Victor Diniz de Pochat

The Role of Septal Cartilage in Rhinoplasty: Cadaveric Analysis and Assessment of Graft Selection

BACKGROUND In addition to providing nearly 50% of total airway resistance via the internal valve, the nasal septum provides support for the cartilaginous portion of the nasal dorsum, and it is responsible for determining the projection of the nasal tip. In modern rhinoplasty, septal cartilage plays an important role as a donor graft material. OBJECTIVES The authors evaluate the anatomy of nasal septal cartilage, identifying variations according to certain regions of the septum and proposing a correlation between the topography and morphology of septal cartilage and graft choice. METHODS An anatomical study was performed on 14 fresh adult cadavers. The excised septal cartilage was placed on grid paper; digital images were taken; all septal cartilage was divided into nine equivalent quadrants; and quantitative measurements for length, height, and area were calculated and compared. Statistical significance was set at P < .05. RESULTS The average length of the septum was 35.14 mm, while the average height was 32.5 mm. The average septal area was 933.11 mm(2). The septal thickness mean values were analyzed in nine quadrants, ranging from 1.04 to 1.71 mm. Statistically-significant differences in mean values were found in 13 of the 14 cadavers. Specifically, the central and cranial areas were thickest, and the area corresponding to the L-strut was thinnest. CONCLUSIONS Anatomical variations of the thickness of septal cartilage excisions were found to be statistically significant, and these differences play an important role in the proper selection of the septal grafts.

Anatomical Study of the Lateral Crural Strut Graft in Rhinoplasty and Its Clinical Application

BACKGROUND Lateral crural strut graft has been used in rhinoplasty to correct deformities such as bulbous nasal tip, lateral crus malposition, alar retraction, collapsed external valve, lateral crus concavity, and alar deformity after domal suture. Despite its widespread use, the lateral crural strut graft has not been the subject of studies that show its benefits objectively and statistically. OBJECTIVES To assess nasal anatomical variations in cadavers that underwent rhinoplasty using the lateral crural strut graft, considering the clinical applications of this graft. METHODS The study was conducted with 16 human cadavers that underwent rhinoplasty with lateral crural strut graft. The variables were basilar nasal width, interalar width, columella-nasal tip height, nostrils width, and length and width of the graft. Measurements were taken with a digital caliper before and after rhinoplasty, and nostril cross-sectional area was measured with a computer program. All measurements were submitted to statistical analysis. RESULTS Most of the cadavers were young, male, and black. Variables values were increased, but only basilar nasal width, columella-nasal tip height, and nostril cross-sectional area showed statistically significant differences (P < .05), leading to changes in the alar base, the nasal tip projection and the external nasal valve. CONCLUSIONS Lateral crural strut graft improves external nasal valve and increases nasal tip projection and basilar nasal width.

Assessment of nasal patency after rhinoplasty through the Glatzel mirror

Summary Introduction: Objective evaluation of nasal function is a constant challenge for plastic surgeons, otolaryngologists, and allergists. The modified Glatzel mirror can evaluate nasal expiratory flow; however, there is little information on this method and its use in the measurement of nasal patency after surgical procedures. Objective: To compare, in a prospective study, the functional results before and after cosmetic rhinoplasty and evaluate the use of the Glatzel mirror as an objective method to assess nasal patency. Methods: To achieve this objective, we analyzed the functional results of surgery through a subjective questionnaire and objective evaluation through a modified Glatzel mirror, and evaluated the correlation between the 2 methods. Twenty patients (14 women and 6 men) underwent aesthetic rhinoplasty using spreader grafts. Pre- and postoperative evaluation (90–120 days) included a respiratory quality score (subjective) and modified Glatzel mirror test (objective). Subsequently, the Spearman test was used to compare the pre- and postoperative subjective and objective data. Results: The subjective evaluation demonstrated a statistical difference between pre- and postoperative scores (8 ± 2 and 9.4 ± 0.7, P ≤ 0.001). There was no statistical difference in mean nasal patency by modified Glatzel mirror. No statistically significant correlation was observed when comparing the modified Glatzel mirror values with the subjective scores reported by patients pre- or postoperatively. Conclusion: The Glatzel method lacks sensitivity in detecting patient-reported improvements in breathing following rhinoplasty. This suggests that the method is a poor assessment tool to detect small, post-surgical changes in the nasal airways.

