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PubMedDate not supplied

Rhinoplasty approaches: current state of the art.

OBJECTIVE: To survey rhinoplasty surgeons to determine their current approaches and the reason for their use, how they have acquired their knowledge, and trends in the use of open and closed approaches. DESIGN: A rhinoplasty questionnaire on open and closed rhinoplasty approaches was presented to surgeons attending the annual meetings of the American Academy of Facial Plastic and Reconstructive Surgery and the American Academy of Otolaryngology-Head and Neck Surgery. The 178 questionnaires were reviewed for analysis, and the results were tabulated by a statistician. Raw data were analyzed and cross-tabulations of specific subsets were reviewed. Main outcome measures included proportion of surgeons in various demographic groups using each technique, preferred incision, reasons for using each technique, usage over the past 5 years, and expected trend in the next 5 years. RESULTS: Most of the surgeons were in private practice, and most described their practice as otolaryngology (ear, nose, and throat [ENT]), facial plastic surgery (FPS), or ENT/FPS. Of the 178 responding surgeons, 46% had FPS practices and 27% devoted 90% to 100% of their practice to FPS. Most perform 100 or fewer rhinoplasties annually, and 23% perform open rhinoplasty 90% to 100% of the time. Sixty-three percent of FPS surgeons and 55% of ENT/FPS surgeons perform open septorhinoplasty (OSR) more than 50% of the time. Surgeons learn OSR mostly during residency (56%) and in didactic courses (51%) and learn closed rhinoplasty mostly during residency (75%). The most common indications for open rhinoplasty were difficult tip surgery (74%), revision procedures (73%), and grafting procedures (68%). Simple tip (65%) and simple dorsal (73%) procedures were common indications for closed rhinoplasty. The preferred incision for open rhinoplasty was the inverted "V" transcolumellar gull wing (58%); for closed rhinoplasty, cartilage delivery (48%) and intercartilaginous (28%). Most surgeons performed OSR at the same frequency during the past 5 years and expected to use OSR at the same frequency in the next 5 years. CONCLUSIONS: Overall, 53% of respondents used OSR more than 50% of the time. The movement toward open rhinoplasty seems to be plateauing, with a possible slight upward trend in its use. Over the past 5 years, there was still some trend toward the increasing use of the OSR approach, and most surgeons are performing OSR at the same frequency. Those with more than 5 years' experience believe that they are unlikely to change their approach in the next 5 years. Open septorhinoplasty may be indicated for rhinoplasties by a large proportion of surgeons, especially for rhinoplasties that are "difficult" or revisions or those requiring grafting.

Data Collection↗

PubMed2002

Differing characteristics in 100 consecutive secondary rhinoplasty patients following closed versus open surgical approaches.

