1
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Hemmerich C, Corcoran A, Johnson AL, Wilson A, Orris O, Arellanes R, Vassar M. Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist. Otolaryngol Head Neck Surg 2024; 171:81-89. [PMID: 38613190 DOI: 10.1002/ohn.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE This study aimed to assess the completeness of adverse event (AE) reporting in randomized control trials (RCTs) focused on rhinoplasty, using the Consolidated Standards for Reporting (CONSORT) Extension for Harms checklist. STUDY DESIGN A cross-sectional design was employed to review RCTs related to rhinoplasty published between January 1, 2005, and January 28, 2022. SETTING The study analyzed clinical trials on rhinoplasty retrieved from PubMed. METHODS We performed a comprehension search on PubMed, blind and duplicate screening, and data extraction. Adherence to the 18 recommendations of the CONSORT Extension for Harms was evaluated, with 1 point assigned for each adhered item. Percent adherence was calculated based on the 18 points, taking into account the multiple subcategories within some recommendations. Descriptive statistics were used to summarize adherence-including frequencies, percentages, and 95% confidence intervals. RESULTS Our search returned 240 articles, of which 56 met inclusion criteria. No RCTs adhered to all 18 CONSORT Extension for Harms items. Twenty-six (26/56, 46.4%) adhered to ≥50% of the items, and 30 (30/56, 53.6%) adhered to ≥33.3% of the items. Seven (7/56, 12.5%) RCTs adhered to no items. Across all RCTs, the average number of CONSORT-Harms items adhered to was 7.2 (7.2/18, 40.0%). The most adhered to item was item 10. Discussion balanced with regard to efficacy and AEs (80.4%, [70.0-90.8]). CONCLUSION This study highlights the inadequacy of AE reporting in rhinoplasty RCTs according to CONSORT-Harms guidelines. Urgent efforts are required to bridge this reporting gap and enhance transparency in surgical research, ultimately safeguarding patient well-being.
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Affiliation(s)
- Christian Hemmerich
- Department of Medical Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Adam Corcoran
- Department of Otolaryngology, Mclaren Oakland, Detroit, Michigan, USA
| | - Austin L Johnson
- Department of Otolaryngology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Andrew Wilson
- Department of Medical Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Olivia Orris
- Department of Medical Research, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Russell Arellanes
- Department of Otolaryngology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Department of Medical Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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2
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Cataneo JL, Mathis SA, Bartelt K, Gelfond A, Arias-Serrato R, Patel PA. Developing the Aesthetic Postoperative Complication Score (APeCS) for Detecting Major Morbidity in Facial Aesthetic Surgery. Aesthet Surg J 2024; 44:463-469. [PMID: 38124347 DOI: 10.1093/asj/sjad379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Facial aesthetic surgery encompasses a variety of procedures with complication rates that are difficult to estimate due to a lack of published data. OBJECTIVES We sought to estimate major complication rates in patients undergoing facial aesthetic procedures and develop a risk assessment tool to stratify patients. METHODS We utilized the Tracking Operation and Outcomes for Plastic Surgeons (TOPS) database from 2003-2018. The analytic database included major facial aesthetic procedures. Univariate analysis and a backward stepwise multivariate regression model identified risk factors for major complications. Regression coefficients were utilized to create the score. Performance robustness was measured with area under receiver operating characteristic curves and sensitivity analyses. RESULTS A total of 38,569 patients were identified. The major complication rate was 1.2% (460). The regression model identified risk factors including over 3 concomitant surgeries, BMI ≥25, ASA class ≥2, current or former smoker status, and age ≥45 as the variables fit for risk prediction (n = 13,004; area under curve: 0.68, standard error: 0.013, [0.62-0.67]). Each of the 5 variables counted for 1 point, except over 3 concomitant surgeries counting for 2, giving a score range from 0 to 6. Sensitivity analysis showed the cutoff point of ≥3 to best balance sensitivity and specificity, 58% and 66%, respectively. At this cutoff, 65% of cases were correctly classified as having a major complication. CONCLUSIONS We developed an acceptable risk prediction score with a cutoff value of ≥3 associated with correctly classifying approximately 65% of those at risk for major morbidity when undergoing face and neck aesthetic surgery. LEVEL OF EVIDENCE: 3
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Ashoori M, Zoroofi RA, Sadeghi M. An Automatic Framework for Nasal Esthetic Assessment by ResNet Convolutional Neural Network. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:455-470. [PMID: 38343266 PMCID: PMC11031543 DOI: 10.1007/s10278-024-00973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 04/20/2024]
Abstract
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 .
