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Fifty patients who primarily desired cosmetic improvement underwent nasal airflow studies using posterior rhinomanometry before and after reduction rhinoplasty. There was no significant difference in nasal resistance before and after surgery. This study demonstrates that neither subjective nor objective nasal obstruction follows reduction rhinoplasty, despite the potential for a decreased cross-sectional area of the valve region.
OBJECTIVE: To validate a method of primary anatomic alar repositioning using a "limited open rhinoplasty" approach, along with cleft lip repair, without presurgical orthopedics. METHODS: The cleft lip deformities were repaired using a modified Tennison technique, and primary muscle union and gingivoperiosteoplasty were achieved in all cases. The alar cartilages were visualized using an inverted "U" incision on the cleft side and a rim incision on the noncleft side, without joining the two with a transcolumellar incision. The domes of the cartilages were approximated by a single horizontal mattress suture. PATIENTS: Thirty-five patients were operated on by this technique between March 1999 and February 2004. The patients ranged in age from 4 to 36 months (mean, 6 months). The follow-up ranged from 4 months to 4.5 years (mean, 18 months). RESULTS: Overall, the results for nasal shape and symmetry have been extremely good. CONCLUSIONS: The technique used here provides an exposure just short of an "open" rhinoplasty without scarring the columella or nasal tip. Arch alignment and a symmetric and stable bony platform are generally achieved by 2 to 3 months after the surgery. In severe cases of complete clefts, we have observed an absolute increase in alar arch length as a result of tissue stretch.
Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.
Almost any forms of complete clefts require a rhinoplasty in spite of good primary results with modern methods of operation in the labial region. The final correction is performed after the fifteenth year of life. The existent supporting tissue is often inadequate and will yield no optimal result if local reconstruction alone is performed. Transplantation of autologous cartilage to the side of the nose and to the columella may compensate for the deficit, the columella cartilage chip permitting to erect the nose, which gives favorable aesthetic and functional results. Consequently, rhinoplasty is recommended for certain unilateral complete clefts and in any case for bilateral complete clefts.
Because of its central location, the nose is an important element in facial aesthetics. The size and the shape is conditioned by the volume and the strength of the osteocartilaginous framework and the thickness of the soft-tissue cover. Rhinoplasty is a complex procedure requiring understanding of the anatomy and how each element contributes to the shape of the nose. In an attempt to obtain a pleasing aesthetic result and to have a satisfied patient 70 patients were operated. The results of open and closed approaches in rhinoplasty and the indications for the open approach are discussed.
OBJECTIVE: To evaluate the long-term effect of augmentation rhinoplasty with silicone. METHOD: 360 patients underwent augmentation rhinoplasty with silicone. Improved "L" shaped implants were used in 343 patients. RESULT: Among 360 patients, 334 cases were successful enough (92.83%). CONCLUSION: The key to the maintenance of the long-term effect is to use properly improved "L"-shaped implant, to choose a suitable tunnel, to prevent various complications and to ask patient's opinions for implant design.
Congenital cleft lip is always associated to nasal deformity. The classical approach has been not to treat the severe nose defects during childhood, in the fear that early surgery would interfere with nasal growth. However, long term follow-up in patients with early conservative rhinoplasty has shown the nose to hold its new shape and its growth to be normal. During the period between november 1996 and november 1998, 22 infants affected with cleft lip underwent early rhinoplasty according to McComb's technique. During the follow-up period (6 months to 30 months) the children had a good nasal growth. The nose tip is in the medial position in all cases, and only the inferior view of the nose shows a discrete nosetril assimetry in some patients.
Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of perisitent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.
BACKGROUND: To review the personal experience of a single surgeon over a 31 year period. METHOD: A retrospective analysis of 7447 rhinoplasties performed by a single surgeon from 1969 to 2000. Ninety-five surgeries performed at educational courses were excluded from this series. RESULTS: During the many years of performing rhinoplasties, cartilage splitting, delivery, and external approach are among the most common techniques. In the first decade, 62% were cartilage splitting, 33% delivery, and 3% externaL In the second decade, 13% were cartilage splitting, 58% delivery, and 26% external. In the third decade, 11% were cartilage splitting, 52% delivery, and 36% external. CONCLUSION: Over a three-decade period, the techniques of the author have been influenced by national trends, training, and patient outcomes.
Septorhinoplasty is the most difficult and complicated procedure in facial plastic surgery. Because of the complex interdependency of the anatomical parts, alteration of one may have an impact on another. Form and function are completely interwoven in septorhinoplasty. The selection of appropriate candidates involves an understanding of their expectations. Outcome research is a new concept in clinical medicine and its importance is increasingly recognized for the patient management and policy decisions. This study includes an analysis of patients' subjective opinion of the surgical outcome after septo-rhinoplasty, with the use of Glasgow Benefit Inventory (postoperatively) and the Nasal Symptom Questionnaire (pre- and postoperatively). In this study we analyze the patient subjective rating of benefit in 41 consecutive patients who underwent septo-rhinoplasty within the first 8 months of 2001, and had completed a follow up period of more than 6 months postoperatively. The early complication rate was recorded and analyzed along with data regarding the patient satisfaction rate using GBI and NSQ. The response rate was 80%, which is high. Patients had significant improvement in all subscales of GBI (General, Social, Physical) related with a decreased number of nasal symptoms postoperatively and a good aesthetic result.