Open rhinoplasty has unquestionably become more popular during the past two decades because of the putative diagnostic and technical advantages that direct transcolumellar access offers. To test the hypothesis that patients initially treated by the opened or closed approaches differed in the secondary deformities that developed, a retrospective study was conducted of 100 consecutive secondary rhinoplasty patients (66 women and 34 men) operated on by the author before February of 1998. Sixty-four percent had previously undergone closed rhinoplasties and 36 had undergone open rhinoplasties; the incidence of prior open rhinoplasty had increased steadily over the survey years, from 21 percent in 1996 to more than 50 percent in 1998, 1999, and 2000 (p < 0.05). The data generated indicate the following. First, the open rhinoplasty patients had undergone more operations (3.1 versus 1.2) and had more presenting complaints (5.8 versus 2.6) than the closed rhinoplasty patients. Second, although the most common presenting complaint among prior closed rhinoplasty patients was an overresected dorsum (50 percent) or tip (33 percent) or internal valvular obstruction (42 percent), prior open rhinoplasty patients complained more frequently than the closed rhinoplasty patients of these problems and also external valvular obstruction (50 percent, p < 0.0001), short nose (39 percent, p < 0.001), wide columella (36 percent, p < 0.001), narrow nose (31 percent, p < 0.001), columellar scar (25 percent, p < 0.001), and symptomatic columellar struts (19 percent, p < 0.001). Only excessive nasal length was more prevalent among closed rhinoplasty patients (20 percent, p < 0.01). Third, ranking of deformities differed significantly (p < 0.0001) between the two groups, so that complaints related to the nostrils, nasal tip, nasal length, or columella were more common among the open rhinoplasty patients than among those previously treated endonasally. Fourth, the relative frequencies of surgical complaints also differed: whereas patients previously treated endonasally were 6.7 times more likely to complain of long noses, patients previously treated by open rhinoplasty complained more frequently of the following: excessive columellar width (open approach, 36 percent of patients; closed approach, none), hard columellar struts (open approach, 19 percent of patients; closed approach, none), external valvular obstruction (4.5 times as frequent with the open approach as it was with the closed approach), alar/nostril distortion (four times as frequent), and narrow nose (3.9 times). Although the most common complaints among all postrhinoplasty patients remain the overresected dorsum, tip, or (internal valvular) airway obstruction, the author's data suggest that patients previously treated by the open approach are more likely to have postsurgical deformities and complaints referable to those anatomic structures most easily reached by transcolumellar exposure and to techniques that can be performed more readily or aggressively through that access route.

Adolescent↗

PubMedDate not supplied

Concurrent endoscopic sinus surgery and rhinoplasty.

BACKGROUND: Concerns over increased surgical risk and associated complications have been reported regarding concurrent endoscopic sinus surgery (ESS) and rhinoplasty procedures. The aim of this study was to evaluate the overall safety of these concurrent procedures in our experience. METHODS: A chart review was performed on 48 consecutive patients undergoing concurrent ESS and rhinoplasty between January 1998 and January 2005 with a mean follow-up of 12 months. The extent of surgical procedures, revisions required, and postoperative complications were documented. RESULTS: Thirty-one (65%) women and 17 (35%) men ranging in age from 16 to 56 years with a mean age of 37 years were included in this study. Forty-five patients (93.7%) underwent a primary rhinoplasty procedure, whereas the other three (6.3%) underwent a revision rhinoplasty. Four patients required minor rhinoplasty revision procedures for a rhinoplasty revision rate of 4/48 or 8.3%. Complications noted in three separate cases included partial nasal obstruction, pain near osteotomy site, and localized infection for a complication rate of 3/48 or 6.3%. CONCLUSION: In this study, rhinoplasty revisions did not appear to be related to the fact that ESS was performed at the same time as rhinoplasty. In addition, the only complication possibly attributed to a combined approach was a postoperative infection that developed in an insulin-dependent diabetic patient who underwent a rhinoplasty for functional reasons. Consequently, we recommend screening patients with poor wound healing factors in addition to those with acute exacerbations of chronic rhinosinusitis or severe chronic rhinosinusitis before performing concurrent ESS and rhinoplasty. In our experience, complications noted during concurrent ESS and rhinoplasty were minor, indicating the overall safe nature of this combined procedure when performed in appropriate patients.

Adolescent↗

PubMed2003

Cosmetic rhinoplasty in body dysmorphic disorder.

