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PubMed1998

The role of outfracture in correcting post-rhinoplasty nasal obstruction.

Post-rhinoplasty nasal osbtruction is often related to narrowing in the region of the nasal valve. Correction of this obstruction can include inferior turbinectomy, septoplasty spreader grafts and nasal valvuloplasty. The authors have seen cases of severe valve stenosis related to infracture after osteotomy which did not respond to any of the aforementioned procedures. These patients were treated with revision osteotomy with outfracture. We discuss patient selection and surgical technique for revision osteotomy with outfracture as well as a cadaver dissection demonstrating the effects of infracture and outfracture on valve area. The clinical results, based on patient satisfaction and pre- and postoperative photographs, are presented. Revision osteotomy with outfracture should be included in the surgeon's armamentarium for the treatment of post-rhinoplasty nasal obstruction.

Adult↗
PubMed1998

[Open rhinoplasty. 5-years experience].

The principle advantages of open rhinoplasty concern diagnosis as well as technical facilities. The transcolumelar approach, initially described by Rheti in 1934 for surgical corrections of the cleft lip nose, was adopted by us since 1992 in 48 patients. We have systematically made a "staggered incision" at the collumella's narrowest point, that allows a great view of nasal structures. The results were considered good, even in difficult rhinoplasties. The scars were inconspicous, without cicatricial hypertrophies or deformities.

Esthetics↗
PubMed1998

Gore-tex augmentation grafting in rhinoplasty--is it safe?

OBJECTIVE: The utility of the Gore-tex soft-tissue patch in vascular and hernia surgery over the last 20 years led to its application in facial augmentation and rhinoplasty over the last decade. The early success of initial reported series must be balanced against the long-term problems that have faced all implant materials used in the nose in the past. Gore-tex is attractive to the facial plastic surgeon because of its ease in handling and sculpting, and its plentiful supply. This review analyzes the results of Gore-tex augmentation grafting. METHODS AND RESULTS: In a personal series of 30 rhinoplasty cases with minimum 18 month follow-up, there were three cases of infection, two of which required Gore-tex removal, and one seroma requiring Gore-tax removal. In two other patients, the Gore-tex was associated with excessive scar tissue. CONCLUSION: Our results led to the development of guidelines for Gore-tex usage in the nose. Since adopting these guidelines, the authors have not yet experienced any complications with Gore-tex.

Adolescent↗
PubMed1999

Rethinking the logic and techniques of primary tip rhinoplasty: A perspective of the evolution of surgery of the nasal Tip

Historically, destructive tip-shaping and positioning techniques, although effective to some degree, have created large numbers of secondary deformities. Tip grafts, necessary in secondary rhinoplasty, have been applied widely in primary rhinoplasty. Their use has introduced variables and has led to a significant reoperation rate. Nondestructive tip-shaping and positioning techniques offer the surgeon a wider range of alternatives, more control and predictability, and a reduced reoperation rate.

Journal Article↗
PubMed1999

Rhinoplasty with advancing age: characteristics and management

Rhinoplasty in the aging nose is a distinctly different entity whose unique characteristics must be appreciated by the rhinoplasty surgeon to optimize the functional and aesthetic results. Although the aesthetic and functional goals are similar to those in younger patients, the operative techniques necessary to achieve these goals in older patients differ. This article reviews the changes that occur in progressive aging of the nose and discusses the unique aspects in the management of the aging nose.

Journal Article↗
PubMed1990

Irradiated homologous costal cartilage for augmentation rhinoplasty.

Although the ideal reconstructive material for augmentation rhinoplasty continues to challenge plastic surgeons, there exists no report in the literature that confines the use of irradiated homologous costal cartilage, first reported by Dingman and Grabb in 1961, to dorsal nasal augmentation. The purpose of this paper is to present a retrospective analysis of the author's experience using irradiated homologous costal cartilage in augmentation rhinoplasty. Twenty-seven dorsal nasal augmentations were performed in 24 patients between 16 and 49 years of age with a follow-up ranging from 1 to 27 months. Good-to-excellent results were achieved in 83.3% (20 of 24). Poor results requiring revision were found in 16.7% (4 of 24). Complication rates included 7.4% infection (2 of 27) and 14.8% warping (4 of 27). The resorption rate was zero. These results compare favorably with other forms of nasal augmentation. Advantages and disadvantages of irradiated homologous costal cartilage are discussed.

