Use of Orthoplast as nasal splint.
Nasal splintage is routinely employed in standard rhinoplasty. For 3 years one of the authors has used Orthoplast as an alternative to plaster of Paris, which has proved to have many advantages.
Humans↗
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The nose in children with unilateral cleft lip and palate.
Surgeons and orthodontists are still challenged to achieve 'better' noses for children with a unilateral cleft or lip, alveoulus and palate (UCLP). Various aspects are discussed: infant anatomy and later changes, developmental mechanics, cleft syndrome in animals with surgically produced facial clefts, untreated patients with congenital clefts, the radical primary correction of the UCLP nose, the unsolved problems in secondary rhinoplasty and suggestions for scientific communication.
Animals↗
Post-surgical nasal cellulitis outbreak due to Mycobacterium chelonae.
An outbreak of post-rhinoplasty nasal cellulitis due to Mycobacterium chelonae in a secondary care centre is described. A case-control study demonstrated that the use of inadequately sterilized surgical equipment in the Otorhinolaryngology Department was a risk factor. The causal organism was cultured from the equipment, from the surface of the operating theatre lamp, adhesive tape and from two of the hospital's general water tanks. Introduction of effective instrument sterilization methods, monitored with biological controls, the use of new air filters and cleansing and disinfection of hospital water tanks, were sufficient to control the outbreak. The antimicrobial susceptibilities of the causal organism were consistently different from those previously reported in M. chelonae.
Case-Control Studies↗
Treatment of over-reduction of the nose and subsequent deformities.
Failures after rhinoplasty are the result of both technical mistakes and of errors of judgement. One of the most common errors is resection of too much tissue from the components of the nose: the dorsum, alar cartilages, or septum. Such deformities may have both cosmetic and functional effects. The defects that most commonly make a nose look unnatural are: a shallow nasofrontal angle, a nose that has been shortened too much, an over-reduced dorsum which emphasises a parrot's beak deformity, and a round nasal tip with a short interdomal length that lacks definition. The purpose of this paper is to describe the most common deformities associated with excessive resection of the nose, and to suggest the appropriate procedures for correcting the defects. Grafting is usually necessary. We will deal first with deformities of the dorsum and septum and then of the nasal base, but it must be borne in mind that a defect in one area is likely to affect the other areas because they are interrelated-for example, over-resection of the dorsum may also effect the tip of the nose. In addition, not all deformities are the result of excessive reduction; some may result from inadequate resection.
Bone Transplantation↗
Use of cantilever iliac bone grafts for reconstruction of cleft lip-associated nasal deformities.
PURPOSE: The purpose of this study was to describe the clinical and radiographic observations on cantilever iliac bone grafts for reconstruction of cleft lip-associated nasal deformities. MATERIALS AND METHODS: Cantilever iliac bone grafts were performed on 14 patients with a severely deformed cleft lip-associated nose using the open rhinoplasty technique. An approximately 6-cm length of iliac bone was tightly inserted into a subperiosteal pocket over the nasal bones, and the nasal tip was elevated by the distal end of the graft. The clinical follow-up ranged from 7 months to 3 years. RESULTS: All patients were judged to have satisfactory results. The grafted bone decreased slightly in size during the first 2 to 3 months, and irregularities in contour became rounded. During the same period, bony union with the underlying nasal bones was observed in all cases. After about 6 months, further changes did not occur in the grafts. CONCLUSION: This type of bone graft can be used for additional structural support and to achieve the desired nasal projection and profile. Augmenting the nasal bridge creates the illusion of a narrower nose. The key to success of the operation seems to be the proper fixation of the grafted bone to the underlying nasal bones.
Adolescent↗
Early correction of the nose in unilateral cleft lip patients using an open method: a 10-year review.
