Journal archive · Revision and secondary rhinoplasty · Rib, ear and septal grafts · Nasal tip · Cleft, trauma and reconstruction · 2020
Pyriform Costal Cartilage Graft Improves Cleft-Side Alar Asymmetry in Secondary Cleft Rhinoplasty
Moore MLG, Nguyen TC, Day KM, Weinfeld AB.
In the archive as a landmark paper: the core sweep runs 2011–2026, and this one is here because the history of rhinoplasty rests on it · cited on subalar graft.
From the abstract
“The asymmetry of a retrusive cleft-side ala positioned posterior, lateral, and inferior relative to the noncleft ala is exacerbated by ipsilateral deficiency of the pyriform aperture. We describe use of pyriform costal cartilage grafts for enhanced structural foundation and alar symmetry in secondary cleft…”
Excerpt; the full abstract is on PubMed.
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Revision and secondary rhinoplasty
Between 5% and 15% of rhinoplasties are done again, and the published series say the second operation is a different problem from the first: the cartilage is gone, the skin is scarred and less able to survive, and the airway is usually part of the complaint.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Nasal tip
Tip surgery is now a support problem rather than a sculpting problem: the septal extension graft holds projection and rotation where the columellar strut loses them (0.2% against 4.7% projection loss at one year), and the current series repair, reposition and reinforce the lower lateral cartilages instead of excising them.
Cleft, trauma and reconstruction
A cleft nose is a sequence spread across a childhood: a repair at three months, sometimes a second at five or six, and a definitive rhinoplasty once the face has finished growing.
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