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PubMed1980

Antibiotics and nasal surgery.

Despite the widespread use of prophylactic antibiotics in nasal surgery, the subject has been paid little attention in the literature. In a retrospective analysis of 210 patients who underwent septal surgery or a rhinoplasty, only 5 developed minor infections. Patients undergoing septal surgery or rhinoplasty (174) were evaluated in a randomized sequence, prospectively, to study the efficacy of systemic antibiotic prophylaxis. Only 4 patients developed minor infections; and 173 patients demonstrated no clinical nor radiographic evidence of subsequent sinusitis. The incidence of infectious complications resulting from intranasal surgery is not sufficient to warrant the use of prophylactic antibiotics. Furthermore, proof of their effectiveness in preventing such infections is lacking.

Adolescent↗
PubMed1981

"How I do it"--plastic surgery: practical suggestions on facial plastic surgery. Surgical excision and primary reconstruction of a moderate size tumor involving the nasal tip and dorsum.

A moderate size tumor of the nasal tip and dorsum is excised and the large defect is primarily reconstructed with local flaps without obliteration of natural convexities and concavities. This is achieved by judicious utilization of numerous techniques. The techniques utilized are a V to Y advancement that produce a partial mobilization of the nasal dorsal skin, a full reduction rhinoplasty that dropped the nasal bony roof allowing for further mobilization of the nasal dorsal skin and allowed for tip elevation. A third technique that was utilized was a Z plasty as applied to correction of raised webs. The excess dorsal skin was converted into the needed length to close the tip defect. The patient tolerated this procedure well. His postoperative course was without complications. Postoperative results were good, but there was some persistent tip elevation that perhaps gave him a too youthful appearance for his age (Fig. 2). A novel use of V to Y advancement, Z plasty, and reduction rhinoplasty is described when used concurrently to primarily close a defect of the nasal tip and dorsum.

Basal Cell Carcinoma↗
PubMed1981

Avulsion of the upper lateral cartilage: etiology, diagnosis, surgical anatomy and management.

Relatively little has been published about upper lateral cartilage abnormalities, trauma, and management in rhinoplastic literature. In this paper we would like to present a relatively common problem seen either by trauma or as a result of rhinoplasty. The upper lateral cartilages are a pair of triangular cartilages, one on each side of the dorsum, which comprise the upper cartilaginous vault with the septum and can be avulsed due to direct trauma. This results in loss of their attachments and resultant healing in a new angulated position. The middle third of the nose, being relatively mobile is less susceptible to trauma than the upper third which is rigid and comprised of bone, and that frequently is the reason for less incidence of avulsion of the upper lateral cartilages compared to fractured nasal bones. The surgical treatment of the structures adjacent to the upper lateral cartilage during the process of rhinoplasty severs many attachments of these cartilages and frequently causes them to be free floating. This may not be recognized and not treated. Lack of appropriate realignment in the normal anatomical position may heal the cartilage in a distorted angulated position. Irrespective of etiology, when distortions of the upper lateral cartilage occur, they may cause significant concavity and "hollowed out" appearance on the side of the avulsion which functionally may impede the nasal airway by encroachment and/or "flutter valve" effect. During inspiration this unsupported upper lateral cartilage may interfere with anatomy, physiology and efficiency of the internal nasal valve function. Avulsion of the upper lateral cartilage is a definite entity and should be recognized and treated appropriately to realign the lateral cartilage in its normal anatomical position for a functional as well as a good cosmetic result.

Adult↗
PubMed1981

External septorhinoplasty: a tool for teaching and for improved results.

The external septorhinoplasty incision is basically a 5 mm. incision across the columella connecting a left and right alar margin incision. This allows retraction of the dorsal skin to expose the entire dorsal skeletal structure. It has great advantage to both surgeon and assistant for teaching and studying deformed nasal anatomy, and for improved rhinoplasty results because it allows binocular visual monitoring of surgery, the use of both hands, control of bleeding by electrocautery, accurate diagnosis of revisional surgery, and structures so that postoperative distortion from healing does not occur. If grafts or implants are needed they can be accurately modelled and sutured in place to prevent post-operative wobbling. The columellar scar it properly closed becomes inconspicuous in a few months, and even early in the healing process it is not noticed because the observer is viewing it at a very oblique angle. It is felt that this operation will be a very valuable addition to every doing rhinoplasties and septoplasties.

