Paranasal augmentation of the piriform aperture in the functional and aesthetic aspect. Age-related changes in the piriform aperture. Systematic review of paranasal augmentation techniques

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Methods of pyriform aperture lateralization: a systematic review. Plastic Surgery and Aesthetic Medicine. 2023;(2):76-80

In the first part of this review, the author considered age-related selective facial skull bone resorption that results aesthetic and often functional dissatisfaction with nasal breathing. Methods of paranasal augmentation with autogenous materials were also described. The second part provides a systematic review of paranasal augmentation with allogenic materials and all available implants. According to various reports, porous polyethylene and silicone are quite popular for facial implants and, in particular, paranasal augmentation. However, there are much less common ones described only in a few publications. Paranasal region is important in the middle part of the face, and surgical interventions in this area present a certain challenge for surgeons. These procedures require functional and aesthetic compromise depending on indications and the desired result.

Keywords:

pyriform aperture

paranasal augmentation

allogenic materials

porous polyethylene

Authors:

D.S. Pshennikov

Ryazan State Medical University;
Semashko Regional Clinical Hospital

ORCID: 0000-0002-1779-8341

Received:

04.06.2022

Accepted:

11.07.2022

List of references:

Douglas B. The relief of vestibular nasal obstruction by partial resection of the nasal process of the superior maxilla. Plast Reconstr Surg. 1952;9:42-51.
Rozner L. Nasal obstruction due to restriction of the bony nasal inlet. Br J Plast Surg. 1964;17:287-296.
Shetty R. Nasal pyramid surgery for correction of bony inlet stenosis. J Laryngol Otol. 1977;91:201-208.
Woodhead CJ. Piriform aperture surgery for alar collapse. Clin Otolaryngol Allied Sci. 1995;20:74-79.
Daniel RK, Palhazi P. Rhinoplasty. An Anatomical and Clinical Atlas. Cham, Switzerland: Springer International Publishing AG; 2018;345.
Erdem T, Ozturan O, Erdem G, Akarcay M, Miman MC. Nasal pyriform aperture stenosis in adults. Am J Rhinol. 2004;18:57-62.
Esen E, Bayar Muluk N, Altintoprak N, Ipci K, Cingi C. Pyriform aperture enlargement in all aspects. J Laryngol Otol. 2017;131(6):476-479. https://doi.org/10.1017/S0022215117000391
Smith W, Lowe D, Leong P. Resection of pyriform aperture: A useful adjunct in nasal surgery. J Laryngol Otol. 2009;123:123-125.
Gilde JE, Handler EB, Shih CW. Pyriform Widening with Concurrent Z-Plasty for Nasal Valve Surgery: Revisiting a Time-Tested Technique. The American Journal of Cosmetic Surgery. 2015;32(4):238-246. https://doi.org/10.5992/AJCS-D-15-00029.1
Roy S, Iloreta AM, Bryant LM, Krein HD, Pribitkin EA, Heffelfinger RN. Piriform aperture enlargement for nasal obstruction. Laryngoscope. 2015;125(11):2468-2471. https://doi.org/10.1002/lary.25343
Sofia OB, Castro Neto NP, Katsutani FS, Mitre EI, Dolci JE. Evaluation of pre- and post-pyriform plasty nasal airflow. Braz J Otorhinolaryngol. 2018;84(3):351-359. https://doi.org/10.1016/j.bjorl.2017.03.013
Lipsky KB, Rusetsky YuYu, Aganesov GA, Arutyunyan EG, Yunusov TSh, Gadagatl AA, Andreeva MA. Conchoplasty and piriform aperture enlargement through vestibular nasal approach. Plastic Surgery and Aesthetic Medicine. 2021;(4):14-19. (In Russ.). https://doi.org/10.17116/plast.hirurgia202104114
Mendelson B, Wong C-H. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic Plast Surg. 2012;36(4):753-760. https://doi.org/10.1007/s00266-012-9904-3
Kahn DM, Shaw RB Jr. Aging of the bony orbit: A threedimensional computed tomographic study. Aesthet Surg J. 2008;28:258-264.
