研究进展作一综述,旨在为临床实践提供相应的参考。
