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PubMed1989

[For or against rhinoplasty in children?].

The correction of nasal malformations in children divides surgeons into two groups: those who prefer to operate in order to rapidly restore the altered anatomical structures, and those who prefer to wait and see, to avoid aggravating the initial lesions by operating during the growth period. Clinical findings and animal experiments fail to clearly support either one of these approaches, at least in the case of very young children, but as recent embryological studies have demonstrated the important role of the septum in the growth of the nose, it still seems legitimate to recommend great caution before performing rhinoplasty in children: caution concerning the indications which should take into account major functional problems, caution in deciding the time of operation, which can frequently be delayed, caution in the technique which should be ultraconservative with preservation of the mucoperichondrium, reposition of the displaced fragments and reinclusion in the case of resection, caution in the desired goal of the operation as it is better to obtain a partial result with the possibility of subsequent revision rather than risk serious problems of growth. Rhinoplasty in young children is always difficult and should therefore remain an exceptional procedure.

Adolescent↗
PubMed1989

[Conservative rhinoplasty of the nasal canopy].

A rhinoplasty technique is proposed to maintain the integrity of the nasal ridge and to retain the natural appearance of the nose. It is derived from Maurel's technique (1940). After global mobilisation of the bony canopy, the resection of a band of nasal septum immediately under the keystone allows displacement of the nose deeper within the face. The advantages of this method, apart from its simplicity, are: preservation of the entire bony ridge, controlled reduction of the profile, relative autonomy of the nasal tip. The indications for this rhinoplasty are essentially confined to straight noses with moderate and harmonious osteocartilaginous kyphosis.

Female↗
PubMed1989

[Rhinoplasty in the elderly].

Though psychological and anatomical conditions are less suitable, cosmetic rhinoplasty in the elderly patient is possible when indicated in selected patients. Their motivations should be looked for. The ones that have been delayed for other reasons are most convenient. The nasal deformities have nothing in particular. Decreased skin elasticity due to ageing is the point to be considered. When this change is moderate, usual surgical technics can be used for mild corrections. Otherwise, cutaneous resections should be limited to the root of the nose in order to carry out an elevation of the skin and a nasal lift. When it's conducted with care, rhinoplasty in the elderly patient deserves its rank in palliative treatment of ageing.

Aged↗
PubMed1989

[The dorsum of the nose as a problem in secondary rhinoplasties].

The dorsum of the nose plays an important role in rhinoplasty. The specific texture of the skin, the cartilageneous structures, and the bony frame have to be regarded in operative procedures. According to the literature up to 15 percent revisions become necessary after rhinoplasty, mostly due to failures during the first operation. Therefore exact analysis and accurate planning as well as careful operation techniques are essentials to obtain good results.

Adult↗
PubMed1989

[Failure and complications of esthetic rhinoplasty. Apropos of 30 reoperations].

Out of 150 rhinoplasties carried out over 3 years in a Surgical Department. 20% of cases had previously undergone one or several surgical procedures. Based on these cases, the authors analysed the principal factors producing failure in cosmetic rhinoplasties and proposed a preventive strategy. The osteocartilaginous dorsum and point of the nose are considered separately in this paper.

Cartilage↗
PubMed1988

Open rhinoplasty.

Open rhinoplasty provides visualization, which for many is essential for the best sculpturing. The indications for its use include every primary and secondary rhinoplasty candidate unless tip grafts are going to be under tension or if the deformity is minor. The technique of opening the nose has been described. Emphasis is placed on (1) suturing the medial crura together, (2) suturing the medial crura to the septum, (3) resecting a portion of the lateral crus, and (4) leaving as much cartilage in the supratip and cephalic parts of the lateral crus as possible. The result is (1) greater tip projection with fewer tip grafts, (2) improved correction of tip convexity, (3) fewer supratip deformities, and (4) fewer Weir excisions. The columella scar is usually inconspicuous and has not been a significant problem in any case.

Adolescent↗
PubMed1987

The anatomy of external rhinoplasty.

The results achieved in rhinoplasty are directly related to the surgeon's ability to elucidate how subtle changes in the bony and cartilaginous supports of the nose will alter its appearance. Therefore, any surgeon who performs rhinoplastic procedures requires a sophisticated knowledge and understanding of the anatomy of the nose. This article reviews the anatomy of the nose from the perspective of the external rhinoplasty approach.

