Original article
Functional and Aesthetic Results After Augmentation Rhinoplasty
Resultados funcionales y estéticos tras rinoplastia de aumento
Mercedes Álvarez-Buylla Blanco
, Adolfo Sarandeses García, Jacobo Chao Vieites, Rosa Babarro Fernández, Carmen Deus Abelenda, Anselmo Padín Seara
Corresponding author
Servicio de Otorrinolaringología, Hospital Universitario A Coruña, A Coruña, Spain
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Throughout the years, various materials have been used to achieve this increase and many have been the subject of controversy due to the problems that they caused.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The final outcome of surgery is determined by a number of factors: anatomical, surgical procedures, scarring process and patient characteristics (race, skin type and consistency of cartilage).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Due to this set of variables that can change our results, we must individualise each case and select the type of material to be used depending on the needs of each patient.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to show our experience with augmentation septorhinoplasty: the type and nature of the grafts used, the morphological characteristics of each case and the aesthetic and functional results in the short and long term.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a descriptive retrospective study by reviewing the medical records of 188 patients operated at our Septorhinoplasty Service during a period of 12 years between January 1998 and April 2009.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 42 patients underwent augmentation septorhinoplasty, which is the subject of our study. The open rhinoplasty approach was used in all patients and all were operated on by the same surgeon.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical data collected in the study were: age, gender, symptoms, medical history, previous surgery, ENT exploration, surgical technique, complications and results.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The mean follow-up period was 73 months (11–136 months).</p><p id="par0045" class="elsevierStylePara elsevierViewall">All patients underwent a photographic study, both preoperative and postoperative, including the frontal, basal, lateral and oblique projections. The aim of this study was to obtain an objective assessment of deformities that helped us to develop a surgical plan, as well as to document the degree of postoperative correction of the deformities existing in each case.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Surgical Technique</span><p id="par0050" class="elsevierStylePara elsevierViewall">We always started the intervention performing septoplasty, using the Cottle technique, to treat deformities of the septum and remove a quadrangular cartilage graft whenever possible.</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the treatment of the nasal back and tip, we performed an open approach in all cases, after making a transcolumellar incision in inverted “V” and a classical marginal incision. We exposed the upper and lower lateral cartilages, following the dissection in an avascular plane to the lower edge of the bones. To complete the dissection, we created a subperiosteal tunnel on the backbone, which reached the nasal spine of the front.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We moulded the graft chosen and adapted it to the required dimensions, shaping it with a number 15 scalpel. This graft had the shape of a boat, measuring approximately 3<span class="elsevierStyleHsp" style=""></span>mm in width by 3<span class="elsevierStyleHsp" style=""></span>cm in length, and could be made from septal cartilage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), ear cartilage (shell) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) or synthetic materials (Gore-Tex<span class="elsevierStyleSup">®</span> in our case), depending on the availability for autologous grafts in each patient. Cartilage plates were also used to achieve the necessary thickness, sutured with monofilament at their edges. The graft was placed in the subperiosteal tunnel, with its head end near the nasion to achieve good immobilisation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The correction of the nasal tip was usually performed through structure repositioning techniques using sutures (5/0 nylon, monofilament or 4/0 polyglycolic acid), with resection techniques being used very rarely.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lastly, we performed the osteotomies. We routinely performed percutaneous lateral and transverse osteotomies. In certain cases, oblique osteotomies were also performed.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">During the study period, we performed 188 septorhinoplasties in our service, of which 42 were augmentation interventions. A total of 66% of patients undergoing ASR were male (28/42), while 33% were female (14/42). The mean age of patients was 28 years, ranging between 16 and 50 years.