PURPOSE: To review a 10-year follow-up of cases with rhinoplasty for a cleft lip-associated nose deformity done during the preschool years. MATERIALS AND METHODS: Sixteen patients from 16 to 19 years of age were evaluated with two indices: the nasal index and the lobule portion of the columella index. RESULTS: Several years after surgery the results appeared to be reasonably satisfactory. However, as the patients approached their adolescent growth spurt at 15 years of age, undesirable features became obvious. Each patient showed a strikingly bulbous nose. The nasal index of male patients ranged from 68.8% to 82.7% (mean, 75.4%) and that of female patients ranged from 72.7% to 85.0% (mean, 79.2%). The mean value of the nasal index in the Japanese male and female is 58.5% +/- 1.5% and 59.0% +/- 1.0%, respectively. The lobule portion index of male patients ranged from 57.1% to 72.0% (mean, 65.1%) and that of female patients ranged from 62.5% to 82.0% (mean, 74.2%). The lobule portion of the columella constitutes 33% of the total columellar length on average. CONCLUSIONS: A possible cause of the undesirable deformities is use of an open surgical method. A second possible cause is mobilization and suspension of the alar cartilages. These undesirable features may occur only in Oriental noses.
Adolescent↗
Local anesthesia infiltration as a cause of intraoperative tension pneumothorax in a young healthy woman undergoing breast augmentation with general anesthesia.
Pneumothorax may be a medical emergency. Iatrogenic pneumothorax is more common than all other forms of spontaneous pneumothorax, and surgical procedures involving the breast are a frequent setting for this. A 32-year-old, 60 kg, woman without any significant medical history underwent a bilateral breast augmentation and rhinoplasty. She underwent a routine general endotracheal anesthetic. Prior to surgical incision, the surgeon infiltrated the breast with lidocaine with epinephrine. Six hours into the surgical procedure, the patient developed hemodynamic compromise and was diagnosed with tension pneumothorax, which was treated emergently with a 14-gauge angiocatheter placed intrapleurally. The patient immediately returned to hemodynamic stability. This case report discusses iatrogenic pneumothoraces as well their most likely causes; which in this specific case was the injection of local anesthetic. Suggestions for prevention and treatment of the unusual complication are discussed.
Adult↗
[Aesthetic surgery and history].
The history of aesthetic surgery is linked to that of the 20th century. The first operations allowed by the progress of anesthesia and asepsis are the correction of "prominent ears" by Ely then rhinoplasty with endonasal incision by Roe. Considered by some as a precursor and a quack by others, C.C. Miller was the first surgeon to specialize and write books on the subject. Before world war I, aesthetic surgery was seldom practiced and publications were few. The war was at the origin of several units of maxillo-facial surgery created for the huge number of casualties with face trauma due to trench warfare. Many of those who will become great names in plastic surgery operated in these units: Blair, Davis, Léon Dufourmentel, Virenque, Morestin and Gillies. After the war, American surgeons were regrouped in scientific societies. Plastic surgery was privileged and aesthetic surgery was lifted for "quacks". In France, several surgeons such as Suzanne Noël, Passot, Bourguet, Dartigues showed an important creativity and described several techniques that inspired recent ones. The Dujarier case discredited French aesthetic surgery but did not stop the creation of the first French Society of Plastic Surgery in 1930. World war II led to new orientations. In England, the East Grinstead center with Gillies and McIndoe during and after the war was at the origin of many vocations. After the war, many national and international societies of plastic surgery started to appear. The French Society of Plastic Surgery was born in 1952.
Anesthesia, General↗
A simple way to assist placement of a bone graft into a soft tissue tunnel.
We describe a simple and cost effective technique for the insertion of calverial bone grafts for augmentation rhinoplasty.
Bone Transplantation↗
The management of midline transcranial nasal dermoid sinus cysts.
