Concavity of the lateral crus of the cartilage of the nose – complex problem in terms of aesthetic and functional correction. Weakening of the lower lateral cartilages leads to the formation of a concave deformity of the lateral wall of the nose, which in turn leads not only to the appearance of a cosmetic defect, but also to function of the external valve of the nose. These problems can be eliminated with the help of surgical rhinoplasty in technique Ashary Sandwich, which is presented in the article estet-portal.com by Dr. Ibrahim A. Ashary (Ibrahim A. Ashari ) and Mawada N. Barakia (avada N. Barakia).
- Concave deformity of the lower lateral cartilage of the nose: description of the problem
- Rhinoplasty Surgical Ashary Sandwich: procedure description
- Results of rhinoplasty Ashary Sandwich for correction of concave nose deformity
Concave deformity of the lower lateral cartilage of the nose: description of the problem
Concavity of the lower lateral cartilages may be secondary, due to congenital asymmetries, weakening or complete absence of the lateral crura, resulting in constriction of the nasal tip.
The normal anatomy of the distal nose may reflect a fine integration of the inferior lateral cartilage, superior lateral cartilage, septum, and skin. Understanding their relationship allows the surgeon to diagnose and treat concave deformities of the distal nose.
The approach to correction depends on the area of the concavity and the functional impairment. If unilateral deformity is localized in the lower lateral cartilage, this affects the length of the "tripod"; nose, causing not only a topographic concavity, but also a deviation of the nasal tip towards the shorter lateral crus.
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The lateral crura should be convex at the vault of the nose and gradually flatten towards the pyriform opening.
In the case shown, the hemispherical cartilage is connected to the superior lateral cartilage by an inwardly directed stalk, which may play a decisive role in the asymmetry and dilation of the nostril. At least one third of the upper lateral cartilage has, in addition to the lateral, a medial wall, which significantly increases the degree of expansion and reactive power of this structure. Such cartilage is more difficult to align.
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Therefore, in some cases it is important to take into account standard anatomical variations in order to make the nostrils symmetrical and
The article presents the results of a retrospective study of 120 patients who underwent primary and secondary rhinoplasty to restore lower lateral cartilage concavity using the Ashary Sandwich technique from November 2018 to November 2019. Patients were followed up for 6 months, deformities analyzed before and after surgery based on clinical assessment and standardized photography. Patient satisfaction was assessed subjectively.
The patients underwent open rhinoplasty using the
techniqueAshary Sandwich. The caudal part of the lower lateral cartilage was not subject to complete removal. It was rotated 180 degrees and used as a flap for the defective part of the cartilage, and then sutured. The inferior lateral cartilage ligament was not removed to stabilize the flap and therefore no further fixation was required. Depending on the defect, the surgeon may apply the Sandwich technique to correct one or both sides of the nose.
In addition, in rare cases, such as a cleft nose, this technique does not completely eliminate the defect and an additional flap from the nasal septum may be needed.
The author also believes that Vicryl fixes the cartilage flap more effectively, since it does not cause skin irritation and provokes less pronounced fibrosis in the dermis. However, most surgeons use prolene because it is not absorbed, but this material causes more fibrosis and in some cases
may lead to infection. Results of Ashary Sandwich Rhinoplasty for Correction of Concave Nasal Deformity
The Ashary Sandwich technique was used on 120 rhinoplasties performed on 41 men and 79 women aged 20-49 years. In 75.83% of cases, rhinoplasty was primary, in 24.16% – secondary.
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Results:smoothing the concavity of the lower lateral cartilage and the asymmetry of the tip of the nose (96.67%);
- reduction of alar retraction in 98.33% of cases and ptosis of the nasal tip in 95% of cases;
- 100% improvement in nasal valve function and alae compression after both primary and secondary rhinoplasty
Ashary Sandwich technique Mean patient follow-up was 6 months.
Patients rated their results as follows:excellent – 88.33%;
- very good – 6.67%;
- good – 3.33%;
- unsatisfactory – 1.67%.
- Concavity of the inferior lateral cartilage often results in external nasal valve dysfunction and aesthetic deformities. The Ashary Sandwich technique, presented by the author, allows you to completely change the structure of the nose tripod and, accordingly, improve its functionality and aesthetic component.
According to Prime magazine.
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