Adult↗
PubMed2003

Treatment of nasal obstruction from nasal valve collapse with alar batten grafts.

Nasal obstruction may require treatment with rhinoplasty techniques. One cause of nasal obstruction is known as nasal valve collapse. This refers to narrowness and weakness at the nasal valve, the narrowest part of the nasal airway. There are a number of surgical approaches available to treat nasal valve collapse. Selection of the appropriate surgical intervention depends on proper identification of the anatomic cause of the collapse. Alar batten grafts are especially useful for addressing nasal valve collapse caused by a weak nasal sidewall. In this report, we review the senior author's experience with the use of alar batten grafts for nasal valve collapse. Twenty-one patients had septoplasty with placement of alar batten grafts; all patients noted improvement in their nasal breathing. Seven patients underwent ear cartilage harvest with alar batten grafts, and five of them noted improvement, one noted partial improvement, one noted no improvement. Six patients underwent revision septorhinoplasty with alar batten grafting, and ten patients underwent revision septorhinoplasty with ear cartilage harvest and alar batten grafting. These patients all reported improvement in their nasal breathing postoperatively. Six patients underwent revision rhinoplasty (no septoplasty) with ear cartilage and battens. These patients hold special interest because no other intranasal procedures were performed that affected nasal breathing. All six of these patients reported significant improvement of their nasal breathing and all patients were satisfied with their postsurgical cosmetic appearance. The nasal valve area is considered to be the location of the least cross-sectional area in the nose. When narrowing of the nasal valve is a result of collapse of the nasal sidewall, alar batten grafts are a useful technique to address the patient's nasal obstruction.

Female↗
PubMedDate not supplied

Acoustic rhinometric assessment of the nasal valve.

The aims of this study are to assess nasal valve cross-sectional areas in healthy noses and in patients with nasal obstruction after rhinoplasty and to evaluate the effect of an external nasal dilator on both healthy and obstructive nasal valves. Subjects consisted of (i) volunteers with no nasal symptoms, nasal cavities unremarkable to rhinoscopy and normal nasal resistance and (ii) patients referred to our clinic complaining of postrhinoplasty nasal obstruction. All subjects were tested before and after topical decongestion of the nasal mucosa and with an external nasal dilator. In 79 untreated healthy nasal cavities the nasal valve area showed two constrictions: the proximal constriction averaged 0.78 cm2 cross-section and was situated 1.18 cm from the nostril, the distal constriction averaged 0.70 cm2 cross-section at 2.86 cm from the nostril. Mucosal decongestion increased cross-sectional area of the distal constriction significantly (p < 0.0001) but not the proximal. External dilation increased cross-sectional area of both constrictions significantly (p < 0.0001). In 26 post-rhinoplasty obstructed nasal cavities, only a single constriction was detected, averaging 0.34 cm2 cross-section at 2.55 cm from the nostril and 0.4 cm2 at 2.46 cm from the nostril, before and after mucosal decongestion respectively. External dilation increased the minimum cross-sectional area to 0.64 cm2 in these nasal cavities (p < 0.0001). We conclude that the nasal valve area in patients with postrhinoplasty nasal obstruction is significantly smaller than in healthy nasal cavities as shown by acoustic rhinometry. Acoustic rhinometry objectively determines the structural and mucovascular components of the nasal valve area and external dilation is an effective therapeutical approach in the management of nasal valve obstruction.

Acoustics↗
PubMed1999

Augmentation of the nasal spine area with tissue bone matrix sponge.