Body dysmorphic disorder (BDD) occurs in about 5% of patients seeking cosmetic surgery. Such patients are often dissatisfied with surgery or their symptoms of BDD are the same or worse after surgery. We report on a study that was designed to determine the frequency of BDD in patients requesting cosmetic rhinoplasty in the UK and to compare them with BDD patients in a psychiatric clinic. In the first stage of the study, we used a screening questionnaire for BDD and found that 20.7% of patients requesting rhinoplasty had a possible diagnosis of BDD. However, we believe that we identified a group of patients with sub-clinical or very mild BDD who are satisfied by cosmetic rhinoplasty. In the second stage of the study, we compared (a) patients without BDD who had a good outcome after cosmetic rhinoplasty with (b) BDD patients seen in a psychiatric clinic (who crave cosmetic rhinoplasty but for a variety of reasons do not obtain it). We found that BDD patients seen in a psychiatric clinic who desire cosmetic rhinoplasty are a quite distinct population from those obtaining routine rhinoplasty without symptoms of BDD. BDD patients are significantly younger, more depressed and anxious than this group, and are more preoccupied by their nose and check their nose more frequently. They are more likely to conduct "D.I.Y" surgery and have multiple concerns about their body. They are more likely to be significantly handicapped in their occupation, social life, and in intimate relationships and to avoid social situations because of their nose. They are therefore more likely to believe that dramatic changes would occur in their life after a rhinoplasty. This study provides some clues for surgeons who wish to identify patients with BDD who might have a poor prognosis in cosmetic rhinoplasty. Further research is required in the development of a screening questionnaire or interview for identifying patients with BDD seeking cosmetic surgery.

Adult↗

PubMed2001

Importance of the nasal-to-cervical relationship to the profile in rhinoplasty surgery.

There is general agreement that when discussing surgery with the prospective rhinoplasty patient, one may also include discussion of the chin because of the important interrelationship between these two regions. It is apparent that on the profile-lateral view, the four prominences-the forehead, nose, chin, and neck-balance and complement one another. The cervical region, the fourth dimension, was examined to estimate the aesthetic significance of the nasal-to-cervical relationship and to determine the implications to rhinoplasty surgery. Part I of the study was a survey to test the hypothesis that the cervical region affects the perceived impression of the nose. Four standard facial-profile black-and-white photographs were chosen to represent varying degrees of nasal dorsum hump and cervical ptosis problems. Using computer-altering software, only the cervical regions were altered to create a pair of photographs for each of the four profiles: one with a youthful-looking non-ptotic cervical region, the other with a ptotic aged-looking cervical region. Raters were asked to give their first-impression opinions of which nose subjectively appeared "better." Raters consistently (84 percent of the time) chose the nose on the faces with the less ptotic neck as being better. Therefore, a less ptotic neck improved the perceived appearance of the nose. Part II was a retrospective chart review of the rhinoplasty patients of a single surgeon by independent raters. To estimate the aesthetic significance of the nasal-to-cervical relationship, the proportion of patients undergoing rhinoplasty surgery who could have potentially benefited from a youth-restoring neck procedure was determined. Criteria originally described by Ellenbogen and Karlin for judging the results of youth-restoring neck procedures were used as relative indications for neck surgery. An average of 27.2 percent of the patients did not have visible criteria and therefore by definition had relative indications for neck-rejuvenating procedures when undergoing rhinoplasty surgery. As demonstrated in part I of the study, improving the neck could improve the perceived results of the rhinoplasty. Part III of the study validated the Ellenbogen and Karlin criteria. The present authors found that the original criteria were probably based on female patients, that male and older patients had more indications for surgery, and that there was significant interrater agreement with the youthful criteria. In summary, the authors established that a strong nasal-to-cervical relationship exists whereby the perceived appearance of the nose is affected by the neck. The significance of this relationship to rhinoplasty surgery was determined, and it was found that more than 27 percent of rhinoplasty patients could obtain better perceived nasal results with a concomitant neck-rejuvenating procedure. Consequently, discussing neck-rejuvenating procedures with the rhinoplasty patient is valuable.

Adolescent↗

PubMed1996

Vascular anatomy of the nose and the external rhinoplasty approach.