Pessa JE, Chen Y. Curve analysis of the aging orbital aperture. Plast Reconstr Surg. 2002;109:751-755.
Pessa JE. An algorithm of facial aging: verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg. 2000;106:479-488 (discussion 489-490).
Shaw RB Jr, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg. 2007;119:675-681.
Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthet Plast Surg. 2007;31:419-423.
Pessa JE, Zadoo VP, Yuan C, Ayedelotte JD, Cuellar FJ, Cochran CS, Mutimer KL, Garza JR. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg. 1999;103:635-644.
Pessa JE, Zadoo VP, Mutimer KL, Haffner C, Yuan C, DeWitt AI, Garza JR. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg. 1998;102:205-212.
Pessa JE, Slice DE, Hanz KR, Broadbent TH Jr, Rohrich RJ. Aging and the shape of the mandible. Plast Reconstr Surg. 2008;121:196-200.
Le Louarn C, Buthiau D, Buis J. Structural aging: the facial recurve concept. Aesthet Plast Surg. 2007;31:213-218.
Rohrich RJ, Hollier LH Jr, Janis JE, Kim J. Rhinoplasty with advancing age. Plast Reconstr Surg. 2004;114:1936-1944.
Mendelson BC, Wong C-H. Changes in the Facial Skeleton with Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesth Plast Surg. 2020;44:1151-1158. https://doi.org/10.1007/s00266-020-01823-x
Deroee AF, Younes AA, Friedman O. External Nasal Valve Collapse Repair: The Limited Alar-Facial Stab Approach. Laryngoscope. 2011;121:474-479. https://doi.org/10.1002/lary.21410
Pessa JE, Desvigne LD, Zadoo VP. The effect of skeletal remodeling on the nasal profile: considerations for rhinoplasty in the older patient. Aesthet Plast Surg. 1999;23(4):239-242. https://doi.org/10.1007/s002669900275
Pessa JE. An algorithm of facial aging: verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg. 2000;106:479-488 (discussion 489-490).
Pessa JE, Zadoo VP, Mutimer KL, Haffner C, Yuan C, DeWitt AI, Garza JR. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg. 1998;102:205-212.
Barton FE, Gyimesi I. Anatomy of the nasolabial fold. Plast Reconstr Surg. 1997;100:1276-1280.
Edelstein DR. Aging of the normal adult nose. Laryngoscope. 1996;106:1-25.
Rosen HM. Treatment planning: aesthetic goals. In: Rosen HM, ed. Aesthetic perspectives in jaw surgery. New York: Springer; 1999;3-23.
Terino EO, Edwards MC. Alloplastic contouring for suborbital, maxillary, zygomatic deficiencies. Facial Plast Surg Clin North Am. 2008;16:33-67.
Tanaka Y. Oriental nose occidentalization and perinasal shaping by augmentation of the underdeveloped anterior nasal spine. Plast Reconstr Surg Glob Open. 2014;2(8):e197. https://doi.org/10.1097/GOX.0000000000000161
Jasin ME. Nonsurgical rhinoplasty using dermal fillers. Facial Plast Surg Clin North Am. 2013;21(2):241-252. https://doi.org/10.1016/j.fsc.2013.02.004
Pilsl U, Rosmarin W, Anderhuber F. The premaxillary space: a location for filler injection? Dermatol Surg. 2014;40(3):301-304. https://doi.org/10.1111/dsu.12431
Moon HJ. Injection Rhinoplasty Using Filler. Facial Plast Surg Clin North Am. 2018;26(3):323-330. https://doi.org/10.1016/j.fsc.2018.03.006
Van Dongen JA, van Boxtel J, Harmsen MC, Stevens HP. The Development of Facial Lipofilling from a Historical Point of View. Facial Plast Surg. 2019;35(4):358-367. https://doi.org/10.1055/s-0039-1694762
Monreal J. Fat grafting to the nose: personal experience with 36 patients. Aesthetic Plast Surg. 2011;35(5):916-922. https://doi.org/10.1007/s00266-011-9681-4
Terino EO, Edward M. The magic of midface threedimensional contour alterations combining alloplastic and soft tissue suspension technologies. Clin Plast Surg. 2008;35:419-450.
Moorhead A, Serra M. Le Fort Osteotomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 21, 2021.
