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PubMedDate not supplied

Foreign-body inclusion cyst presenting on the lateral nasal sidewall 1 year after rhinoplasty.

Hemostasis and decreased risk of synechiae formation are benefits of nasal packing after sinus surgery; however, these must be weighed against the possible complications, which can include devastating toxic shock syndrome. Nasal packing is often impregnated with an ointment that allows for a less traumatic placement into and removal from the nasal cavity, as well as providing some antibiotic coverage for nasal bacterial flora. Orbital complications secondary to the petroleum-based packing have been reported. When sinus surgery is performed in conjunction with a rhinoplasty, there is a possibility of petroleum ointment migrating into intranasal incisions or osteotomy sites. A 15-year-old girl was examined 1 year after endoscopic sinus surgery combined with an open rhinoplasty had been performed at another institution. Physical examination showed a widened nasal dorsum with an open-roof deformity and a 1-cm firm mass lateral to her lateral nasal sidewall. The pathological examination after removal of the cyst showed a foreign-body inclusion cyst or lipogranuloma. The cyst contained a petroleum-based substance.

Adolescent↗
PubMedDate not supplied

Rhinoplasty and the nasal SMAS augmentation graft: advantages and indications.

We evaluated the nasal superficial musculoaponeurotic system (SMAS) as an autologous augmentation graft material in the thick-skinned patient undergoing cosmetic rhinoplasty using a retrospective review. Representative case reports demonstrated preliminary long-term results after augmentation with the nasal SMAS graft in an academic rhinoplasty practice. En bloc excision of the nasal SMAS in thick-skinned patients produced uniformly favorable improvements in nasal tip definition without adverse sequelae. Moreover, in 10 patients, the harvested material was also used for volume augmentation at various adjacent nasal sites, including the radix, nasal sidewall, and nasal dorsum. Long-term follow-up ranging from 1 to 3 years suggests stable volume augmentation in this initial patient series. No donor morbidity was observed in properly selected patients, and enhancements in nasal tip definition were uniformly favorable. Additional studies are needed to more accurately characterize long-term nasal SMAS graft survival in all patients.

Adolescent↗
PubMedDate not supplied

Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection.

BACKGROUND: It is accepted in rhinoplasty that complications are more common with alloplastic implants than with autografts. There is little guidance in the literature on how to deal with the cosmetic and/or functional problems that follow alloplastic implant rejection. The conventional advice has been to remove the allograft and not place any graft at the same time. The present article presents our experience treating allograft rejection and immediately repairing any structural defect with autografts. OBJECTIVE: To demonstrate that immediate nasal reconstruction using autogenous cartilage is a good technique when an alloplastic material has to be removed because of rejection, inflammation, or infection. DESIGN: A retrospective analysis of outcome for a case series. METHODS: A retrospective review of the management of 8 patients who presented to 2 tertiary referral centers with alloplastic implant rejection following rhinoplasty. In 7 cases, the alloplastic implant had to be removed because it had migrated and caused a foreign body reaction; in 1 case, the implant had caused a bacterial infection. RESULTS: In all 8 cases, the nasal deformity that followed the removal of the allograft was so marked that the nose was immediately reconstructed with autogenous cartilage. The patients all made a good recovery after immediate reconstruction, although skin changes associated with the alloplastic implant remained after a mean follow-up of 3 years 3 months. CONCLUSION: The use of autogenous cartilage is a good option for nasal augmentation immediately after the removal of an alloplastic implant.

Adult↗
PubMedDate not supplied

The transvestibular approach: a new horizon in rhinoplasty.

The lower lateral cartilage has intricate anatomical elements that define shape, projection, and relations with other nasal tip structures. Good exposure of the lower lateral cartilages is an essential step in rhinoplasty. Conservative surgical techniques are essential to get natural long-term results. Different endonasal techniques have limitations in visualizing the lateral and intermediate crura, predisposing patients to asymmetries in reduction and rearrangement. In this article, a new endonasal rhinoplasty approach is described. Using a marginal incision, the vestibular skin is elevated and the endonasal surface of the lower lateral cartilage is exposed, permitting precise reduction, rearrangement, and placement of interdomal suspension sutures and lateral crural spanning sutures. This article discusses the surgical steps and results of my experience using this approach. This transvestibular approach is a new, dependable, and simple method that should allow rhinoplastic surgeons to perform this operation with predictable results and limited variables.

