Friday, June 22, 2012

Tragal cartilage graft: Another donor site for cartilage

Tragal cartilage graft is taken from the tragus region of the ear. Gubiesch and Kotzur in a three year study reported in 2003,  using tragal cartilage grafts in 84 cases none experienced donor site morbidity. They were able to harvest grafts up to 1.5cm by 1.5 cm in size. The advantage of tragal cartilage over conchal cartilage is that it is flat and less elastic.  The authors consider it, therefore, to be the ideal graft for augmentation of the dorsum, compensation of irregularities, or correction of open roof deformities. They also claim that the tragus is easily accessible, as a donor site. In another 2007 study Cochran and Defatta determined that the tragus provides a simple, convenient alternative source of cartilage for rhinoplasty in graft-depleted patients. Tragal cartilage grafts were used in three primary and three secondary rhinoplasty patients. Postoperative follow-up ranged from six months to 12 months. Tragal cartilage was used as five alar contour grafts, one lateral crural onlay graft, one dorsal onlay graft, and one infratip lobule graft. Tragal cartilage was used to close the septal perforation of one patient. Tragal contour was preserved in all patients, and there were no complications noted with this procedure.

One study did find a negative side effect to use of tragal cartilage removal. Pothier D.D & Charaklias N. in 2006 study showed ten of the 12 patients in the tragal harvesting group who had used " in the ear"earphones pre- and post-operatively had had problems with earphones post-operatively, which in eight cases were due to pain or the devices falling out. Of the 12 respondents in the non-tragus group, only one had similar problems (p<0.05).


Thursday, June 21, 2012

Ethnic Noses: Rhinoplasty surgeons experienced in ethnic rhinoplasty

Rhinoplasty surgeons are striving to respect ethnic nasal variations realizing that patients typically want to refine their nasal appearance yet preserve their ethnic features. This respect serves to maintain facial harmony among the esthetic units and tends to achieve a natural look.

Rhinoplasty surgeons experienced in ethnic noses  (African American, Asian, Hispanic & Middle Eastern noses):

Dr. Ferdinand A. Ofodile       Plastic Surgeon            cert. 1976
Dr. Jennifer Parker Porter     E.N.T/Facial Plastics    cert. 1998
Dr. Sam Rizk                        E.N.T/Facial Plastics    cert. 2000
Dr. Oleh Slupchynski            E.N.T/Facial Plastics    cert. 1998
Dr. Jeffrey Epstein                E.N.T/Facial Plastics    cert. 1994
Dr. David Kim                       E.N.T/Facial Plastics    cert. 2003
Dr. Sam Nacify                     E.N.T./Facial Plastics    cert. 1999
Dr. Samuel Lam                    E.N.T./ Facial Plastics  cert. 2002
Dr. Derek Kofi O Boahene    E.N.T/Facial Plastics   cert. 2005
Dr. Babak Azizzadeh            E.N.T/Facial Plastics    cert.2003
Dr. Monte Harris                   E.N.T/Facial Plastics     cert.2000
Dr. Philip Young                    E.N.T/Facial Plastics     cert.2005
Dr. Paul Nassif                      E.N.T/Facial Plastics    cert. 1998

Ethnic features: one nose does not fit all     Dr. David W. Kim

Anatomical Variations

Disclaimer: it is overly simplistic to classify a non-Caucasian nose as an “ethnic” nose to which “ethnic rhinoplasty” principles apply. Two noses from two different ethnic backgrounds are likely to be as different from each other as they are from a Caucasian nose. In addition, significant variations in facial features are found within any given ethnic group. That being said, three broad nasal morphology types have been used to describe ethnic variations. The leptorrhine (“tall and thin”) nose is associated with Caucasian or Indo-European descent. Because it is the most extensively studied in modern nasal analysis, it also inevitably becomes the reference point for comparison when studying noses of different ethnicity's. Only recently have non-Caucasian standards of nasal analysis been developed for specific ethnic groups.
The platyrrhine (“broad and flat”) nose is associated with African descent. It is characterized by thick skin, a low radix, a short dorsum, a bulbous and underprojected tip, and flared nostrils. An analysis of the African-American female nose shows that compared to the Caucasian standard for nasal analysis, the columella-to-lobule ratio is decreased, and the alar width relative to the intercanthal distance is increased. The mesorrhine (“intermediate”) nose has features intermediate between the leptorrhine nose and the platyrrhine nose. The “typical” Asian or Latino nose is commonly regarded as mesorrhine, with a low radix, variable anterior dorsal projection, rounded and underprojected tip, and rounded nostrils. In Dr. Kim’s practice, patients of different backgrounds tend not to want to strive for measurements and metrics consistent with a Caucasian leptorrhine nose. Rather, many patients prefer to soften certain features of their nose while retaining some of their “ethnic identity”. 

Recommended reading:
Chapter 13 Revision Rhinoplasty of the ethnic nose .Dr.  Jennifer Parker Porter & Chapter 14 Asian Revision Rhinoplasty. Dr. Jeffrey M.Ahn & Dr. Jeffery C. Liu.

Race vs Ethnicty