Philippe Pasche - Academia.edu (original) (raw)
Papers by Philippe Pasche
ANZ Journal of Surgery, 2010
Background: To evaluate global survival, disease-free period, complications, evolution and functi... more Background: To evaluate global survival, disease-free period, complications, evolution and function in vertical partial hemilaryngectomy (VPHL) plus reconstruction with false cord. Methods: Descriptive and retrospective study. In aertiary care medical center in Mexico City. Eight patients with early diagnosis of early glottic cancer (T1 and T2), treated with VPHL plus reconstruction with false cord imbrication. Results: Fifty percent of the patients were clinical stage I, 37.5% stage II and 12.5% stage III. Nasogastric tube was not placed and oral feeding was reinitiated within 3 days on average. Tracheostomy was removed after an average of 2.1 days. Average hospital stay was 3.3 days. Average of the PSS-HNC (Performance Status for Head and Neck Cancer) and Karnofsky Performance Status evaluation was 91 to 97 and 100 at 1 year of evaluation. Voice evaluation demonstrated normal voice in 87.5% of patients. Intensity was below normal with improvement on annual evaluation. Global survival was 100% and disease-free period was 71% at 3 years. Conclusions: VPHL with reconstruction by false cord imbrication is an excellent therapeutic option for early glottic cancers. Multiple functional advantages are demonstrated without sacrificing oncological control as well as providing an audible and intelligible voice. In cases of recurrence, various management options are available. Materials and methods Eight patients with early glottic carcinomas (TNM Stage as defined by American Joint Committee on Cancer) were included in this
American Journal of Otolaryngology, 1997
Purpose: "Early" glottic squamous cell carcinoma classified as Tl-T2NO with anterior commissure i... more Purpose: "Early" glottic squamous cell carcinoma classified as Tl-T2NO with anterior commissure invasion is conventionnaly managed with vertical partial laryngectomy (VPL) or radiation therapy (RT). At our institution, in the early 1980s vertical partial laryngectomy was progressively replaced by supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). The medical files and operative charts of 62 patients with "early" glottic carcinoma classified as Tl-T2NO invading the anterior commissure, consecutively managed with cricohyoidoepiglottopexy, were retrospectively reviewed to ascertain whether any conclusions could be drawn regarding this treatment modality. Materials and Methods: Survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate was analyzed using the Kaplan-Meier life table method. Results: The 3-and 5-year actuarial survival estimate was 93.3% and 86.5%, respectively. The 3-and .5-year actuarial local control estimate was 98.2%. The only patient with local recurrence was successfully salvaged with RT resulting in an overall 100% local control rate and laryngeal preservation rate. The 3-and 5year actuarial nodal recurrence estimate was 1.8%. The 3-and 5-year actuarial distant metastasis estimate was 0% and 2%, respectively. Aspiration related completion total laryngectomy and permanent tracheostomy never occurred. Conclusion: The present retrospective study suggests that cricohyoidoepiglottopexy for glottic carcinoma classified as Tl-T2 invading the anterior commissure resulted in higher local control rates and overall laryngeal preservation rate when compared with historical series using either VPL or RT. Further series are warranted to confirm our results. Copyright 0 1997 by W.B. Saunders Company. Historically, patients with "early" glottic squamous cell carcinoma classified as Tl-T2NO presenting anterior commissure invasion have been managed with vertical partial laryngectomy (VPL) or radiation therapy (RT).lm5 Laser therapy, once advocated, was progressively abandoned because of high local recurrence rate.6-8 At our institution, VPL was the management policy historically advocated
Introduction: Head and Neck Mucosal Melanoma (HNMM) is an uncommon malignancy that arises in decr... more Introduction: Head and Neck Mucosal Melanoma (HNMM) is an uncommon malignancy that arises in decreasing order in the nasal cavity, the paranasal sinuses, and the oral cavity. Although radical surgery followed by eventual radiotherapy is acknowledged as the mainstay treatment, patients with advanced stages or multi-focal tumors benefit from new systemic therapies. We wish to share our experience with these treatments and review the current literature. Materials and Methods: We present a case review of every patient treated in our center for an HNMM over the past 10 years, including every patient treated in our center for an HNMM over the past 10 years. We analyzed clinical characteristics, treatment modalities, and outcomes. Results: We included eight patients aged from 62 to 85 years old. We found six MM in the nasal cavity, one in the sphenoidal sinus, and one in the piriform sinus. Six patients underwent endoscopic surgery with negative margins, six underwent radiotherapy with var...