Lazaridis K, Lazaridou M, Athanasiou AE. Pulpal and Periodontal Tissues Changes Associated with Le Fort I and Sagittal Split Ramus Osteotomies: A review. Open Dent J. 2018;12:24-31. https://doi.org/10.2174/1874210601812010024
Kim YI, Park SB, Son WS, Hwang DS. Midfacial soft-tissue changes after advancement of maxilla with Le Fort I osteotomy and mandibular setback surgery: comparison of conventional and high Le Fort I osteotomies by superimposition of cone-beam computed tomography volumes. J Oral Maxillofac Surg. 2011;69(6):225-233. https://doi.org/10.1016/j.joms.2010.12.035
Nkenke E, Vairaktaris E, Kramer M, Schlegel A, Holst A, Hirschfelder U, Wiltfang J, Neukam FW, Stamminger M. Three-dimensional analysis of changes of the malar-midfacial region after LeFort I osteotomy and maxillary advancement. Oral Maxillofac Surg. 2008;12(1):5-12. https://doi.org/10.1007/s10006-008-0094-8
Hernández-Alfaro F, García E, Martí C, Porta A. U-shaped osteotomy in management of paranasal deficiency. Int J Oral Maxillofac Surg. 2006;35(12):1145-1148. https://doi.org/10.1016/j.ijom.2006.09.014
Chow TK, Yu CN, Fung SC, Tang BN, Wong SL, Lok GC. Pyriform rim sandwich osteotomy: A new regional osteotomy for correction of para-alar deficiency. J Oral Maxillofac Surg. 2004;62(2):256-260. https://doi.org/10.1016/j.joms.2003.07.005
Jeon YT, Han SJ. Comparative Study of the Effect of Paranasal Augmentation with Autologous Bone in Orthognathic Surgery. J Oral Maxillofac Surg. 2019;77(10):2116-2124. https://doi.org/10.1016/j.joms.2019.04.028
Volkov AV, Potapov MB, Nazaryan DN, Smbatyan BS, Zakharov GK, Fedosov AV. Morphological aspects of bone tissue transplantation. Plastic Surgery and Aesthetic Medicine. 2020;(1):21-29. (In Russ.). https://doi.org/10.17116/plast.hirurgia202001121
Nissan J, Mardinger O, Calderon S, Romanos GE, Chaushu G. Cancellous bone block allografts for the augmentation of the anterior atrophic maxilla. Clin Implant Dent Relat Res. 2011;13(2):104-111.
Palshin GA, Torduin SS, Markov PV. Use of vascularized autotransplants of adjoining tubular bones during change of bone defects with use of alloimplant «Perfoost». Acta Biomedica Scientifica. 2006;4:246-252. (In Russ.).
Muramatsu K, Hashimoto T, Tominaga Y, Taguchi T. Vascularized bone graft for oncological reconstruction of the extremities: review of the biological advantages. Anticancer Res. 2014;34(6):2701-2707.
McCurdy J Jr, Lam S, ed. Cosmetic Surgery of the Asian Face. 1st Edition. New York: Thieme; 2005. https://doi.org/10.1055/b-002-56117
Kim WS, Kim C-H, Yoon J-H. Premaxillary augmentation using autologous costal cartilage as an adjunct to rhinoplasty. J Plast Reconstr Aesthet Surg. 2010;63(9):686-690. https://doi.org/10.1016/j.bjps.2010.04.007
Moore MLG, Nguyen TC, Day KM, Weinfeld AB. Pyriform Costal Cartilage Graft Improves Cleft-Side Alar Asymmetry in Secondary Cleft Rhinoplasty. Cleft Palate Craniofac J. 2020;57(5):537-542. https://doi.org/10.1177/1055665619882558
Liang Y, Wang X. Application of Diced Autologous Rib Cartilage for Paranasal Augmentation in Cleft Nose. Aesthetic Plast Surg. 2021;45(3):1169-1175. https://doi.org/10.1007/s00266-020-02036-y
Dong W, Xu Y, Han R, Zheng R, Fan F. Paranasal Augmentation Using Diced Costal Cartilage for Midface Concavity: A Retrospective Study of 68 Patients. Published online ahead of print, 2021 Sept 28. Aesthetic Plast Surg. 2021;10.1007/s00266-021-02593-w. https://doi.org/10.1007/s00266-021-02593-w
O’Hara KL, Urrego AF, Garri JI, O’Hara CM, Bradley JP, Kawamoto HK. Improved malar projection with transconjunctival hydroxyapatite granules. Plast Reconstr Surg. 2006;117:1956-1963.
Moreira-Gonzalez A, Jackson IT, Miyawaki T, DiNick V, Yavuzer R. Augmentation of the craniomaxillofacial region using porous hydroxyapatite granules. Plast Reconstr Surg. 2003;111:1808.
