Biomedical subjects
Publications and source records attributed to Russell W H Kridel.
This article reviews the case of a 31-year-old female who had originally sustained a softball injury to her face and nose. Four years after the injury, she underwent her first rhinoplasty, which included spreader grafts. Unfortunately, a few months later, she sustained further nasal trauma, motivating her to seek a revision septo-rhinoplasty.
In the patient who undergoes revision rhinoplasty, tip grafts are used often when overresection has resulted in structural deficit of deformity. As a result, the last 20 years have witnessed a progressive movement toward more conservative handling of the nasal tip. Still, as some surgeons have not adopted that philosophy and because many more surgeons have not adopted that philosophy and because many more surgeons now take on difficult primary tip problems because of the advent of the external approach, major tip problems continue to plague the final result. Despite these potential variables, when used correctly, the tip graft is critical in achieving the successful reconstruction of the nasal tip region. This article reviews the indications and techniques for tip grafts in revision rhinoplasty and explores how these indications and techniques for tip grafts in revision rhinoplasty and explores how these indications could be prevented in the primary setting.
An otherwise attractive nose can be diminished aesthetically if the relationship of the nostril border and ala to the columella is not refined and proportional. Compared with other aspects of rhinoplasty, there has been little attention devoted to the proper diagnosis and treatment of alar columellar disproportion. This article highlights the relevant anatomic components, defines the proper alar columellar relationship, systematically analyzes the different types of alar columellar dis proportion, and stresses the importance of identifying the causative factors in formulating the optimal treatment plan, with particular emphasis on applications to revision rhinoplasty.
Nasal septal perforations present a distinct challenge to the facial plastic surgeon. A clearcut causal factor must be established from a long, diverse list of potential causes. Surgical repair presents a complex technical challenge, because a septal perforation is a hole in three distinct contiguous layers composed of both right and left septal mucoperichondral flaps and the intervening cartilage, all three of which must be separated from each other and repaired individually. This article describes presenting symptoms and findings for septal perforations, the history and physical examination, causes, helpful hints for prevention of perforations, and surgical and nonsurgical treatment options and outcomes.
Nasal cysts are rare complications of rhinoplasty, and numerous theories exist regarding their cause. The term "paraffinoma" has been used to describe cyst formation observed after topical antibiotic ointment application with nasal packing in the immediate postoperative period. Such complications are rare but may occur because of the inherent properties of the agent used or a lack of meticulous technique (in the placement of incisions and nasal packing). Three cases of postrhinoplasty cysts with a variety of presentations, including incidental intraoperative findings, bilateral medial canthal masses, and a draining dorsal cyst, are described. Although such cysts are uncommon, techniques to prevent these unwanted sequelae should routinely be used, with the judicious application of non-petroleum-based topical antibiotic preparations.
OBJECTIVE: To describe the technique for correction of the soft tissue pollybeak deformity using intralesional injection of triamcinolone acetonide. METHODS: We discuss our philosophy, regimen, and technique for treatment of the soft tissue pollybeak using triamcinolone injection. We include results from a series of 173 patients who underwent rhinoplasty performed by one of us (N.J.P.). RESULTS: Triamcinolone was injected at 1 week after surgery in 127 patients (73%). A second injection was performed in 92 (72%) of the 127 patients at 4 weeks after surgery. One hundred eight (85%) of the 127 patients had an acceptable result, as judged by the surgeon, with good supratip definition. Nineteen (15%) of the 127 patients had a less than optimal result, with residual supratip fullness, as judged by the surgeon. There were no complications caused by triamcinolone injection. CONCLUSIONS: Because revision surgery is difficult and may be associated with complications, intralesional triamcinolone injection is the first-line treatment for the soft tissue pollybeak deformities caused by subdermal scarring. Should intralesional steroid injection fail to satisfactorily treat the deformity, revision rhinoplasty can subsequently be performed.
Asymmetrical alar flare without a history of trauma, surgery, or congenital clefting is extremely rare; therefore, a thorough investigation into the underlying reasons for the asymmetry should be undertaken before a unilateral alar base resection is performed. Nasoalveolar cyst is a readily apparent diagnosis that should not be missed after proper intranasal and intraoral examination. Excision is recommended via a sublabial approach. We describe a patient in whom a unilateral alar base reduction was initially recommended, when in fact she had a nasoalveolar cyst. We also discuss the histologic characteristics, embryological pattern, and differential diagnosis.
Patients seeking rhytidectomy desire an improved neckline, jawline, and midface, but rarely at the price of signs that betray a face-lift, namely, visible incisions. We describe our face-lift incisional planning and the rationale behind specific surgical maneuvers for preventing unwanted sequelae. The telltale signs of poorly placed incisions include temporal hair loss, conspicuous scars, an unnatural appearance to the tragus, and a posterior hairline distorsion. Special considerations are given to the male patient and to the salvage of readily visible incision lines from previous surgery.
OBJECTIVE: To describe our experiences with nasal tip bossae, suggest a standard nomenclature, discuss causative factors, and provide a comprehensive, analytic approach to the prevention and correction of bossae. BACKGROUND: Nasal tip bossae are knoblike protuberances of the alar cartilages that can arise after rhinoplasty. Early bossae are due to uncorrected or inadvertently created asymmetries, while late bossae are due to fibrosis and scar contracture acting on a weakened or unreconstituted cartilaginous framework. Numerous techniques may be used to prevent and treat bossae; however, we found no article in the existing literature that presents an in-depth, analytic description of management techniques. METHODS: We analyzed the predisposing factors and techniques leading to bossa formation and studied principles of prevention and correction. All rhinoplasty cases that presented for revision from 1985 through 2000 were reviewed for bossae formation via internal computer search. Previous operative records for rhinoplasty cases were examined when available. Intraoperative notes and photgraphs of the revision surgery were examined. RESULTS: Etiologies for bossae were consistently found, and successful treatment modalities were noted. CONCLUSIONS: Nasal tip bossae are most often due to dynamic forces acting on iatrogenic changes and/or weakness in the alar cartilages. By minimizing cartilage excision, reinforcing areas of weakness, avoiding asymmetry and irregularity, and maintaining alar integrity, formation of bossae may be prevented. The treatment of bossae must be individualized and can range from simple suture stabilization techniques to complex domal cartilage replacement grafts, depending on the observed defect.
OBJECTIVES: To simplify the approach and diagnosis of alar base reduction, suggest a treatment algorithm, and evaluate the long-term outcomes of 3 different techniques used separately or in conjunction with one another. DESIGN: Retrospective review of 124 patients seen in a private practice by a single surgeon. Patients ranged in age from 15 to 59 years (mean age, 30.4 years). Patients were undergoing primary (83.9%) or revision (16.1%) procedures. RESULTS: Of the 124 patients undergoing alar base reduction, 31 (25%) were male and 93 (75%) were female. Average follow-up was 2 years. All patients underwent wedge excision, and for 64 patients (51.6%), this was the only technique used on the alar base. Alar wedge and nasal sill excisions were performed in 21 patients (16.9%); 19 (15.3%) underwent alar wedge excision with V-Y advancement, and 20 (16.1%) underwent alar wedge excision, nasal sill excision, and V-Y advancement. Thirty-one patients (25.0%) received dermabrasion for notable postoperative incision scars. CONCLUSIONS: The data represent the senior author's outcomes of alar base reductions over the past 20 years. The 3 techniques we describe have been effective when used alone or in combination in reducing alar flare and in narrowing the nasal base. Patients should be counseled that dermabrasion of the wedge excision areas in the alar-facial groove may be necessary to diminish visible scars.
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.