![Research paper thumbnail of [Laryngeal cancer in patients younger vs older than 40 years old: a matched-paired analysis]](https://attachments.academia-assets.com/75334244/thumbnails/1.jpg)
](Background To compare clinical and demographic data between laryngeal cancer patients younger and... more Background To compare clinical and demographic data between laryngeal cancer patients younger and older than 40 years old. Methods Is a matched-paired study, realized from 1989 to 2002. We selected 500 laryngeal cancer patients treated in the National Cancer Institute of Mexico. Fifteen cases of patients younger than 40 years that accomplished inclusion criteria were identified, pair-matched and compared by clinical stage with 33 patients older than 40 years. We analyzed demographic factors and disease-free and Overall Survival by Kaplan-Meier method. Results We included 9 male and 6 female patients with a mean age of 34 years in contrast to a mean age of 62 years in the comparison group. Four cases in clinical stage I, none clinical stage II, 6 in stage III and 5 in stage IV were included in the younger group and compared to 8 patients in stage I, 15 in stage III and 10 in stage IV in the older group. No differences in demographic variables or lifestyle habits were found. All patie...
Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cel... more Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC.
Introduction The unilateral cleft lip nose is characterized by numerous complex and interdependen... more Introduction The unilateral cleft lip nose is characterized by numerous complex and interdependent deformities. Secondary rhinoplasty techniques aim to correct cleft lip nose deformities by using multiple maneuvers combining septum and nasal spine medialization and alar cartilage, as well as soft tissue mobilization and repositioning. Moreover, cartilage grafting is frequently used to restore adequate tip projection and nasal symmetry. We present a technique of cartilage grafting commonly used in noncleft rhinoplasties that we modified for cases of moderate cleft lip nose deformities. Patients and Methods We present a retrospective case study of 21 patients with moderate unilateral cleft lip nose deformities who underwent secondary septorhinoplasty with an L-shaped septal extension spreader graft combined with alar rim, alar batten graft, and soft tissue repositioning. Exclusion criteria were severe or complex septal deviation avoiding a stable fixation of the graft. Mean follow-up ...
European Journal of Cancer Supplements
Head & neck, Oct 10, 2017
Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cel... more Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC. Retrospective analysis of survival estimates in patients with surgically treated oropharyngeal SCC using tumoral positivity for human papillomavirus (HPV) and risk-of-death categories according to a study from 2010 as stratification factors. The 5-year overall survival (OS) and disease-specific survival (DSS) rates after surgery alone were higher in HPV-associated oropharyngeal SCC (OS 80% vs 62%; P = .01; DSS 92% vs 76%; P = .03). Patients in the low-risk category had higher survival rates (OS 91%; DSS 99%) than patients in the intermediate-risk group (OS 63%; DSS 83%), and high-risk group (OS 61%; DSS 75%). Nonsmokers with HPV-positive oropharyngeal SCC have a better prognosis than smokers with HPV-positive orop...
Plastic and reconstructive surgery. Global open, 2016
Complications after head and neck free-flap reconstructions are detrimental and prolong hospital ... more Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome-related parameters. Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications. A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9-3.5; P = 0.000...
