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PubMedDate not supplied

The lost muscles of the nose.

This is a review of the muscular anatomy of the nose. Areas of inconsistency in the main anatomy texts are highlighted and concentrate particularly on the omission of three identifiable muscles from modern textbooks. Two topographical areas of the nose in need of further anatomical development are identified. In a sample of 121 subjects from the general population, 40% were found to be incapable of flaring the nostrils voluntarily or subconsciously in conjunction with energetic inspiration with the mouth closed. The authors recommend systematic clinical assessment of the nasal musculature be incorporated in the pre- and postoperative examination of the rhinoplasty patient. The division of the nose into five sections for assessment is proposed and the muscles contributing to each area are defined together with their individual surgical relevance.

Adult↗
PubMedDate not supplied

Improving nasal tip projection and definition using interdomal sutures and open approach without transcolumellar incision.

The object of this study was to maximally take advantage of the combination of two surgical techniques to manage the nasal tip. For this, an approach similar to the open tip approach without a transcolumellar incision was performed and the management of the alar cartilages with multiple combined sutures was carried out. This study represents more than two years of work where 57 primary and secondary rhinoplasty patients were operated on. In all of them, the nasal tip was managed by means of utilizing different types of sutures in the alar cartilages, according to the characteristics and needs of each patient. At the same time, an extensive lipectomy was performed on the nasal tip, if indicated. All of the nasal tip surgeries were performed with an open approach without transcolumellar incision. This approach has been previously described, is highly simple, and it eliminates the principal disadvantage of a transcolumellar scar that arises from the open approach technique. Although the scar is hardly noticeable in Caucasian patients, in non-Caucasians it could constitute an important undesirable effect. This approach permits us to manage the cartilages using sutures in many diverse types and variations in a more complete form, similar to which one could achieve using the classical open approach technique. The results are highly satisfactory and result in a definition and rotation of the nasal tip which would be difficult using the closed technique. Therefore, this study represents another alternative surgical technique in the surgical management of the nasal tip.

Adult↗
PubMedDate not supplied

Unilateral osteotomies for externally deviated noses.

Despite the many methods described for correction of the deviated nose, it still continues to be one of the most challenging problems in rhinoplasty. It is obvious from the literature that the deformities present in the deviated nose can be quite different from patient to patient and that there is no one method that should be used for every deviated nose. Although unilateral osteotomy technique is not a new concept, so far it has not received the interest of plastic surgeons. Shorter operation time, lessened surgical trauma to the nose, lessened intraoperative bleeding, lessened postoperative edema, and lessened recurrence of the deviation are distinct features of the unilateral osteotomy technique that should be considered when planning surgery on such a complex deformity. We present our experiences with unilateral osteotomy and recommend it for patients who have a deviation related to only one side of the nose.

Adolescent↗
PubMed2003

Modified alar swing procedure in saddle nose correction.

Reconstruction of the saddle nose may involve the use of different augmentation materials, from autogenous bone and cartilage to alloplastic materials. The most important problems when considering the choice of reconstructive technique, besides underlying pathology and expected result, include: long-term stability, donor morbidity, tendency of the implant to infection, extrusion, and resorption. The use of the lateral crura of the lower lateral cartilages as dorsal onlay was reserved for the corrections of minor supratip depressions (flying wing and alar swing procedure). The authors suggest the use of pedicled flaps of cephalic portions of lateral crura as dorsal septal strut, which may increase the profile line more than dorsal onlay. Reconstruction is performed using open rhinoplasty approach. Pedicled flaps of the cephalic portions of lateral crura are transfixed in the sagittal plane and, following separation of upper lateral cartilages and medial crura, placed on the dorsum of nasal septum. Upper laterals are sutured to newly formed cartilaginous dorsum, or a new bridge is created using conchal cartilage. Columellar strut may be formed of the septal cartilage. Authors have performed such corrections in 15 patients with good long-term functional and aesthetic results.

Adult↗
PubMedDate not supplied

Isolated congenital absence of the nasal bones and aesthetic surgical correction: managing and case report.

A rare case of isolated congenital bone agenesis in a young woman referred to the authors for aesthetic correction of the dorsum profile is described. There are no descriptions of surgical treatment for this isolated facial defect in the literature. After a complete and accurate diagnostic study, a rhinoplasty was performed with a good result and without complications during a 2-year follow-up period. To explain this congenital malformation, several hypotheses were examined, such as bony resorption and embryologic bony development syndromes. This report describes the possibility of intervention in the case of nasal bone absence and shows how risks of structural instability can be avoided with an accurate preoperative study and a careful surgical approach.

Adult↗
PubMed2006

Foreign body removal and immediate nasal reconstruction with superficial temporal fascia.

