Background Cephalic malposition of the lower lateral cartilage (CMLLC) is a relatively common anatomical variant, particularly in Middle Eastern patients. The characteristics of CMLLC include long alar creases, a boxy and ball-shaped nasal tip, parenthesis tip deformity and external valvular incompetence. The gold standard for correcting CMLLC is the lateral crural strut graft (Gunter graft), but many patients experience problems after this technique. Objective To evaluate the efficacy of the repositioned lateral crural flap (RLCF) technique in correcting CMLLC, and to discuss the cosmetic and functional results. Methods In the present study, 123 primary septorhinoplasty operations using the RLCF technique were performed between May 2012 and March 2013. The mean follow-up period was 11.4 months (range nine to 24 months). Four parameters were measured and compared pre- and postoperatively: the angle between the line connecting the maximum convexity of the lower lateral cartilage (LLC) to the tip-defining point and midline on each side (angle of rotation); the total distance between the maximum convexity of LLC right and left to midline (representing the size of the parenthesis deformity); satisfaction scale rating of the patients' nasal tip appearance; and the satisfaction scale rating of patients' breathing through their nostrils. Results The mean angle of the LLC to the midline significantly increased and the mean distance between the maximum convexities was significantly reduced, indicating correction of the malposition and reduction of the parenthesis deformity, respectively. The mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved. Conclusion CMLLC can be corrected using the RLCF technique, resulting in both aesthetic and functional improvements.
C ephalic malposition of the lower lateral alar cartilage is a relatively common anatomical variant, particularly in Middle Eastern patients (1); it was first described by Sheen (2) in 2000. The diagnosis of cephalic malposition of the lower lateral alar cartilage is now widely accepted; however, to date, a definitive classification has not been established. It has been described as the lateral crura positioned ≤30° from midline directed toward the ipsilateral medial eye canthus. A normally positioned (orthotopic) lateral crura diverges ≥45° from midline and is directed toward the ipsilateral lateral eye canthus (3). According to previous studies on alar cartilage malposition (4-6), cephalically positioned alar cartilages show a variety of characteristics including long alar creases, boxy (7) and ball-shaped nasal tip (8), parenthesis tip deformity and, finally, external valvular incompetence (9-11). Previous studies have suggested techniques to correct cephalic malposition (12-15), but the gold standard is still lateral crural strut graft (Gunter graft) (16); however, many patients experience problems after this technique. In the present study, the efficacy of the repositioned lateral crural flap in correcting cephalic malposition of lateral crura was evaluated, and the cosmetic and functional results are discussed and compared with previous studies.
Introduction: Larsen syndrome is a congenital skeletal disorder manifested by several facial, ligamentous and spinal complications. Cervical kyphosis is one of the serious manifestations of the Larsen syndrome. However, there is no consensus regarding the best procedure of cervical kyphosis management in these patients. Case Presentation: A 1-year-old boy with the diagnosis of the Larsen syndrome was admitted to our hospital and undergone several corrective surgeries for knee, hip and foot deformities. At the age of 2 years, scoliosis was diagnosed and surgically managed. At the same time, cervical kyphosis was observed and monitored until the symptoms of neurological deficit due to cord compression led to the correction of cervical Kyphosis at the age of 4.5 years. Accordingly, an anterior/posterior (360 degree) cervical spinal fusion surgery was performed. Subsequently, cervicothoracic fusion was performed to correct cervicothoracic instability. No neurological complications were reported afterward. Conclusions: In spite of existing controversy around the best method of cervical kyphosis management in Larsen syndrome's patients older than 2-year old, anterior release and posterior fixation followed by anterior spinal fusion and strut grafting led to the satisfactory result in our case.
Background: There are different classifications for adolescent idiopathic scoliosis (AIS), among which Lenke classification is the most recent and comprehensive method. It is 3 dimensional and treatment organized. In most previous studies, thoracic hypokyphosis was more common, but it may be different in many patients. Objectives: The current study aimed at assessing the prevalence of thoracic hyperkyphosis in AIS for the first time in Iranian population. Methods:The study was performed retrospectively on 242 patients with AIS treated surgically in the university hospital from 2009 to 2014. Three parameters were evaluated in each patient including the 6 curve types of Lenke classification, thoracic sagittal balance, and lumbar spine modifier. Results: Adolescent idiopathic scoliosis was more common in female patients (83.5%). Type one curve was the most common type (48%). In lumbar spine modifier, type A was the most common (44%), similar to other studies. Hyperkyphosis was the most common type of thoracic sagittal balance (54%), which was in contrast to the original study by Lenke. The mean thoracic sagittal balance was hyperkyphosis in all Lenke types except type 5, which was normal. No relationship was found between the prevalence of thoracic kyphosis, and lumbar spine modifier, or the 6 types of Lenke classification. Conclusions:The frequency of different types of curves in Iranian population was the same as that of the original article by Lenke except that in the current study more thoracic hyperkyphosis was observed than hypokyphosis in the population.
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