Medecine Et Hygiene, 1998
Jusqu'a recemment, la paralysie faciale ancienne etait traitee par une suspension de la commi... more Jusqu'a recemment, la paralysie faciale ancienne etait traitee par une suspension de la commissure labiale, assurant une symetrie au repos et permettant l'ebauche de mouvements volontaires. Les progres de la microchirurgie ont permis de developper une nouvelle technique consistant a transferer le muscle gracilis au niveau de la face, a le revasculariser et a le reinnerver par le nerf facial homolateral ou controlateral. Cette technique a l'avantage de pouvoir restaurer les mouvements spontanes exprimant les emotions et la personnalite du sujet. Les auteurs decrivent les indications, la technique et relatent leur experience qui porte sur deux cas.
Acta Endoscopica, Aug 31, 1991
Is 2-year control panendoscopy justified in head and neck cancer patient ? ~, La panendoscopia po... more Is 2-year control panendoscopy justified in head and neck cancer patient ? ~, La panendoscopia post-terapeutica a 2 afios se justifica en oncologia ORL ? RI2SUMI~ Les patients porteurs d'un carcinome 6pidermoide O.R.L. constituent un groupe ~ haut risque enclin h d6velopper une seconde localisation carcinomateuse m6tachrone. Le but de cette 6tude est d'6valuer l'apport de 100 panendoscopies successives 2 ans apr/~s le traitement d'une tumeur O.R.L. Le taux de secondes tumeurs m6tachrones d6couvertes est de 19 % (15 % des patients). Utilis6e comme examen de d6pistage chez des patients asymptomatiques, sans 6vidence de 16sion et pr6sentant une radiographie du thorax normale, la pan-endoscopie h 2 ans a un rendement de 12,8 %. Ces secondes tumeurs m6tachrones sont localis6es dans la sph6re O.R.L. (58 %), dans l'0esophage (26 %) et dans les bronches (16 %). EUes sont d6couvertes ~un stade pr6coce (T1 et Tis) dans les 94 % des cas, ce qui permet un traitement curatif non mutilant chez la majorit6 des malades, aussi bien pour les Iocalisations O.R.L. qu'oesophagiennes et bronchiques (3 traitements photodynamiques, 1 radioth6rapie, 3 interventions chirurgicales non mutilantes et 2 r6sections superficielles au laser CO2).
Revue Medicale Suisse, Oct 5, 2011
Journal of Otolaryngology - Head & Neck Surgery, 2016
Background: Silicone Implants and other alloplastic materials are frequently used in rhinoplasty ... more Background: Silicone Implants and other alloplastic materials are frequently used in rhinoplasty to augment Asian short noses. However, nasal deformities as a result of implant-related infections are increasing in incidence. The resulting tissue scarrings hinder the application of traditional techniques of lengthening short noses. The following paper presents a technique to correct severe postoperative retractions of the tip and columella caused by silicone implants. Methods: We present a retrospective case study of two Asian patients with recurrent acute infections, secondary to silicone dorsum implants, leading to chronic inflammation of the tip and columella. The treatment consisted of implant removal and the immediate nasal reconstruction by combining uni-or bilateral gingivobuccal flaps along with L-shaped costal cartilage grafting. To evaluate the surgical results, various anthropometric measurements, particularly the nasal length (NL) and nasal tip projection (NTP) of pre-and postoperative profile photographs, were analyzed. Results: Successful nasal lengthening and correction of columellar retraction were achieved. In case I, postoperative NTP and NL increased by 34.7 % and 21.1 %, respectively. In case II, NL and NTP increased by 23.8 % and 10.6 %, respectively. However, case II presented necrosis of the distal extremity of one gingivobuccal flap without rib graft resorption, which later healed by secondary intention. Conclusion: Pronounced columellar retraction in severe short noses can be successfully managed with a combination of gingivobuccal flaps along with L-shaped costal cartilage grafting. The use of autologous materials decreases the risk of long-term extrusion through the tip. The gingivobuccal flap provides vascularity to the exposed rib cartilage on the columella and prevents its resorption.