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Affiliation(s)
- Maryam Ashoori
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Reza A Zoroofi
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Sadeghi
- Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran
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4
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Altunal SK, Celik M, Kocer U, Kucukguven A. Sensory Changes in Nasal Subunits Following Open and Closed Rhinoplasty: A Randomized Controlled Trial. Aesthetic Plast Surg 2024; 48:1118-1125. [PMID: 37438671 DOI: 10.1007/s00266-023-03496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Skin sensation changes are common after rhinoplasty and can be troublesome for patients postoperatively. The closed technique may be considered as causing less sensory loss compared to the open technique due to its conservative approach, minimal dissection and low tissue damage potential. A randomized study was planned to compare the sensory changes in the subunits of the nasal skin caused by the two main methods using objective and subjective parameters. METHODS In the analysis of the patients, the nose was divided into seven subunits: nasion, rhinion, nasal tip, left alar wing, right alar wing, infratip lobule and columella base. Evaluations were done preoperatively and at the first, third, sixth and twelfth months postoperatively. Objective sensory evaluations were done using the Semmes-Weinstein monofilament test. The subjective sensory changes of each nasal unit were subjectively evaluated by the patients on a three-point Likert scale. RESULTS Both objective and subjective evaluations showed a statistically significant decrease in sensation in the nasal tip and infratip lobule in the open group one month after surgery. In the closed group, no significant differences were observed between the preoperative and postoperative sensory values for nasal subunits across all periods. CONCLUSION While a decrease in sensation was observed in the tip and infratip lobule in the open technique by the first month postoperatively, this loss of sensation returned to a normal level by the third month. In the closed technique, however, no significant loss of sensation was detected in the postoperative period. In light of our findings, surgeons can have a better insight into postoperative sensory changes in the subunits of nasal skin which makes them more confident and reassuring when there are concerns regarding altered sensation after rhinoplasty. Level of Evidence II 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)
- Sinan Kadir Altunal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey.
| | - Murat Celik
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| | - Ugur Kocer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| | - Arda Kucukguven
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey
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Al-Sebeih KH, Albazee E, Abu-Zaid A, Alsakka MA. Long-Term Safety and Reliability of Using Tutoplast-Processed Fascia Lata to Refine the Nasal Dorsum in Primary and Revision Rhinoplasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-03860-2. [PMID: 38379010 DOI: 10.1007/s00266-024-03860-2] [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: 10/25/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Tutoplast-processed fascia lata (TPFL) is an allograft substance employed alongside cartilaginous materials to achieve optimal augmentation in rhinoplasty. Alternatively, it can be utilized to conceal and smooth irregularities of the nasal dorsum during the procedure. Despite its application, there is limited available data on the extended safety of TPFL. Consequently, our objective was to assess the enduring long-term safety and reliability of TPFL in both primary and revision rhinoplasty. METHODS A retrospective cohort study was conducted on 300 patients who underwent primary and revision rhinoplasty with TPFL grafts. Baseline characteristics, types of surgical techniques, and surgical outcomes were evaluated. The surgical success and satisfaction rates were assessed as primary outcomes. The Statistical Package for Social Sciences (SPSS), version 27 for Windows, was used to conduct the statistical analysis. RESULTS TPFL was used in both primary and revision rhinoplasty, with septal cartilage being the most common conjunction graft material. The overall surgical success rate was 97.3%, with only 2.7% of patients experiencing complications. The satisfaction rate was 92.7%, with no significant difference between primary and revision cases. The highest satisfaction rate was found in patients who underwent the crushed cartilage in fascia technique (96.3%). CONCLUSIONS TPFL in conjunction with cartilaginous materials; is a safe and reliable option for dorsal augmentation and camouflage material in primary and revision rhinoplasty, with low complication and high patient satisfaction rates. 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)
- Khalid H Al-Sebeih
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Kuwait University, Jabriya, Hawalli, Kuwait.