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The most frequent cause was the presence of nasal trauma, present in 91% of cases (38/42). In 85.7% (36/42) of patients we performed augmentation septorhinoplasty as primary surgery and in 14% (6/42), as secondary surgery.</p><p id="par0085" class="elsevierStylePara elsevierViewall">We used various types of graft to increase the dorsum of the nose, depending on the needs of each patient. An onlay graft of quadrangular cartilage was used in 66% of cases (28/42), a single sheet of cartilage in 22 patients (85.7%) and a double graft of quadrangular cartilage in 6 patients (21%).</p><p id="par0090" class="elsevierStylePara elsevierViewall">To avoid displacement of the grafts, we sutured them to the triangular cartilages in 18/28 cases (we also sutured the sheets together in patients with 2 layers of cartilage) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and we used fibrin glue in 4 of 28 patients.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In 6 cases, we wrapped the graft in Espongostan<span class="elsevierStyleSup">®</span> sheets to regularise their surface and minimise the potential irregularities that sometimes occurred in the dorsum, especially in fine skins.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In 14 patients, it was necessary to use grafts of synthetic material: in all cases, we used Gore-Tex<span class="elsevierStyleSup">®</span>. This was the sole graft material in 12 (28.5%) patients and it was used together with septal cartilage in two (4.7%) patients.</p><p id="par0105" class="elsevierStylePara elsevierViewall">To increase nasal tip projection and support it, we used a columellar strut.</p><p id="par0110" class="elsevierStylePara elsevierViewall">We used various techniques on the alar cartilages to define the point. In 18 patients, we used dome sutures, with these being in butterfly shape in 6 patients (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). In 10 patients, we performed resection of the proximal edge of the alar cartilages associated to medial suture thereof.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Complications could be classified into 2 groups according to the nature of the graft used. In 4 patients in whom we used synthetic material (Gore-Tex<span class="elsevierStyleSup">®</span>), there was a foreign body reaction (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>) that occurred with local infection of the soft tissues of the nasal dorsum. Initially, we followed a conservative treatment with local cures and antibiotics. This action solved the problem conservatively in one case, while it was necessary to remove the Gore-Tex<span class="elsevierStyleSup">®</span> graft in the remaining 3 patients. They underwent a second surgical procedure to correct the defect of the nasal dorsum, using conchal cartilage grafts obtained from the patients themselves in all 3 cases (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Patients with autologous cartilage grafts presented significant resorption as a complication in 4 cases. The complication was mild and did not require reintervention in 3 cases, as the final result was satisfactory. However, the fourth patient developed a significant degree of resorption after 5 years, which caused a significant deformity in the nasal dorsum and necessitated review surgery. We decided to use a Gore-Tex<span class="elsevierStyleSup">®</span> graft for this second operation, with no short- or long-term complications (<a class="elsevierStyleCrossRefs" href="#fig0035">Figs. 7 and 8</a>).</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">In total, 4 patients required review surgery, which represents a reintervention rate of 9.5% (4 of 42).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">Septorhinoplasty is a surgical technique that requires a deep understanding of the anatomy of the nasal pyramid and its possible variants. However, we must take into account the long-term effects that may arise from the techniques used on the elements of the nasal pyramid. For these reasons, a long follow-up of patients is of great importance for the detection of potential complications.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">When evaluating the results of a septorhinoplasty, it is important to note that its goal is not to achieve a given surgical outcome, but the aesthetic and functional satisfaction of the patient.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Consequently, the operation may meet the expectations of patient but not of the surgeon, and vice versa.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The reconstruction of the nasal dorsum requires knowledge of different surgical techniques and resources, as well as the use of different types of implants, depending on the needs of each patient. In general, it is possible to classify the grafts used in ASR into 3 groups according to their nature: autologous (mainly cartilage or bone), homologous and alloplastic or synthetic.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The ideal graft would be one combining biocompatibility, low rate of complications and long-term stable results, although this only exists as a concept for now.