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Biomedical subjects

R K Daniel

Publications and source records attributed to R K Daniel.

At least 19 recordsLinked to original sources
PubMed2001

Rhinoplasty: large nostril/small tip disproportion.

Surgeons must recognize large nostril/small tip disproportion as a distinct challenge in rhinoplasty surgery. The critical first step is to correctly analyze the intrinsic and extrinsic factors that contribute to the deformity. The nostril axis is drawn between the nostril apices and extended in both directions. It is then subdivided into a nostril and intrinsic tip component. The ratio of nostril to tip should be 55:45; a ratio of 60:40 is acceptable. The surgical solution requires both an increase in intrinsic tip projection by lengthening the infralobular segment and a nostril reduction. The anatomical deformity consists of three components: (1) the alar cartilages are highly divergent, (2) the infralobular segment is quite short, and (3) the domal segment is flat and ill defined. The operative technique advocated by the author combines a three-stitch tip procedure, including an interdomal suture over a straight strut, plus nostril sill/alar wedge resections.

Adult↗
PubMed1999

Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty.

Tip suture techniques offer a reliable and dramatic method of tip modification without needing to interrupt the alar rim strip or add tip grafts. The present simplified three-stitch technique consists of the following: (1) a strut suture to fix the columella strut between the crura, (2) bilateral domal creation sutures to create tip definition, and (3) a domal equalization suture to narrow and align the domes. If required, columella septal sutures can be added; either a dorsal rotational suture or a transfixion projection suture can be used. This simplified method represents a refinement based on more than 13 years of experience with tip suture techniques. It does not require a complex operative sequence or specialized sutures. Primary indications are moderate tip deformities of inadequate definition and excessive width and certain specific tip deformities, including the parenthesis tip and nostril/tip disproportion. The primary contraindications are for patients with minor tip deformities that are best done through a closed approach and those with severe tip deformities requiring an open structure graft. The technique is simple, efficacious, and easily learned.

Adult↗
PubMed1999

Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part II: secondary rhinoplasty.

Tip suture techniques have proven effective in managing many secondary tip deformities. The open approach is used in most cases because it allows analysis and utilization of the alar remnants. If the alar rim strip is intact and not deformed, then a three-stitch technique (strut, domal creation, and domal equalization) is used. If the domes were previously transected, they are repaired and an attempt is made to shape them with sutures. If sutures are ineffective or the domes are deformed, judicious excisions and tip-shaping sutures are employed to achieve an aesthetic "tip shape," as expressed through the overlying skin. Removal of sutures from previously sutured tips has proven effective in the columella and infralobular area, ineffective in the supratip midline, and unpredictable over the domal segment. Overall, tip suture techniques should be considered in secondary tip deformities whenever the alar cartilage remnants permit.

Adult↗
PubMed1996

Endoscopic forehead lift: an operative technique.

On the basis of over 100 endoscopic forehead lifts, we present an in-depth view of the current operative technique. The critical components are the following: (1) a subgaleal resection of muscle insertions rather than a subperiosteal approach to muscle origins, (2) a complete periosteal release along the lateral orbital rim, (3) a vertical suspension utilizing screws and staples that are removed at 1 week, and (4) a lateral temporal expansion using absorbable sutures. With this technique, a more controlled eyebrow position and eyebrow shape can be achieved.

Adult↗
PubMed1995

Secondary rhinoplasty following open rhinoplasty.

On the basis of 56 cases of secondary rhinoplasty following an initial open rhinoplasty, I conclude that secondary surgery is safe and effective. Either an open or closed approach can be used in most cases with little risk of skin necrosis or poor scar formation. The decision as to which approach to use depends on numerous factors. In general, a closed technique is favored when augmentation is the solution, while an open technique is favored when structural correction is required. Reopening the nose was done consistently without problems but was avoided in two patients because of severe thinning following previous defatting. However, certain "stigmata" were seen following open primary rhinoplasty and should be avoided: (1) a depressed, visible scar, (2) destruction of the soft-tissue facets and nostril apices, (3) columella deformities with associated nostril asymmetry, and (4) excessive tip or supratip defatting.

Adult↗
PubMed1995

Endoscopic forehead lift. Aesthetics and analysis.

The endoscope already has revolutionized aesthetic forehead surgery by reducing the morbidity rate associated with the forehead lift operation. The ability to do the operation through a minimally invasive approach is predicated on the illumination and magnification that the endoscope provides. It is this same illumination and magnification that is being brought to bear on the aesthetics, analysis, goals, and techniques that have guided the classical procedure. Both patients and surgeons will benefit from this renewed focus on aesthetic surgery of the forehead.

Blepharoptosis↗
PubMed1994

Rhinoplasty and rib grafts: evolving a flexible operative technique.

A flexible operative technique for utilizing rib grafts in difficult rhinoplasty and nasal reconstruction cases requiring support is presented. An osseocartilaginous rib segment is used for dorsal contour or support, while a rigid cartilaginous strut provides for both tip projection and columellar contour. The bone is contoured extensively, while the cartilage is altered minimally. An open approach is employed. A bony fixation platform is established by radix reduction followed by bony fixation with ultramicroscrews. Distally, the grafts are united when nasal lengthening or total support is required; otherwise, the grafts are juxtaposed to allow lateral movement. The operative technique and technical difficulties are described in detail based on experience in 14 patients.

Adult↗
PubMed1992

The nasal tip: anatomy and aesthetics.

