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Öğe Modification of Low Septal Strip Septoplasty to Reduce Hump Recurrence in Dorsal Preservation Rhinoplasty(Lippincott Williams and Wilkins, 2024) Çelik, Vasfi; Tuluy, YavuzBackground: Among the problems encountered in the dorsal preservation rhinoplasty technique are residual hump and hump recurrence. In our study we performed a modification to lower strip resection and the fixation of the septum. The clinical results of these modifications on hump recurrence were investigated. Patients and methods: 231 patients who underwent dorsal preservation rhinoplasty with low septal strip septoplasty between November 2021 and February 2023 were included in the study. Closed dorsal preservation rhinoplasty was performed with low septal strip septoplasty in 31.2% (n=72) and modified low septal strip septoplasty technique in 68.8% (n=159) patients. All cases were primary rhinoplasty. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. Results: The mean follow-up period of the cases was 9.68±4.02 (3-16) months. Gender and age of the cases did not differ statistically significantly between the groups (p>0.05). Complications were observed in 3.5% of the patients (n=8/231). The complications in the low septal strip septoplasty group were statistically significantly higher than in the modified low septal strip septoplasty group (p=0.012; p<0.05). The incidence of recurrent hump complications in the low septal strip septoplasty group was statistically significantly higher than in the modified low septal strip septoplasty group (p=0.029; p<0.05). Conclusions: Septum fixation is one of the most important parts of the surgery in dorsal preservation rhinoplasty and must be done properly. In this modification that we described, the risk of recurrent hump is reduced, as sufficient septum fixation is achieved. © 2024 Lippincott Williams and Wilkins. All rights reserved.Öğe Scroll Ligament Repair in Dorsal Preservation Rhinoplasty: A Cartilage as a Guide on Nasal Skin Envelope for Suturing(Springer, 2025) Tuluy, Yavuz; Celik, Vasfi; Parspanci, Aziz; Sir, EminBackgroundThe scroll ligament provides support to the internal and external valve, and its repair in rhinoplasty provides good functional and aesthetic results. In this study, it was aimed to repair the scroll ligament complex by leaving cartilage in the nasal skin envelope, and clinical results were shared.Patients and Methods 216 patients who underwent closed preservation rhinoplasty with modified low septal strip septoplasty were included in the study. A 10 x 1 mm of cartilage is left in the nasal skin envelope at the midpoint of the cranial part of the lateral crus of the LLC, leaving it as a guide to repair the scroll ligament complex in the anatomically correct place. Demographic data, complications, revision surgeries, follow-up periods and satisfaction of the patients were analyzed retrospectively.ResultsResidual humps were observed in 2 patients. Inferior turbinate hypertrophy was observed in 4 patients. In 1 patient, total septal reconstruction was performed. Two hundred and three patients were evaluated the results as poor, moderate, good and very good. One hundred and sixteen patients rated the functional outcome as very good, 80 patients as good, 4 patients as moderate and 3 patients as poor. One hundred and twenty-eight patients rated the aesthetic result as very good, 72 as good and 3 as moderate.Conclusion Repairing the scroll ligament complex provides both internal and external valve support, better redraping and eliminating the dead space. Leaving cartilage on the nasal skin envelope as a guide helps to repair the scroll ligament complex in the anatomically correct place at the end of the surgery.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.Öğe Tip Surgery in Dorsal Preservation Rhinoplasty: The Effect of Modified Low Septal Strip Septoplasty on Tip Plasty(Springer, 2025) Celik, Vasfi; Tuluy, Yavuz; Bozkurt, Gokcen cakirBackgroundThe aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results.Patients and MethodsOne hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively.ResultsThe mean age of the patients is 29.58 +/- 9.04 (17-65). The mean follow-up period was 14, 50 +/- 2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient.ConclusionsA strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR.Level of Evidence IIThis 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.Öğe Total nasal reconstruction with pre-laminated, super-thin anterolateral thigh flap: A case report(Wiley, 2021) Bali, Zülfükar Ulaş; Karatan, Berrak; Parspancı, Aziz; Tuluy, Yavuz; Keçeci, Yavuz; Yoleri, LeventMany techniques for nasal reconstruction have been described to achieve aesthetically and functionally favorable results. Local tissues, specifically the forehead flap, provide the best tissue match with the nose. However, when local tissue donor sites are limited, alternative options such as free tissue transfers should be considered. Herein, we describe a case of a 72-year-old male patient who had a total nasal and left malar defect reconstructed with a two-staged, pre-laminated, super-thin anterolateral thigh (ALT) flap. The patient's nasectomy was performed 15 years ago. The adjacent left malar defect was due to recent squamous cell carcinoma excision. Local tissues were unavailable for reconstruction due to previous tumor excisions. For the 8.5 x 5 cm defect, a 12.5 x 8 cm ALT flap was planned, with 7.5 x 8 cm for nasal reconstruction and 5 x 4 cm for malar reconstruction. During the first stage, a super-thin fascial ALT flap was raised without dissecting the perforators, and the nasal skeleton was laminated between these two flaps. Costal cartilages were harvested for the nasal skeleton and positioned between the suprafascial and the fascial ALT flaps. During the second stage, two perforators were dissected to the pedicle on the pre-laminated flap, and the flap was divided from the donor site. The nasal skeleton was fixed and anastomosis with the facial vessels was established. After both stages, no complications were observed. After one month, a revision surgery was performed to enhance the transition between the reconstructed nose and the cheek, and improve the nasal projection. Postoperatively, after one year, the patient had a stable nasal reconstruction with good breathing. Prelaminated, super-thin ALT flaps provide the advantages of a wide and versatile donor site and an acceptable donor site scar. They may be an option for patients who are not amenable to traditional reconstruction methods.