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6,7</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Autologous cartilage grafting is the one that best fits the above criteria, due to its excellent biotolerance, low rate of infection and extrusion and its ease of production. At present, it is still considered as the material of choice in augmentation nasal surgery.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7,8</span></a> In our experience, it is the first choice in cases of ASR, with low rates of extrusion, infection and displacement, as well as of irregularities in the dorsum. We have had no donor site complications (haematoma or septal abscess) and, unlike other areas, there are no visible scars.</p><p id="par0150" class="elsevierStylePara elsevierViewall">We should note that in 4 patients in our series who received crushed septal cartilage onlay grafts, we observed a significant degree of resorption (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> For this reason, we currently do not use crushed cartilage, despite support grafts reducing this trend.</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">In cases where it was not possible to obtain septal cartilage (trauma, infection or prior surgery), we usually chose ear cartilage as a second option.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> This has similar characteristics to septal cartilage in terms of rate of infection, extrusion and resorption, and is easily obtained with minimal donor site complications and its curved shape makes it ideal in areas where this contour is required.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a> Possible late complications include irregularities on the dorsum and graft deviation or resorption, hence the importance of long-term monitoring in patients with auricular cartilage grafts.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,10</span></a> Patients with major deformities that require a significant increase of the nasal dorsum (greater than 4<span class="elsevierStyleHsp" style=""></span>mm) present poorer results with auricular grafts. In these cases, we tended to select other types of grafts (costal cartilage or alloplastic materials).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,11,12</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Costal cartilage provides significant volume and represents an excellent structural support, although it has greater rigidity, a higher tendency to become curved and larger resorption rates than the previous types of grafts. In addition, the possibility of donor site complications (pneumothorax, chest wall deformity or severe postoperative pain) limits its use to severe cases of saddle nose deformity.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,12</span></a> Due to the risk of complications in the donor area and the possibility of curvature and unpredictable postoperative resorption, we do not use costal cartilage, preferring other options for increasing the nasal dorsum.</p><p id="par0165" class="elsevierStylePara elsevierViewall">In a study published in 2006, Araco et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> compared different autologous cartilage grafts (atrial, septal, costal and mixed) and assessed the degree of postoperative satisfaction in patients from the 4 groups, finding greater satisfaction in the groups of septal cartilage and auricular cartilage.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The literature contains numerous studies supporting the long-term results of autologous cartilage grafts, both due to their low complication rate and to the high degree of patient satisfaction.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7,10,13</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">In our everyday practice, we do not use bone grafts (cranial, iliac crest) or homologous materials (irradiated costal cartilage), so we will not mention them in this article.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In all our patients who received quadrangular cartilage onlay grafts, we used fixing measures to prevent displacement of the fragments. The most commonly used method was suture of the graft to the triangular cartilages. If the graft consisted of 2 sheets, these were stitched together.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Since the final years of the 20th century, many synthetic materials have been introduced in nasal reconstructive surgery. The advantages provided by these materials are their ease of use and unlimited availability, good immediate results, lack of need for a second surgical site (which decreases morbidity) and low cost.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,11,14</span></a> On the other hand, their disadvantages include high rates of mobilisation, infection and extrusion and the need to remove the material, as well as uncertain long-term outcomes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The most commonly used alloplastic materials in nasal surgery can be classified into 2 groups: solids (silicone) or porous (polyethylene-Medpor<span class="elsevierStyleSup">®</span> and polytetrafluoroethylene-Gore-Tex<span class="elsevierStyleSup">®</span>).