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PubMed1958

Rhinoplasty.

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Humans↗
PubMedDate not supplied

Endoscopic-assisted correction of the deviated nose.

The approach to nasal bone classic corrective rhinoplasty is an almost-blind technique, where the results depends on feeling by the surgeon's hand. To overcome these drawbacks, endoscopic-assisted corrective rhinoplasty and septoplasty were performed for 16 cases of deviated noses between January 1995 and May 1997. The average follow-up period was 18 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection, and septal deviation. The postoperative courses were satisfactory in most cases, with few complications. Compared with 28 cases of classic rhinoplasty, the patient satisfaction rate was high (87.5% in endoscopic-assisted rhinoplasty, 71.4% in classic rhinoplasty), and the complication and revision rate was low (0% in endoscopic-assisted rhinoplasty, 14.3 and 7.1% in classic rhinoplasty). But extra time (about 40 min) and greater expense were required for endoscopic-assisted rhinoplasty. It appeared to us that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum, the cause of the deformity, and the immediate effect of the corrective measures used. The use of an endoscope in corrective rhinoplasty for deviated noses provides an expanded field of vision, direct manipulation of lesions, and better aesthetic and functional results.

Adolescent↗
PubMed2003

The interdomal fat pad of the nose: a new anatomical structure.

The nose is one of the most operated organs in the body and its anatomy has been well defined by plastic and ENT surgeons. Although rhinoplasty is the most commonly performed operation in plastic surgery, some unexpected results and complications may be related to unknown or unclarified anatomical structures in the nose. We aimed to evaluate the interdomal region in four fresh cadavers and 24 patients who underwent open rhinoplasty, since the nasal tip area is the most difficult part of the rhinoplasty. Detailed cartilage and soft tissue interactions were studied in fresh cadavers. The existence of the interdomal fat pad as a separate anatomical structure was proven in necropsy specimens from cadavers using various histochemical dyes. Nasal tip ultrasonography was performed preoperatively in patients who underwent rhinoplasty. All patients had a fat pad in the interdomal space, of varying sizes, but fatty (bulbous) noses had larger fat pads. Interdomal fat pad tissue, which occupies the interdomal space, was demonstrated by ultrasonography. The size of the fat pads varied from 1.2 mm x 2.4 mm to 3.6 mm x 5.2 mm. Anatomical observation and biopsies were performed during surgery. Finally, surgical and radiological anatomy of the interdomal fat pad was demonstrated in all cadavers and patients. We speculate that the interdomal fat pad is an important anatomical structure and may contribute to unexpected postoperative results in rhinoplasty. This newly defined fat pad can be assessed by ultrasonography, a safe and inexpensive technique. The surgical approach to the interdomal fat pad is solely through open rhinoplasty technique. Thus, a consideration of the interdomal fat pad and detection of its size preoperatively may play a key role in choice of technique and success of rhinoplasty.

Adipose Tissue↗
PubMedDate not supplied

Nasal augmentation using Gore-Tex. A 10-year experience.

OBJECTIVE: To determine on an ongoing basis the safety and efficacy of expanded polytetrafluoroethylene (Gore-Tex soft tissue patch and preformed nasal implants) as an implant in rhinoplasty. DESIGN: A retrospective study of 309 consecutive patients who underwent rhinoplasty, including augmentation with Gore-Tex, during a 10-year period. SETTING: Two major academic medical centers and 2 private office surgical centers. INTERVENTION: One hundred sixty-two patients (52%) presented for primary rhinoplasty; the remaining 147 (48%) presented for revision surgery. All received Gore-Tex implants to augment the nasal dorsum and/or base. The grafts ranged from 1 to 10 mm in thickness. Follow-up ranged from 5 months to 10 years, 5 months, with an average of 40.4 months. MAIN OUTCOME MEASURES: Clinically noted complications and patient satisfaction. RESULTS: Ten (3.2%) of 309 grafts became infected and were removed. One graft was removed and 1 graft was modified and replaced postoperatively because of excessive augmentation. Infection requiring removal occurred in 8 patients (5.4%) undergoing revision rhinoplasty and in 2 patients (1.2%) undergoing primary rhinoplasty. Nasal septal perforation was present preoperatively in 3 of the patients who developed infection requiring removal, and we consider it a contraindication for nasal Gore-Tex implantation. CONCLUSIONS: Gore-Tex remains an effective implant material for nasal augmentation in rhinoplasty. The complication rate in primary cases is low. The risk of infection necessitating removal rises significantly in revision cases, where its use may still be desirable but must be weighed more carefully.

