Upton, Richard J.

Disturbance of the normal relationship between the caudal border of the upper lateral cartilage and the cephalic margin of the lobular cartilage—the so‐called “cul‐de‐sac” area—can result in alar collapse and nasal airway obstruction. This may be caused by either the aging process or trauma, both surgical and nonsurgical. Rhinolift is a surgical procedure that was developed for the treatment of the aging ptotic nasal tip. We have applied this technique to patients with nasal airway obstruction resulting from alar collapse. Elevation of the cephalic margin of the lobular cartilage to a position superficial to the upper lateral cartilage restores the normal relationship between these two structures. The upper lateral cartilage then assists in stenting the vestibule open, and thereby improves nasal breathing. Over the past 10 years, 20 patients have had rhinolifts at our institution for the relief of nasal airway obstruction. Concomitant surgery included nasal septal reconstruction in 12 patients, polypectomy in one patient, and placement of a silicone rubber septal prosthesis for closure of a large septal perforation in three patients. Rhinolift was the sole procedure used for the correction of valvular pathology in 10 patients. The other 10 patients had modifications made in their upper lateral cartilage along with the rhinolift. Five patients described restoration of normal nasal breathing, while 14 patients showed partial symptomatic improvement. One patient reported no improvement in nasal breathing. Rhinolift is a safe effective surgical technique for functional improvement of nasal breathing in patients with alar collapse resulting from inadequate cartilaginous support.

Bilateral nerve cable graft repairs were made in the sciatic nerves of Wistar rats. One group of repairs was treated locally with triamcinolone acetonide (0.5 mg), one group was exposed to the systemic effects of the drug, and one group was left untreated. Nerve regeneration was measured by nerve‐stimulated muscle twitch strength, as well as several electrophysiologic parameters of the compound action potential conducted through the graft. Results suggest that nerve regeneration through an autogenous graft is significantly improved by local treatment with triamcinolone acetonide. Further studies are indicated to determine appropriate dosage necessary to maximize the beneficial local effects.