- Department of Otorhinolaryngology and Facial Plastic Surgery, Canadian Medical Center, Sharqe, Kuwait City, Kuwait.
| | - Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mahmoud A Alsakka
- Department of Otorhinolaryngology and Facial Plastic Surgery, Canadian Medical Center, Sharqe, Kuwait City, Kuwait
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Sazgar AA, Sazgar MA, Sazgar AK. Outcome Evaluation of Reconstructive Septorhinoplasty in Patients with a History of Nasal Skin Necrosis. Facial Plast Surg Aesthet Med 2024. [PMID: 38350143 DOI: 10.1089/fpsam.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background: Nasal skin necrosis represents a severe rhinoplasty complication, potentially leading to nasal deformity and psychological distress. Objectives: To assess the safety, nasal function enhancement, and esthetic satisfaction in individuals with a history of nasal skin necrosis following reconstructive septorhinoplasty using patient-reported outcome measures. Methods: The case series included patients who underwent reconstructive septorhinoplasty 1 year after experiencing skin necrosis. Skeletal reconstruction was performed with an open approach using various autografts and techniques. The data collected encompassed demographics, medical history, operative reports, and postoperative events. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively. Results: Most patients were female (35/38, 92%), with median age of 33.5 years (17-57) and 2 prior rhinoplasties (1-5) by 1 surgeon (1-2). The follow-up median was 23.78 months (11.83-54.23). Necrosis predominantly affected the nasal tip and soft tissue triangles. Septorhinoplasty utilized 11 V-shaped columellar base and 27 mid-columella incisions, lasting on average 274 min (175-405). Septal grafts were adequate for reconstruction in only three cases. Autografts for reconstruction encompassed auricular cartilage (31), rib cartilage (22), temporal fascia (14), and rectus fascia (6). SCHNOS scores improved significantly, with the obstruction domain decreasing from a preoperative mean of 75.92 (±22.83) to 34.08 (±27.87) and the cosmesis domain from 85.43 (±19.06) to 39.73 (±23.77). No postoperative severe vascular complication occurred. More previous surgeries linked to decreased patient satisfaction. Conclusion: Reconstructive septorhinoplasty can be successful in restoring relatively normal nasal contour following prior soft tissue necrosis, with limited risk for complications.
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Affiliation(s)
- Amir A Sazgar
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehr A Sazgar
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir K Sazgar
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Peters RD, Vasudev M, Hakimi AA, Dilley KK, Nguyen TV, Hu A, Wong BJF. Boomerang Modification of the Septal Extension Graft: Graft Design and Functional Outcomes. Facial Plast Surg Aesthet Med 2024. [PMID: 38215259 DOI: 10.1089/fpsam.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Background: A "boomerang" graft is an end-to-end caudal septal extension graft (SEG) that conforms to the geometry of the anterior septal angle, and avoids septal overlap, unlike a side-to-side SEG. Objective: To compare breathing improvements in rhinoplasty patients receiving boomerang SEGs and patients receiving side-to-side SEGs. Methods: Retrospective cohort analysis of patients undergoing rhinoplasty with either end-to-end boomerang SEG or a side-to-side SEG. Functional outcomes were assessed through the Nasal Obstruction Symptom Evaluation (NOSE) survey. Results: The boomerang SEG cohort had a mean age of 34 years and were 68% female compared with 38 years and 67% female in the side-to-side SEG cohort (p > 0.05). The cohorts did not differ in the proportion of the lateral crural tensioning, spreader graft placement, or history of rhinoplasty. The boomerang cohort demonstrated a 67% reduction in NOSE scores compared with a 70% reduction among the side-to-side SEG cohort (p = 0.14). Men undergoing boomerang graft placement reported significantly less postoperative functional improvement than men undergoing placement of a side-to-side SEG (62% vs. 77%, p = 0.01). Conclusion: Use of a boomerang graft is not likely to negatively affect rhinoplasty functional outcomes when compared with a side-to-side SEG.
