Secondary nasal revisions after rhinoplasties

Walter, C

doi:10.1007/bf01577966

“…These studies try to predict maxillary movement in response to transverse forces based on the distribution of stresses (36). However, if a biological response is not only a part of the process, but it is the main part of the skeletal response to transverse forces, then these predictions misrepresent the clinical reality, which could explain the conflicting results between these in vitro studies and clinical studies (37)(38)(39).…”

Section: Sutural Opening In Response To Transverse Forces Is a Biologmentioning

confidence: 99%

Osteoclasts: The Biological Knife In Sutural Responses To Mechanical Stimulation

Alansari¹,

Jearah²,

Gadhavi³

et al. 2018

1

0

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Background: It is assumed that transverse force physically opens maxillary sutures and induces a tensile stress that directly stimulates bone formation. However, orthopedic/ orthodontic tensile stresses are static, which cannot directly stimulate bone formation. We hypothesize that the anabolic response to transverse force is indirect, resulting from inflammation-induced osteoclast activation followed by a transition into osteogenesis. The purpose of this study was to evaluate the tissue, cellular and molecular responses in the sutures during maxillary expansion. Materials & Methods: Adult Sprague-Dawley rats where divided into 4 groups: untreated Control (C), Sham (S), Experimental (Exp), and Experimental with nonsteroidal anti-inflammatory medication (Exp+NSAID). Maxillae were collected 0, 1, 3, 7, 14, and 28 days post-expansion for micro-computed tomography, fluorescence and light microscopy, gene and protein expression, and immunohistochemistry analysis. Results: The Exp group showed early expression of inflammatory cytokines in the mid-palatal suture that was followed by osteoclast activation, bone resorption and a transient decrease in bone density. A significant widening of the suture occurred only after osteoclast activation and bone resorption. Bone formation was delayed, occurring after the initial catabolic phase. NSAIDs significantly decreased the magnitude of maxillary sutural widening and bone formation in response to transverse forces. During the transition from the catabolic to the anabolic response, expression of communicator molecules between osteoclasts and osteoblasts increased significantly. Conclusion: We demonstrated that maxillary transverse force stimulated three distinct phases in the mid-palatal suture: 1) the Catabolic Phase starts with inflammatory markers and osteoclast recruitment and activity, 2) the Transition Phase, where osteoclasts activate osteoblast activity, 3) the Anabolic Phase, during which osteoblasts restore the integrity of the skeleton. INNOVATION: Our findings are novel and support a new theory for sutural response to orthopedic forces that emphasizes the importance of osteoclasts in the process and makes these cells the possible target of orthopedic treatment: 1) as the "biological knife" at the sutures that allows the separation of maxillae for orthopedic movement, and 2) as the trigger for osteoblasts activation and bone regeneration, anytime we need to stimulate bone formation especially at the surface of the cortical bone.

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“…These studies try to predict maxillary movement in response to transverse forces based on the distribution of stresses (36). However, if a biological response is not only a part of the process, but it is the main part of the skeletal response to transverse forces, then these predictions misrepresent the clinical reality, which could explain the conflicting results between these in vitro studies and clinical studies (37)(38)(39).…”

Section: Sutural Opening In Response To Transverse Forces Is a Biologmentioning

confidence: 99%

Osteoclasts: The biological knife in sutural responses to mechanical stimulation

Alansari¹,

Jearah²,

Gadhavi³

et al. 2018

0

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Background: It is assumed that transverse force physically opens maxillary sutures and induces a tensile stress that directly stimulates bone formation. However, orthopedic/ orthodontic tensile stresses are static, which cannot directly stimulate bone formation. We hypothesize that the anabolic response to transverse force is indirect, resulting from inflammation-induced osteoclast activation followed by a transition into osteogenesis. The purpose of this study was to evaluate the tissue, cellular and molecular responses in the sutures during maxillary expansion. Materials & Methods: Adult Sprague-Dawley rats where divided into 4 groups: untreated Control (C), Sham (S), Experimental (Exp), and Experimental with nonsteroidal anti-inflammatory medication (Exp+NSAID). Maxillae were collected 0, 1, 3, 7, 14, and 28 days post-expansion for micro-computed tomography, fluorescence and light microscopy, gene and protein expression, and immunohistochemistry analysis. Results: The Exp group showed early expression of inflammatory cytokines in the mid-palatal suture that was followed by osteoclast activation, bone resorption and a transient decrease in bone density. A significant widening of the suture occurred only after osteoclast activation and bone resorption. Bone formation was delayed, occurring after the initial catabolic phase. NSAIDs significantly decreased the magnitude of maxillary sutural widening and bone formation in response to transverse forces. During the transition from the catabolic to the anabolic response, expression of communicator molecules between osteoclasts and osteoblasts increased significantly. Conclusion: We demonstrated that maxillary transverse force stimulated three distinct phases in the mid-palatal suture: 1) the Catabolic Phase starts with inflammatory markers and osteoclast recruitment and activity, 2) the Transition Phase, where osteoclasts activate osteoblast activity, 3) the Anabolic Phase, during which osteoblasts restore the integrity of the skeleton. INNOVATION: Our findings are novel and support a new theory for sutural response to orthopedic forces that emphasizes the importance of osteoclasts in the process and makes these cells the possible target of orthopedic treatment: 1) as the "biological knife" at the sutures that allows the separation of maxillae for orthopedic movement, and 2) as the trigger for osteoblasts activation and bone regeneration, anytime we need to stimulate bone formation especially at the surface of the cortical bone.

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“…If upper or lower lateral cartilage is depressed and caved in, reposition it to reverse this (spreader grafts 6 or sutures). If the cartilages are bulging outward, divide and reconfigure them (cutting or sutures 7 ). If bones have fallen, refracture the bone and move it out and, if displaced laterally, infracture the bone.…”

Section: No Of Patients (%)mentioning

confidence: 99%

Conservative Subtraction‐Addition Rhinoplasty

Younger

¹

1997

Otolaryngol.--head neck surg.

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The deviated external nose remains a difficult technical challenge to even the most masterful rhinoplastic surgeon. The classic septorhinoplasty approach to the deviated nose demonstrated a 9.8% revision rate in this study. During a 2-year period, the conservative subtraction-addition rhinoplasty procedure was developed, which subsequently reduced the revision rate to 1.3%. Conservative subtraction-addition rhinoplasty foregoes aggressive septal surgery and equalizes and enhances the airway through asymmetric turbinate volume reduction. Minimal bony and upper lateral work through rasping, soft tissue removal, and/or cartilage grafting allows for external nasal alignment. Both internal and external conservative subtraction-addition rhinoplasty components thus maintain perioperative structural stability and ensure long-term nasal symmetry.

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Secondary nasal revisions after rhinoplasties

Abstract: This article describes procedures for correcting some of the most common deformities after rhinoplasty. Double or triple osteotomies, partial removal of the nasal bones, autogenous cartilage transplantations, and the value of the transplantation of auricular composite grafts are discussed.

Cited by 5 publications

References 6 publications

Osteoclasts: The Biological Knife In Sutural Responses To Mechanical Stimulation

Osteoclasts: The Biological Knife In Sutural Responses To Mechanical Stimulation

Osteoclasts: The biological knife in sutural responses to mechanical stimulation

Conservative Subtraction‐Addition Rhinoplasty

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