For nasal augmentation, various materials have been used for many years. The injection of foreign body has been carried on, although it is performed mostly by laymen. Because many complications arise after augmentation rhinoplasty by foreign body injection, secondary correction has been needed. These complications have included headaches, swelling, redness, palpable mass, skin discoloration, telangiectasia and fear of cancer. The authors treated 10 patients who had undergone injection of foreign body to the nose. After the foreign body was removed, we immediately reconstructed nasal deformity by silicone implant wrapping with superficial temporal fascia. This method has many advantages including easy contouring of nasal shape and fixation, absence of foreign body reaction, reduced inflammatory reaction, no or minimal concerns regarding the migration or extrusion of the implants, and nonvisible donor scar. The mean follow-up period was 8 months, and no complications occurred. The authors conclude that nasal deformity can be successfully reconstructed immediately using silicone implant wrapping with superficial temporal fascia after foreign body is removed from the nose. In the authors' experience, this procedure has improved aesthetic appearance and met patients' expectations.

Adult↗
PubMed2005

Postoperative camouflage therapy in facial aesthetic surgery.

BACKGROUND: This study investigated the effectiveness of makeup camouflage procedures for patients who have experienced social problems because undesirable ecchymoses and edemas after aesthetic surgery, The impacts of camouflage procedures for such patients also were studied. METHODS: For this study, 46 rhinoplasty patients were divided into two groups: postoperative camouflage makeup was used for 23 patients, whereas the other 23 patients were assessed as the control group, Additionally, 18 blepharoplasty patients also were divided into two similar camouflage and control groups. RESULTS: The State-Trait Anxiety Inventory test given to the patients postoperatively indicated that postoperative makeup provided positive effects for patients. CONCLUSION: The current clinical study investigated the effects of cosmetics on the psychological state of patients during the postoperative period and included the application of camouflage makeup for postrhinoplasty and postblepharoplasty patients with edemas and ecchymoses. Psychologically, the patients felt better.

Adolescent↗
PubMedDate not supplied

Mersiline mesh in premaxillary augmentation.

Premaxillary retrusion may distort the aesthetic appearance of the columella, lip, and nasal tip. This defect is characteristically seen in, but not limited to, patients with cleft lip nasal deformity. This study investigated 60 patients presenting with premaxillary deficiencies in which Mersiline mesh was used to augment the premaxilla. All the cases had surgery using the external rhinoplasty technique. Two methods of augmentation with Mersiline mesh were used: the Mersiline roll technique, for the cases with central symmetric deficiencies, and the Mersiline packing technique, for the cases with asymmetric deficiencies. Premaxillary augmentation with Mersiline mesh proved to be simple technically, easy to perform, and not associated with any complications. Periodic follow-up evaluation for a mean period of 32 months (range, 12-98 months) showed that an adequate degree of premaxillary augmentation was maintained with no clinically detectable resorption of the mesh implant.

Adolescent↗
PubMed2004

Bone chips and diced cartilage: an anatomically adopted graft for the nasal dorsum.

Since 1996, cranial bone chips or septal bone chips harvested during septal deviation surgery and small chips of ear or septal cartilage have been used in 67 patients for dorsal nasal augmentation or for smoothing dorsal nasal irregularities. In this study, 59 overresections of ostecartilaginous nose structures during previous aesthetic nose surgeries and 8 primary rhinoplasties occasioned the use of bone or cartilage grafts. For 57 patients both bone and ear cartilage grafts were used for the reconstruction. Bone grafts were used for seven cases and cartilage grafts for three cases. The results from 7 years, of experience with this method of nasal dorsum reconstruction were satisfactory and durable. The most important advantage of this method is that the bony side of the nose is reconstructed with bone and the cartilage side with cartilage. Another advantage is that the bone chips are incorporated with both nasal bones, building a strong dorsal nasal bony mono-black. This technique also is useful for augmenting mild saddle nose deformity and dorsal nasal projection deficiency on the bony part, cartilage part, or both parts.

Ear Cartilage↗
PubMedDate not supplied

Correction of the crooked nose using custom-made high-density porous polyethylene extended spreader grafts.

Correction of the crooked or deviated nose, a complex cosmetic and functional problem, is a big challenge for the rhinoplasty surgeon. Although corrections using a wide range of surgical techniques to straighten the nose and maximize nasal function have been proposed, recurrence is very common because of cartilage memory and scar contracture. Therefore, to prevent recurrence and to maintain the correction of the septum, a permanent support that is stable and strong, with the ability to maintain its given shape after placement on one or both sides of the septum, is needed. For this purpose, the authors planned to use a pair of custom-made high-density porous polyethylene (HDPP) extended spreader grafts. In this study, the concept and technique of HDPP, composed of a nonresorbable alloplastic material for correction of the crooked nose, and the authors' experience using it, are presented. Currently, HDPP is readily available on the market as a thin plain sheet (0.85 x 38 x 50 mm) that can be cut to an appropriate size for spreader grafts. Ingrowths of fibrous tissue inside and around HDPP stabilize the upper lateral cartilages and septum in their new corrected position and maintain the corrected/straightened position. This material was used in 20 patients with crooked noses (9 with C-type and 11 with S-type noses). During a mean follow-up period of 18 months (range, 8-30 months), there were no complications, recurrences, or extrusions. Functional evaluation was performed using a visual analog scale before surgery and 6 months after surgery. Patients were asked to score their nasal breathing on a scale ranging from 0 to 100. The mean preoperative value was 32.50% +/- 11.18%, and the postoperative value was 88.75% +/- 8.71%. In conclusion, the use of custom-made HDPP extended spreader grafts is a safe, effective, reliable, and permanent method for correction of the crooked nose. In the long term, the authors believe that custom-made HDPP extended spreader grafts provide functional recovery and increased strength against further trauma or forces of scar contracture, and have the ability to prevent recurrence attributable to cartilage memory.