Because obstruction of nasal breathing accompanies a large proportion of the noses which appear to require correction externally, internal and external correction of the nose must always be carried out at the same time. Corrective rhinoplasties are not rarely connected with a certain risk because of a false estimation of the patient's psychic situation and too high expectations concerning the postoperative result. The various problems of the corrective procedure for crooked nose and saddle nose are described as well as the possibilities of using cartilaginous and bony transplants or Silastic implants. The use of histoacryl tissue glue to stick cartilage together in the reconstruction of a saddle nose can only be recommended with great reservations. The method carries a risk of persistent graft damage as a result of exothermic polymerisation processes and various end and split products of histoacryl can cause a long term inflammation and partial necrosis of the strut. The use of Cialitstored homologous cartilage can be recommended. However, in several cases (about 5%) a certain kind of inflammation around the homologous transplants could be observed, perhaps as a consequence of an immunological reaction or as a reaction against the mercury salt in the Cialit solution. The experiences with Silastic implants were very disappointing. In corrective rhinoplasties in childhood the anatomical and functional characteristics of the still developing midface must be taken into consideration. In adults, both esthetic and functional aspects must be borne in mind. The medico-legal situation and the importance of the preoperative informed consent of the patient are discussed.
OBJECTIVE: To explore the new classification and marking method for traumatic deviated nose treated by septo-rhinoplasty. METHODS: Twenty-six selected cases of traumatic deviated nose were analysed. There were 5 C-type cases, 12 O-type cases and 9 S-type cases. Deviated parameters were measured before and after operation. All patients were treated by seven-step method. RESULTS: Clinical data in seventeen patients including C-type and O-type were complete. There was significant difference in changes of deviated parameters before and after operation( t = 6.9031, P = 0.0001). The cure rate was 58.8%, the effective rate was 88.2%. CONCLUSIONS: The new clinical classification and marking method for traumatic deviated nose are suitable for clinical study. Septo-rhinoplasty is effective for traumatic deviated nose.
Orthognathic surgery commenced with mandibular procedures, progressed to maxillary procedures, and then onto bimaxillary procedures. So far, there has been an inadequate appreciation of the need to include nasal appearance in orthognathic planning. This paper discusses the relationship of rhinoplasty to orthognathic surgery, and outlines an operative technique for rhinoplasty.
10 to 15% of all rhinoplasties need a second operation. This depends mostly on an inexact analysis, an insufficient planing or an inadequate rough technique. Typical examples of cases of secondary rhinoplasties are demonstrated.
Although the external rhinoplasty remains controversial it is difficult to understand why. The columella scar is of little significance since this becomes nearly invisible if the closure is carefully performed. There is a relative postoperative prolongation of nasal tip swelling in comparison with the closed technique, however this also becomes negligible with time. On the other hand, in our experience the open approach will achieve better understanding of the patient's individual anatomy and thus lead to a more predictable result through increased exposure and precision tailoring. The external technique facilitates the application of the great variety of tip refinements that have been developed over the years to allow facial plastic surgeons to get consistently excellent results in rhinoplasty.
The technique of external rhinoplasty has enjoyed a renaissance over the last ten years primarily for cosmetic and functional septorhinoplasty. The versatility of this approach for a variety of rhinologic problems is exemplified by the previous case studies. More specifically, it affords unparalleled exposure of the nasal architecture and for the repair of septal perforations and nasal obstruction secondary to nasal valve deficiency. It may also aid the surgeon in defining the level of cartilage and skin thickness in the excision of rhinophyma. Beyond the unchallenged advantage of improved exposure that the external rhinoplasty approach affords, the surgeon is able to use both hands (as one is not occupied with the nasal speculum) and to view the procedure with binocular vision and greater depth perception. The teaching advantages are obvious. The method is not difficult, it may be done under local anesthesia and it entails no additional risk to the patient.
On the basis of 30 cases of rhinoplasty utilizing an ulnar crest graft performed over the past few years, the authors review the various types of grafts used for rhinoplasty and describe the technique for sampling the ulnar crest graft in detail. They stress the merits of this procedure: --superficial, easily accessible donor site; --simple postoperative period; --minimal scars; --good-quality graft requiring minimum modeling.
The current popularity of cocaine use poses special hazards for the patient and the plastic surgeon during rhinoplasty. It is incumbent upon the surgeon to inquire preoperatively about possible recreational use of cocaine. As the preferred site of cocaine administration, the nasal septal mucosa is exposed to both the intense vasoconstrictive action of cocaine and the irritative effects of numerous contaminating additives. Pathologic changes in the septal mucosa should be recognized by preoperative rhinoscopy and evaluated by biopsy. In this series of 13 patients, fewer than half were properly identified as cocaine users during the preoperative consultation. Preoperative rhinoscopic findings varied from grossly unremarkable septal mucosa to visible perforation and microscopic evidence of granulomas, inflammation, and necrosis. Surgical complications consisted of localized septal collapse, delayed mucosal healing, and inadequate correction of septal deflection. Submucous resection and septoplasty should be avoided in patients with a known history of intranasal cocaine application. Although rhinoplasty can be safely performed in selected patients with a history of cocaine use, it may be extremely limited, unfeasible, or hazardous in those with significant mucosal and cartilaginous impairment as well as in those patients who refuse or are unable to relinquish the drug.