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PubMedDate not supplied

Nasal valve reconstruction: experience in 53 consecutive patients.

OBJECTIVES: To determine the cause of nasal valve obstruction in a series of patients requiring surgical correction, to evaluate the efficacy of our surgical techniques, and to assess the cosmetic effect of nasal valve repair. METHODS: Retrospective review of 53 consecutive cases involving adult patients who underwent nasal valve reconstruction over an 8-year period. The preoperative symptom severity, cause of nasal valve obstruction, preoperative photographs, anatomical findings at the time of surgery, and reconstructive techniques were reviewed. Postoperative photographs and resolution of symptoms were analyzed. RESULTS: The most common cause of nasal valve obstruction was previous rhinoplasty (79%), followed by nasal trauma (15%) and congenital anomaly (6%). Spreader grafts were used in 42 patients (79%), and alar batten grafts were used in 19 patients (36%). The patients received a minimum of 1 year of follow-up. All 12 patients with external valve dysfunction showed improvement after surgery. Thirteen (93%) of the 14 patients with concomitant external and internal valve dysfunction had improvement in nasal obstruction after treatment. Twenty-four (89%) of 27 patients with internal nasal valve dysfunction reported improvement in nasal obstruction. Spreader grafts caused a widening of the middle third of the nose. Alar batten grafts resulted in effacement of deep alar creases and a widening of the nasal tip. CONCLUSIONS: We have found that surgical correction of nasal valve obstruction is extremely effective in improving subjective nasal obstruction. Success of this procedure is predicated by correct diagnosis and appropriate surgical technique.

Adolescent↗
PubMedDate not supplied

Viability of crushed and diced cartilage grafts: a study in rabbits.

OBJECTIVE: To investigate the effects of dicing and different degrees of crushing on cartilage graft viability and outcome in rhinoplasty. METHODS: Cartilage was harvested from both ears of 29 rabbits. For each animal, 6 cartilage pieces were prepared as follows and inserted into the paraspinal subcutaneous tissue: (1) left intact, (2) diced to approximately 1 x 1-mm pieces and then wrapped in oxidized regenerated cellulose, (3) slightly crushed, (4) moderately crushed, (5) significantly crushed, and (6) severely crushed. Animals were killed at 2, 5, and 10 months, and graft specimens were microscopically examined. RESULTS: As crushing intensity rose, cartilage viability decreased and more cartilage tissue was transformed to connective tissue. The intact and slightly crushed grafts showed significant chondrocyte proliferation. This decreased as crushing intensity increased, and the severely crushed and diced cellulose-wrapped grafts exhibited almost no peripheral chondrocyte proliferation. CONCLUSIONS: Slight crushing of a cartilage graft can produce outstanding graft material that forms softer nasal contours and fills defects well. However, severe crushing of cartilage grafts results in extensive necrosis and eventual reduction in graft volume. The use of oxidized regenerated cellulose to wrap diced cartilage grafts also tends to reduce clinical predictability owing to negative effects on cartilage viability and regeneration.

Animals↗
PubMedDate not supplied

Caudal septoplasty for treatment of septal deviation: aesthetic and functional correction of the nasal base.

OBJECTIVES: To describe our technique in the treatment of significant caudal septal deviation; to evaluate the effectiveness of our technique of caudal septoplasty in the treatment of caudal septal deviations. DESIGN: Retrospective review of cases taken from a database of more than 2000 patients who underwent rhinoplasty performed by 1 surgeon in a private facial plastic surgery practice. RESULTS: Medical charts were reviewed to determine the rate of preoperative nasal obstruction in 59 (95%) of 62 patients as well as nasal obstruction postoperatively 11 (17%) of 62 (P < .001). Photographs were reviewed to determine the severity of caudal deviation and the postoperative result. By photographic evaluation, we found that all but 3 patients had significant improvement in their postoperative appearance. Twenty-six patients had no evidence of residual asymmetry. The rate of revision was 5 (8%) of 62 patients. CONCLUSIONS: The caudal septoplasty technique is effective, relatively easy to perform, and shows long-term reliability in correcting caudal septal deviation. In properly selected patients, the technique is effective in improving cosmesis and nasal airflow.

Esthetics↗
PubMedDate not supplied

Perforating double lateral osteotomy.

Reshaping of the bony vault in primary and revision rhinoplasty is a simple, yet precise, maneuver that requires both skill and experience in creating predictable outcomes. Different methods for remodeling the nasal pyramid using various types of osteotomies have been devised to achieve narrowing, straightening, and reduction in nasal height. However, the current options of techniques including medial, transverse oblique, low to low lateral, low to high lateral, and intermediate osteotomies do not address all types of deformities encountered. These include the wide pyramid, the prominent frontal process of the maxilla, the convex nasal bone, and the deviated nose. Accordingly, the senior author has devised a new procedure, named the "perforating double lateral osteotomy," that has been used on hundreds of patients, with excellent results.

Humans↗
PubMedDate not supplied

Nasal tip overprojection: algorithm of surgical deprojection techniques and introduction of medial crural overlay.

OBJECTIVES: To discuss the evaluation of the overprojected nasal tip, present an algorithm of various treatments for deprojection of the nasal tip, and introduce our experience of greater than 10 years with medial crural overlay. DESIGN: Retrospective review of a large sequential series of patients undergoing rhinoplasty who were treated with various deprojection techniques by the senior author (R.W.H.K.) from January 1, 1991, through December 31, 2002. Patients underwent preoperative and postoperative evaluation during this period on a regular basis to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction. Medical records and photographic documentation were reviewed. The occurrence of postoperative complications and secondary revision procedures were noted. We used the information obtained to evaluate and expound on an algorithmic paradigm for treatment of nasal tip overprojection. RESULTS: From 1991 to 2002, 130 cases used 1 or more of the senior author's preferred methods for deprojection. Ten patients were excluded owing to the primarily reconstructive nature of their surgery. Of the remaining 120 patients, 3 (2.5%) underwent minor revision of dorsal irregularities and another 5 (4.2%) underwent tip revision. Only 9 patients (7.5%) required concomitant alar base reduction. One patient had postoperative epistaxis, and there were no cases of postoperative functional complaints. CONCLUSIONS: Deprojection of the overprojected nasal tip can be accomplished successfully with a handful of properly used techniques. Once proper analysis has been accomplished, an algorithm can be used to help simplify the approach to deprojection. These techniques offer sound functional approaches to effect deprojection while controlling the level of rotation. The beneficial effects observed using this algorithm are attested to by the minimal number of complications, the relatively low number of patients requiring revision, and the overall long-term patient satisfaction with their results.

Algorithms↗
PubMedDate not supplied

Powered endoscopic septoplasty for septal deviation and isolated spurs.

Septoplasty is commonly performed for nasal airway obstruction or rhinologic headache due to contact irritation, often in conjunction with other nasal procedures, including cosmetic rhinoplasty and endoscopic sinus surgery.Traditionally, it is performed before these procedures via a "headlight" technique. This article describes the use of the microdebrider in 29 cases of endoscopic septoplasty. Many of the procedures were performed in conjunction with functional endoscopic sinus surgery; however, several were performed as an isolated procedure or with inferior turbinoplasty. The technique is described in detail. All 29 patients had significant improvement in their symptoms, and no patient developed a perforation or postoperative hematoma. Conversion to a traditional septoplasty was required in 1 case because of the severity of the deviation. Power-assisted endoscopic septoplasty is a useful adjunct in cases involving isolated septal spurs or moderate septal deviations. Patients with severe nasal obstruction due to caudal deflection of the septum off the nasal spine are better served with traditional headlight septoplasty.

Debridement↗
PubMedDate not supplied

Lateral crus pull-up: a method for collapse of the external nasal valve.

Collapse of the nasal vestibule during inspiration is a frequently encountered symptom, often caused by weak or medially displaced lateral crura in the lower lateral cartilages. Numerous techniques are available for lateralizing and strengthening the lateral crura using cartilage grafts or suture techniques. In most cases, they involve an external rhinoplasty approach or additional incisions. An elegant endonasal method for widening and strengthening the lateral component of the nasal valve area is described herein. The basis of the procedure is a permanent submucosal spanning suture between the piriform aperture and the distal part of the lower lateral cartilage. The effect of this technique is 2-fold. First, it provides superolateral rotation of the lateral crura, increasing the cross-sectional area, and second, the spanning suture provides additional support for the lateral wall of the nasal vestibule.

Cartilage↗
PubMedDate not supplied

An alternative method of middle vault reconstruction.

Surgery of the nasal valves is a challenging aspect of rhinoplasty surgery. The middle nasal vault assumes an important role in certain aspects of nasal valve collapse. Techniques that address pathologies of the middle vault include the placement of spreader grafts and the butterfly graft. We present an alternative technique of middle vault reconstruction that allows simultaneous repair of nasal valve collapse and creation of a smooth dorsal profile. The surgical technique is described in detail and representative cases are discussed.

Cartilage↗
PubMedDate not supplied

Analysis of the physical properties of costal cartilage in a porcine model.

OBJECTIVE: To determine the impact of interventions on the degree of warping of costal cartilage. METHODS: The project was conducted at a large university animal research laboratory. The costal cartilage of eight 30-kg domestic pigs was harvested. The cartilage was cut into central and peripheral segments with a standard cutting die. Two sizes of rectangular cubes were compared. The central portions of costal cartilage were segmented and glued with octyl-2-cyanoacrylate. The shape of the cartilage was documented with both digital and film photography. The cartilage was placed into subdermal pockets on the dorsum of the pigs. The animals were killed at 4 weeks, and the cartilage was photographed. Adobe Photoshop software was used to measure the degree of warping. Statistical analysis was calculated by t test analysis. RESULTS: A total of 115 rectangular costal cartilage blocks were treated. Large blocks warped less than small blocks (P<.02). Centrally cut blocks warped less than peripherally cut blocks (P<.03). The octyl-2-cyanoacrylate incited a significant sterile inflammatory response such that the blocks could not be accurately assessed for warpage. CONCLUSION: Costal cartilage can be effectively used for grafting in rhinoplasty with minimal warping if large grafts from the central portion of cartilage are used.

Animals↗
PubMed2004

The effect on snoring of structural nasal valve dilatation with a butterfly graft.

OBJECTIVE: To evaluate the effect on snoring of structural nasal valve dilatation with butterfly spreader grafts in patients with nasal valve insufficiency. DESIGN: Retrospective medical chart review and telephone follow-up; mean +/- SD follow-up time, 20.7 +/- 11.34 months (range, 3-48 months). SETTINGS: Tertiary care referral center. SUBJECTS: A total of 37 snoring patients with nasal valve insufficiency who underwent nasal valve dilatation with a butterfly spreader graft. INTERVENTIONS: The conchal cartilage butterfly graft technique was performed during rhinoplasty through either an external or endonasal approach. MAIN OUTCOME MEASURE: To establish through a retrospective review that butterfly graft conchal cartilage nasal reconstruction is effective in reducing snoring. RESULTS: After surgery, 30 patients (81%) had significant improvement in breathing, 5 (14%) had slight improvement, and 2 (5%) had no benefit in breathing. Snoring stopped completely in 11 (30%) of the patients after surgery. The improvement in snoring was significant in 13 patients (35%) and slight in 3 (8%). Twenty-six patients (70%) reported tiredness and grogginess on awakening before the surgery. Surgery significantly improved patients' tiredness and grogginess on awakening in 15 cases (58%), slightly improved them in 5 (19%), and did not change the patients' tiredness and grogginess in 6 cases (23%). CONCLUSION: The conchal cartilage butterfly graft yields successful results not only in breathing but also in snoring symptoms in patients with nasal valve insufficiency.

Adult↗
PubMed2004

Three-step reconstruction of complex saddle nose deformities.

OBJECTIVE: To evaluate a reproducible surgical technique for augmentation rhinoplasty of complex saddle nose deformities, which are characterized by substantial loss of nasal structural support and result in multiple nasal abnormalities. DESIGN: Case series and surgical outcome study. SETTING: Tertiary referral center. PATIENTS: A total of 43 patients (32 female and 11 male; mean +/- SD age, 36 +/- 12 years) with complex saddle nose deformities and extensive loss of nasal volume, shape, and support who underwent reconstructive surgery between 1997 and 1999. INTERVENTION: A standardized 3-step surgical procedure using autogenous costal cartilage. MAIN OUTCOME MEASURES: Assessment of additional nasal abnormalities, graft recipient site conditions, postoperative complications, postoperative analgesic consumption, and subjective outcome assessed with a standardized telephone interview 2 years following surgery. RESULTS: Besides nasal abnormalities characteristic of complex saddle nose deformities, several additional nasal abnormalities were frequently encountered. Forty of the 43 patients had undergone previous septorhinoplasty, 26 of whom through multiple procedures. One transplant extrusion was recorded, which required revision surgery. In 8 patients, minor surgical corrections were performed. Nasal airflow was judged satisfactory or good by 30 of the 37 patients who were contacted by telephone and aesthetic appearance was considered good by 17, satisfactory by 10, and unsatisfactory by 10. CONCLUSIONS: Three-step nasal reconstruction with costal cartilage is indicated in severe saddle nose deformities. It is a comparatively reliable surgical procedure yielding satisfying results even in patients with severe deformities and unfavorable recipient site conditions.

Adult↗
PubMed1975

A psychological study of patients undergoing cosmetic surgery.

This is an investigative study of the personality of patients requesting cosmetic rhinoplasty. Analysis of data obtained from objective projective tests and psychological interviews indicated that patients seeking cosmetic surgery are not as psychologically disturbed as often as described. Comparative studies showed certain personality characteristics to be associated with patients who seek cosmetic surgery. While evaluations 18 months after surgery showed no major personality change, self-concept was improved. Certain disturbing personality patterns indicative of psychological risk were identified. These fell more in the range personality disorders, exemplified by the infantile-narcissistic and the manipulative controlling personalities rather than in somatic ranges. We recommend a simple interview question method of counseling designed to identify underlying psychological manifestations and to control the potential problem patient.

Adolescent↗
PubMed1977

Nasal projection.

The challenge of enduring tip projection is met with the use of a septal cartilage graft between the medial crura. With suturing, a "sandwich" is created composed of the two medial crura and the graft between them. The sandwich can be trimmed as necessary, in accordance with the surgeon's taste requirements for good tip profile and projection. The graft allows much more projection than from the medial crura alone. We describe the Goldman technique of rim incisions, delivery of the lower lateral cartilages, bisection of each, and then creation of the sandwich. The technique has been performed on more than 40 patients, in most of whom the results have remained successful more than six months postoperatively. The results indicate excellent fixation of the projected tip with maintenance of position, strength, and form. The indications for this tip technique are the classical ones for medial crura projection, such as hypoplastic tip cartilages, short columella revision rhinoplasty, and most importantly, the increase of real projection not attained by simple rotation.

Cartilage↗
PubMed1977

Correction of the over-projecting nasal tip by the suture technique.

A simple method can be used for correctingan excessively projecting nasal tip. The technique involves suturing the anterior part of the medial crura of the alar cartilages to the posterior part of thecaudal end of the septal cartilage through a transfixion incision using permanent suture material. This technique is not applicable in cases where the integrity of the caudal end of the septum is compromised. Application of this procedure may, at times, result in an undesirable widening of the alae. In such cases, full-thickness resection of the alar bases is necessary. This method of nasal tip reduction has been used in 14 cases of rhinoplasty with a follow-up period of seven to 28 months. The results generally have been satisfactory, with few complications.

Adolescent↗
PubMed1978

Nasal tip projection changes related to cheeks and lip.

Nasal profiles are altered in almost every rhinoplasty operation. Often neglected in diagnosis and surgery are alterations in profiles of the cheeks and upper lip that should be made at the same time. We show aesthetic effects produced by alterations in these structures and describe how we measure and record the adjustment. A few examples of results are presented to indicate the techniques used and the importance of including changes in profiles of the cheeks and upper lip in cosmetic rhinoplastic diagnosis and treatment.

Cheek↗
PubMed1978

The anatomy of the nose. External support.

The anatomy of the nose is poorly defined, even in standard anatomical texts. Wide disagreement exists regarding the interdigitation of the supporting cartilages, the articulation of these cartilages with the nasal bones, and the contribution of each of these cartilages to the support of the external nose. An understanding of this nasal anatomy is essential to the facial plastic surgeon. The authors describe the fundamental anatomical structure of the adult nose based on gross and microscopical observations and serial sections in 31 cadaveric noses. Tables of cartilage measurements and variation, plus appropriate drawings define the anatomy encountered. Structural variations are common and can be predicted by external appearance in selected cases. To discuss relationships of importance in the surgical alteration of the nose in rhinoplasty, anatomical findings are compared to descriptions in the surgical and anatomical literature. Preservation of essential support and physiological function is stressed.

Adult↗
PubMed1979

Nasolacrimal obstruction after maxillary sinus and rhinoplastic surgery.

Transient nasolacrimal obstruction is a common complication of maxillary sinus, as well as rhinoplastic surgery. Permanent epiphora, however, is unusual. This communication describes 11 patients with surgical injury to the lacrimal drainage system, which necessitated dacryocystorhinostomy for correction. Seven of these cases occurred subsequent to nasoantral window procedures, three occurred after rhinoplasty, and one resulted from a partial maxillectomy. It has been shown that the two areas most vulnerable to inadvertent surgical injury are the nasolacrimal sac, located just beneath the medial canthal ligament, and the ductal ostium in the inferior meatus. We discuss the relevant anatomy of the nasolacrimal apparatus, in addition to surgical methods for avoiding injury to the system. We also describe the currently applied techniques for diagnosing and managing lacrimal obstruction and review the literature.

Adult↗
PubMed1980

Polyamide mesh used in facial plastic surgery.

For approximately ten years I have been using polyamide mesh as a filler material in facial plastic surgery, particularly in augmentation rhinoplasty, for saddle-nose deformity, and in augmentation mentoplasty. The results in this series of 130 patients have been extremely good, probably better than can be obtained with any other type of alloplastic implant material or even with any autogenous graft.

Chin↗