Atividades de dissecção de cadáveres e residência médica: relato da experiência do Serviço de Cirurgia Plástica do Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia

INTRODUCAO: O adequado conhecimento da anatomia do ser humano e crucial para o desenvolvimento de uma tecnica cirurgica apurada. O treinamento com pecas anatomicas no meio universitario, muitas vezes, e insuficiente para o aprendizado. Assim, o uso de cadaveres para o ensino de anatomia e habilidades cirurgicas na graduacao e pos-graduacao tem sua importância reforcada. O objetivo deste estudo foi relatar a produtividade do Servico de Cirurgia Plastica do Hospital Universitario Professor Edgard Santos (HUPES) da Universidade Federal da Bahia, no que se refere as atividades de disseccao de cadaveres realizadas de 2009 a 2011, bem como a importância dessa atividade no treinamento dos residentes do servico. METODO: Foi realizada analise observacional retrospectiva da producao do servico em decorrencia das atividades de treinamento em disseccao de cadaveres, no periodo de 2009 a 2011. RESULTADOS: Foram desenvolvidas atividades no âmbito de ensino, pesquisa e extensao por meio de convenio firmado entre o Servico de Cirurgia Plastica do HUPES e o Instituto Medico Legal do Estado da Bahia. Entre as acoes pedagogicas empreendidas, a atividade de disseccao proporcionou a criacao de um material rico de ensino que inclui diversos retalhos importantes para a pratica diaria dos medicos residentes. Em relacao a pesquisa, foram desenvolvidos diversos artigos cientificos que geraram publicacoes e apresentacoes em eventos cientificos. Essa atividade deu origem, ainda, a uma monografia de conclusao de residencia e a uma tese de doutorado. Por meio do convenio firmado, foi realizado estagio extracurricular para os academicos de medicina, membros da Liga Baiana de Cirurgia Plastica (LBCP), em que puderam desenvolver habilidades nao praticadas na universidade. CONCLUSOES: Pode-se concluir que o Servico de Cirurgia Plastica do HUPES obteve ganhos consideraveis com o desenvolvimento das atividades de disseccao cadaverica. Isso demonstra que o servico vem consolidando sua atuacao nos tres pilares da educacao: ensino, pesquisa e extensao.

Complex nasal reconstruction after paracoccidioidomycosis infection - Case report

Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles.

Management of an unusual presentation of Ascher syndrome.

Ascher syndrome is defined by the association between double lip, blepharochalasis, and nontoxic goiter. Because it is a rare disease, it is most often misdiagnosed, despite its implications for quality of life. We report a variation of an incomplete type of Ascher syndrome affecting the upper lip, upper eyelids, and lateral canthi of a young male patient. The surgical management, follow-up, and a brief overview of the syndrome are described. The results presented show an aesthetic and functional improvement of the facial deformities.

Detalhes anatômicos das cartilagens laterais inferiores em afrodescendentes: estudo em cadáveres

INTRODUCTION: There have been few studies measuring the morphology of the lower lateral cartilages in African-descendents. The aim of this study was to describe the anatomy of the lower lateral cartilages and their variations in African-descendents. METHODS: We studied 16 fresh adult cadavers. The noses were dissected through an open-approach rhinoplasty, with identification and release of lower lateral cartilages connections. The lateral crus and middle / medial crus were analyzed for shape, length and width, and were identified on the side and sex. The distance between the domus and the caudal septum was evaluated. A millimeter rule was used for measurements. The measures found were recorded and analyzed by BioEstat 5.0. RESULTS: The convex shape of the lateral crus was predominant, while unilaterally concave shape occurred in two cases and bilaterally in one case. The footplates of the medial crura were united in 81.25% of the sample and separated in 18.75% of cases. The distance between the angle of the caudal septum and the domus was 4 to 10 mm (mean = 6.86 ± 1.75 mm). CONCLUSION: The lower lateral cartilages of African-descendents had dimensions similar to those described in the literature.

Preliminary stages before nasal reconstruction using forehead flap: restoring perinasal subunits and nostril patency

Due to the complex three-dimensional structure of the nose, the repair of the nasal defect requires reconstruction of three different layers: skin envelope, osteocartilaginous framework and nasal lining. Before nasal reconstruction can be accomplished, the nose must rest on a stable platform to avoid late nasal obstructions, and septal deviations resulting from scar contraction. We present three cases of nasal reconstruction using a forehead flap in which we performed a preliminary stage to increase reliability of outcomes.

Eyebrow composite graft for eyelash reconstruction: A case report and review of the literature

Reconstructing the eyelash margin is a challenge for plastic surgeons because eyelashes have specific characteristics. There is still no gold standard procedure for this type of reconstruction, which seeks to protect the eyeball and make the eyelid appear natural. The eyebrow composite graft can be a good option for reconstructing the eyelash margin because it is technically simple and safe, and takes advantage of the structural similarity between the eyelashes and eyebrow. The results presented showed the effectiveness of the technique by providing improved occlusion and a good aesthetic result.