Rev Inst Nac Cancerol, Mar 1, 1999
ANZ Journal of Surgery, 2010
Background: To evaluate global survival, disease-free period, complications, evolution and functi... more Background: To evaluate global survival, disease-free period, complications, evolution and function in vertical partial hemilaryngectomy (VPHL) plus reconstruction with false cord. Methods: Descriptive and retrospective study. In aertiary care medical center in Mexico City. Eight patients with early diagnosis of early glottic cancer (T1 and T2), treated with VPHL plus reconstruction with false cord imbrication. Results: Fifty percent of the patients were clinical stage I, 37.5% stage II and 12.5% stage III. Nasogastric tube was not placed and oral feeding was reinitiated within 3 days on average. Tracheostomy was removed after an average of 2.1 days. Average hospital stay was 3.3 days. Average of the PSS-HNC (Performance Status for Head and Neck Cancer) and Karnofsky Performance Status evaluation was 91 to 97 and 100 at 1 year of evaluation. Voice evaluation demonstrated normal voice in 87.5% of patients. Intensity was below normal with improvement on annual evaluation. Global survival was 100% and disease-free period was 71% at 3 years. Conclusions: VPHL with reconstruction by false cord imbrication is an excellent therapeutic option for early glottic cancers. Multiple functional advantages are demonstrated without sacrificing oncological control as well as providing an audible and intelligible voice. In cases of recurrence, various management options are available. Materials and methods Eight patients with early glottic carcinomas (TNM Stage as defined by American Joint Committee on Cancer) were included in this
American Journal of Otolaryngology, 1997
Purpose: "Early" glottic squamous cell carcinoma classified as Tl-T2NO with anterior commissure i... more Purpose: "Early" glottic squamous cell carcinoma classified as Tl-T2NO with anterior commissure invasion is conventionnaly managed with vertical partial laryngectomy (VPL) or radiation therapy (RT). At our institution, in the early 1980s vertical partial laryngectomy was progressively replaced by supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). The medical files and operative charts of 62 patients with "early" glottic carcinoma classified as Tl-T2NO invading the anterior commissure, consecutively managed with cricohyoidoepiglottopexy, were retrospectively reviewed to ascertain whether any conclusions could be drawn regarding this treatment modality. Materials and Methods: Survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate was analyzed using the Kaplan-Meier life table method. Results: The 3-and 5-year actuarial survival estimate was 93.3% and 86.5%, respectively. The 3-and .5-year actuarial local control estimate was 98.2%. The only patient with local recurrence was successfully salvaged with RT resulting in an overall 100% local control rate and laryngeal preservation rate. The 3-and 5year actuarial nodal recurrence estimate was 1.8%. The 3-and 5-year actuarial distant metastasis estimate was 0% and 2%, respectively. Aspiration related completion total laryngectomy and permanent tracheostomy never occurred. Conclusion: The present retrospective study suggests that cricohyoidoepiglottopexy for glottic carcinoma classified as Tl-T2 invading the anterior commissure resulted in higher local control rates and overall laryngeal preservation rate when compared with historical series using either VPL or RT. Further series are warranted to confirm our results. Copyright 0 1997 by W.B. Saunders Company. Historically, patients with "early" glottic squamous cell carcinoma classified as Tl-T2NO presenting anterior commissure invasion have been managed with vertical partial laryngectomy (VPL) or radiation therapy (RT).lm5 Laser therapy, once advocated, was progressively abandoned because of high local recurrence rate.6-8 At our institution, VPL was the management policy historically advocated
Introduction: Head and Neck Mucosal Melanoma (HNMM) is an uncommon malignancy that arises in decr... more Introduction: Head and Neck Mucosal Melanoma (HNMM) is an uncommon malignancy that arises in decreasing order in the nasal cavity, the paranasal sinuses, and the oral cavity. Although radical surgery followed by eventual radiotherapy is acknowledged as the mainstay treatment, patients with advanced stages or multi-focal tumors benefit from new systemic therapies. We wish to share our experience with these treatments and review the current literature. Materials and Methods: We present a case review of every patient treated in our center for an HNMM over the past 10 years, including every patient treated in our center for an HNMM over the past 10 years. We analyzed clinical characteristics, treatment modalities, and outcomes. Results: We included eight patients aged from 62 to 85 years old. We found six MM in the nasal cavity, one in the sphenoidal sinus, and one in the piriform sinus. Six patients underwent endoscopic surgery with negative margins, six underwent radiotherapy with var...
