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Dean M Toriumi

Publications and source records attributed to Dean M Toriumi.

17 recordsLinked to original sources
PubMed2026

Rhinoplasty Difficulty Scale: Development and Psychometric Analysis of a Surgeon's Assessment of Rhinoplasty Technique and Nasal Deformity Correction.

BACKGROUND: Rhinoplasty surgeons lack a universal scale of the relative difficulty of rhinoplasty techniques and rhinoplasty deformities. OBJECTIVE: To compare the expert opinion of the difficulty of rhinoplasty techniques and rhinoplasty deformities among international rhinoplasty surgeons, as measured by a scale of difficulty. METHODS: A cross-sectional survey of rhinoplasty surgeons collected training levels, experience, case volume, and perceived expertise. Rhinoplasty techniques/deformities (n = 64) were rated from 1-10, representing the least to most technically demanding. Rasch analysis was used to examine the fit of the observed data to Rasch model requirements, assess rating scale functioning, and provide estimates of internal consistency. RESULTS: Respondents (n = 63) were in practice (<5 years, 14%; 5-10, 20%; 10-20, 20%; 20-30, 26%; >30, 20%), and rhinoplasty volume ranged from <25 (14%) to >100 cases/year (32%). Self-reported expertise was comfortably novice (32%), intermediate (10%), advanced (28%), and expert (30%). Otolaryngology (42%), facial plastic surgery (30%), and plastic surgery (28%) were represented. Rasch estimates of internal consistency reliability were excellent (0.96 for surgeons and 0.99 for items); the item difficulties were more heterogeneous (mean: 0, SD: 1.23) than the distribution of surgeons (mean: -0.09, SD: 0.58). Survey items were ordered by difficulty, ranging from least difficult (inferior turbinate reduction = 1.01) to most difficult (contracted nose repair post-infection = 8.24). CONCLUSION: The newly developed Rhinoplasty Difficulty Scale provides ratings of common rhinoplasty techniques and deformities with a high correlation among experts using this rating scale.

Humans↗
PubMed2006

Correcting the short nose in revision rhinoplasty.

The scope of this article is directed toward strategic planning and surgical treatment of the postoperative short nose deformity. Emphasis is placed on controlled repositioning of the central compartment of the nose (tip and columella), followed by moving the nostrils back into a more natural position with the use of autologous grafting techniques. The overall goal is to achieve the desired esthetic transformation while maximizing nasal function with good long-term results.

Cartilage↗
PubMed2005

Structure approach in rhinoplasty.

Over the past decade, rhinoplasty techniques have moved away from excisional methods and focused more on repositioning and restructuring existing tissues. These changes in surgical technique were made in part because of some of the untoward long-term complications noted in noses that were treated with excisional techniques. The incidence of many of these complications is greater in patients with certain nasal anatomy. It is the responsibility of the surgeon to identify these anatomic variants and make necessary adjustments in surgical technique to avoid complications.

Cartilage↗
PubMed2005

Biomechanical strength of human nasal septal lining: comparison of the constituent layers.

OBJECTIVE/HYPOTHESIS: Nasal septal perforation is a common complication following surgery involving the nasal septum. Septoplasty, septorhinoplasty, and submucosal resection may result in the inadvertent resection of perichondrium, which may predispose the patient to septal perforations. STUDY DESIGN: Controlled human cadaver study testing the biomechanical strength of the constituent layers of nasal septal lining. METHODS: Uniform samples of nasal septal mucosa, perichondrium, and a composite of both layers were obtained from five fresh human cadavers. The mechanical tensile strength of these layers was evaluated and compared with the Instron 4301 Mechanical Testing System (Canton, MA). RESULTS: Mixed-effects regression analysis demonstrated a significant difference in the tensile strength of the three groups (mean values +/- SD: mucosa, 662 +/- 308 g; perichondrium, 1370 +/- 798 g; composite, 2340 +/- 1252 g). All three pairwise comparisons among the three groups showed a significant difference in tensile strength. CONCLUSION: The perichondrial layer imparts the majority of the biomechanical strength to septal lining. Lining flaps containing both perichondrium and mucosa are stronger than flaps with either perichondrium or mucosa alone. Dissection in the subperichondrial plane during septal surgery provides a stronger septal flap and may prevent the development of nasal septal perforation during nasal surgery.

Biomechanical Phenomena↗
PubMed2005

The role of powered instrumentation in rhinoplasty and septoplasty.

Rhinoplasty and septoplasty are commonly performed surgical procedures that have as many variables in execution as the number of surgeons that perform them. Initially, these procedures were performed using manual instrumentation. Recently, however, powered instruments have been used to perform portions of the two procedures. Powered oscillating rasps have been described for reducing dorsal bony humps during rhinoplasty, and it has been suggested that powered osteotomes may reduce tissue trauma when performing nasal osteotomies. Powered burrs have also been used for taking down dorsal bony humps and refining boney irregularities. Although septal spurs have traditionally been excised manually, powered instrumentation has proved useful in this area as well. This article reviews the indications for using powered instrumentation in rhinoplasty and septoplasty.

Humans↗
PubMed2004

Management of posttraumatic nasal deformities: the crooked nose and the saddle nose.