Adolescent↗
PubMed1999

Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty.

To examine the effects of single-dose dexamethasone use on edema, ecchymosis, and intraoperative bleeding in rhinoplasty, a double-blind, randomized trial with placebo control was planned. A total of 55 consecutive patients were included in the study. The dexamethasone (10 mg) was given intravenously just before surgery (preoperative group, n=18) or at the end of surgery (postoperative group, n=20). In the placebo group, 17 patients received saline preoperatively or postoperatively. Intraoperative blood loss was recorded for each patient. Postoperative scoring of eyelid swelling and ecchymosis was begun after approximately 24 hours and lasted into postoperative day 9. Only for the first 2 days was the difference between steroid groups (preoperative and postoperative) and the placebo group statistically significant for a decrease in eyelid edema (p < 0.05). A statistically significant difference in upper eyelid ecchymosis for both preoperative and postoperative steroid groups versus the placebo group also existed in the first 2 days (p < 0.05). Preoperative or postoperative steroid administration had no influence on the ecchymosis of the lower eyelid. When the results of the preoperative and postoperative steroid groups were compared, no significant difference was detected between the two groups in either edema or ecchymosis. To determine whether steroid use shortened the recovery period, the days on which edema and ecchymosis reached a minimum level were compared among the groups; no statistically significant difference was found among them. Using single-dose dexamethasone preoperatively did not alter intraoperative blood loss. Use of single-dose dexamethasone (either preoperatively or postoperatively) in rhinoplasty has a significant effect in decreasing upper and lower eyelid edema and upper eyelid ecchymosis for the first 2 days when compared with a placebo group. However, the effect of dexamethasone was lost after the first 2 days, and its use did not shorten the recovery period.

Adult↗
PubMedDate not supplied

Mucous cyst formation after rhinoplasty.

The development of a deforming nasal-dorsal mass after rhinoplasty is a very rare and, for the most part, an avoidable complication. The list of differential diagnoses for such a postoperative external nasal lesion ranges from simple soft tissue edema or hematoma, which is usually temporary, to more serious lesions, such as lipogranulomas, epidermoid inclusion cysts, tumefactive cartilage proliferation, and mucous cysts, which can cause permanent deformities. Although various nasal tumors, infections, and granulomatous diseases are not specifically related to surgery, they should also be considered.

Adult↗
PubMedDate not supplied

Dacron implants in rhinoplasty: a review of 136 cases of tip and dorsum implants.

The achievement of successful results in rhinoplasty may require the use of autografts, homografts, or alloplastic materials. Among the alloplasts, Dacron is an easily handled and manipulated synthetic material, readily applicable to nasal augmentation. The following represents the indications, surgical technique, outcome results, and analysis of our experience with Dacron mesh implants to the nasal tip, dorsum, and lateral walls in 136 patients.

Adult↗
PubMedDate not supplied

The use of Heanley bone-cutting forceps to reduce the thickened and broad bony dorsum in rhinoplasty.

Heanley bone-cutting forceps can be used in a modified rhinoplasty technique for patients with nasal bones that are broad and thickened by callus as a result of several previous nasal fractures. In these patients, the conventional technique of dehumping followed by medial and lateral osteotomies may leave a roof of thickened nasal bones due to callus formation that prevents the pyramid from being narrowed. In this situation, Heanley forceps may be used instead of medial osteotomies to resect paramedian segments of the remaining thickness of the nasal bones so that the nasal bones can be medialized. If no dehumping is required and the bones are just splayed and thickened by callus, Heanley forceps can be used before infracturing and lateral osteotomies. Several points are important for the success of this technique, including introducing the beaks of the forceps submucosally in the correct plane on each side of the nasal bones, advancing the tips of the forceps as far as the nasion, and mobilizing the bony segments before performing lateral osteotomies.

