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Page 31
allied
academies
September 10-11, 2018 | Paris, France
&
Joint Event
Otolaryngology: ENT Surgery
6th International Conference on
Cell & Stem Cell Research
World Congress and Expo on
Journal of Otolaryngology Online Journal | Volume 8
Correction of the contracted noses
Dong Hak Jung
Shimmian Rhinoplasty Clinic, Korea
P atients seeking dorsal augmentation often have features of
a shortened and associated small nose. The small nose can
be defined as a nose with a low dorsum and a short length. This
is particularly common among the people of South China and
South East Asia where many patients have a short and overly
rotated nose. Objective markers of the short nose include a
nasolabial angle of more than 100-105 degrees and when the
middle thirdof the face (frombrowtobaseof nose) to total facial
height ratio is less than 1:3. The causes of a severely shortened
nose, particularly in South East Asians include congenital
causes and post-operative contraction. Post-operative causes
occur due to immunologic reaction to graft material. Repeated
surgery and post-operative infection are other known causes.
The correction of this deformity requires dorsal augmentation
and nasal lengthening. Poorly performed surgery can results
in worsening of the contracture and shortening. The mainstay
of surgical treatment is the extended spreader graft. In
congenital cases, skin elasticity is good as no prior surgery has
been performed. Adequate lengthening can be achieved and
maintained with autologous septal and auricular cartilage.
However, in cases of post-operative contraction, the rigid and
scarred skin is often resistant to lengthening. A stronger, more
rigid graft may be required. The choice of graft material in
this case is often the autologous rib cartilage graft. Although
bilateral extended spreader grafts give good lengthening and
symmetry, the increased pressure on the dorsal septum can
cause cartilage necrosis and perforation, to avoid this, thewidth
of the spreader grafts should not exceed 5mm. The author uses
a unilateral extended spreader graft to avoid this complication.
When there is severe and asymmetric contraction. Adequate
correction may require the use of several types of local flaps.
These include unilobular and bilobed flaps, alar rotation/
advancement flaps and the subnasale flap.
e:
ENT and Stem Cell 2018, Volume 8
DOI: 10.4066/2250-0359-C1-003