The most common congenital midline nasal masses are nasal dermoid sinus cysts (NDSC) [Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass--a review. Head Neck Surg 1980;2:222-33.]. Their clinical importance hinges on their potential to communicate with the central nervous system. Preoperative diagnosis of an intracranial extension allows for referral to a craniofacial team with the appropriate skills and experience for a transcranial approach. All patients with a NDSC require imaging with high resolution multiplanar MRI scans and complimentary fine cut CT scan to reveal the anatomical extent of the tract and its relationship to the anterior cranial fossa. A single-stage craniofacial approach to resection of midline NDSC extending to the anterior cranial base is effective with minimal morbidity [Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg 1999;103:2082-3; Denoyelle F, Ducroz V, Roger G, Garabedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795-800; Rohrich RJ, Lowe JB, Schwartz MR. The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 1999;104:2163-70; Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid-a 30-year experience. Arch Otolaryngol Head Neck Surg 2003;129:464-71; Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 1994;93:745-54 [discussion 755-56]; Bartlett SP, Lin KY, Grossman R, Kratowitz J. The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 1993;91:1208-15.]. The cyst and tract are accessed through a combination of a nasal and transcranial approach. This allows visualisation and dissection of the tract with only a small incision on the nasal dorsum to include the cutaneous punctum when present. Transnasal endoscopic techniques have been advocated where the dermoid is located within the nasal cavity and there is little or no cutaneous involvement [Weiss DD, Robson CD, Mulliken JB. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 1998;101:2119-23.]. We present a review of five cases referred to our unit between 1999 and 2004 with a diagnosis of a midline nasal dermoid sinus cyst and radiological evidence of intracranial communication. All cases had a communication with the anterior cranial fossa diagnosed preoperatively and were treated surgically with a craniofacial approach. An intracranial extension was identified at operation in each case and this was confirmed on histopathology. The only significant complication resulted from an early postoperative infection, requiring re-operation. There were no recurrences and acceptable aesthetic outcomes have been observed in all cases.
Bone Diseases↗
Correction of the Asian deviated nose with no hump using unilateral bony mobilisation and dorsal septal suture fixation.
A deviated nose is corrected by straight realignment and long-term maintenance of the bony and cartilaginous structure. Traditional rhinoplasty usually involves complete separation of both upper lateral cartilages from the septum and bilateral bony mobilisation after osteotomy. In the Asian deviated nose with no hump, these procedures are intrinsically destabilising and may weaken the supporting bony and cartilaginous structure. To avoid these problems, I performed unilateral bony mobilisation with anterior wedge resection and suture fixation of the dorsal septum to the nasal bone without separation of the upper lateral cartilage. This manoeuvre is simple and reproducible and produces satisfactory straightening and maintenance of the nasal dorsum while maximally preserving the structural support. Here, I describe the surgical techniques including the choice of the site of unilateral osteotomy and wedge resection, a new classification of bony deviation, two surgical modifications applied to different types of deviation and rationale of dorsal septal suture fixation. Also, clinical cases of nasal deviation are presented.
Adult↗
Correction of the nasal tip and columella in Koreans by a complete septal extension graft using an extensive harvesting technique.
The nose of most Koreans is characterised by a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a complete septal extension graft, along with augmentation rhinoplasty has been developed. However, the use of this type of graft is frequently problematic because the septal cartilage is not large enough. In a study involving 10 cadavers, a complete septal extension graft was achieved in two of them by using septal cartilage harvested according to standard techniques. Therefore, the septal cartilage was harvested, leaving a 5-mm L-shaped strut, and a complete septal extension graft was implanted. The present report describes the results obtained in 34 patients and offers an analysis of the results as judged by the columella-labial angle and three proportional indices (nose height index, nasal bridge length index, and nasal tip projection index), measured by photogrammetry. The postoperative values obtained in these four categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally. Moreover, these positive outcomes were maintained during long-term follow-up, and no side effects, such as saddle nose deformity, were reported.
Adolescent↗
Osseous genioplasty in facial aesthetic surgery--a personal perspective reviewing 54 patients.
The chin is an important and often neglected feature of facial balance. Genioplasty is a useful procedure in aesthetic surgery and often can be combined with other procedures to obtain an optimal aesthetic outcome. A retrospective case note review of the senior author's (BMJ) experience of aesthetic genioplasty over an 11-year period was undertaken. Cases with non-aesthetic indications for genioplasty were excluded and overall 64 patients were included in this study. Our technique of intraoral osseous genioplasty is described and discussed. A total of 54 patients underwent osseous genioplasty, eight underwent alloplastic genioplasty and two underwent removal of a chin prosthesis only. Most of the patients who had an osseous genioplasty had a sliding advancement correction. Four of these patients required secondary surgery, five had additional minor complications and there were seven cases of transient numbness. Nine patients had a genioplasty alone, 26 had one additional procedure and 19 had more than one, with an average of 2.9 additional procedures. Twenty-four patients had a simultaneous rhinoplasty and 18 had a facelift. Osseous genioplasty is our preferred technique for its versatility and long-term stability compared to alloplastic methods. If performed correctly it provides excellent results with a high degree of patient satisfaction and few long-term complications.
