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Fallahi HR, Keyhan SO, Fattahi T, Mohiti AK. Comparison of Piezosurgery and Conventional Osteotomy Post Rhinoplasty Morbidities: A Double-Blind Randomized Controlled Trial. J Oral Maxillofac Surg 2019; 77:1050-1055. [DOI: 10.1016/j.joms.2019.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 01/05/2019] [Accepted: 01/05/2019] [Indexed: 11/29/2022]
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Supercooled Liquid Serum Physiologic Solution Instantly Crystallized on the Nurse Table Used for Cooling of Periorbital Region During Rhinoplasty. Aesthetic Plast Surg 2019; 43:453-456. [PMID: 30535556 DOI: 10.1007/s00266-018-1287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Formation of less periorbital ecchymosis in post-operative period of rhinoplasty is a popular trend. We present the use of instantly crystallizing supercooled serum physiologic solution for periorbital cooling. PHYSICS OF SUPERCOOLING There are circumstances in which water temperature drops below its freezing point, but no phase transition happens while water remains in the liquid phase. This is called supercooling. Pure water can be supercooled below the freezing temperature without transforming into ice. Tap water will not supercool because it contains impurities that serve as nucleation sites for crystallization. For freezer temperatures in the range of - 4 °C, - 6 °C, and - 8 °C, nucleation was not observed and pure water remained in the supercooled condition for a long time. DESCRIPTION OF THE TECHNIQUE Sterile serum physiologic solution at + 5 °C can be supercooled in the freezer at - 14 °C only between the 257 and 277 min time interval. But when it is supercooled in the freezer at - 8 °C it is possible to save it in liquid form for at least 7 days as we have observed in our trials. CLINICAL USE AND DISCUSSION It is easily possible to transform this supercooled liquid sterile serum physiologic within a few seconds into moldable snow-like ice that can be used safely and more nicely rather than solid ice for periorbital cooling in rhinoplasty operations. Its sterile inner bag is held tight and struck over the sterile nurse table and it crystallizes within a few seconds. For frozen solutions, tearing of the inner plastic bag and extracting the ice and then crushing of big masses of ice to small pieces is exhaustive and a time-consuming process. The temperature of the supercooled fluid will be zero at the moment of nucleation with no risk of frostbite. The crystallized serum physiologic solution preserves its ice-gel form for nearly 25 min. CONCLUSION The instant crystallization of supercooled liquid serum physiologic solution can be applied as a tissue cooling method in rhinoplasty and in several other surgical procedures. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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New Technologies in Rhinoplasty: A Comprehensive Workflow for Computer-assisted Planning and Execution. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2121. [PMID: 31044106 PMCID: PMC6467623 DOI: 10.1097/gox.0000000000002121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
Abstract
Rhinoplasty in facial cleft patients is among the most challenging types of reconstructive facial surgery due to its variability. Advances in 3-dimensional imaging enable improved preoperative assessment in rhinoplasty. In complex cases with bony support irregularities and asymmetry, it is rational to initiate planning with reconstruction of the aberrant substructure (ie, “bottom-up” planning) rather than starting the surgical design with soft-tissue morphing. We present a new comprehensive workflow in which novel advanced technologies are implemented to perform “bottom-up” computer-assisted planning and execution in complex rhinoplasty cases. This workflow enables meticulous planning, use of grafting templates, and 3-dimensional–guided osteotomies with integration of piezotome and intraoperative navigation. Previous reports separately discuss some of these innovations. However, greater benefit lies in the combination of these techniques, with emphasis on preoperative computer analysis, virtual planning, and transfer to the operation theater. Surgeons are seeking new ways to enhance minimally invasive approaches and to obtain predictable and favorable clinical results. The presently introduced workflow allows clinicians to plan complex cases in a simple, effective, and safe manner, with the combination of different techniques to produce consistent results.
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Severe Delayed Hemorrhage After Cosmetic Rhinoplasty in the Setting of Maxillary Vascular Malformation. Ann Plast Surg 2018; 81:146-147. [DOI: 10.1097/sap.0000000000001492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yu MS, Jung MS, Kim BH, Kang SH, Lim DJ. Aerosolized Fibrin Sealant Is Effective for Postoperative Edema and Ecchymosis in Open Rhinoplasty Without Osteotomy. J Oral Maxillofac Surg 2018; 76:2000.e1-2000.e8. [PMID: 29908888 DOI: 10.1016/j.joms.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Fibrin sealant (FS) was approved as a hemostatic agent, sealant, and adhesive by the Food and Drug Administration in 1998. Our study sought to determine whether FS also reduced edema and pain in rhinoplasty without osteotomy. MATERIALS AND METHODS We conducted a prospective randomized trial involving patients who underwent open rhinoplasty without osteotomy. The patients were randomly assigned to 1 of 2 groups: those treated with aerosolized FS (FS group) and those not treated (control group). The effect of FS on edema of the eyelid, edema of the dorsum and tip of the nose, and periorbital ecchymosis was separately rated postoperatively using a scale of 0 to 4 or 0 to 3. Postoperative pain was evaluated using questionnaires quantified with a visual analog scale. The Mann-Whitney U and Wilcoxon tests were used to compare parameters between the groups. RESULTS A total of 41 patients were included in this study. The FS group (n = 20) consisted of 13 male and 7 female patients with a mean age of 34.8 ± 5.8 years. The control group (n = 21) consisted of 15 male and 6 female patients with a mean age of 32.4 ± 4.8 years. There were no statistically significant differences between the 2 groups with respect to age, gender, or combined surgical techniques (P > .05). Aerosolized FS significantly reduced not only ecchymosis and swelling in the periorbital area but also edema of the nasal dorsum (P < .05). CONCLUSIONS Aerosolized FS can be effective for reducing eyelid edema, dorsal edema, and periorbital ecchymosis after open rhinoplasty. FS may serve as an adhesive for minimizing dead space by promoting adherence of the skin flap and as a hemostatic agent in reducing the amount of postoperative bleeding by sealing capillary vessels.
