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Biomedical subjects

P A Adamson

Publications and source records attributed to P A Adamson.

At least 19 recordsLinked to original sources
PubMed1998

Analysis of nasal air flow following repair of vestibular stenosis.

OBJECTIVE: Vestibular stenosis is an uncommon but debilitating cause of nasal obstruction. The etiology of the stenosis is variable, but iatrogenic causes are by far the most common. A number of techniques have been described for repair of the stenotic segment. We present a surgical technique that employs the concepts of: excision of the stenotic segment, enlargement of the bony pyriform aperture, and placement of a full-thickness skin graft. RESULTS: Our results have been very favourable, and we have documented improvement in nasal obstruction by performing preoperative and postoperative nasal airflow studies on all our patients. CONCLUSIONS: These results suggest that significant improvement in nasal airflow can be obtained in most patients with the use of this technique.

Airway Resistance↗
PubMed1996

The long-term effects of open cosmetic septorhinoplasty on nasal air flow.

OBJECTIVE: To determine if elective cosmetic septorhinoplasty impacts on nasal air flow resistance over the long-term. DESIGN: Case series. Mean postoperative follow-up period was 41.5 months (range, 16 to 77 months). PATIENTS: A consecutive sample of 200 patients having undergone cosmetic open septorhinoplasty by one of us (P.A.A.) before July 1992 were contacted by telephone; 50 agreed to participate, and 27 actually participated in the study. INTERVENTIONS: Open cosmetic septorhinoplasty performed by one of us (P.A.A.). MAIN OUTCOME MEASURES: Comparison of preoperative and postoperative nasal resistance values by headout body displacement plethysmography; correlation of preoperative and postoperative nasal valve anatomy with nasal resistance values; and correlation of postoperative nasal resistance values with subjective evaluation of nasal air flow as reported on a 10-point analogue scale. RESULTS: Of the 27 patients, 10 had normal preoperative nasal resistance values and 17 had elevated resistance values. Preoperative Normal Group: Four of the 10 patients' mean resistance values exceeded normal limits postoperatively. One of these four patients reported subjective nasal obstruction. Preoperative Abnormal Group: Of the 17 patients, surgery resulted in normal resistance values postoperatively in six, decreased but still above normal resistance values in eight, and no decrease in postoperative resistance values in three. CONCLUSIONS: (1) Patients with normal nasal resistance values may suffer long-term, asymptomatic increase in nasal resistance values after cosmetic open septorhinoplasty, often with no quantifiable change at the nasal valve. (2) Patients with elevated nasal resistance measurements generally improve with open septorhinoplasty. Patients with isolated septal deformities improve with septoplasty. Patients with upper lateral cartilage collapse improve with spreader grafts. The lasting objective improvement on the nasal valve using spreader grafts is reported herein for the first time. (3) Subjective estimations of nasal patency do not correlate well with objective measures of patency, namely nasal resistance measurements. (4) Cosmetic septorhinoplasty can alter nasal patency. Continued care must be exercised when manipulating the nasal framework for cosmetic purposes, as slight changes to the nasal valve may result in significant alterations in nasal air flow resistance.

Adolescent↗
PubMed1996

Transcutaneous lower blepharoplasty.

Transcutaneous lower blepharoplasty as a standard procedure for cosmetic lower blepharoplasty is being replaced by transconjunctival blepharoplasty and laser resurfacing techniques. Nevertheless, there remain specific indications for the transcutaneous approach and its modifications. The accomplished facial plastic surgeon will be able to choose the appropriate technique based on the patient's concerns, the eyelid pathology, and his or her clinical experience.

Aged↗
PubMed1995

Otoplasty techniques.

Otoplasty has undergone a number of important developments over the course of the past 150 years. While cartilage-incision techniques were favored earlier in the century, suture-only techniques are now favored. Prominauris, a condition that affects 5% of the Caucasian population, is inherited as an autosomal dominant trait. Protruding ears commonly are due to a combination of two defects: under-development of antihelical folding, and overdevelopment of the conchal wall. Utilizing a graduated approach, consistently superior results can be obtained. Our approach includes: fusiform skin excision; concha-mastoid sutures; scapha-conchal sutures; and refinement of the scapha, helix, and lobe. The aesthetic results are well retained and significant complications are rare.

Cicatrix↗
PubMed1994

Vertical dome division in open rhinoplasty. An update on indications, techniques, and results.

