Biomedical subjects

Jack P Gunter

Publications and source records attributed to Jack P Gunter.

4 recordsLinked to original sources

PubMed2006

Management of intraoperative fractures of the nasal septal "L-strut": percutaneous Kirschner wire fixation.

BACKGROUND: The area where the septal cartilage joins the perpendicular plate of the ethmoid is a vulnerable region where overresection or disruption during rhinoplasty causes a loss of support and potential collapse of the nasal dorsum, leading to a saddle-nose deformity. Previously described methods of repair involve suture techniques that are often inadequate to restore septal stability. The authors present the senior author's (J. P. G.) experience in managing intraoperative fractures of the septal "L-strut," describe a classification system for the types of dorsal septal L-strut fractures, and present a new method of treatment using percutaneous Kirschner wire fixation. METHODS: The authors conducted a retrospective review of 1372 primary and secondary rhinoplasties performed by the senior author. A classification system was developed to describe the type and location of dorsal septal L-strut fractures. Each patient was treated with immediate restabilization of the fractured dorsal septal L-strut with dorsal spreader grafts, percutaneous Kirschner wire fixation, or a combination of both methods. RESULTS: Seventeen patients sustained an intraoperative fracture of the septal L-strut with an overall incidence of 1.2 percent. Complications included minor dorsal deviation and inadequate reduction/moderate dorsal depression in three patients requiring revision surgery to correct the dorsal deformities. CONCLUSIONS: An intraoperative fracture of the septal L-strut is a rare but unfortunate occurrence during rhinoplasty. Although technically difficult to perform, the percutaneous Kirschner wire fixation technique with or without spreader grafts is a novel and effective approach to this complication.

Bone Wires↗

PubMed2006

Frequently used grafts in rhinoplasty: nomenclature and analysis.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Accurately name the most frequently used grafts in primary and secondary rhinoplasty. 2. Describe the precise anatomical position of each graft. 3. Discuss the clinical indications of each graft. SUMMARY: In this article, the authors present the grafting techniques most commonly used to sculpt the nasal framework in primary and secondary rhinoplasty. The grafts are described in terms of their nomenclature, anatomical location, and clinical indications, presenting a simple and easy-to-reference guide for both beginners and expert surgeons.

Humans↗

PubMed2002

Digital photography for rhinoplasty.

Standardized, high-quality, preoperative photographs of the nose are critical for preoperative rhinoplasty planning, comparative postoperative assessment, and demonstration of surgical results. To produce these high-quality, reproducible photographs, it is essential to standardize lighting, to properly position the patient in standard views, to avoid lens distortion, and to maintain consistent camera-to-subject distances. Traditional photographic standards have been well documented in the literature; however, most do not address digital photography, and none address digital photography for rhinoplasty. Certain variables in digital photography that are not present in 35-mm photography can be critical to the appearance of the final image. Variables such as image color and contrast (which usually vary between digital cameras), focal length differences between 35-mm and most digital cameras, the effect of resolution and compression on image quality, and the effect of the printing method used can affect the appearance of the external anatomy of the nose in the final print or image. Lack of detail in the external nasal anatomy becomes an issue if the surgeon uses the photograph intraoperatively for reference, as the authors do. Initially, the authors experienced difficulties with observing subtleties in the tip-defining points and tip anatomy using digital photography when compared with our traditional methods of 35-mm photography. The lack of detail in the external anatomy was most prevalent in the frontal and basal views. Thus, the authors have since tailored their photographic methods to document the rhinoplasty patient to maximize the visual information of the external nasal anatomy in the photographic and the printed image. This article is intended to review the photographic principles for standardized rhinoplasty photography, address the additional considerations necessary when using digital photography, discuss the printing variables that can affect overall quality of the printed image, and discuss the authors' new method of photographing the rhinoplasty patient.

Humans↗

PubMed2002

The deviated nose: optimizing results using a simplified classification and algorithmic approach.

The deviated nose presents a particular challenge to the rhinoplasty surgeon because, frequently, both a functional problem (airway obstruction) and an aesthetic problem must be addressed. An approach to the deviated nose is presented that relies on accurate preoperative planning and precise intraoperative execution of corrective measures to return the nasal dorsum to midline, restore dorsal aesthetic lines, and maintain airway patency. The principles of correction include wide exposure through the open approach, release of all deforming forces to the septum, straightening of the septum while maintaining an adequate dorsal and caudal strut, restoring long-term support, reducing the hypertrophied turbinates, and performing controlled stable percutaneous osteotomies. An operative algorithm is described that emphasizes simplicity and reproducibility, and case studies demonstrate the results that can be achieved with this approach.

Adult↗