OBJECTIVE: High-density tissue bone matrix (TBM) sponge is a homograft derived from human cadaver. It is reported to be osteoinductive. The objective of this paper is to measure the bone formation and cosmetic effect of TBM sponge implanted in the nasal spine area of patients undergoing rhinoplasty with retraction of this region and loss of nasal tip support. DESIGN: The study was designed as a prospective trial. SETTING: Patients were selected from private facial cosmetic practice and from public otolaryngology practice. PATIENTS: Six patients were selected who had retraction of the nasal spine area and loss of tip support. INTERVENTION: Patients had implantation of the TBM sponge in the nasal spine area either as a sole procedure or in conjunction with other rhinoplasty maneuvers. MAIN OUTCOME MEASURES: Palpation was used to assess position, size and consistency of the implant. Cosmetic effect was assessed by computer imaging, which was used to measure nasolabial angle and tip projection. Bone formation was assessed by computed tomography scanning. RESULTS: The implant could be palpated in all six patients at 1 month postoperatively, but at 3 months was either smaller or could not be felt. Nasolabial angle and tip projection were improved in all patients initially, but 3 months following surgery this cosmetic improvement was maintained in only two patients. At 3 months, CT scanning showed no evidence of bone formation. CONCLUSION: The TBM sponge was not found to be osteoinductive or permanent when implanted in the nasal spine area and therefore is not a good implant in that region.

Bone Matrix↗
PubMed2000

The use of resorbable spacers for nasal spreader grafts.

The concept and technique of the use of resorbable synthetic material for nasal spreader grafts are presented. The material is felt to be particularly useful in revision rhinoplasty, in which the likelihood of internal valve collapse is high and the septum (the most common source of material for spreader grafts) often has already been harvested. The material used is a commercially available polymer of polylactic and polyglycolic acid, Lactosorb. It is supplied as a mesh sheet that can be cut to an appropriate size for spreader grafts. Although the material absorbs after approximately 12 months, it is believed that this is sufficient time for the upper lateral cartilages to be stabilized by fibrosis in their new position and to maintain the appropriate internal valve angle. This material was used on 10 patients with valvular collapse undergoing secondary rhinoplasty. In follow-up observations ranging from 12 to 18 months, there has been no recurrence of airway obstruction.

Adult↗
PubMed2006

Characterization of nasal paraffinoma following septorhinoplasty by attenuated total reflection--fourier transform infrared spectroscopy (ATR-FTIR).

Vaseline and paraffin have been injected into various parts of the body. Vaselinoma and paraffinoma are well-described complications, despite which nasal packing with Vaseline gauze is still common in the management of epistaxis, after rhinoplasty, endonasal surgery, to control bleeding and prevent synechiae or restenosis. Our aim is to highlight this complication, propose a safe method for its diagnosis and establish guidelines for its prevention. We report two cases of paraffinoma occurring after rhinoplasty and discuss prevention of this rare but serious complication, and suggest an alternative dressing. Attenuated total reflection (ATR) FI7R spectra have proven to be a definitive characterising tool for surgical extracts, guaranteeing detection of mineral products that histology does not offer. For these lesions we propose the name "petroleum oilomas" which we feel to be more appropriate than the more commonly used paraffinomas. Relevance of the work: a description of an innovative and safe method of diagnosis, and proposal of a procedure for postrhinoplasty packing (without mineral oils) to avoid this complication.

Adult↗
PubMed2006

[Saddle nose surgery: long term aesthetic outcomes of support grafts].

UNLABELLED: Saddle nose surgery requires support grafts to improve the aesthestic of the nose such as the functional ventilation. Many kind of graft are available: Calvarial bone graft, iliac crest, septal cartilage, conchal cartilage, nasal hump, bony inferior turbinate. OBJECTIVES: To define the surgical strategy and long term aesthetic outcomes of rhinoplasty with support graft for saddle nose correction. MATERIAL AND METHOD: Retrospective study during the period 1985-2005: 160 patients underwent rhinoplasty with support graft for saddle nose correction. Patients were divided into 3 groups depending on the deformation (group I: Minor saddle nose; group II: Intermediate saddle nose; group III: Major saddle nose). Long term results were analysed at least 5 years after surgery, in 70 patients. RESULTS: An intranasal approach was performed in 92 cases, while an open approach was performed in 68 cases. A bony support graft was used in 85% of patients of group II and 94% of patients of group III. These grafts allowed a more rigid correction of the saddle nose than cartilage. For groups II and III patients, cartilage support grafts were not used because of the lack of quantity to correct the saddle nose. CONCLUSION: Calvarial bone support graft has a great role in saddle nose surgery. The postoperative aesthetic outcomes are interesting and its absorption is low.