Humans↗
PubMed1981

Systematic approach to correction of the nasal tip in rhinoplasty.

Surgical correction of the nasal tip is considered to be the most difficult component of rhinoplasty. We describe a systematic method of analyzing and operating on the tip, and discuss the anatomical factors that contribute to tip support. The "tripod" theory of tip projection, support, and rotation is described and illustrated. Altering tip support and excising portions of the lower lateral cartilages have a decided effect on the tripod and the eventual outcome of the nasal tip. We describe four categories of tip procedures, namely, complete strip, rim strip, lateral crural flap, and dome division. An attempt is made to provide the rhinoplasty surgeon with the different techniques from which to choose for each specific type of nasal tip deformity.

Cartilage↗
PubMed1983

Unusual and fatal complications of rhinoplasty.

Serious complications of cosmetic rhinoplasty are extremely rare. However, awareness of their existence is essential so that the surgeon can minimize the potential hazards of the procedure. This demands a careful preoperative examination, a meticulous intraoperative technique, and a careful postoperative monitoring of the patient. The complications of rhinoplasty have been classified into infectious, traumatic, hemorrhagic, systemic, and miscellaneous groups. The pertinent literature is reviewed, as well as cases of inclusion cyst formation, disturbance of eye closure, local activation of systemic disease, and fatalities from intracranial injury with brain laceration and pneumocephalus.

Adolescent↗
PubMed1985

Enbucrilate as cartilage adhesive in augmentation rhinoplasty.

Enbucrilate (Histoacryl) as a cartilage adhesive in augmentation rhinoplasty was used in 39 cases. The unique properties of this tissue adhesive enhances the ability to augment the nose during cosmetic and reconstructive rhinoplasty. Enbucrilate interacts superbly well with local tissues, causing no systemic or local untoward effects. Its main attribute stems from its ability to bond cartilage instantaneously and with great reliability, which allows for intricate fabrication of cartilage implant components. Five subcategories of dorsal, tip, and columella augmentation are presented with their technical details outlined. The aesthetic and functional results in 39 cases were deemed excellent, safe, and effective.

Enbucrilate↗
PubMed1986

Complications of the external (combination) rhinoplasty approach.

More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.

Adult↗
PubMed1988

Reduction cheiloplasty. An adjunctive procedure in the black rhinoplasty patient.

The reduction cheiloplasty is a simple surgical procedure that can easily be used adjunctively with a black patient who is undergoing rhinoplasty. Its acceptance by patients and surgeons is increasing, but his useful procedure continues to be underutilized. This article urges the incorporation of the reduction cheiloplasty in the armamentarium of those who routinely perform rhinoplasties on black patients. It is a relatively minor procedure that is easily reproducible and yields excellent, predictable results with few complications. The technique, pitfalls, and morbidity are outlined in this article. The improvement achieved in facial harmony by the addition of this procedure makes it a surgical bargain.

Black People↗
PubMed1989

Rhinoplasty and general anesthesia. Halothane vs enflurane as agent of choice.

In 500 rhinoplasties, infiltration of 1% lidocaine (Xylocaine) hydrochloride with epinephrine chloride (Adrenalin) 1:100,000 was used in combination with inhalation of halothane (Fluothane) or enflurane (Ethrane). Three arrhythmias requiring treatment occurred when halothane was used. No arrhythmias occurred with the use of enflurane. No complications from anesthesia were observed. No patient had laryngospasm. Bleeding was comparable with that which occurs when infiltration anesthesia is used with intravenous sedation. Enflurane is therefore the inhalation agent of choice for use with 1% lidocaine with epinephrine 1:100,000 for rhinoplasty. Clinical methods and guidelines for safety are set forth with special consideration for the in-office surgical suite.

Adolescent↗
PubMed1990

Incision and scar analysis in open (external) rhinoplasty.

Open (external) rhinoplasty is becoming increasingly popular. Two of its disadvantages most frequently espoused are the difficulty in making the external incision atraumatically and the resulting scar. To diminish these concerns, different incision lines and methods of exposure have been proposed by various authors. These are reviewed along with our preferred technique. We reviewed 100 consecutive cases of open rhinoplasty, yielding 81 patients who underwent subjective and objective scar analysis. There was 1 subjective failure (1.2%), and 2 minor objective failures (2.5%). Recommendations are made to minimize difficulties in performing the open approach and to maximize scar cosmesis.