Humans↗
PubMed1988

Precision rhinoplasty. Part I: The role of life-size photographs and soft-tissue cephalometric analysis.

I describe a simple technique of full-scale life-size photography using marker/stickers and a ruler at the side of the face as an index for magnification. I also report a technique of soft-tissue cephalometric analysis that consists of some new proportion and some old angles and measurements. This technique will enable the plastic surgeon, even if not artistically inclined, to draw an aesthetically pleasing and very proportionate profile outline of the nose and measure the proportions of the front view on the majority of patients. The difference between the patient's nasal outline and the planned nasal definition is then measured and expressed in quarters of millimeters to give the surgeon a very precise numeric guide for surgery. This will help the plastic surgeon define the aesthetic goals very accurately and also might be helpful in detecting other facial disharmonies that might be influential in the outcome of the rhinoplasty. Using this technique of analysis, along with the prediction guidelines extrapolated from my study on soft-tissue response to surgical alteration, one can develop a fairly predictable approach to rhinoplasty.

Cephalometry↗
PubMed1987

Rhinoplasty: a CT-scan analysis.

In order to assess the postoperative consequences of various rhinoplasty techniques, CT scans were done in 35 patients having a rhinoplasty operation. This series can be subdivided into those having preoperative and postoperative scans at both 2 days and 6 months (15 patients), a postoperative scan only at 48 hours (10), or a long-term postoperative scan at a mean of 12 months (10). Preoperative analysis indicates that a wide variation exists in lateral nasal wall anatomy and angulation. Surgically, the lateral nasal walls undergo limited medial movement, with tilt a significant component. Postoperatively, extensive remodeling can occur, and virtually all osteotomies are healed by osseous union at 6 months. Future application of CT scans in severely deviated noses may be justified.

Adult↗
PubMed1987

Interactive computer graphics: a new technology to improve judgment in rhinoplasty.

A teaching system has been developed that employs interactive computer graphics to simulate the surgical experience of rhinoplasty, allowing the surgeon to experiment within a model of nasal behavior. The ability to experiment without risk and to safely learn the laws governing nasal behavior should augment the development of surgical judgment in rhinoplasty.

Computer Graphics↗
PubMed1987

The expert teaching system: a new method for learning rhinoplasty using interactive computer graphics.

We have developed software that employs interactive computer graphics to simulate the surgical experience of rhinoplasty by allowing the surgeon to experiment within a model of nasal behavior. For any of three preoperative noses, the surgeon can choose and see the effects of dorsal resection, modification of nasal spine or caudal septum, alar cartilage resection, osteotomy, alar wedge resection, and a variety of nasal grafts. The available choices and views total nearly 3000 images, or approximately 200 different surgical solutions. The surgeon can get textual analysis at any time or see accelerated healing to the projected nasal appearance at 1 year. We believe that the ability to experiment without risk, to safely learn the biological laws governing nasal behavior, should augment the development of surgical judgement in rhinoplasty.

Computer Graphics↗
PubMed1985

External (combination) rhinoplasty approach for trans-sphenoidal adenectomy.

The external (combination) rhinoplasty approach and the sublabial approach to trans-sphenoidal adenomectomy have been used at this institution for seven years. A summary of experience with the external (combination) rhinoplasty technique in 10 patients is reported; and a comparison is made between this approach and the sublabial approach in 12 patients. Advantages unique to this approach are: the distance to the sphenoid sinus is decreased allowing greater ease of instrumentation, the Hardy speculum may be opened widely to increase exposure, uniquely this allows synchronous cosmetic or reconstructive septorhinoplasty, and this technique is also invaluable for revision surgery--especially when septal cartilage has been removed by a previous sublabial approach. Disadvantages of this technique are the external incision across the columella, which leaves an imperceptible scar of no clinical significance, and postoperative nasal tip edema, which resolves with time.

Adenoma↗
PubMed1979

Concomitant treatment of developmental jaw deformities with rhinoplasty.