Bone Transplantation↗
PubMed1991

Bone scanning in the early assessment of nasal bone graft viability.

This study examined the role of radionuclide bone scanning in the early assessment of free autologous cancellous bone grafts in augmentation rhinoplasty and compared the failure rates of grafts taken from the calvaria and ilium. Twenty patients had three-phase bone scanning of the facial regions performed between 2 and 15 wk after rhinoplasty, and a comparison was made with the results of clinical assessment and X-ray findings 3 mo after surgery. Eleven patients had grafts taken from the calvaria and nine had iliac grafts. On lateral views, bone graft uptake of isotope, which was less than or equal to the adjacent soft tissue, was found in 2 out of 20 patients and this finding predicted subsequent graft failure as measured by clinical assessment and X-ray evidence of bone resorption. Both failures had grafts taken from the calvaria while none from the ilium failed. These failure rates, however, were not significantly different.

Adult↗
PubMed1988

[Preventive antibiotic administration in complicated rhinosurgical interventions--a double-blind study].

Revision rhinoplasty was performed in 100 patients. In most cases a complete rhinoplasty with septal reconstruction, osteotomies, wedge resection and free transplants had to be done. Intranasal swabs for bacterial culture were taken pre- and postoperatively. 48 patients received three mega units of propicillin transorally for 12 days, 52 patients received a placebo. White blood count, erythrocyte sedimentation rate, and temperature were taken to indicate inflammation of the nasal region. Turbid nasal secretion, reddening and swelling of the nasal linings, and bleeding of the noninjured nasal mucosa were taken as clinical signs of infection. Preoperatively staphylococcus epidermidis was cultured in 69% from the nasal cavities, staphylococcus aureus in 42%, streptococci in 24%, diphtheroids in 22% etc. (see Table 1). Serious infections developed in six patients (five of them without antibiotics), more localized infections in twelve patients (nine of them without antibiotics). Some of the infections developed after removal of the nasal packing. In five patients with serious infections either streptococcus viridans or streptococcus pneumoniae could be cultured preoperatively. In three of five cases the streptococci were propicillin-sensitive. Clinical signs and laboratory parameters were not helpful in identifying patients with infections. We conclude that patients undergoing revision rhinosurgery should be followed carefully for at least two weeks. Postoperative administration of propicillin appears to be able to prevent serious nasal infections especially if free transplants are used.

Adult↗
PubMed1988

[Rhinoseptoplasty in patients from the Maison de Nanterre. Indications, technics and results].

There are many indications of rhinoseptoplasty for patients of ENT department in the hospital of the "Maison de Nanterre". Must frequently we have to manage sequellae of nasal traumatisms (consequences of fights or falls). Aesthetic rhinoplasties are less frequent: nasal deformities from ethnic or familial origin. The operatory technic used is very classic: septoplasty as the first step, then rhinoplasty by extra mucosal way, with paramedial and lateral osteotomies allowing rebuilding of nasal osseous pyramid. Results as well on anatomic and functional point of view as on psychologic consequences are arguments to be interventionist.

Humans↗
PubMed1986

Understanding aerodynamics in the correction of the narrow nose.

Nasal obstruction can be relieved in the prominent and narrow nose by a nasal widening procedure called the "let out" based on the "en bloc" mobilization used in the "push down" rhinoplasty. Calculations using measurements made on the cadaver show that widening of the angle of the liminal valve and an increased rigidity of the upper lateral cartilage are responsible for the improved airway rather a presumed increase of the cross section of the valve. The associated increase of intranasal velocity provides an aerodynamic explanation for certain phenomenons observed after cosmetic rhinoplasties. A clinical case is presented and the principles of "en bloc" mobilization are shown by line drawings.