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Silicone is a non-porous polymer material, whose solid form provides great structural support. Being a non-porous material, it reduces the chance of bacterial growth, but this also makes stabilising it more difficult.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its main disadvantages are its mobility and tendency towards extrusion, especially when using long implants in areas of tension or in patients with fine skins.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Zeng et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> suggest that, to minimise the incidence of complications, the silicone implant should be placed in a deep plane (subperiosteal), rather than a subcutaneous or subfascial one. In addition, Romo et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> suggest that the risk of extrusion with silicone implants is 50% when placed in the columella, compared to 10% when used on the dorsum.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Lin and Lawson<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> collected different works presenting a complication rate between 9.7% and 18%. Complications can occur in the first 2 weeks and are mostly secondary to infection by <span class="elsevierStyleItalic">Staphylococcus aureus</span>, or after 4 weeks, with the most frequent being alterations of superjacent skin.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Among the porous materials, we highlight polyethylene (Medpor<span class="elsevierStyleSup">®</span>) and polytetrafluoroethylene (Gore-Tex<span class="elsevierStyleSup">®</span>), with the latter being the only one used by us.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Medpor<span class="elsevierStyleSup">®</span> is a porous, high-density polyethylene. The size of its pores varies from 100 to 250<span class="elsevierStyleHsp" style=""></span>μm, which allows growth of fibrovascular tissue, thus contributing fixation and stability to the graft and making it more resistant to infection.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Romo et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> refer its use in more than 300 rhinoplasties, with an infection rate of 3%–4%. However, they indicate a higher likelihood of poor results in patients with fine skin and columellar grafts.</p><p id="par0215" class="elsevierStylePara elsevierViewall">In our experience, the most interesting alloplastic material is Gore-Tex<span class="elsevierStyleSup">®</span>. This is a porous polymer with a pore size of 10–30<span class="elsevierStyleHsp" style=""></span>μm.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These micropores enable limited growth of tissue, which helps to stabilise the graft without hindering its removal if needed. In addition, its hydrophobic characteristics reduce adherence of bacteria to the graft.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Gore-Tex<span class="elsevierStyleSup">®</span> can be cut and shaped to fit different shapes and sizes. Due to its characteristics, it is more useful for volumetric compensation than for support functions,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> being a poor choice as a columellar strut or as a graft for the external valve.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Various studies show 2.5% of complications, mainly infection with implant removal,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> which can appear up to 3 years after the intervention.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">In our series we used Gore-Tex<span class="elsevierStyleSup">®</span> as a graft on the nasal dorsum in 14 patients. It was used in isolation in 12 of them and associated with cartilage in 2 patients. In 4 cases, we found an infectious process, which required implant removal in 3 patients.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">Augmentation septorhinoplasty is a complex technique requiring precise knowledge of the nasal anatomy, comprehensive technical management by the surgeon, adequate preoperative planning and the use of different reconstructive options tailored to each particular case.</p><p id="par0235" class="elsevierStylePara elsevierViewall">At present, autologous cartilage, and septal cartilage in particular, is the first option in ASR. If septal cartilage is not available, we always turn to grafts of conchal cartilage of one or both sides depending on the need for material.