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Affiliation(s)
- R Daniel Peters
- Raleigh Capitol Ear, Nose, and Throat, Raleigh, North Carolina, USA
| | - Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Amir A Hakimi
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Katelyn K Dilley
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Allison Hu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Brian J F Wong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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8
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Rouientan A, Khodaparast MB, Safi Y. Evaluation of diagnostic accuracy of cone beam computed tomography and multi-detector computed tomography for detection of anatomical variations in rhinoplasty. Head Face Med 2024; 20:1. [PMID: 38172987 PMCID: PMC10763271 DOI: 10.1186/s13005-023-00401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Different imaging techniques, such as multi-detector computed tomography (MDCT) scan and cone beam computed tomography(CBCT), are used to check the structure of the nose before rhinoplasty. This study aimed to evaluate the accuracy of two imaging techniques, MDCT scan, and CBCT, in diagnosing structural Variations in rhinoplasty for the first time. METHODS This diagnostic accuracy study was conducted on 64 rhinoplasty candidates who complained of snoring and sleep apnea or had a positive result in the examination with Cottle's maneuver or modified Cottle technique between February 2021 and October 2022 at 15- Khordad Hospital affiliated to Beheshti University of Medical Sciences. Before rhinoplasty, patients were randomly assigned to one of the CT and CBCT techniques with an equal ratio. Scans were assessed for the presence of Nasal septum deviation (NSD), Mucocele, Concha bullosa, and nasal septal spur by two independent radiologists. The findings of the two methods were evaluated with the results during rhinoplasty as the gold standard. RESULTS NSD was the most common anatomical variation based on both imaging techniques. The accuracy of CBCT for diagnosing Nasal Septum Deviation and Mucocele was 80% and 75%, respectively. The sensitivity, specificity, and accuracy of CBCT in detecting Concha bullosa were 81.3% and 83.3%, respectively. The Kappa coefficient between CBCT and intraoperative findings for diagnosing NSD and Concha Bullosa was 0.76 and 0.73, respectively (p < 0.05). CONCLUSION CBCT can be considered a suitable method with high accuracy and quality to evaluate the anatomical variations before rhinoplasty.
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Affiliation(s)
- Abdolreza Rouientan
- Department of Plastic Surgery, 15 Khordad Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Bashir Khodaparast
- Department of Plastic Surgery, 15 Khordad Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Facial Cosmetic Surgery. J Oral Maxillofac Surg 2023; 81:E300-E324. [PMID: 37833027 DOI: 10.1016/j.joms.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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10
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Ross T, Arwyn-Jones J, Navaratnam AV, Pendolino AL, Randhawa PS, Andrews P, Saleh HA. Litigation in Septorhinoplasty Surgery: A Pan-Specialty Review of National Health Service (the United Kingdom) Data. Facial Plast Surg 2023; 39:142-147. [PMID: 35882369 DOI: 10.1055/a-1910-0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Success in septorhinoplasty surgery can be difficult to assess due to a lack of objective and measurable outcomes. If patients' expectations are not met, it places surgeons performing septorhinoplasty at risk of litigation which can be stressful and costly. The National Institute of health (NHS) Resolution is a government-funded organization in the United Kingdom that provides expertise to the NHS on resolving patient concerns. Data were requested from NHS Resolution for claims involving septorhinoplasty surgery over a period of 5 years between April 2015 and April 2020. Rhinoplasty claims performed by all specialties were included. Data included the claim status, incident details, alleged injury, damages claimed, and damages paid. A total of 31 claims were identified by the study, equating to a total cost of £1,347,336.10. Of the 31 claims for rhinoplasty or septorhinoplasty, 9 cases were open (29%, £962,361.00) and 22 cases were closed (71%, £384,975.10). The common causes for claims were "intraoperative problems (32%)," "failure to warn-informed consent (19%)," and "foreign body left in situ (13%)." The most common injuries were "cosmetic disfigurement (39%)," "unnecessary pain (29%)," and "additional/ unnecessary operation (29%)." This study highlights the need for improved awareness of clinical negligence claims among surgeons who perform septorhinoplasty. Results are applicable to all specialties who perform the procedure. The study highlights the importance of assessing patients' motives and expectations prior to surgery and emphasizes the need for a well-documented rigorous consent process.