OBJECTIVE: To characterize the venous, lymphatic, and arterial blood supply of the nose and determine the effect of the external rhinoplasty approach on this vasculature. We hypothesized that dissection in the areolar tissue plane below the musculoaponeurotic layer of the nose will preserve the nasal vasculature and minimize postoperative nasal tip edema. DESIGN: The study included preoperative and postoperative clinical evaluation, cadaver dissection, and histologic examination. In the clinical section, lymphoscintigraphy was performed before and after rhinoplasty using the endonasal (transnostril) or external (open) approach. Additionally, nasal tip edema was subjectively quantified at specified interval after surgery. In the cadaver dissection section, 15 fresh cadavers were dissected to identify the venous and arterial vasculature. In the histology section, fresh nasal tissue was examined by light microscopy to verify the anatomy of arteries, veins, and lymphatic vessels. SETTING: Subjects for the clinical section of the study were volunteers undergoing primary rhinoplasty surgery at the University of Illinois College of Medicine at Chicago. PATIENTS: Lymphoscintigraphy was performed on nine patients who underwent rhinoplasty surgery. Seven of these patients underwent postoperative lymphoscintigraphy. INTERVENTIONS: The rhinoplasty procedures included three different methods of exposure of the nasal structures. Two patients underwent an endonasal (transnostril) nondelivery approach using a transcartilaginous incision. Five patients underwent the external approach with three receiving dissection in the areolar tissue plane below the musculoaponeurotic layer (preserving major nasal vasculature) and two undergoing dissection above the musculoaponeurotic layer (disrupting nasal vasculature). MAIN OUTCOME MEASURES: In the clinical section of the study, the outcome measures were tracer flow as seen on lymphoscintigraphy and tip edema scores subjectively quantitated on a scale from 1 (none) to 4 (maximal). RESULTS: Clinical Section: Lymphoscintigraphy revealed flow of tracer along the lateral aspect of the nose (cephalic to lateral crura) to the preparotid lymph nodes. Postoperative scans revealed preservation of flow of tracer with the endonasal (transnostril) approach and the external approach with submusculoaponeurotic areolar tissue plane dissection. There was loss of normal flow of tracer with the external approach using dissection that disrupted the musculoaponeurotic layer with supratip debulking. The nasal tip edema scores for the transnostril and external approach using areolar plane dissection were significantly lower than the external approach with disruption of the musculoaponeurotic layer. Cadaver Dissection Section: Other than the lateral nasal veins, the major arteries, veins, and lymphatic vessels ran superficial to the musculoaponeurotic layer of the nose. The lateral and dorsal nasal and the columellar arteries comprise an alar arcade that provides the major blood supply to the flap elevated in the external rhinoplasty approach. Histologic Section: Light microscopy of plastic resin sections verified the lymphoscintigraphic and cadaver dissection findings. The lymphatic vessels were located primarily in the reticular dermis above the muscle layer. CONCLUSIONS: The major arterial, venous, and lymphatic vasculature courses in or above the musculoaponeurotic layer of the nose. In the external rhinoplasty approach, dissection in the areolar tissue plane below the musculoaponeurotic layer will minimize tip edema and protect against skin necrosis by preserving the major vascular supply to the nasal tip.

Cadaver↗

PubMedDate not supplied

Simultaneous open rhinoplasty and alar base excision for secondary cases.

BACKGROUND: Simultaneous open rhinoplasty and alar base excision are a very safe procedure for protecting the vascular supply of the nasal dip and the columellar skin in primary cases when surgical dissection is performed below the musculoaponeurotic layer of the nose. Major arteries of the external nose lie above the musculoaponeurotic layer. However, secondary cases may pose increased risks to the blood supply of the nasal tip and columella skin because of the decreased vascular supply and increased scar tissue from the previous rhinoplasty. We studied our secondary cases of simultaneous open rhinoplasty and alar base excision, to assess the real risk for necrosis of the nasal tip and columellar skin. METHODS: A total of 12 secondary patients (6 men and 6 women) underwent simultaneous open rhinoplasty and alar base excision in the past 3 years. Their average age was 27 years (range, 21-35 years). The average follow-up period was 15 months (range, 1-35 moths). A modified grading system, originally described by Bafaqeeh and Al-Qattan, was used for assessment of the blood supply in the nasal tip and the columellar skin. RESULTS: Satisfactory results were obtained for our patients, with the exception of one case. Grade 3 vascular compromise to the nasal tip and the columella was observed in one case, but the patient healed well with wound care treatment. CONCLUSION: Simultaneous alar base excision and open rhinoplasty can be performed safely in secondary cases. However some surgical maneuvers such as subcutaneous pocket preparation for the tip graft in closed rhinoplasty and subdermal defatting in the first rhinoplasty as well as previous scarring on the nasal lobule can disrupt the vascular supply of the nasal tip and columella skin. Under these conditions, alar base excision should be deferred and then performed as an isolated excision procedure.

Adult↗

PubMedDate not supplied

Surgical maneuvers performed on rhinoplasty procedures carried out at an otorhinolaryngology residency program.

UNLABELLED: Rhinoplasty is one of the most challenging surgical procedures, due both to the diversity of the techniques and to the difficulty in foreseeing long-term outcomes. Each patient has a different nasal anatomy, dictated by genetic inheritance--race, thus requiring a different technique for each case. The international literature emphasizes the techniques used for the Caucasian nose, which is rarely seen in our region. AIM: Evaluate and discuss surgical maneuvers used on rhinoplasty procedures performed on local patients at our ENT residency services. MATERIALS AND METHODS: We evaluated the operative notes from all patients submitted to rhinoplasty at the Residency Program on Otorhinolaryngology at the Federal University of Uberlândia, from December 2003 to June 2004. RESULTS: One hundred and sixty-six patients were submitted to rhinoplasty, in which marginal incisions were performed in 118 (71.1%), with the delivery technique performed on the inferior lateral cartilages and some procedures carried out on them (strut, sheen, sutures, etc). Only 45 patients (27.1%) were submitted to basic rhinoplasty and 3 (1.8%) to open rhinoplasty. CONCLUSION: Most of our patients demanded additional procedures, and the "basic rhinoplasty", commonly performed on the Caucasian nose was an exception on our patients.

Cartilage↗

PubMed2005

Steroids in rhinoplasty: a survey of current UK otolaryngologists' practice.

The use of steroids during rhinoplasty to reduce post-operative periorbital oedema and ecchymosis has been advocated. A number of randomized controlled trials have demonstrated the benefit of steroids in rhinoplasty. The aim of this study was to determine current UK practice in the use of steroids during rhinoplasty performed by otolaryngologists. A postal survey of consultant otolaryngologists in the UK was conducted. We received 203 responses, with 115 consultants performing 12 or more rhinoplasties per year. Only 28 consultants (24 per cent) used steroids routinely in patients undergoing rhinoplasty and of these 11 used a protocol, although this was unpublished. Dexamethasone was the most common steroid used (82 per cent), being administered as a single intravenous dose of 8 mg in the majority of cases (54 per cent). There was no correlation between the use of steroids and the number of rhinoplasties performed by individual consultants. Despite the evidence supporting the use of steroids to reduce post-operative sequelae following rhinoplasty, only a minority of consultants in the UK appear to use them as part of their practice.

Anti-Inflammatory Agents↗

PubMed1996

The use of the labiocolumellar crease incision in rhinoplasty.

Aurel Rethi, in 1934, first described the transverse upper columellar incision for open rhinoplasty for resection of a portion of columella in cases of overly projecting nasal tip. The mid columellar incision has come to be known as the "Rethi" incision. Numerous variations of this approach have been popularized through the years. Recently, a great debate has raged over the criteria to be used in selecting patients for rhinoplasty. In this paper, we review 100 consecutive rhinoplasties and discuss our technique of labiocolumellar crease incision for open approach, and relate the criteria that we utilize to select patients for open rhinoplasty. There were 37 male and 63 female patients. Of these, 32 primary, 45 secondary, 18 cleft, and 5 reconstructive rhinoplasties were performed. Twenty-eight percent of primary, 62% of secondary, 78% of cleft, and 80% of reconstructive rhinoplasties were performed using the open approach via the labiocolumellar crease incision. There were no cases of circulatory compromise of the columella. The presence of a scar along the columella base (as with the C-flap in cleft patients) should be an indication for open rhinoplasty. Several myths about the labiocolumellar crease incision are dispelled. Adhering to principles of aesthetic subunits should guide the surgeon to place scars in a less noticeable position.

Adult↗

PubMed1999

Anatomic reconstruction of the nasal tip cartilages in secondary and reconstructive rhinoplasty.

Most techniques for secondary rhinoplasty assume that useful residual remnants of the tip cartilages remain, but frequently the alar cartilages are missing--unilaterally, bilaterally, completely, or incompletely--with loss of the lateral crura, middle crura, and parts of the medial crura. In such severe cases, excision of scar tissue and the residual alar remnants and their replacement with nonanatomic tip grafts have been recommended. Multiple solid, bruised, or crushed cartilage fragments are positioned in a closed pocket or solid shield-shaped grafts are fixed with sutures during an open rhinoplasty. These onlay filler grafts only increase tip projection and definition. Associated tip abnormalities (alar rim notching, columellar retraction, nostril distortion) are not addressed. Problems with graft visibility, an unnatural appearance, or malposition have been noted. Fortunately, techniques useful in reconstructive rhinoplasty can be applied to severe cosmetic secondary deformities. Anatomic cartilage replacements similar in shape, bulk, and position to normal alar cartilages can be fashioned from septal, ear, and rib cartilage, fixed to the residual medial crura and/or a columellar strut, and bent backward to restore the normal skeletal framework of the tip. During an open rhinoplasty, a fabricated and rigid framework is designed to replace the missing medial, middle, or lateral crus of one or both alar cartilages. The entire alar tripod is recreated. These anatomic alar cartilage reconstructive grafts create tip definition and projection, fill the lobule and restore the expected lateral convexity, position the columella and establish columellar length, secure and position the alar rim, and brace the external valve against collapse, support the vestibular lining, and restore a nostril shape. The anatomic form and function of the nasal tip is restored. This technique is recommended when alar cartilages are significantly destroyed or absent in secondary or reconstructive rhinoplasty and the alar remnants are insufficient for repair. Anatomically designed alar cartilage replacements allow an aesthetically structured skeleton to contour the overlying skin envelope. Problems with displacement are minimized by graft fixation. Graft visibility is used to the surgeon's advantage. A rigidly supported framework with a nasal shape can mold a covering forehead flap or the scarred tip skin of a secondary rhinoplasty and create a result that may approach normal. Anatomic alar cartilage reconstructions were used in eight reconstructive and eight secondary rhinoplasties in the last 5 years. Their use in the repair of postrhinoplasty deformities is emphasized.

Cartilage↗

PubMedDate not supplied

[Open rhinoplasty: indications and limits of a controversial method].

As Aufricht has said, rhinoplasty is "... an easy operation to do, but it is hard to get good results". As it clearly observed in ENT rhinoplasties which deal with severe and combined defects of the nose which result in functional impairment. The aim of this study was to analyse complications in a personal series of open rhinoplasties as well as those in literature in order to standardize different surgical approaches possible in correcting various nasal deformities, divided according to a personal classification. Other than the classical intramucosal technique (following Roe, Joseph and Weir), the more conservative extramucosal operation (described by Jost and Aiach) and the more aggressive external approach are available to the surgeon. Intramucosal rhinoplasty is still the most dependable and widely used technique. However open rhinoplasty which brings about complications in less than 10% of the procedures, offers clear-cut advantages if employed following precise indications. In our experience, the main indications for open rhinoplasty are: severely crooked nose, above all of the II and III arch: crooked nose with saddle deformity; asymetrical defects (including those due to a cleft lip); 50% of the secondary rhinoplasties (excluding minor procedures).