Background To compare clinical and demographic data between laryngeal cancer patients younger and... more Background To compare clinical and demographic data between laryngeal cancer patients younger and older than 40 years old. Methods Is a matched-paired study, realized from 1989 to 2002. We selected 500 laryngeal cancer patients treated in the National Cancer Institute of Mexico. Fifteen cases of patients younger than 40 years that accomplished inclusion criteria were identified, pair-matched and compared by clinical stage with 33 patients older than 40 years. We analyzed demographic factors and disease-free and Overall Survival by Kaplan-Meier method. Results We included 9 male and 6 female patients with a mean age of 34 years in contrast to a mean age of 62 years in the comparison group. Four cases in clinical stage I, none clinical stage II, 6 in stage III and 5 in stage IV were included in the younger group and compared to 8 patients in stage I, 15 in stage III and 10 in stage IV in the older group. No differences in demographic variables or lifestyle habits were found. All patie...
Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cel... more Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC.
Introduction The unilateral cleft lip nose is characterized by numerous complex and interdependen... more Introduction The unilateral cleft lip nose is characterized by numerous complex and interdependent deformities. Secondary rhinoplasty techniques aim to correct cleft lip nose deformities by using multiple maneuvers combining septum and nasal spine medialization and alar cartilage, as well as soft tissue mobilization and repositioning. Moreover, cartilage grafting is frequently used to restore adequate tip projection and nasal symmetry. We present a technique of cartilage grafting commonly used in noncleft rhinoplasties that we modified for cases of moderate cleft lip nose deformities. Patients and Methods We present a retrospective case study of 21 patients with moderate unilateral cleft lip nose deformities who underwent secondary septorhinoplasty with an L-shaped septal extension spreader graft combined with alar rim, alar batten graft, and soft tissue repositioning. Exclusion criteria were severe or complex septal deviation avoiding a stable fixation of the graft. Mean follow-up ...
European Journal of Cancer Supplements
Head & neck, Oct 10, 2017
Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cel... more Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC. Retrospective analysis of survival estimates in patients with surgically treated oropharyngeal SCC using tumoral positivity for human papillomavirus (HPV) and risk-of-death categories according to a study from 2010 as stratification factors. The 5-year overall survival (OS) and disease-specific survival (DSS) rates after surgery alone were higher in HPV-associated oropharyngeal SCC (OS 80% vs 62%; P = .01; DSS 92% vs 76%; P = .03). Patients in the low-risk category had higher survival rates (OS 91%; DSS 99%) than patients in the intermediate-risk group (OS 63%; DSS 83%), and high-risk group (OS 61%; DSS 75%). Nonsmokers with HPV-positive oropharyngeal SCC have a better prognosis than smokers with HPV-positive orop...
Plastic and reconstructive surgery. Global open, 2016
Complications after head and neck free-flap reconstructions are detrimental and prolong hospital ... more Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome-related parameters. Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications. A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9-3.5; P = 0.000...
Medecine Et Hygiene, 1998
Jusqu'a recemment, la paralysie faciale ancienne etait traitee par une suspension de la commi... more Jusqu'a recemment, la paralysie faciale ancienne etait traitee par une suspension de la commissure labiale, assurant une symetrie au repos et permettant l'ebauche de mouvements volontaires. Les progres de la microchirurgie ont permis de developper une nouvelle technique consistant a transferer le muscle gracilis au niveau de la face, a le revasculariser et a le reinnerver par le nerf facial homolateral ou controlateral. Cette technique a l'avantage de pouvoir restaurer les mouvements spontanes exprimant les emotions et la personnalite du sujet. Les auteurs decrivent les indications, la technique et relatent leur experience qui porte sur deux cas.
Acta Endoscopica, Aug 31, 1991
Is 2-year control panendoscopy justified in head and neck cancer patient ? ~, La panendoscopia po... more Is 2-year control panendoscopy justified in head and neck cancer patient ? ~, La panendoscopia post-terapeutica a 2 afios se justifica en oncologia ORL ? RI2SUMI~ Les patients porteurs d'un carcinome 6pidermoide O.R.L. constituent un groupe ~ haut risque enclin h d6velopper une seconde localisation carcinomateuse m6tachrone. Le but de cette 6tude est d'6valuer l'apport de 100 panendoscopies successives 2 ans apr/~s le traitement d'une tumeur O.R.L. Le taux de secondes tumeurs m6tachrones d6couvertes est de 19 % (15 % des patients). Utilis6e comme examen de d6pistage chez des patients asymptomatiques, sans 6vidence de 16sion et pr6sentant une radiographie du thorax normale, la pan-endoscopie h 2 ans a un rendement de 12,8 %. Ces secondes tumeurs m6tachrones sont localis6es dans la sph6re O.R.L. (58 %), dans l'0esophage (26 %) et dans les bronches (16 %). EUes sont d6couvertes ~un stade pr6coce (T1 et Tis) dans les 94 % des cas, ce qui permet un traitement curatif non mutilant chez la majorit6 des malades, aussi bien pour les Iocalisations O.R.L. qu'oesophagiennes et bronchiques (3 traitements photodynamiques, 1 radioth6rapie, 3 interventions chirurgicales non mutilantes et 2 r6sections superficielles au laser CO2).
Revue Medicale Suisse, Oct 5, 2011
Journal of Otolaryngology - Head & Neck Surgery, 2016
Background: Silicone Implants and other alloplastic materials are frequently used in rhinoplasty ... more Background: Silicone Implants and other alloplastic materials are frequently used in rhinoplasty to augment Asian short noses. However, nasal deformities as a result of implant-related infections are increasing in incidence. The resulting tissue scarrings hinder the application of traditional techniques of lengthening short noses. The following paper presents a technique to correct severe postoperative retractions of the tip and columella caused by silicone implants. Methods: We present a retrospective case study of two Asian patients with recurrent acute infections, secondary to silicone dorsum implants, leading to chronic inflammation of the tip and columella. The treatment consisted of implant removal and the immediate nasal reconstruction by combining uni-or bilateral gingivobuccal flaps along with L-shaped costal cartilage grafting. To evaluate the surgical results, various anthropometric measurements, particularly the nasal length (NL) and nasal tip projection (NTP) of pre-and postoperative profile photographs, were analyzed. Results: Successful nasal lengthening and correction of columellar retraction were achieved. In case I, postoperative NTP and NL increased by 34.7 % and 21.1 %, respectively. In case II, NL and NTP increased by 23.8 % and 10.6 %, respectively. However, case II presented necrosis of the distal extremity of one gingivobuccal flap without rib graft resorption, which later healed by secondary intention. Conclusion: Pronounced columellar retraction in severe short noses can be successfully managed with a combination of gingivobuccal flaps along with L-shaped costal cartilage grafting. The use of autologous materials decreases the risk of long-term extrusion through the tip. The gingivobuccal flap provides vascularity to the exposed rib cartilage on the columella and prevents its resorption.
Rev Inst Nac Cancerol, Mar 1, 1999