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Affiliation(s)
- Talisa Ross
- Department of Otolaryngology, Royal National Ear, Nose and Throat Hospital, London, United Kingdom
| | - James Arwyn-Jones
- Department of Otolaryngology, West Middlesex University Hospital, London, United Kingdom
| | | | - Alfonso L Pendolino
- Department of Otolaryngology, Royal National Ear, Nose and Throat Hospital, London, United Kingdom
| | - Premjit S Randhawa
- Department of Otolaryngology, Royal National Ear, Nose and Throat Hospital, London, United Kingdom
| | - Peter Andrews
- Department of Otolaryngology, Royal National Ear, Nose and Throat Hospital, London, United Kingdom
| | - Hesham A Saleh
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
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11
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Davis SJ, Landeen KC, Sowder JC, Kimura KS, Shastri KS, Clymer MC, Stephan SJ. Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty. Facial Plast Surg Aesthet Med 2022; 24:337-343. [DOI: 10.1089/fpsam.2021.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seth J. Davis
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly C. Landeen
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin C. Sowder
- Department of Otolaryngology – Head and Neck Surgery, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
- Center for Facial Plastic and Reconstructive Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Kyle S. Kimura
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karthik S. Shastri
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark C. Clymer
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Clymer Facial Plastic Surgery, Brentwood, Tennessee, USA
| | - Scott J. Stephan
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Davis SJ, Rossi Meyer M, Misch E, McLeod M, Occhiogrosso J, Yau J, Mims M, Dedhia RD, Sowder JC, Shockley R, Cerrati E, Shaye D, Shockley W, Owen S, Stephan SJ. Septal Perforation Repair Using a Temporoparietal Fascia and Polydioxanone Plate Construct: A Multi-Institutional Analysis. Facial Plast Surg Aesthet Med 2022; 25:212-219. [PMID: 36173756 DOI: 10.1089/fpsam.2021.0421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Nasal septal perforations (NSPs) are notoriously difficult to fix and closure can paradoxically lead to worsening of symptoms, prompting numerous techniques for repair including temporoparietal fascia (TPF)-polydioxanone (PDS) plate interposition grafting. Objectives: To compare rates of NSP closure with TPF-PDS interposition grafting among a variety of institutions with diverse environmental influences and patient-specific factors. Methods: Retrospective review of patients undergoing TPF-PDS interposition grafting at seven different U.S. institutions over 5 years. Outcomes include closure rate, self-reported symptom improvement, change in Nasal Obstruction Symptomatic Evaluation (NOSE) score, and postoperative complications. Results: Sixty-two patients (39 female) with a mean age of 41.5 years were included. Most common perforation location was anterior (53%), and average size was 1.70 cm2. NSP closure with symptomatic improvement was achieved in 95% of participants. Postoperative NOSE scores decreased on average by 42 points. Residual crusting occurred in 29% of patients, independent of external factors. Conclusions: TPF-PDS interposition grafting is highly effective for NSP repair in a wide variety of settings, and NOSE scores correspond well with patient-reported outcomes.
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Affiliation(s)
- Seth J. Davis
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica Rossi Meyer
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emily Misch
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan McLeod
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Jenny Yau
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Marc Mims
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Raj D. Dedhia
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Justin C. Sowder
- Department of Otolaryngology – Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Center for Facial Plastic and Reconstructive Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Ross Shockley
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Cerrati
- Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Shaye
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William Shockley
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Scott Owen
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of Facial Plastic and Reconstructive Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott J. Stephan
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Evaluation of Clinical Outcomes and Satisfaction of Rhinoplasty with or without Smasectomy with the Aim of
Thinning the Nasal Tip in Patients with Thick Nasal Skin. World J Plast Surg 2022; 11:117-128. [PMID: 36117895 PMCID: PMC9446124 DOI: 10.52547/wjps.11.2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Rhinoplasty is one of the most common plastic surgeries and a challenging procedure for people with thick nasal skin. There are several techniques to improve the outcome of the operation. Methods: Our study is a double-blind randomized controlled trial conducted in Esfahan, Iran in 2020. Seventy participants were equally divided into two groups (35 people). In the control group, only rhinoplasty was performed without SMASectomy and in the intervention group, rhinoplasty was performed with SMASectomy. The results were obtained and the satisfaction of patients and physicians was collected through patient examination and a questionnaire. Statistical analysis of data was calculated by SPSS software version 23 at a significance level of less than 0.05. Results: The mean total skin thickness before surgery in the two groups was equally, which showed a significant difference between the two groups at after 12 months (P <0.05). Comparison of 3, 6 and 12 months after rhinoplasty in the two groups showed that the percentage of patient, doctor, hairdresser and nurse satisfaction, in 12 months after rhinoplasty, in the intervention group compared to the control group had a significant increase (P <0.05). Furthermore, in the control group 2.85% and in the intervention group 5.71% bleeding was observed. No other complications were observed in any of the groups. Conclusion: Overall, SMASectomy, which is performed simultaneously with rhinoplasty, is considered as an important technique in rhinoplasty. As we observed in our study, the complications of these surgeries in patients were very small.
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14
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Maghsoudipour N, Mohammadi A, Nazari H, Nazari H, Ziaei N, Amiri SM. The effect of 3 % hydrogen peroxide irrigation on postoperative complications of rhinoplasty: A double-blinded, placebo-controlled Randomized Clinical Trial. J Craniomaxillofac Surg 2022; 50:681-685. [DOI: 10.1016/j.jcms.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
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15
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Wu B, Chen S, Sun K, Xu X. Complications Associated with Rhinoplasty: An Umbrella Review of Meta-analyses. Aesthetic Plast Surg 2022; 46:805-817. [PMID: 34590168 DOI: 10.1007/s00266-021-02612-w] [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: 07/17/2021] [Accepted: 09/19/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND An increasing number of studies have investigated the effect of various methods in avoiding complications in rhinoplasty. Our study aims to analyze the connections between various choices in rhinoplasty and the rate of multiple complications by summarizing results in related meta-analyses. MATERIALS AND METHODS Through Pubmed, MEDLINE, Embase, and the Cochrane Database were associated systematic reviews searched to gather and review the available evidence of different plans and health outcomes in rhinoplasty for this umbrella review. RESULTS The study included 14 systematic reviews with 128 meta-analyses of randomized clinical trials. Edema and ecchymosis were the two most investigated outcomes. The implementations of steroid, tranexamic acid, periosteal preservation, external approach in lateral osteotomy, and piezoelectric osteotomy were linked with significantly lower incidence of several complications. Multiple administration of steroids was found to be associated with fewer complications in a prolonged time. CONCLUSIONS With summarized evidence of complications related to rhinoplasty, this research can help surgeons to avert patients from suffering complications and optimize cosmetic outcomes. 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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16
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The Effect of Subcutaneous Dexamethasone to Reduce Edema and Ecchymosis in Rhinoplasty Patients. Int J Otolaryngol 2022; 2022:3054767. [PMID: 35198028 PMCID: PMC8860562 DOI: 10.1155/2022/3054767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background Rhinoplasty is one of the most common types of cosmetic surgery undertaken. In most rhinoplasty patients, an osteotomy is used to reshape the nasal pyramid. The most common complications following osteotomy are edema and ecchymosis. Edema and ecchymosis have a significant effect on a patients' satisfaction with surgery and their return to social activities. For this purpose, various methods have been used to reduce edema and ecchymosis, including intravenous injection of corticosteroids, cold compresses, and tranexamic acid. Objective To reduce edema and ecchymosis in rhinoplasty patients by administering a subcutaneous injection of dexamethasone and thereby prevent unwanted systemic side effects of corticosteroid treatments. Method We conduct a hospital-based nonrandomised study of rhinoplasty patients, with their informed consent treated over the course of one year. Dexamethasone was injected on one side of consenting patient's face immediately before surgery and the results were compared with the opposite side that was not injected. The face images of patients were taken on the front view on the first, third, seventh, and fourteenth days following the treatment. The grade of edema and ecchymosis encountered in each patient was determined by three ENT specialists. The degree of edema and ecchymosis was compared on the injected and noninjected sides and the findings were statistically analysed. The nonrandomised study considered 42 rhinoplasty patients. The mean age of patients was 27.9 years and their age ranged between 17 and 52 years. For 20 patients (47.6%), injection was performed on the right side, and for 22 patients (52.3%), injection was performed on the left side. Findings. The statistical analysis of patient outcomes reveals that a supraperiosteal injection of dexamethasone was not effective in reducing edema and ecchymosis after rhinoplasty.
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17
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Sahraian A, Janipour M, Tarjan A, Zareizadeh Z, Habibi P, Babaei A. Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates. Aesthetic Plast Surg 2022; 46:332-337. [PMID: 34820690 DOI: 10.1007/s00266-021-02603-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants. OBJECTIVE The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates. MATERIALS AND METHODS This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16). RESULTS A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021). CONCLUSIONS According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education. 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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Abstract
Rhinoplasty is widely regarded as one of the more technically challenging surgeries, owing in part to the many possible short- and long-term complications that can arise. Although severe complications are uncommon, unforeseen complications can lead to esthetic and functional compromise, patient dissatisfaction, and need for revision surgery. The rhinoplasty surgeon must be prepared to counsel patients and identify and manage the range of complications that may result from this procedure. This article reviews some of the most frequently encountered complications related to rhinoplasty and their management approaches.
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Affiliation(s)
- Danielle F Eytan
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, 222 E 41st Street, 8th. Floor, New York, NY 10017, USA.
| | - Tom D Wang
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, SJH01, Portland, OR 97239, USA
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19
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Shamil E, Scenza GD, Ghani SA, Fan KS, Ragulan S, Salem J, Šurda P, D'Souza AR. A Quality Assessment of Online Patient Information Regarding Rhinoplasty. Facial Plast Surg 2021; 38:530-538. [PMID: 34583412 DOI: 10.1055/s-0041-1735622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
There is a large demand for online patient information for patients considering rhinoplasty. While there are many resources available, the quality and content of the information provided are unknown. This study aimed to assess the quality of the most popular information available online, using the "Ensuring Quality Information for Patients" (EQIP) tool to evaluate the content, structure, and readability of patient information on websites. Search terms including nose operation, nose job, nose reshaping, nose tip surgery, rhinoplasty, septorhinoplasty, were identified using Google AdWords and Trends. Unique links from the first 10 pages for each term were identified and evaluated with websites written in English and for general non-medical public use were included. 295 websites met the eligibility criteria with a median overall EQIP score of 17. Only 33% contained balanced information on the risks and benefits. Bleeding and infection risk was only mentioned in 29% and 27% of websites, respectively. Two percent described complication rates of the procedures and only 20% of articles explained further surgery may be required to achieve patient cosmetic or functional satisfaction. Information regarding rhinoplasty available online is currently of poor quality. The lack of effective risk counselling, possible outcome management, and complications may likely lead to unrealistic expectations of rhinoplasty. It is crucial the risks of surgery are communicated to the patient to ensure they can make an informed decision. Improved education through online resources would likely help to promote more realistic patient expectations.
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Affiliation(s)
- Eamon Shamil
- Department of Ear, Nose and Throat, St George's University Hospitals NHS Foundation Trust, Tooting, London, United Kingdom
| | - Gabriela Di Scenza
- St. George's University Medical School, Cranmer Terrace, London, United Kingdom
| | - Shahi Abdul Ghani
- St. George's University Medical School, Cranmer Terrace, London, United Kingdom
| | - Ka Siu Fan
- St. George's University Medical School, Cranmer Terrace, London, United Kingdom
| | - Suthaharan Ragulan
- Department of Ear, Nose and Throat, St George's University Hospitals NHS Foundation Trust, Tooting, London, United Kingdom
| | - Joseph Salem
- Department of Ear, Nose and Throat, St George's University Hospitals NHS Foundation Trust, Tooting, London, United Kingdom
| | - Pavol Šurda
- Department of Ear, Nose and Throat, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alwyn Ray D'Souza
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust Ringgold Standard Institution, London, United Kingdom
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20
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Jahandideh H, Dehghani Firouzabadi F, Dehghani Firouzabadi M, Roomiani M. Lagophthalmos of the upper eyelid after rhinoplasty: A case report. Clin Case Rep 2021; 9:e04776. [PMID: 34552734 PMCID: PMC8444282 DOI: 10.1002/ccr3.4776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/15/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
Lagophthalmos is an inability to close the eyelids which can result from many causes. Septorhinoplasty surgery is an uncommon reason for that. This paper reports the lagophthalmos complication, after a septorhinoplasty surgery.