El Deeb M, Tompach PC, Morstad AT. Porous hydroxylapatite granules and blocks as alveolar ridge augmentation materials: A preliminary report. J Oral Maxillofac Surg. 1988;46:955.
Mendelson BC, Jacobson SR, Lavoipierre AM, Huggins RJ. The fate of porous hydroxyapatite granules used in facial skeletal augmentation. Aesthet Plast Surg. 2010;34:455-461.
Yaremchuk MJ, Israeli D. Paranasal implants for correction of midface concavity. Plast Reconstr Surg. 1998;102(5):1676-1685. https://doi.org/10.1097/00006534-199810000-00055
Kwon TG, Kang SM, Hwang HD. Three-dimensional soft tissue change after paranasal augmentation with porous polyethylene. Int J Oral Maxillofac Surg. 2014;43(7):816-823. https://doi.org/10.1016/j.ijom.2014.03.004
You JS, Kim SG, Oh JS, Lim KS, Shin SM, Kim CM. Paranasal augmentation using medpor implant and changes in lateral profile. Oral Biol Res. 2013;7:125-130.
Yaremchuk MJ, Vibhakar D. Pyriform Aperture Augmentation as An Adjunct to Rhinoplasty. Clin Plast Surg. 2016;43(1):187-193. https://doi.org/10.1016/j.cps.2015.09.012
Yaremchuk MJ, Israeli D, Terino EO. Paranasal Implants for Correction of Midface Concavity. Plastic Reconstructive Surgery. 1998;102(5):1685. https://doi.org/10.1097/00006534-199810000-00056
Caronni EP. A new method to correct the nasolabial angle in rhinoplasty. Plast Reconstr Surg. 1972;50(4):338-340. https://doi.org/10.1097/00006534-197210000-00004
Fanous N, Yoskovitch A. Premaxillary augmentation: adjunct to rhinoplasty. Plast Reconstr Surg. 2000;106(3):707-712. https://doi.org/10.1097/00006534-200009030-00031
Fanous N, Yoskovitch A. Premaxillary augmentation for central maxillary recession: an adjunct to rhinoplasty. Facial Plast Surg Clin North Am. 2002;10(4):415-422. https://doi.org/10.1016/s1064-7406(02)00035-4
Kim JH, Jung MS, Lee BH, Jeong HS, Suh IS, Ahn DK. Silicone Implant-Based Paranasal Augmentation for Mild Midface Concavity. Arch Craniofac Surg. 2016;17(1):20-24. https://doi.org/10.7181/acfs.2016.17.1.20
Sclafani AP, Romo T 3rd. Biology and chemistry of facial implants. Facial Plast Surg. 2000;16(1):3-6.
De la Pena-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Intranasal surgical approach for malar alloplastic augmentation. Aesthet Surg J. 2012;32:27-38.
Cook TA, Wang TD, Brownrigg PJ, Quatela VC. Significant premaxillary augmentation. Arch Otolaryngol Head Neck Surg. 1990;116(10):1197-1201. https://doi.org/10.1001/archotol.1990.01870100091020
Lee TY, Chung HY, Dhong ES, Jeong SH, Han SK. Paranasal Augmentation Using Multi-Folded Expanded Polytetrafluorethylene (ePTFE) in the East Asian Nose. Aesthet Surg J. 2019;39(12):1319-1328. https://doi.org/10.1093/asj/sjz103
Foda HM. Mersiline mesh in premaxillary augmentation. Aesthetic Plast Surg. 2005;29(3):169-173. https://doi.org/10.1007/s00266-004-0130-5
Capone RB, Kim MM, Genther DJ. Piriform Margin Augmentation as a Treatment for Persistent Nasal Valve Dysfunction: A Cadaveric Investigation and Report of Initial Clinical Results. J Otolaryngol Rhinol. 2016;2:021.
Rohrich RJ, Hoxworth RE, Thornton JF, Pessa JE. The pyriform ligament. Plast Reconstr Surg. 2008;121:277-281.
Sclafani AP, Romo T 3rd. Biology and chemistry of facial implants. Facial Plast Surg. 2000;16(1):3-6.
Sajjadian A, Rubinstein R, Naghshineh N. Current status of grafts and implants in rhinoplasty: part I. Autologous grafts. Plast Reconstr Surg. 2010;125(2):40-49.
Sajjadian A, Naghshineh N, Rubinstein R. Current status of grafts and implants in rhinoplasty: part II. Homologous grafts and allogenic implants. Plast Reconstr Surg. 2010;125(3):99-109.
Shokri T, Wang W, Cohn JE, Kadakia S, Ducic Y. Premaxillary Deficiency: Techniques in Augmentation and Reconstruction. Semin Plast Surg. 2020;34(2):92-98. https://doi.org/10.1055/s-0040-1709175

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