The purpose of this paper is to emphasize the importance of a complete assessment of facial profile and dentition in selected patients who seek rhinoplasty or correction of developmental jaw anomalies. To offer these individuals the optimum result, it is mandatory to have close liaison with an orthodontic colleague. At times it may be necessary for the surgeon to urge orthodontic care even though this was not contemplated by the patient. The orthodontist will prepare occlusion and study models of the teeth. X-ray examination includes a Panorex projection and cephalometric radiography. The surgeon should be familiar with the rudiments of skeletal analysis, as it facilitates joint discussion of the proposed treatment. Soft tissue profile, photographs, and clinical examination complete the assessment. A wafer splint is an important adjunct for accurate placement of the occlusion at the time of surgery. Three patients are presented to illustrate the advantage of combined treatment planning. The end result in each has been enhanced. In maxillary protrusion, simultaneous osteotomy and rhinoplasty have halved the surgical procedures required.

Adolescent↗
PubMed1982

[Results of rhinoplasties. A computer study of 351 medical records].

The authors studied the cosmetic results of 1380 rhinoplasties carried out over a period of 10 years by two surgeons, Professor A. Pech and Professor M. Cannoni. They used a classical reduction rhinoplasty technique. Different procedures were used for the tip of the nose depending on the individual indications, and the development of ideas over a period of time. Only 351 files, complete with pre- and post-operative photographs have been selected. The photographs have been analyzed on the basis of 70 criteria by an independent, young female ENT specialist, and the results of her analysis were fed to the computer. The study provides three types of answer. Firstly, the results were good in 69% of cases, and the greater the experience of the surgeon, the greater the success. Secondly, the different techniques for correcting the tip of the nose are analysed with good scores for Cinelli's technique (69%). The tip modeling procedures of Converse and of Lipsett have been abandoned owing to the high frequency of round tips. Finally, the different types of anomalies encountered are listed: 42% round tips, 20% asymmetrical tips, 17% residual humps, 11% of wide nasal bones, hooked noses and postoperative deviations. The authors then comment on the results, focusing on following points: the frequency of incomplete files (70%); the general improvement in the results with the gaining of experience, the decline in the proportion of hooked noses, also in line with experience, from 24% in the first 5 years to 7% after 10 years; the development of ideas concerning the techniques to be used in correcting the tip of the nose with an evergrowing place for those sacrificing the dome of the alar cartilages, such as the "Hockey stick" and a personal procedure derived from Pollot; wide nasal bones and failures in the tracing of the naso-frontal angle (64%) for which no solution is suggested; and, finally, postoperative nasal deviations. Since undertaking this study, the authors have successfully avoided this defect by using the external approach.

Computers↗
PubMed1983

[Frequent mistakes in corrective rhinoplasty].

The choice of special techniques and a certain flexibility of the surgeon in performing his personal methods, and also the preoperative and intraoperative evaluation of specific characteristics of the nasal structures, are important factors in the prevention of mistakes and complications in rhinoplasty. Typical mistakes in septoplasty and the surgical treatment of the turbinates and the dermal and soft tissue structures are discussed. Septal subluxation, deviations of the nasal tip or postoperative scar formation often result in difficult postoperative corrective problems. Lack of care in the removal of bony or cartilaginous humps can lead to very bad nasal deformations. Precise control of all structures at the end of the operation and eventual final correction or "finishing" will often help to avoid secondary septo-rhinoplasties.

Cartilage↗
PubMed1982

A history of rhinoplasty.

The history of rhinoplasty, from the writings of Sushruta in 500 BC to the present, is discussed. The interest shown in plastic surgery was sporadic for several thousand years and punctuated by peaks of interest stimulated by the attainments of the Brancas and Tagliacozzi. A stagnant period of 200 years ended with the revival of the art as a result of a letter published in the Gentleman's Magazine of London in 1794. The influence that this description of a forehead flap reconstruction of the nose had on Joseph Carpue and European surgeons, and the effects it had in modern times, are noted. The introduction of cosmetic surgery by Roe, Weir and Jacques Joseph, and the enormous influence of the latter on modern concepts are outlined. The psychosocial aspects of rhinoplasty as it affects the patient and surgeon are discussed, and the challenges facing the discipline evaluated.

Egypt↗
PubMedDate not supplied

[The conception of rhinoplasty on the basis of different skin types (author's transl)].

During X Rays carried out after fractures of the nose or rhinoplasty, it has been noted that there is often absence of superimposition between bony displacement and the esthetic state of the nose. The author studies the course of this difference and draws the conclusion that it is related to an important parameter: skin type. Thus, during rhinoplasty osteo-cartilaginous resection should be adapted to different skin types, rather than the contrary.

Esthetics↗