The crooked nose deformity and the saddle nose deformity represent two of the most challenging complications of nasal trauma. Optimal management requires careful preoperative analysis and thoughtful surgical planning. The surgeon must make the mental and philosophical commitment to address the difficult cosmetic components and the functional problems related to these deformities. Because these conditions result from disruptions of the nasal septum, their surgical correction mandates use of techniques that modify the septum, and they might require reconstruction of the sacrosanct dorsal-caudal strut. By understanding the three-dimensional anatomy of this L-shaped strut, how its relationship to the other structural components of the nose determines external nasal contour, and the techniques available to stabilize this structure into an optimal position, the surgeon can correct these difficult cosmetic problems effectively while maintaining the overall structural and functional integrity of the nose.

Esthetics↗
PubMed2003

Botulinum toxin A for the treatment of lateral periorbital rhytids.

The lateral periorbital area represents one of the earliest and most bothersome facial stigmata of aging. Although traditional techniques have had limited success in treating the static cutaneous component to rhytid formation in this region, they have been largely unsuccessful in addressing the dynamic hyperkinetic lines that are created by the activity of the lateral orbicularis oculi muscle. Botox A injection represents a safe and reproducible technique to selectively denervate muscle activity in this troublesome area. This minimally invasive technique has led to significant improvement of periorbital lines, either when used as a single agent or in combination with other methods (Fig. 3). As more experience is gained with this toxin, as well as other Botox serotypes, continued progress is likely to occur in this area, as well as in other facial regions.

Botulinum Toxins, Type A↗
PubMed2002

Cyanoacrylate tissue adhesives for skin closure in the outpatient setting.

Cyanoacrylate and fibrin tissue adhesives can aid the facial plastic surgeon performing surgery in the outpatient setting. Octyl-2-cyanoacrylate is ideal for superficial skin closure and eliminates the need for suture removal. Subcutaneous sutures are needed in most cases to provide the best cosmetic outcomes. Fibrin tissue adhesives can be used to aid in attaining hemostasis or to seal or fixate tissues. Cyanoacrylate and fibrin-based adhesives can simplify office-based facial plastic surgery.

Ambulatory Care↗
PubMed2002

Structure approach in rhinoplasty.

Many postoperative sequellae of rhinoplasty can be prevented by minimizing resection of the supporting tissues of the nose and by using structural grafting to increase tip support. Stabilizing the nasal base is a critical step in providing a good long-term outcome with preservation of nasal tip projection. The surgeon must also anticipate the effects of scar contracture, which can aid in creating a favorable tip contour over time and avoid complications.

Esthetics↗
PubMedDate not supplied

Concentric and eccentric carved costal cartilage: a comparison of warping.

OBJECTIVE: To determine if a systematic, concentric graft-carving technique results in less warping than eccentric carving. METHODS: Costal cartilage from ribs 3 through 9 were harvested from fresh human cadavers. Concentric dorsal grafts were carved from cartilage obtained from one side of the cadaver (n = 7) and eccentric grafts were carved from the opposite side (n = 11). After carving, grafts were placed in saline sponges (isotonic sodium chloride) for 1 hour, and photographs were then taken from a lateral and a frontal view. Identical photographs were taken after 2 weeks of incubation in saline (36.7 degrees C). The angle of curvature was measured from the photographs. RESULTS: More warping occurred in the eccentric group than the concentric group on lateral view at 1 hour (4.4 degrees vs 0.4 degrees; P<.001) and at 2 weeks (5.8 degrees vs 1.4 degrees; P = .003). Eccentric grafts progressively warped between the 1-hour and 2-week points. CONCLUSION: Meticulous concentric carving of costal cartilage grafts may minimize the complication of graft warping.

Cadaver↗
PubMedDate not supplied

New concepts in nasal tip contouring.

Control of nasal tip contour has always been a key component of a successful rhinoplasty. Typically, this procedure is performed with an emphasis on narrowing the nasal tip structure. Creating a natural-appearing nasal tip contour is a complex task and requires a 3-dimensional approach. In an effort to identify the characteristics that make an ideal nasal tip, I evaluated numerous aesthetically pleasing nasal tips. After extensive study, I created a series of images to demonstrate how specific contours create highlights and shadows that will help guide the surgeon in creating a natural-appearing nasal tip contour. Many commonly used nasal tip techniques can pinch the tip structures if an overemphasis is placed on narrowing. These changes isolate the dome region of the nasal tip and can create an undesirable shadow between the tip lobule and alar lobule. Prior to contouring the nasal tip, the surgeon must stabilize the base of the nose with a columellar strut, suturing the medial crura to a long caudal septum, caudal extension graft, or an extended columellar strut graft. Stabilizing the nasal base will ensure that tip projection is maintained postoperatively. To contour the nasal tip, dome sutures are frequently used to flatten the lateral crura and eliminate tip bulbosity. Placement of dome sutures can deform the lateral crura and displace the caudal margin of the lateral crura well below the cephalic margin. This can result in a pinched nasal tip with the characteristic demarcation between the tip and the alar lobule. Alar rim grafts can be used to support the alar margin and create a defined ridge that extends from the tip lobule to the alar lobule. This form of restructuring can create a natural-appearing nasal tip contour with a horizontal tip orientation continuing out to the alar lobule. When dome sutures alone are inadequate, lateral crural strut grafts are used to eliminate convexity and prevent deformity of the lateral crura. Shield tip grafts can be used in patients with thick skin and an underprojected nasal tip. Whenever a shield tip graft is used, it must be appropriately camouflaged to avoid undesirable visualization of the graft as the postoperative edema subsides. When contouring the nasal tip, the surgeon should focus more on creating favorable shadows and highlights and less on narrowing. Nasal tips contoured in this manner will look more natural and will better withstand the forces of scar contracture that can negatively affect rhinoplasty outcomes.

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↗