</p><p id="par0240" class="elsevierStylePara elsevierViewall">Despite the availability of synthetic material, Gore-Tex<span class="elsevierStyleSup">®</span> in our case, we gave up its use years ago as material of choice for use in augmentation techniques to correct the nasal dorsum due to the complications which resulted in 4 patients included in this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres94832" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec81984" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres94833" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción y objetivos" 2 => "Material y método" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec81985" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical Technique" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-12-21" "fechaAceptado" => "2011-03-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec81984" "palabras" => array:5 [ 0 => "Augmentation rhinoplasty" 1 => "Dorsal augmentation" 2 => "Cartilage grafting" 3 => "Alloplastic grafting" 4 => "Complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec81985" "palabras" => array:5 [ 0 => "Septorrinoplastia de aumento" 1 => "Aumento de dorso nasal" 2 => "Injertos autólogos" 3 => "Injertos sintéticos" 4 => "Complicaciones" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Augmentation rhinoplasty could be defined as the method whose goal is to increase the dimensions of the nasal pyramid, both the dorsum and the tip. For a long time, surgeons have used different kinds of materials that have often been the object of discussion.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to report our experience with augmentation septorhinoplasty, emphasising the type and nature of the grafts employed and the ensuing complications.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective study describing the medical history of 188 patients who underwent septorhinoplasty surgery in our department over a period of 12 years, from January 1998 to April 2009. Of these patients, 42 underwent augmentation septorhinoplasty, which is the object of our study.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In 66% of the cases (28/42), quadrangular autologous cartilage was the “onlay” graft most widely employed; we used a single graft in 22 (85.7%) cases and a double one in the other 6 (21%).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In 14 patients, it was necessary to use grafts of synthetic material: in all the cases Gore-Tex<span class="elsevierStyleSup">®</span> was chosen, in 12 (28.5%) patients as the only graft material and in 2 (4.7%) used together with septal cartilage.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Nasal dorsum reconstruction requires the knowledge of different methods and surgical procedures, as well as the use of different types of grafts according to the needs of each patient. The ideal graft, which exists only as a concept, would be the one combining biocompatibility, a low complication rate and results that remained stable for a long time.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">At present, autologous cartilage, and more precisely septal cartilage, is still the first option for augmentation rhinoplasty. If septal cartilage is not available, we always turn to conchal cartilage grafts, from one or both sides depending on the amount of cartilage required.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La septorrinoplastia de aumento (SRA) podría definirse como aquella técnica cuya finalidad es conseguir un aumento de las dimensiones de la pirámide nasal, tanto del dorso como de la punta. A lo largo de los años, para conseguir este aumento se han utilizado múltiples materiales que han sido objeto de controversia.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El objetivo del presente estudio es mostrar nuestra experiencia con la septorrinoplastia de aumento, resaltando el tipo y la naturaleza de los injertos utilizados y las complicaciones acaecidas.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio retrospectivo descriptivo mediante la revisión de historiales clínicos de 188 pacientes intervenidos de septorrinoplastia en nuestro servicio en un período de 12 años comprendido entre enero de 1998 y abril de 2009.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En 42 pacientes se realizó una septorrinoplastia de aumento, la cual constituye el objeto de nuestro estudio.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En un 66% de casos (28/42) se utilizó un injerto <span class="elsevierStyleItalic">onlay</span> de cartílago cuadrangular, en 22 pacientes (85,7%) una lámina única de cartílago y en 6 pacientes (21%) un injerto doble de cartílago cuadrangular.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">En 14 pacientes fue necesario recurrir a los injertos de material sintético: en todos los casos se empleó el Gore-Tex<span class="elsevierStyleSup">®</span>, en 12 (28,5%) pacientes como único material del injerto y en 2 (4,7%) pacientes conjuntamente con cartílago septal.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La reconstrucción del dorso nasal exige el conocimiento de diferentes técnicas y recursos quirúrgicos, así como la utilización de diferentes tipos de injertos en función de las necesidades de cada paciente. El injerto ideal, que existe sólo como concepto, sería aquel que aúna biocompatibilidad, baja tasa de complicaciones y resultados estables a largo plazo.