Cicatrix↗
PubMed1992

Revision rhinoplasty. An analysis of aesthetic deformities.

Revision rhinoplasty can present difficult and challenging problems, which maximally test the skill and judgment of the facial plastic surgeon. We conducted a retrospective study of 1221 consecutive rhinoplasties, of which 170 were revision procedures. The rate of revision of our own procedures is 5.3%. Postrhinoplastic deformities are divided anatomically into the upper, middle, and lower thirds of the nose. The largest category of deformities occur in the lower thirds of the nose, in which bossa are the most common problem. Overall, pollybeak is the most common deformity in 33% of the procedures performed, followed by bossa in 26%, and excessive dorsal removal in 24%. We analyzed the causes and selected management of these cases.

Female↗
PubMed1995

A graduated method of tip graft fixation in rhinoplasty.

Projection of the nasal tip has gained increased recognition as a measurable and visual characteristic that has an impact on the results of aesthetic rhinoplasty. Autologous cartilage tip grafts have been used in many techniques to increase tip projection and contour the tip during rhinoplasty. This article introduces a graduated method of tip graft fixation correlated with specific clinical measurements related to tip projection. After careful analysis of tip projection and contour, a predictable graft fixation technique can be selected to obtain the desired degree of nasal tip projection and sculpting.

Cartilage↗
PubMedDate not supplied

Management of the septum during rhinoplasty.

Septal deviation is the rule more than the exception in most cases of rhinoplasty. When deviation of the septum precludes a good rhinoplasty's functional and aesthetic results because of impairment of nasal air flow, residual deviation, or inadequate medialitation of the lateral nasal wall, a modified submucous resection of the deviated part is certainly indicated. If possible, a dorsocaudal L-strut of cartilage should be maintained, but, if necessary, it can be resected partially or totally and the support of this area reestablished by dorsal and columellar cartilage grafts. The authors recommend a bilateral mucoperichondrial-mucoperiosteal dissection of the septum from its caudal edge to the most posterior deviated part, because it provides easy septal resection in a good surgical field.

Adolescent↗
PubMed1994

Endoscopic control during rhinoplasty.

Endoscopy during rhinoplasty is an advance that permits the surgeon to obtain better results in cartilage and bony resections. It should decrease the number of secondary nasal revisions for small cartilaginous or bony irregularities. From May 1993, 30 patients have undergone primary and secondary rhinoplasties with complementary resections in all cases obtained with endoscopic control after the normal rhinoplastic procedure was completed.

Adolescent↗
PubMed1992

Secondary rhinoplasty via transcolumellar incision.

The transcolumellar rhinoplasty was used in 90 patients with severe nasal sequelae caused by one or more previous surgical interventions. In each case the deformity was located mainly on the nasal tip making it extremely difficult to correct with conventional surgical procedures. We chose the transcolumellar rhinoplasty procedure to avoid another failure for these patients who sought complete resolution of their problem. At the same time, the technique provides a more secure surgical field to make a definitive diagnosis and to treat the sequelae properly.

Female↗
PubMed1989

The use and abuse of external incisions in rhinoplasties.

The author emphasizes his basic opposition to the use of external incisions in surgical rhinoplasty with only a few minor exceptions. External incisions are justifiable in only a limited number of cases, and when they are published these cases should be exceptional indeed and not suggested as an alternative technique or as an innovation to be used on a routine basis. The endonasal approach should be used in the vast majority of aesthetic rhinoplasties with only a few exceptions mentioned here.

Esthetics↗
PubMed1983

Rhinoplasty update: preoperative evaluation of 4,040 cases.

A total of 4,040 cases of cosmetic rhinoplasty surgery was evaluated in terms of sex distribution, age, marital status, and motivating factors. There was a male to female ratio of 1:15.9. Of the 1,880 patients operated on between 1975 and 1980, there were 40.2% females and 33.3% males over the age of 24 years. This is an increase over a previous patient group of 2,160 patients treated between 1964 and 1974, in which older women comprised 26.8% and older men 24% of those treated. The proportion of married patients has increased since 1975, with 29.1% of the women married and 11.4% of the men (versus 18.6% and 4.8%, respectively, for the earlier period). Motivating factors included the patient's own desire for a change, external influences such as advice from family or friends, and observation of someone who had undergone rhinoplasty successfully.

Adolescent↗