Grafting in Modern Rhinoplasty

Prospective Clinical Trial Evaluating the Outcomes Associated with the Use of Fresh Frozen Allograft Cartilage in Rhinoplasty

Background

There are different types of grafts for rhinoplasty, each with certain advantages and disadvantages. Fresh frozen cadaveric costal allograft (CCA) provides an alternative to rhinoplasties. The aim of this study was to compare the outcomes of fresh frozen CCA and traditional autologous costal cartilage in cosmetic and reconstructive rhinoplasty procedures.

Methods

This is a prospective, single-center, nonrandomized, open-label clinical trial. Objective assessment to evaluate warping, resorption, and displacement of the cartilage was achieved by measuring the differences of standardized values (deviation angle, nasofrontal angle, total facial convexity, nasofacial angle, and nasolabial angle) obtained at 6-months and 12-months postoperative follow-up on standard two-dimensional photographs (Δ = ∣measurement6 - measurement12∣). Subjective assessment was measured by the FACE-Q assessment.

Results

Fifty eligible patients between March 2017 and October 2020 were included. The average age was 43.9 ± 16.6 years and the mean follow-up period was 14.8 months. In the control group, the changes (Δ) in the deviation angle and nasolabial angle were greater than in the CCA group (P < 0.05). In the CCA group, the mean score of satisfaction with nose improved at 6 months and 1 year postoperatively (P < 0.05). The mean score of satisfaction with nostrils and overall facial appearance also increased in the CCA group at 6 months postoperatively (P < 0.05). Six patients from the CCA group and 10 patients from the control group experienced postoperative complications.

Conclusions

Fresh frozen CCA is a safe and reliable source of rhinoplasty grafts. It is aseptic, readily available, and free of donor site complications.

Application of methylene blue combined with ropivacaine intercostal nerve block in postoperative analgesia of autologous costal cartilage augmentation rhinoplasty

OBJECTIVE

To observe the effect of methylene blue combined with ropivacaine intercostal nerve block on postoperative analgesia after autologous costal cartilage augmentation rhinoplasty.

METHODS

In this study 100 female patients who underwent autologous costal cartilage comprehensive augmentation rhinoplasty in Chongqing Huamei Plastic Surgery Hospital from April to November 2021 were randomly divided into an experimental group and a control group, with 50 cases in each group. In the experimental group methylene blue was combined with ropivacaine intercostal nerve block as patient controlled intravenous analgesia (PCIA), and the control group was ropivacaine intercostal nerve block combined with PCIA. The visual analogue scale (VAS) scores of resting and coughing at 6 h (T1), 24 h (T2), 48 h (T3), 72 h (T4) after surgery were recorded and evaluated. At the same time, the number and times of oral analgesics were recorded as well as nausea, vomiting, burning pain and paresthesia.

RESULTS

The VAS scores of the experimental group were lower than those of the control group at all time points. At 6 h, 24 h and 48 h after surgery, the VAS score of the experimental group was lower than that in the control group, but the difference was not statistically significant (P > 0.05). The VAS score of calm 72 h after surgery in the experimental group was significantly lower than that in the control group (P < 0.05). The analgesic effect of the two groups was better when they coughed after surgery. At 6 h after surgery, the VAS score of coughing in the experimental group was lower than that in the control group, but the difference was not statistically significant (P > 0.05); At 24 h, 48 h and 72 h after surgery, the VAS score of the coughing state in the experimental group was significantly lower than that in the control group (P < 0.05).

CONCLUSION

Intercostal nerve block with methylene blue combined with ropivacaine can achieve good postoperative analgesic effects in augmentation rhinoplasty with autologous costal cartilage.

The Past Decade in Courts, What Oral-Maxillofacial Surgery Should Know About Facial Cosmetic Surgery

PURPOSE

The primary objective of this study was to examine medical malpractice in facial cosmetic surgery procedures to characterize factors that determine legal liability and help make the oral-maxillofacial surgeon (OMS) more comfortable with treating this patient population.

METHODS

The Thomson Reuters Westlaw Edge is a subscription-based legal database that contains decisional law and other data from a variety of state and federal court records. The database was queried for medical malpractice cases involving facial surgical cosmetic procedures from 2010 to 2020.

RESULTS

A total of 763 malpractice cases were identified through the search. After removing duplicates, 758 malpractice cases were hand reviewed based on inclusion/exclusion criteria. A total of 55 cases met criteria for inclusion. Verdict decisions and settlements occurred in the years of 2010 to 2019. Of those 55 cases, the highest concentration of cases occurred in New York (14), California (10) and Pennsylvania (6). Seventy-four percent of the verdicts were in favor of the defendant, 4% of cases settled and 22% of cases were decided in favor of the plaintiff. The minimum award of damages was $8,597.71 with the maximum of $4,150,000.00 (mean: $72,1915.69 ± $1,131,245.94). The provider's primary specialty was most often plastic and reconstructive surgery (84%), followed by ophthalmology (7%), dermatology (3%) and ENT (4%).

CONCLUSION

While it is comforting to know that 74% of malpractice cases in the last decade were found in favor of the surgeon, it is important to realize how devastating the litigation experience can be for a medical practitioner. The best defense to a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal.