Septal Bony Paste Graft: A Life-Saving Material in Rhinoplasty Camouflage

Rib Plaster: A Versatile, Moldable Derivative from Scraping the Periphery of the Rib

SUMMARY

A simple technique is described for obtaining rib plaster by scraping the whitish peripheral portion of residual segments of rib after the perichondrium is removed and appropriate multiple laminations are derived. This putty-like substance tends to conglomerate appropriately because of its high density and has unique properties. It is readily compacted into diced cartilage inserters, smoothly injected, and easy to mold. Rib plaster works well for camouflage of irregularities of the dorsum and tip as well as in mild augmentation. It adds no further cost, and is in adequate supply once a full-thickness rib segment has been harvested for secondary rhinoplasty.

An Automatic Framework for Nasal Esthetic Assessment by ResNet Convolutional Neural Network

Nasal base aesthetics is an interesting and challenging issue that attracts the attention of researchers in recent years. With that insight, in this study, we propose a novel automatic framework (AF) for evaluating the nasal base which can be useful to improve the symmetry in rhinoplasty and reconstruction. The introduced AF includes a hybrid model for nasal base landmarks recognition and a combined model for predicting nasal base symmetry. The proposed state-of-the-art nasal base landmark detection model is trained on the nasal base images for comprehensive qualitative and quantitative assessments. Then, the deep convolutional neural networks (CNN) and multi-layer perceptron neural network (MLP) models are integrated by concatenating their last hidden layer to evaluate the nasal base symmetry based on geometry features and tiled images of the nasal base. This study explores the concept of data augmentation by applying the methods motivated via commonly used image augmentation techniques. According to the experimental findings, the results of the AF are closely related to the otolaryngologists' ratings and are useful for preoperative planning, intraoperative decision-making, and postoperative assessment. Furthermore, the visualization indicates that the proposed AF is capable of predicting the nasal base symmetry and capturing asymmetry areas to facilitate semantic predictions. The codes are accessible at https://github.com/AshooriMaryam/Nasal-Aesthetic-Assessment-Deep-learning .

SELF: A Novel Algorithm for Deciding the Position of Lateral Osteotomies in Rhinoplasty Patients with Minimal External Deviation

BACKGROUND

Although the different techniques and instruments described for lateral osteotomies date back decades, the literature on deciding the position of lateral osteotomies between the sides is limited. In general, the position of lateral osteotomies is decided by frontal view and palpation, but this is not always easy, especially in minimally deviated noses.

METHODS

The SELF algorithm, which includes 4 developmentally related parameters, was used to decide the position and number of lateral osteotomies. Parameters of the SELF algorithm are septal position in nasal floor, external alar length, lateral pyramidal length and frontal pyramidal deviation's starting side. After considering and evaluating these parameters, either double lateral or high lateral osteotomy was performed on the side where the bony wall was considered to be longer.

RESULTS

Out of 521 patients whose lateral osteotomy level was decided by applying the SELF algorithm, 493 were female, and 28 were male. The ages of the patients ranged from 18 to 59 years. Based on the SELF algorithm, 401 double lateral and 85 high lateral osteotomies were performed on the side with the longest anterior-posterior distance of the bony pyramid. No serious complications, either functionally or aesthetically, were encountered related to lateral osteotomies performed based on the SELF algorithm.

CONCLUSIONS

There is a relationship between the position of the septum at the nasal floor, external alar length, lateral pyramidal projection and frontal deviation, as the tissues in the nose are shaped in relation to each other during development. The SELF algorithm based on these parameters can provide assistance to the surgeon in terms of selecting the position and number of lateral osteotomies, especially in minimally deviated noses.

LEVEL OF EVIDENCE IV

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