Adult↗

PubMed1977

[Middle ear pressure after rhinoplasty surgery (author's transl)].

Middle ear pressure after rhinoplasty surgery was determined by tympanometry. Measurings were done in 94 patients (total of 177 ears) before the rhinoplasty operation and during the following 6 days respectively in special cases up to three weeks. In 153 ears normal middle ear pressure was found before the operation. After the rhinoplasty in about 2/3 of all cases negative pressure up to 300 mm Ws developed. This negative pressure was equalized in the vast majority of cases (84.3%) after the tamponade was removed. In some cases negative pressure persisted for 6 days after the operation (9.8%); in few cases (5.9%) up to three weeks. In 13 out of 24 patients having negative middle ear pressures together with rhinomanometrically objectified impaired nasal ventilation rhinoplasty led to normal middle ear pressure. Reasons for the development of negative pressures in the middle ear are discussed. The results of the investigations lead to consequences concerning tympanoplasty in connection with rhinoplasty operations. Rhinoplasty and tympanoplasty should not be performed on the same day--there should be an intervall of 4--6 days between these operations. Negative pressure in the middle ear in cases of impaired nasal ventilation can be improved by rhinoplasty.

Airway Obstruction↗

PubMedDate not supplied

Postauricular cartilage storage in rhinoplasty.

In the past decade, the number of patients demanding rhinoplasty has increased, and this has increased the use of grafts. Although different materials are used as grafts, cartilage is the most popular one. In secondary rhinoplasties the need for cartilage is very frequent. The most suitable cartilage grafts are the ones extracted during primary rhinoplasty. These grafts are disposed of after the operation and in a secondary operation, grafts are obtained from a new donor site. In our department, the surplus cartilages obtained during primary rhinoplasties of the patients who are thought to be probable secondary rhinoplasty candidates are stored in a postauricular pocket after their volumes are measured and marked down. In the secondary operations the volume of the grafts are measured again and the grafts are used. We have found out that there is no significant difference between the initial and secondary volumes of lower lateral cartilages (3.6% of initial volume is lost), but the difference between the initial and secondary volumes of septal cartilages is significant (6.9% of initial volume is lost), and the stored cartilages are sufficient qualitatively and quantitatively for the secondary rhinoplasties.

Cartilage↗

PubMed2005

Complications associated with isotretinoin use after rhinoplasty.

BACKGROUND: This study aimed to evaluate the association between the postoperative use of isotretinoin and the formation of nasal tip deformities after rhinoplasty. METHODS: A retrospective study investigated a case series of patients who presented with nasal tip deformities subsequent to the use of isotretinoin after rhinoplasty. Patients who had taken isotretinoin after rhinoplasty were identified from a single surgeon's case log. Clinic charts and operative reports were reviewed. Predisposing factors and time intervals to complications were identified. RESULTS: Three patients were found to have undergone isotretinoin therapy after rhinoplasty. Nasal tip deformities included bossa formation, asymmetry, and prominence of a composite graft. All three patients required subsequent procedures to repair soft tissue nasal tip deformities. In all three cases, isotretinoin was started within 2 years of the primary rhinoplasty. The nasal tip deformities were first observed within 6 months after isotretinoin was started. CONCLUSIONS: Three cases are described in which postoperative use of isotretinoin was associated with nasal tip deformities after rhinoplasty. Further studies are needed to investigate this possible causative relationship and to describe the risks involved.

Adolescent↗

PubMedDate not supplied

Repetitive reconstructive rhinoplasty.