Adult↗
PubMedDate not supplied

Outcomes research in facial plastic surgery: a review and new directions.

Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physician's judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures.

Humans↗
PubMedDate not supplied

New surgical concepts: nasal tip function.

Since the birth of plastic surgery, rhinoplasty has been an outstanding chapter. Facial balance has been endeavoured with two parameters: size and shape. Now, however, the criterion for harmony has involved two more parameters; position and function. Position is related to other facial elements, such as, upper maxilla, upper lip, forehead, and frontonasal sulcus. Function is important because nasal superficial musculoaponeurotic system (SMAS) muscles are important for Nasal tip movement. To understand this better, we must analyze the nasal SMAS, which consists of primary or intrinsic and secondary or extrinsic muscles. When the extrinsics contract, they allow function of the intrinsics. They are the ala nasalis dilator, the ala nasalis elevator, the tranversus, and the tip depressor. Obvious hypertrophies of the dilator and the elevator has been observed in young athletes. Our method combines conventional, new, and modern aspects. It is conventional because the alar cartilages have been completely freed by intercartilaginous and marginal approaches, and the upper or lower border trimmed according to the case. It is more important to measure how much cartilage is left, than how much is removed. The new aspect is consideration of nasal SMAS to treat short noses that display a tendency to descend with laughter, and the modern aspect is the evaluation of dynamic surgical results, apart from the static.

Facial Expression↗
PubMedDate not supplied

Technique for harvesting of conchal cartilage grafts.

Conchal cartilage is an important source of cartilage for the rhinoplasty surgeon [Falces E, Gorney M: Plast Reconstr Surg 50:147, 1972; Hage J: Brit J Plast Surg 18:92, 1965; Juri J et al: Plast Reconstr Surg 63:377, 1979]. We describe a technique to harvest conchal cartilage which minimizes morbidity for the patient and produces an excellent scar.

Ear Cartilage↗
PubMedDate not supplied

Bioplastique as a complement in conventional plastic surgery.

This research presents reports of cases where a biocompatible and alloplastic biomaterial-Bioplastique-was used, associated with conventional plastic surgery or as a complement to it, with the aim of achieving a better final aesthetic result. Four cases are presented where Bioplastique was used in association with rhytidoplasty, rhinoplasty, and other surgical techniques. This material has shown itself to be appropriate to complement surgery; achieving a final result which would not be possible without any resort to a complement or any other hard procedure by the surgeon and is not more traumatic for the patient.

Adult↗
PubMedDate not supplied

Saddle nose: our approach to the problem.

Saddle nose is usually caused by a trauma or by excessive resection of the septal cartilage. Nevertheless, there are other, less frequent causes of injury, such as congenital, syphilis, leishmaniosis, and leprosy. Within this context, it is very likely to see widening of the bony bridge and dropping of the tip of the nose. For this clinical status, we found extremely satisfactory a therapy in which we use a dorsum cartilage graft, followed by narrowing of the nasal bridge and shortening of the nose. To achieve this aim, different kinds of materials were employed. The authors usually prefer rehydrated (0.9% saline solution) human costal cartilage. This material was used in a study of a series of patients with saddle nose in which we used open rhinoplasty and cartilage homografts.

Cartilage↗
PubMedDate not supplied

Bilateral double dome: a case report.

The authors present an unusual case of nasal tip deformity of the nose not mentioned in the literature. The nose tip presented hypertrophy of all the components of the crura and the cranial part of the lateral crus was rotated externally and widened. An extra dome was present bilaterally between the medial crus and the medial part of the lateral crus. This increased the columella show and made it deformed like a break in the middle of the columella. An open-approach rhinoplasty was performed and the alar cartilages were reshaped.

Female↗
PubMed1984

Bilateral nasal bone osteophytosis associated with short-term oral isotretinoin therapy for cystic acne vulgaris.

Bilateral 2.5 and 3.0 mm nasal bone osteophytes developed five weeks following the initiation of oral isotretinoin therapy (50 mg daily) for severe cystic acne vulgaris in a healthy 30-year-old white woman who had undergone uneventful rhinoplasty 12 years earlier. Histologically mature bone fragments were removed at surgery. Vitamin A and its analogs have been reported to cause hyperostosis of the vertebrae and long bones, but no known reports link them to nasal bone changes. Clinically significant nasal bone osteophytosis may be another adverse reaction to oral isotretinoin therapy.

Acne Vulgaris↗