Bony Callus↗
PubMedDate not supplied

The use of percutaneous sutures for graft fixation in rhinoplasty.

We reviewed our 10-year experience using percutaneous suturing to secure cartilage grafts in rhinoplasty. A total of 382 patients having up to 4 percutaneous sutures per surgery were analyzed. Cases using this suture technique included lower lateral onlay grafts, dorsal onlay grafts, tip grafts, and intact conchal cartilage grafts to repair nasal valve collapse. Sutures are ideally placed in a horizontal mattress fashion beginning at the skin surface, continuing into the nasal cavity, and then out through the skin. Sutures are strategically placed to secure the graft and at times stent open the nasal valve. The suture is tied loosely over the skin taking in to consideration the anticipated edema formation. There is no need to use a bolster technique. Sutures are removed at the second postoperative visit. Long-term follow-up reveals precise graft placement. There are in most instances no visible suture marks and our results achieve over 95% patient satisfaction. Percutaneous suture placement is a simple technique that allows precise graft placement and fixation without resultant scarring. It coapts the skin and soft tissues to the grafted nasal skeleton and prevents fluid accumulation, hematoma formation, and graft migration. We believe that it aids in decrease long-term tissue edema and excessive fibrosis, therefore promoting quicker healing. Our patients are both functionally and cosmetically pleased.

Cartilage↗
PubMedDate not supplied

The use of "inside-out" lateral osteotomies to improve outcome in rhinoplasty.

OBJECTIVE: To evaluate the anatomic effects of the transnasal nasal "inside-out" lateral osteotomy in comparison to a continuous lateral osteotomy to widen the excessively narrow bony nasal pyramid. DESIGN: A series of 4 fresh cadavers were used. Lateral osteotomies were performed on each cadaver. On one side, a continuous lateral osteotomy was performed with a curved, guarded 4-mm osteotome. On the contralateral side, a straight 2-mm osteotome was used to perform the transnasal perforating inside-out lateral osteotomy. The soft tissue was then dissected off the nasal dorsum and the effects were noted. Specifically, the following factors were assessed: (1) the continuity of the internal and external periosteum; (2) any change, without manipulation, of the position of the lateral nasal walls; (3) the mobility of the fragments; and (4) the effect of any of the preceding factors on the nasal airway. RESULTS: All 4 cadavers showed identical results. The external and internal periostea were significantly disrupted on each of the sides with continuous osteotomies. The periosteum was completely preserved on the sides, which underwent inside-out lateral osteotomies, with the exception of the 3 or 4 holes created by the 2-mm osteotome. In each of the sides with continuous osteotomies, the lateral nasal wall was demonstrably unstable, as the segment was, to varying degrees, displaced inwardly. The inside-out lateral osteotomized segments were uniformly lateralized and stable to gentle palpation. Finally, these changes corresponded to a visible effect on the diameter of the nose in the region of the nasal valve. The inward displacement of the segments undergoing continuous osteotomies narrowed the airway. However, the contralateral inside-out osteotomized segments were lateralized, which widened the diameter of the valve. CONCLUSIONS: The inside-out lateral osteotomy is an effective technique for lateral repositioning of the bony lateral sidewall of the nose. It is reproducible and accurate and appears to provide greater preservation of the periosteal support of the bony segments than a continuous osteotomy. This technique provides a more predictable long-term result, with preservation and/or improvement of the nasal airway. The procedure is ideal for managing the bony nasal segment that needs lateralization, particularly in revision rhinoplasties or after trauma.

Cadaver↗
PubMedDate not supplied

Objective assessment of tip projection and the nasolabial angle in rhinoplasty.