Airway Obstruction↗
PubMed1977

Septal plasty in children: influence on nasal growth.

The results of a septoplasty because of a nasal obstruction were studied in 261 children, their ages ranging from 4 to 14. No arrest of nasal growth after the septoplasty and osteotomies was recorded. Histological examination revealed a cartilaginous regeneration at the borders of the resected septal cartilage in 15 cases in which a second rhinoplasty was necessary because of a new nasal obstruction. Often the cartilaginous growth was undirected and excessive leading to a new septal deviation. In 80 per cent of our cases good functional long-term results were obtained by one rhinoplasty only which was performed according to the techniques of Cottle and Masing.

Adolescent↗
PubMed1993

Unhooking the hook: sculpting the nasal tip by replanting the medial crura.

A great challenge of rhinoplasty is the tip with insufficient projection or the hooked nose. Tip grafting is the standard method used to correct this. The open rhinoplasty technique provides exposure of nasal structures not afforded by the closed approach. We have used this approach to sculpt the nasal tip. Successful "unhooking of the hooked nose" by gaining tip projection has been achieved by completely replanting the medial crura. In the operation, the medial crura are freed in their entirety. The lateral alae of the lower cartilages are trimmed. The medial crura are then advanced dorsally until adequate nasal tip projection is obtained. They are secured to each other and to the septum in their new position with interrupted sutures. More tip definition can be obtained, if needed, by suturing the medial crura together near the tip. The dome can be sculpted to an appropriate width in a similar manner. This technique is advantageous because exact symmetry and positioning of the cartilages can be obtained under direct vision. It contours the tip structures to achieve more nasal tip projection, obviating the need for tip grafting. The technique is particularly useful in the patient with a low dorsum and acute nasolabial angle who will benefit from tip augmentation and elevation. The technique simultaneously thins the tip, adds nasal tip projection of 4 to 6 mm, and corrects the nasolabial angle. We have used this technique with good results in 15 patients. The technique and results were illustrated.

Adult↗
PubMed1996

[The evolution of the techniques used to correct nasal septum function].

At the dawn of rhinosurgery, the otolaryngologist operated on the nasal septum while a plastic surgeon handled treatment of the "noble" portion of the nose, i.e. the nasal pyramid. However, the plastic surgeon dealt more with esthetics than with function. Discussion and doubts revolved around the priorities of septum vs. pyramid treatment. Such doubts have often gone unresolved and has led to an unusual dichotomy in nasal surgery: the break down into septoplasty and rhinoplasty. This scission has fallen by the wayside during the course of the years. Indeed, today, where necessary, one tends associate corrective rhinoplasty during the course of septal procedures. During this historical review of functional surgery of the nasal septum, some mention is made of the numerous techniques and variations thereof which have been presented by various authors.

Humans↗
PubMedDate not supplied

Informed consent in facial plastic surgery: effectiveness of a simple educational intervention.

OBJECTIVE: To evaluate the effectiveness of oral communication about the risks of facial cosmetic procedures compared with oral and written communication. DESIGN: A prospective randomized study conducted in an ambulatory surgery center. One hundred twenty consecutive patients were included; they presented for consultation for rhinoplasty, rhytidectomy, or laser resurfacing. Patients were randomly assigned to 1 of 2 groups: (1) those receiving oral discussion of the risks of the procedure and (2) those receiving oral and written communication about the risks. Two weeks after the initial consultation, patients were surveyed for recall of the risks. RESULTS: The group that received a pamphlet had a better risk recall than the group that did not (2.5 vs1.5 of 5 risks; P<.001). The recall rate in the following groups that received a pamphlet was also better: (1) university-educated patients (P =.02), (2) patients who underwent rhinoplasty (P<.001), (3) patients who underwent laser resurfacing (P =.02), and (4) female patients (P<.001). CONCLUSIONS: Written disclosure of the risks of cosmetic procedures enables patients to retain and understand more clearly those potential risks. They are, therefore, able to give an informed consent to the proposed procedure. This study also identifies patient groups who may require more intensive presurgical teaching. The medicolegal implications are apparent.

Adolescent↗