Adult↗
Acoustic rhinometry and its uses in rhinology and diagnosis of nasal obstruction.
Acoustic rhinometry is a tool that can aid in the assessment of nasal obstruction. The test is noninvasive, reliable, convenient, and easy to perform. Common clinical and practical uses of acoustic rhinometry for the rhinologic surgeon include assessment of"mixed" nasal blockage, documentation of nasal alar collapse, and preoperative planning for reduction rhinoplasty. Acoustic rhinometry can also be used to document the positive effect of surgery on nasal airway obstruction.
Airway Resistance↗
A modern approach to nasal osteotomies.
A thorough understanding of the anatomy of the nose is paramount in rhinoplasty. Correction of deformities of the nasal vault presents a challenge to the facial plastic surgeon. Suboptimal aesthetic results may occur when either inadequate or excessive mobilization of the nasal bony-cartilaginous framework is performed. Furthermore, postoperative complications such as collapse of the nasal airway may occur. A number of techniques are available to appropriately mobilize and reposition the bony nasal vault. In this article, we will review pertinent anatomy, technical considerations and clinical perspectives on mobilization of the nasal bones.
Humans↗
Endoscopic placement of spreader grafts in the nasal valve.
OBJECTIVE: Surgery to the internal nasal valve is presently approached either externally via an open rhinoplasty incision or transnasally. The endoscopic approach has become the preferred method of access to various other sinonasal conditions. The goal of this study was to evaluate 1) whether the internal nasal valve could be accessed and evaluated endoscopically and 2) whether a spreader graft placed under endoscopic visualization could widen the nasal valve area. STUDY DESIGN AND SETTING: Single-blinded study on 8 cadaveric heads. One side per head was randomly selected to be studied. The contralateral side served as the control. The nasal valve was approached endoscopically via the submucoperichondrial plane of the nasal septum with a 30-degree endoscope. After fully examining and subsequently separating the internal nasal valve, a spreader graft was placed. A blinded examiner then performed acoustic rhinometry to measure the nasal valve area as well as corroborate the position from an external approach. This data was then statistically analyzed using the paired Student t test. RESULTS: The nasal valve was easily detected endoscopically and the position of the spreader grafts was externally confirmed in all 8 specimens. The mean change of the nasal valve area on the side with the spreader grafts was 0.28 cm2. On the control side, the mean change was 0.026 cm2. This difference was statistically significant (P = 0.004). CONCLUSION: The endoscopic approach is a viable option in accessing the nasal valve. Endoscopic placement of a spreader graft has also been shown to statistically widen the nasal valve area.
Cadaver↗
[Upper lateral cartilage transposition in the surgical management of nasal valve incompetence].
We have operated eight patients with nasal obstruction secondary to internal valvular incompetence. In three of them an alar collapse were associated. Diagnosis was made by anamnesis and clinical exploration. Open rhinoplasty approach was employed. Surgical technique was the transposition of lateral over alar cartilage. In the three patients with alar collapse, a fixation graft of septal cartilage were added to the previous technique. Nasal obstruction and valvular incompetence missapeared in all the patients.
Adult↗
[Diagnosis of septo-pyramidal defects. Our report].
OBJECTIVE: The aim of the study is to determine the characteristics of patients who are operated on because of a nasal or septal deformity: clinical features before surgery, physical examination, anterior active rhinomanometry, and computed tomography (CT). METHODS: We retrospectively reviewed prospective data collected on 372 patients operated on between January 1998 and June 2002 by means of a septoplasty or a rhinoplasty. RESULTS: Gender distribution was: 253 male, 119 female. A smaller percentage of men underwent correction of pyramidal deformities in comparison to women. Nasal endoscopic examination diagnosed associated inflammatory pathologies in 12.4% of patients. We found a significant relationship between previous nasal trauma, laterorrinia and defects of the dorsum. Anterior active rhinomanometry had a high variability between patients. CONCLUSIONS: Prospective data collected on these patients was useful to know more precisely our activities and how to adapt them to suit management decisions. Endoscopic examination proved high efficiency in the diagnosis of this pathology.
Adolescent↗
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