New anatomic observations and expanded aesthetics are presented based on an in-depth analysis of 50 patients undergoing primary open rhinoplasty. The alar cartilages can be conceived of as three crura (medial, middle, and lateral), each composed of two segments, plus distinct intervening junction points of aesthetic importance. The classic four-dot tip aesthetics can be expanded and wrapped around the nasal lobule in a three-dimensional fashion. Three nasal tip angles are easily defined (angle of tip rotation, angle of domal definition, and angle of domal divergence) and can be created surgically.

Esthetics↗
PubMed1991

Rhinoplasty and the male patient.

A review of male patients undergoing rhinoplasty indicates a surprising diversity of anatomy and especially skin coverage. When compared with rhinoplasty in the female adolescent, the goal must be more of a "balanced rhinoplasty" rather than a reductive rhinoplasty, and the techniques required are more diverse. Careful screening of patients is essential to eliminate a subgroup of men with severe psychologic obsessions.

Adolescent↗
PubMed1990

The "biplanar" forehead lift.

A new technique of forehead rhytidectomy is presented that combines the best features of the coronal incision with those of the anterior hairline incision. The plane of dissection is formed by an anterior subcutaneous plane dissecting a lateral subgaleal plane. This approach is particularly valuable in patients with high foreheads, severe static wrinkling, and asymmetrical eyebrows.

Follow-Up Studies↗
PubMed1990

Rhinoplasty: the light reflexes.

The physical characteristics of the light reflexes of the nasal tip are defined in large part by the studio lighting configuration. By varying the lighting configuration, it is possible to alter the light reflexes as regards their number, distance apart, symmetry, and size. For the plastic surgeon, the quarter light system of the medical photographer has definite advantages over the key light system of the portrait photographer. The quarter light system consists of two lights of equal intensity with symmetrical angles of incidence placed at 45 degrees to the camera-subject axis. Measuring changes in the light reflexes as a method of determining the efficacy of surgical techniques is valid under very controlled conditions.

Esthetics↗
PubMed1989

Rhinoplasty: the retractable roof.

A new operative technique is described in which the natural curved nasal dorsum is retained in a modified fashion. Specifically, the nasal dorsum is elevated, the nasal height is reduced, and then the newly designed roof is lowered. Based on a minimum 1-year follow-up of 14 patients and a total experience of 28 patients, the procedure has the following advantages: (1) near normal anatomic structure is retained, (2) common secondary dorsal deformities are avoided, (3) the retained roof can function as a spreader graft, (4) the skin attachment with its attendant blood supply is preserved, and (5) the graft can be removed primarily or easily modified secondarily. Disadvantages appear to be the need for greater finesse and a limited follow-up of 2 years.

Adolescent↗
PubMed1988

High-voltage electrical injury: acute pathophysiology.

A reproducible high-voltage electrical injury model was established in the primate using a new approach to energy administration, measurement instrumentation, and data acquisition. Patterns of current repartition and temperature generation were examined in 24 primates. The predominant current load was carried in muscle, which is the tissue group occupying the largest cross-sectional area. Highest temperature values observed were in muscles of small cross-sectional diameter and in tissues of high inherent resistance. Surgeons should be aware of the principles and the pattern of current distribution when performing early debridement and/or definitive coverage procedures.

Animals↗
PubMed1988

High-voltage electrical injury: chronic wound evolution.

A chronic electrical burn model employing documentary and diagnostic techniques was designed in the primate for investigating wound evolution up to 10 days after injury. A standardized 40-kJ, 3500-V, 4.2-A, 2.5-s bilateral, symmetrical upper extremity electrical injury was performed. Gross observation studies documented tissue injury extending more proximally on the deep surfaces of individual muscles and between muscle layers. Specific regions, or "choke" points, in the forearm exist in which decreased cross-sectional areas and highly resistant tissue composition resulted in increased heat production and more severe tissue damage. Muscle injury was analyzed using light microscopy, revealing patchy cellular necrosis intermixed with viable cells. Digital subtraction angiography demonstrated segmental narrowing and "pruning" of large vascular trunks with a significant decrease in nutrient vessels in affected areas. Ulnar nerve conduction studies showed loss of conduction proximal to the cubital fossa with no recovery. Although characteristic patterns of injury were documented in skin, muscle, vessels, and nerves, no experimental evidence was found for progressive necrosis.

Angiography↗
PubMed1988

The minus-plus mastopexy.

The minus-plus mastopexy technique is designed for correction of moderate or major breast ptosis where breast volume is adequate but located in the lower quadrants and increased fullness in the upper quadrants is desired. The advantages of this procedure are absence of a medial scar, excellent projection, ensured nipple viability, speed, and flexibility.

Adult↗
PubMed1988

Rhinoplasty: nasal anatomy.

On the basis of over 100 fresh cadaver dissections as well as a review of nasal embryology and development, several important observations can be made regarding surgical anatomy of the nose. Within the bony vault, nasal profile modification consists of two distinct maneuvers: bony hump removal and modification of the nasofrontal groove area. The cartilaginous vault is in reality a unified, winged structure composed of septum and upper lateral cartilages. Within the nasal lobule, a continuous cartilaginous ring exists. The nose itself is covered by a superficial muscular aponenotic system.

Cartilage↗
PubMed1988

Rhinoplasty: image and reality.

The rhinoplasty surgeon must convert a mental image into a surgical reality through aesthetics, anatomy, and analysis. This article attempts to provide a reasoned solution to the recurrent difficulty of progressing from image to reality.

Humans↗