A cartilaginous columellar strut in cleft lip rhinoplasties.
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Psychological effects of rhinoplastic operations were evaluated in male and female patients who had sought surgical correction because of psychological distress caused by the appearance of the nose or because of a medical referral to correct functional disorders. Seventy-two patients selected by gender and operation motivation were asked to fill out the MPI and the IPAT Anxiety scale 2-3 months before and 8 months after the operation. Results at follow-up highlighted a significant decrease of the mean Neuroticism and Anxiety scores and an increase in Extroversion scores in the group as a whole. The psychological benefits gained by the female patients were greater than those of the males. Patients whose motivation was exclusively aesthetic were, overall, more psychologically distressed than those with a functional motivation.
In reality, the process of surgery is initiated at the moment patient and surgeon first meet. Patients arrive as candidates for surgery for a wide variety of reasons; motivational factors must be searched out and thoroughly evaluated by the surgeon. No completely accurate checklist exists to compute the psychologic makeup of individuals who seek facial plastic surgery. Before surgery is contemplated, significant education of patients is essential. This article examines the evaluative and analytical process of preoperative preparation for elective surgery.
Recognition and correction of septal abnormalities in rhinoplastic surgery has been a constant evolution aided by the development of an in depth anatomic understanding of the nose and the refinement of techniques based on the pertinent anatomy. Whether the deformity presents a functional, aesthetic, or combined problem, the authors prefer a single stage technique that separates the structural components of the nose, isolating the deformities present, and then reconstructing the components to effect a desirable result in terms of airway and appearance. Although no two nasal surgeries are identical, there are characteristic deformities that are noted to be generally more problematic. We briefly review normal septal anatomy as it pertains to the septorhinoplasty operation and then discuss our approach to specific septal variations that we have found to have a significant impact with regard to achieving satisfactory functional and aesthetic results.
Correction of the unilateral cleft lip nasal deformity can be a formidable surgical challenge. Multiple techniques have been developed over the last 75 years addressing the deformity. This article is a review of those surgical techniques. The most successful techniques and the reasons behind their effectiveness are described and analyzed.
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22 septorhinoplasties were performed in conjunction with orthognathic surgery, and followed for at least 12 months. No significant difference could be established between 15 cases done with a LeFort I and 7 cases done with isolated sagittal split osteotomies. Rigid bicortical fixation of the mandible was required to change the endotracheal tube from nose to mouth. Plating of the maxilla is recommended to achieve a stable bony support for the nose. Patient satisfaction and perception were surveyed. Clinical results are presented with pre- and post-operative photographs, along with mean data for the total group.
Deepening of the nasofrontal groove is considered a fiddly task. The unwonted chisel ostectomy technique (Skoog, 1974; McCarthy, 1990; Aiach and Levignac, 1991) was therefore modified and evaluated both experimentally and clinically. The hump is removed in one piece together with the nasal bones up to the horizontal part of the frontonasal suture. To accomplish this, the reduction osteotomy has to be performed in a wave line fashion. The depth of resection in the sellion area depends upon the aesthetic planning. In cases with most severe hypertrophy, the osteotome enters the vertical frontonasal suture behind the nasal bones and in front of the nasal spine of the frontal bone. The nasal bones are disarticulated with a levering movement. Cadaver studies demonstrate the safety of the technique: no fracture lines were detected in the frontal process of the maxilla, ethmoid, frontal or lacrimal bones, by either clinical inspection, or by standardised radiological examination. The clinical cases show a convincing outcome.
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