Plastic surgeons have the appropriate knowledge and clinical experience to perform a rhinoplasty. In the past 8 years, the authors have received for consultation some patients who had already undergone more than one rhinoplasty. As this shows, the specialist must be familiarized with the surgical technique specific for each case and its respective terminology. The authors propose the use of "repetitive reconstructive rhinoplasty" in referring to all the patients who for different reasons come to the specialist for a new rhinoplasty after a minimum of three surgeries performed previously. It must be emphasized that the plastic surgeon assumes the responsibility for choosing to perform repetitive reconstructive rhinoplasty, incurring the legal risk that the aesthetic or functional results may not satisfy the patient's expectations. One of the principal reasons for introducing repetitive reconstructive rhinoplasty emphasizes the "reconstructive" rather than the "aesthetic" role, whereas the legislation in many countries interprets the word "aesthetic" to imply an obligation for results that approximate perfection.

Female↗

PubMed2006

Repair of nasal complex fractures and the need for secondary septo-rhinoplasty.

PURPOSE: This study was undertaken to evaluate the efficacy of closed reduction of nasal fractures and determine the incidence of the need for post-traumatic septo-rhinoplasty in the management of residual nasal deformities. PATIENTS AND METHODS: Medical records of all patients with nasal fractures evaluated and treated by the Division of Oral and Maxillofacial Surgery at the University of Florida Health Science Center, Jacksonville, FL between January 2001 and October 2004 were retrospectively evaluated. Out of a total of 344 patients, 50 patients met the inclusion criteria. Forty-four patients (group A) underwent closed reduction of nasal bones and septum along with a septoplasty if needed within 2 weeks of initial injury. Six patients (group B) could not tolerate any surgical intervention because of multisystem injury or comorbidities. All 50 patients were then followed up in the Division of Oral and Maxillofacial Surgery to determine overall efficacy of the initial treatment modality, as well as the need for secondary post-traumatic septo-rhinoplasty. Group A was then further subdivided into groups A1 and A2. Group A1 consisted of patients who underwent a closed reduction of their nasal complex fracture without a residual deformity or the need for a secondary post-traumatic septo-rhinoplasty. Group A2 consisted of patients who underwent a closed reduction of their nasal complex fracture and developed a secondary nasal deformity significant enough to require a septo-rhinoplasty. RESULTS: The follow-up period ranged from 1 week to 12 months. Nine patients in group A were lost to follow-up. Patients in group A1 (31 patients) were pleased with their results and did not require a secondary surgery. Four patients developed a post-traumatic nasal deformity requiring a post-traumatic septo-rhinoplasty (group A2). All patients in group B required post-traumatic septo-rhinoplasty. CONCLUSION: Closed reduction of nasal fractures appears to be an effective method of treatment as long as careful attention is paid to the key regions in the nasal complex, including the septum at the initial time of treatment. Ideal results are obtained when surgery is performed within 2 weeks of initial injury. Factors such as timing of surgery, the status of the nasal septum, delay in treatment, and other associated injuries may influence the overall result.

Adolescent↗

PubMed2003

Auricular cartilage in revision rhinoplasty.

Revision rhinoplasty is a challenge in reconstruction to the rhinoplasty surgeon, both in the techniques of repair and the choice of implant material for augmentation grafting. Often, patients seeking revision or reconstructive rhinoplasty have previously undergone septoplasty with sacrifice of major amounts of septal cartilage. These situations confront the surgeon with the need for a decision about the material that will be used for structural grafting. The senior author follows the time-tested approach of generations of surgeons who have used exclusively autogenous material for nasal reconstruction because of its superior long-term survival characteristics, its ready availability in the head and neck region, its resistance to infection and resorption, and its bendability and flexibility when implanted in the nose. With this in mind, the subject of this article is the use of auricular cartilage in revision rhinoplasty. Careful strategic planning must be undertaken to get the maximal and ideal benefit from the auricular cartilage. The revision rhinoplasty surgeon must understand the anatomy of the external ear and must be able to manage the precious cartilage supply to get the maximum use of it in reconstructive rhinoplasty.

Ear Cartilage↗