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Published on: May 23, 2020
Cartilage Support with Alar Groove Reconstruction for Nasal Deformity in Hemifacial Atrophy: A Multicenter
Yang Hu1, Chengwu Zhang1, Chao Li1
1Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China.
Background:
Nasal alar deformity in hemifacial atrophy is challenging due to combined loss of structural support and surface landmarks. Existing techniques usually address either volumetric deficiency or framework reinforcement alone. This study evaluates a strategy integrating autologous cartilage support with simultaneous reconstruction of the supra-alar and alar-facial grooves.
Methods:
In this prospective multicenter study, consecutive patients with hemifacial atrophy and unilateral alar collapse with groove attenuation or obliteration underwent standardized surgical correction (subcutaneous release, autologous cartilage grafting, and multi-point traction suturing). Outcomes were assessed using standardized two-dimensional photographic morphometric analysis and the validated Nasal Obstruction Symptom Evaluation scale.
Results:
Among 91 enrolled patients, 84 completed follow-up for 12 to 36 months. Significant improvements were observed in objective alar symmetry, including reduction in alar base asymmetry from 8.72 ± 0.99 mm preoperatively to 1.12 ± 0.49 mm postoperatively (P < 0.001) and nostril width discrepancy from 6.22 ± 0.87 mm to 0.74 ± 0.38 mm (P < 0.001). Apparent two-dimensional photographic parameters of supra-alar and alar-facial groove morphology demonstrated sustained improvement in groove definition and continuity among patients with available longitudinal data. Functional outcomes improved, with NOSE scores decreasing from 68.4 ± 12.6 preoperatively to 17.4 ± 7.5 at final follow-up (P < 0.001). The overall complication rate was low, and no major revision surgery was required.
Conclusions:
This single-arm prospective cohort suggests that cartilage support combined with alar groove reconstruction is a feasible approach for selected patients with hemifacial atrophy and may provide sustained improvements in alar symmetry and surface landmark definition. Because of the absence of a comparative control group, these findings should be interpreted as preliminary, and further comparative studies are required to confirm the relative effectiveness of this technique.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