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Affiliation(s)
- Myeong Sang Yu
- Professor, Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Moon Sik Jung
- Resident, Department of Otolaryngology, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Bo-Hyung Kim
- Professor, Department of Otolaryngology, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Sung-Ho Kang
- Professor, Department of Otolaryngology, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Dae Jun Lim
- Professor, Department of Otolaryngology, Konkuk University School of Medicine, Chungju, Republic of Korea
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Mehdizadeh M, Ghassemi A, Khakzad M, Mir M, Nekoohesh L, Moghadamnia A, Bijani A, Mehrbakhsh Z, Ghanepur H. Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis. Aesthetic Plast Surg 2018; 42:246-252. [PMID: 28980055 DOI: 10.1007/s00266-017-0969-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard. METHODS A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0-4. Periorbital edema and ecchymosis were examined in all groups. RESULTS In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT. CONCLUSION Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mohammad Mehdizadeh
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Alireza Ghassemi
- Consultant Oral and Maxillofacial Surgeon, Klinikum Lippe, Academic Hospital of the University of Göttingen, Detmold, Germany
- Medical Faculty University RWTH Aachen, Aachen, Germany
| | - Mohammad Khakzad
- Department of Plastic Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mehrafza Mir
- Department of Anesthesiology and Intensive Care, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Leili Nekoohesh
- Department of Medical Biotechnology, School of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Moghadamnia
- Department of Pharmacology and Toxicology, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Mehrbakhsh
- Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hosein Ghanepur
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran.
- Department of Oral and Maxillofacial Surgery, 5 Azar Hospital, Golestan University of Medical Sciences, 5 Azar Street, Gorgan, Iran.
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Lee HS, Yoon HY, Kim IH, Hwang SH. The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. Eur Arch Otorhinolaryngol 2017; 274:2685-2694. [PMID: 28314960 DOI: 10.1007/s00405-017-4535-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/14/2017] [Indexed: 12/25/2022]
Abstract
Rhinoplasty is the most common facial plastic surgical procedure, and the occurrence of periorbital edema and ecchymosis is normal after rhinoplasty. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of postoperative care of edema and ecchymosis following rhinoplasty. Two authors independently searched the databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to September 2016. We included studies that compared postoperative care methods (intervention groups) with no treatment (control group) where the outcomes of interest were edema, ecchymosis, and satisfaction rate of patients on postoperative days. Sufficient data for meta-analysis were retrieved for 11 trials with a total of 627 patients. Eyelid edema and ecchymosis during the first 7 days postoperatively were statistically decreased in the arnica administration groups versus the control group. Eyelid edema and ecchymosis during the first 24 h postoperatively were statistically decreased in the cold compression group versus the control group. The ratio of patient satisfaction was statistically higher in the tapping application group than in the control group. However, the analysis indicated that surgeons had a significant tendency to decrease intranasal packing. The administration of arnica, cold compression, and tape could reduce eyelid edema and ecchymosis. Intranasal packing was associated with more adverse effects in terms of postoperative ecchymosis compared to non-packing. However, additional trials with thorough research methodologies should be conducted to confirm the results of this study.
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Affiliation(s)
- Ho Seok Lee
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Seoul, Gyeonggi-do, 14647, Republic of Korea
| | - Ho Young Yoon
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Seoul, Gyeonggi-do, 14647, Republic of Korea
| | - In Hye Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Seoul, Gyeonggi-do, 14647, Republic of Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Seoul, Gyeonggi-do, 14647, Republic of Korea.
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Abstract
Osteotomies are critical techniques in rhinoplasty. There are a variety of approaches, trajectories, and tools used with no widely standardized classification or nomenclature. Percutaneous osteotomies are gaining in popularity, and picture framing the nasomaxillary bone is crucial for predictable fracture and reproducible results. This is best accomplished with medial, lateral, and transverse osteotomies. Intermediate osteotomies are used less frequently, but provide more mobility. With a detailed understanding of anatomy and a thorough approach to nasal osteotomies, the contour and function of the bony vault can be reshaped with a successful outcome for both the surgeon and patient.
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Affiliation(s)
- Kyle K VanKoevering
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Andrew J Rosko
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA; Center for Facial Cosmetic Surgery, 19900 Haggerty Road, Suite 103, Livonia, MI 48152, USA.
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Discussion: Interventions to Decrease Postoperative Edema and Ecchymosis after Rhinoplasty: A Systematic Review of the Literature. Plast Reconstr Surg 2016; 137:1463-1464. [PMID: 27119921 DOI: 10.1097/prs.0000000000002102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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