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En la actualidad, el cartílago autólogo, y más concretamente el cartílago septal, permanece como primera opción en la SRA. En caso de no disponer de cartílago septal, recurrimos siempre a los injertos de cartílago de concha, de uno o de ambos lados según la necesidad de material.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Álvarez-Buylla Blanco M, et al. Resultados funcionales y estéticos tras rinoplastia de aumento. Acta Otorrinolaringol Esp. 2011;62:347–54.</p>" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1579 "Ancho" => 2500 "Tamanyo" => 556457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Carving of septal cartilage graft.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1603 "Ancho" => 3333 "Tamanyo" => 625857 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Obtaining conchal cartilage graft.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1296 "Ancho" => 1167 "Tamanyo" => 201366 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Suture of graft to alar cartilages.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 782 "Ancho" => 2500 "Tamanyo" => 214972 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Placement of columellar strut and suture of domes in butterfly wing shape.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1190 "Ancho" => 1665 "Tamanyo" => 248011 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Foreign body reaction in a patient with Gore-Tex<span class="elsevierStyleSup">®</span> graft.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1391 "Ancho" => 2350 "Tamanyo" => 399866 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Preoperative and postoperative images of a patient with nasal dorsum reconstructed using ear cartilage.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 703 "Ancho" => 2492 "Tamanyo" => 267544 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Reconstruction of the nasal dorsum with Gore-Tex<span class="elsevierStyleSup">®</span> after resorption of septal cartilage.</p>" ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1808 "Ancho" => 2436 "Tamanyo" => 522117 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Reconstruction of the nasal dorsum with Gore-Tex<span class="elsevierStyleSup">®</span>.</p>" ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1548 "Ancho" => 1000 "Tamanyo" => 211608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Resorption of crushed septal cartilage graft.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Injertos en rinoplastia. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 April | 1 | 2 | 3 |
| 2023 March | 1 | 0 | 1 |
| 2023 January | 1 | 2 | 3 |
| 2022 April | 1 | 0 | 1 |
| 2021 July | 1 | 2 | 3 |
| 2021 February | 0 | 2 | 2 |
| 2021 January | 0 | 2 | 2 |
| 2020 November | 0 | 1 | 1 |
| 2020 June | 0 | 1 | 1 |
| 2020 March | 37 | 10 | 47 |
| 2020 February | 63 | 10 | 73 |
| 2020 January | 82 | 7 | 89 |
| 2019 December | 93 | 14 | 107 |
| 2019 November | 49 | 10 | 59 |
| 2019 October | 56 | 3 | 59 |
| 2019 September | 61 | 7 | 68 |
| 2019 August | 34 | 3 | 37 |
| 2019 July | 69 | 16 | 85 |
| 2019 June | 148 | 31 | 179 |
| 2019 May | 243 | 39 | 282 |
| 2019 April | 130 | 39 | 169 |
| 2019 March | 28 | 10 | 38 |
| 2019 February | 41 | 13 | 54 |
| 2019 January | 23 | 9 | 32 |
| 2018 December | 24 | 9 | 33 |
| 2018 November | 34 | 7 | 41 |
| 2018 October | 29 | 19 | 48 |
| 2018 May | 7 | 2 | 9 |
| 2018 April | 52 | 15 | 67 |
| 2018 March | 71 | 5 | 76 |
| 2018 February | 35 | 3 | 38 |
| 2018 January | 50 | 5 | 55 |
| 2017 December | 50 | 3 | 53 |
| 2017 November | 45 | 2 | 47 |
| 2017 October | 36 | 7 | 43 |
| 2017 September | 38 | 8 | 46 |
| 2017 August | 56 | 10 | 66 |
| 2017 July | 42 | 10 | 52 |
| 2017 June | 59 | 11 | 70 |
| 2017 May | 74 | 14 | 88 |
| 2017 April | 36 | 9 | 45 |
| 2017 March | 41 | 26 | 67 |
| 2017 February | 37 | 3 | 40 |
| 2017 January | 25 | 3 | 28 |
| 2016 December | 58 | 7 | 65 |
| 2016 November | 73 | 8 | 81 |
| 2016 October | 99 | 7 | 106 |
| 2016 September | 91 | 3 | 94 |
| 2016 August | 71 | 6 | 77 |
| 2016 July | 57 | 1 | 58 |
| 2016 June | 63 | 17 | 80 |
| 2016 May | 68 | 17 | 85 |
| 2016 April | 72 | 24 | 96 |
| 2016 March | 91 | 25 | 116 |
| 2016 February | 82 | 22 | 104 |
| 2016 January | 73 | 24 | 97 |
| 2015 December | 60 | 16 | 76 |
| 2015 November | 50 | 20 | 70 |
| 2015 October | 96 | 23 | 119 |
| 2015 September | 52 | 11 | 63 |
| 2015 August | 81 | 10 | 91 |
| 2015 July | 120 | 7 | 127 |
| 2015 June | 47 | 4 | 51 |
| 2015 May | 54 | 7 | 61 |
| 2015 April | 86 | 10 | 96 |
| 2015 March | 96 | 20 | 116 |
| 2015 February | 48 | 2 | 50 |
| 2015 January | 46 | 6 | 52 |
| 2014 December | 51 | 9 | 60 |
| 2014 November | 18 | 2 | 20 |
| 2014 October | 39 | 9 | 48 |
| 2014 September | 29 | 3 | 32 |
| 2014 August | 31 | 9 | 40 |
| 2014 July | 28 | 4 | 32 |
| 2014 June | 19 | 2 | 21 |
| 2014 May | 24 | 5 | 29 |
| 2014 April | 25 | 6 | 31 |
| 2014 March | 25 | 9 | 34 |
| 2014 February | 28 | 4 | 32 |
| 2014 January | 20 | 3 | 23 |
| 2013 December | 38 | 4 | 42 |
| 2013 November | 48 | 4 | 52 |
| 2013 October | 67 | 9 | 76 |
| 2013 September | 49 | 9 | 58 |
| 2013 August | 23 | 2 | 25 |
| 2013 July | 1 | 0 | 1 |
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