Female↗
PubMed2002

The "iatrogenic-hanging columella": preserving columellar contour after tip retroprojection.

This article discusses a method for treating the ultraprojecting tip by the resection of columellar skin in open rhinoplasty. Lack of postoperative contraction of columellar skin and soft tissue may result in an "iatrogenic-hanging columella." Columellar skin resection frequently produces its own deformities because of a discrepancy in the width of the columellar base side and the infralobular flap side. The ultraprojecting tip was present in 56 of 660 consecutive rhinoplasty patients (8 percent) over 8 years (1991 to 1998). Of these 56 patients, 48 underwent partial resection of the infralobular skin flap. Of these 48 patients, eight (17 percent) required secondary skin revision of the columellar resection area. The technique was then modified since 1998. Over 2 years, 13 of 129 consecutive rhinoplasty patients (10 percent) were judged to have an ultraprojecting tip. Of these, eight patients were treated with a modification in the technique by resecting skin on the posterior columellar base. No resection areas were revised in the second series. Of the 789 patients in both series, 647 (82 percent) underwent primary rhinoplasties, 126 (16 percent) had secondary rhinoplasties, and 16 (2 percent) had tertiary rhinoplasties. The treatment of excess columella skin adds a subtle aesthetic improvement to the postoperative nasal contour. By resecting skin on the posterior columellar base or the posterior columellar base and, rarely, the anterior flap, an iatrogenic-hanging columella can be avoided.

Adult↗
PubMed1975

Evaluation of nasal tip surgery.

Nasal tip surgery has been evaluated with respect to correction of the lower lateral cartilages. Indications, techniques, results, and complications related to three generic approaches to the lower lateral cartilages are described. In 673 consecutive rhinoplasties the commonest type of nasal tip surgery was excisional, utilizing either a marginal or cartilage splitting technique. These techniques were utilized: 1. to accomplish debulking, and 2. to accomplish the installation of facets. The excisional technique found its greatest utility in primary rhinoplasties. The version technique, utilizing a change of direction of the thrust of the lower lateral cartilages was utilized in a variety of situations, particularly for the correction of moderately congenitally hypoplastic tip cartilages. It also found great utility in surgery of the Negro or cleft palate nose, increasing tip projection, correcting unacceptable bifidity, and in revision rhinoplasty. Augmentation rhinoplasty, utilizing conchal cartilage as an elastic strut was particularly useful for severe hypoplastic cartilage deficits, the Negro nose, columellar retraction, and alar rim deficits. The overall complication rate of lower lateral rhinoplasty was 17.4 percent. The rate of unacceptable complications related to lower lateral rhinoplasty was 2.7 percent.

Evaluation Studies as Topic↗
PubMedDate not supplied

The contoured auricular projection graft for nasal tip projection.

In all rhinoplasty surgery, the universal need exists to increase, decrease, or preserve existing tip projection. When proper tip projection is lacking, a variety of techniques are useful for improving projection. We describe a valuable technique for tip projection, particularly useful and indicated in the Asian rhinoplasty, African American rhinoplasty, and in certain revision rhinoplasties. In the past 15 years, the senior author (M.E.T.) has used the contoured auricular projection graft in selected patients for achieving satisfactory tip projection in patients with blunted tips. The aesthetic outcomes have been predictable, pleasing, and reliable for the long term. Precision pocket preparation for auricular conchal cartilage graft placement is key to symmetry and projection of the final outcome. The results yielded a rounded nasal tip that may be more natural-appearing in Asians, African Americans, and selected patients with revision rhinoplasty. The contoured auricular projection graft provides a highly useful graft for the nasal tip.

Asian People↗