OBJECTIVE: To provide an objective method to measure the extent of nasal tip projection and the nasolabial angle. DESIGN: We retrospectively studied preoperative and postoperative images using a novel approach. The constant position of the cornea in lateral views and the diameter of the iris in frontal views were used to standardize and compare digitalized images of patients before and after surgery. We tested this objective assessment technique using the digitized slides of patients with saddle nose deformities and measured changes in their nasal tip projection and nasolabial angle. We included 63 patients who had undergone an open rhinoplasty with the I-beam technique by the same surgeon over a 7-year period. We tested the reproducibility of these measurements with 10 independent investigators. We also determined whether the measurements using this objective technique correlated with the surgeon's or patients' subjective assessments of the outcome. RESULTS: We were able to use the objective measurement technique in 42 patients (67%). It was not possible to use the technique in 21 patients (33%) because the photographic conditions had not been fulfilled. The measurement variability of 10 different investigators expressed as standard deviations in percentage of the mean value was 6.7% for nasal tip projection and 1.3% for the nasolabial angle. The surgeon's subjective assessment of the outcome correlated with the objective changes of nasal tip projection (P = .045) and the nasolabial angle (P = .045). There was no correlation between the patients' assessments and the objective measurements. CONCLUSIONS: The objective measurements tested were easy to use and investigator independent. They also correlated with the surgeon's assessment of outcome.

Adolescent↗
PubMed1977

Curved lateral osteotomy for airway protection in rhinoplasty.

Lateral osteotomies performed posteriorly enough to avoid step-like prominences at the sides of the nose may allow medial displacement of bone to impinge on the airways. This obstruction near the floor of the nasal passageway is prevented by leaving a triangular piece of bone at the pyriform aperture intact just superior to the level of the inferior turbinate. A curved lateral osteotomy, as described here, cuts bone posteriorly only where aesthetic narrowing is required in rhinoplasty. Techniques providing the recommended curved or angulated lateral osteotomies with osteotomes are demonstrated in the cadaver and in patients.

Airway Obstruction↗
PubMed1979

Rhinoplasty record and retrieval system.

The rhinoplastic surgeon must vary technique to fit the anatomic variations of nose and face. Our system to record and correlate preoperative findings with surgical methods could help accomplish this. It includes three forms to record pertinent findings of the history and physical examination, operative findings and techniques, and postoperative evaluations. These forms are numerically coded, and data can be transferred to a punch card system or computer cards for quick and easy retrieval and statistical analysis. The system tries to simplify the many anatomic and surgical variations, yet remain complete. We hope that this system, which has been used in other disciplines, can be applied to rhinoplasty. In this way, more scientific statistical data can be used to support surgical approaches.

Adult↗
PubMed1979

Is the lacrimal apparatus injured following cosmetic rhinoplasty?

A study was undertaken to test the validity of the belief that lacrimal apparatus injury is common in patients who undergo a cosmetic rhinoplasty. Dacryocystography was done in 15 patients immediately following the lateral osteotomy, and there was no evidence of lacrimal sac injury or extravasation of the dye in any patient.

Adult↗
PubMed1985

External rhinoplasty approach to transsphenoidal hypophysectomy.

The history of transsphenoidal hypophysectomy demonstrates the soundness of the basic concept of approaching the sella turcica in a midline fashion through the nose. Conceptually, it has not been eclipsed since first evolved by Cushing in the early part of this century. The surgical advances since Cushing's time have been major refinements in instrumentation and minor refinements of his basic technique. The external rhinoplasty approach is such a refinement. We have used this technique in a two-year period between June 1982 and June 1984 on 14 patients. We have found this technique for transsphenoidal hypophysectomy to be a simple, reliable, rapid technique for exposing the septum and the floor of the nose. It provides excellent exposure to the sphenoid sinus and pituitary gland without loss of nasal tip projection or other cosmetic deformity.

Adult↗
PubMed1985

A scale for evaluating results of rhinoplasty.

A system was developed to numerically grade noses before and after rhinoplasty. Based on the use of photographs, it permits objective assessment of the amount of improvement resulting from operation. By extension, it could be used to rate surgical proficiency.

Esthetics↗