OBJECTIVE: A new modification of vertical dome division (VDD) in rhinoplasty using cartilage overlap and suturing to reestablish the integrity of the alar cartilages is analyzed and compared with the more standard technique of cartilage resection and suturing. DESIGN: Retrospective before-and-after trial. SETTING: Private patients of one of the authors (P.A.A.) undergoing surgery in the Department of Otolaryngology of the University of Toronto (Ontario). PATIENTS: A consecutive sample of 116 patients having undergone open rhinoplasty with VDD between 1981 and 1990 were evaluated. Seventy-five had VDD before 1987, when a cartilage resection and suturing technique was used (P.A.A.); 41 had their surgery after 1987, with the cartilage overlap and suturing technique. All patients were available for follow-up. The mean follow-up time was 15.2 months, with a range of 6 to 63 months. INTERVENTION: Indications for VDD were lobule asymmetry (47%), retrodisplacement (24%), wide domal arch (22%), hanging infratip lobule (6%), and rotation (1%). Prior to 1987, VDD was performed by dividing the alar cartilages, resecting certain portions, and then suturing the cartilages together again to recreate the alar margin. After 1987, VDD was revised by overlapping the portions of cartilage that would have been previously resected and suturing the overlapping portions to recreate the alar margin. MAIN OUTCOME MEASURES: Patient satisfaction; physician evaluation; physical examination; blinded comparison of preoperative and postoperative photographs; need for revision surgery. RESULTS: Overall, six (5.0%) of 116 patients required revision surgery or had photographic and/or physical evidence of nasal tip irregularities. Three (4.0%) of 75 patients from the cartilage excision group and one (2.4%) of 41 patients from the overlap group required revision surgery. The other two patients, one in each group, had minor tip irregularities not requiring surgery. The tip irregularities were due to nasal bossae in four patients and lobule asymmetries in two. There was no alar notching or lower nasal third pinching. Tip irregularities were three times as likely to occur in patients presenting for revision rhinoplasty than in those for primary rhinoplasty. CONCLUSIONS: Vertical dome division is a powerful tool in rhinoplasty, allowing for complex manipulations of alar cartilages to selectively enhance projection, rotation, and domal arch width. It also allows for correction of lobule asymmetries and elongation or hanging of the infratip lobule. The cartilage overlap technique reduces the occurrence of several common postoperative tip abnormalities and lowers the need for revision surgery when compared with cartilage resection VDD. The reported results can only be considered trends, as sample sizes in the series were too small to allow for statistical significance.

Adolescent↗
PubMed1994

The nasal hinge.

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, it plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.

Adolescent↗
PubMed1994

Soft tissue rhinoplasty.

The majority of rhinoplasty studies emphasize the management of the cartilaginous and bony nasal framework. Often overlooked is the soft tissue envelope. One hundred consecutive rhinoplasty patients were studied with respect to their soft tissue deformities, the surgical techniques applied for correction, and the aesthetic outcome. Results were analyzed utilizing preoperative and postoperative assessment sheets, progress notes, and photographs. The importance of proper diagnosis and management of soft tissue deformities in achieving superior aesthetic results is discussed. As well, clinical examples of illustrative deformities and their corrections are presented.

Adolescent↗
PubMed1993

Open structure rhinoplasty.

Open structure rhinoplasty (OSR) uses the open or external approach via a mid-columellar and bilateral marginal incision. In combination with grafting procedures, such as columellar struts, dorsal grafts and tip grafts, rhinoplasty has developed from a merely reductive procedure to a more graduated approach to the nose. Emphasis is now placed on repositioning, augmentation and restructuring the nasal anatomy to create as natural and functional a nose as possible. This retrospective study analyses our experience with 130 rhinoplasties over a 3-year-period. The study reveals OSR to be a safe and reliable technique which produces predictable results.

Adolescent↗
PubMed1992

The coronal forehead lift--modifications and results.

The coronal forehead lift has produced excellent results in the rejuvenation of the upper face. The problem of brow and glabellar ptosis, as well as the problem of frontoglabellar rhytids, are directly addressed with this procedure while producing no visible scars. In addition, the pretrichial modification of it can be used without alteration in the hairline. The success and low morbidity of the coronal forehead lift has made it the procedure of choice for upper facial rejuvenation in females, and many male patients. A review of 41 coronal forehead lifts performed by the senior author is presented, with emphasis placed on the results and the refinements brought to the surgical technique. A discussion comparing this procedure to other brow lift procedures is also presented, outlining their respective advantages and disadvantages.

Adult↗
PubMed1991

Extended blepharoplasty.

Extended blepharoplasty involves extending the dissection of the skin-muscle flap used in standard lower eyelid blepharoplasty to a level below the infraorbital rim. This technique is useful in the management of infraorbital, or malar, bags that are seen in as many as 10% of blepharoplasty candidates. A concomitant eyelid shortening procedure is frequently needed to treat horizontal eyelid laxity. Achievement of satisfactory results depends on the proper suspension of the skin-muscle flap to the lateral canthal periosteum. Extended blepharoplasty is an innovative way to improve infraorbital pouching, which is otherwise beyond the reach of the standard blepharoplasty procedure.

Adult↗
PubMed1991

Postblepharoplasty ectropion. Prevention and management.

Lower-eyelid malposition is one of the more serious complications encountered following lower-lid blepharoplasty, ranging in severity from mild lower-lid retraction to frank ectropion with marked lower-lid eversion. We define a grading system for postblepharoplasty lid malposition based on the severity of lower-lid retraction. In a critical review of 111 patients who underwent lower-lid blepharoplasty between January 1985 and January 1990, 15% were thought to have some degree of lower-lid retraction. Presence of lid laxity preoperatively and increasing amounts of skin excision at surgery were significant factors in the development of malposition. Placement of orbicularis suspension sutures tended to decrease the incidence of lid retraction. No patients had frank ectropion; however, three patients with grade 2 or 3 malposition required a secondary surgical procedure for correction. All three patients had resolution of their symptoms and good cosmetic results using standard treatment methods. A literature review and discussion of the causes, sequelae, and management of post-operative ectropion is presented as a reminder to surgeons performing blepharoplasty. Avoidance of this entity by appropriate preoperative assessment is emphasized, along with conservative operative technique. These factors combined are essential for the successful outcome of lower-lid blepharoplasty.

Adult↗