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Affiliation(s)
- Hesam Jahandideh
- ENT and Head & Neck Research Center The Five Senses Health Institute Iran University of Medical Sciences Tehran Iran
- Department of Otolaryngology-Head and Neck Surgery Firoozgar Hospital Iran University of Medical Sciences Tehran Iran
| | - Fatemeh Dehghani Firouzabadi
- ENT and Head & Neck Research Center The Five Senses Health Institute Iran University of Medical Sciences Tehran Iran
- Department of Otolaryngology-Head and Neck Surgery Firoozgar Hospital Iran University of Medical Sciences Tehran Iran
| | - Mohammad Dehghani Firouzabadi
- ENT and Head & Neck Research Center The Five Senses Health Institute Iran University of Medical Sciences Tehran Iran
- Department of Otolaryngology-Head and Neck Surgery Firoozgar Hospital Iran University of Medical Sciences Tehran Iran
| | - Maryam Roomiani
- ENT and Head & Neck Research Center The Five Senses Health Institute Iran University of Medical Sciences Tehran Iran
- Department of Otolaryngology-Head and Neck Surgery Firoozgar Hospital Iran University of Medical Sciences Tehran Iran
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21
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Alar Flare Preservation Using the Sandwich Technique as an Adjunct to Alar Base Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3569. [PMID: 33977001 PMCID: PMC8104200 DOI: 10.1097/gox.0000000000003569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Achieving an aesthetic balance and natural appearance when modifying soft tissues of the nasal tip, alae, and nostrils is fundamental to the success of rhinoplasty surgery. The present study aimed to investigate the ability of a simple “sandwich” technique combined with external alar base reduction to preserve the alar flare and achieve a natural and appealing alar contour.
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22
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Kumar V, Jain A, Atre S, Shome D, Kapoor R, Doshi K, Vadera S. Non-surgical rhinoplasty using hyaluronic acid dermal fillers: A systematic review. J Cosmet Dermatol 2021; 20:2414-2424. [PMID: 33900020 DOI: 10.1111/jocd.14173] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-surgical rhinoplasty using hyaluronic acid dermal fillers is a cosmetic procedure that has been becoming increasingly popular among patients wanting to correct nasal deformities or nasal irregularities, in the recent years. AIM This systematic review aims to provide quality evidence about the success of non-surgical rhinoplasty procedures in terms of patient satisfaction and complications. METHODS A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Scopus, and EBSCO online databases was conducted from November 2005 to February 2021. Additionally, the reference lists of included systematic reviews were hand searched. Data collected included patient satisfaction and complications from prospective and experimental studies providing highest level of evidence. Articles were critically appraised, and MINORS scale was used to assess the risk of bias. RESULTS Based on the search criteria, 2896 citations were found. After removing duplicates and screening for relevance, 23 citations were finalized for full-text review, of which 12 articles were excluded and 11 articles were included in the study. The average satisfaction of patients amongst the studies was found to be >90%. In all the studies, transient edema and erythema, post-injection pain, and bruising were some temporary complications. Rare complications that were reported were vascular impairments and hematoma. CONCLUSIONS Non-surgical rhinoplasty is a good, minimally invasive alternative over conventional rhinoplasty. There is however a paucity of quality data in the form of experimental and prospective studies regarding the accuracy, effectiveness, and complications of non-surgical rhinoplasty.
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Affiliation(s)
- Vaibhav Kumar
- The Esthetic Clinics, Mumbai, India.,Department of Public Health Dentistry, Terna Dental College, Navi Mumbai, India
| | - Anuj Jain
- Craniomaxillofacial Surgeon & Implantologist, Nagpur, India
| | | | - Debraj Shome
- Department of Facial Plastic & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery, The Esthetic Clinics, Mumbai, India
| | - Komal Doshi
- Department of Facial Plastic & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Sapna Vadera
- Department of Facial Plastic & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
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23
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Zarrati S, Fathesami S, Manafi A. Custom nasal stent and columellar reconstruction after a rhinoplasty complication: A clinical report. J Prosthet Dent 2021; 128:823-826. [PMID: 33691937 DOI: 10.1016/j.prosdent.2020.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022]
Abstract
Nostril stenosis is typically caused by retraction and contraction after trauma or infection, although loss of nasal tissue is not common during rhinoplasty. This clinical report describes the fabrication of a nasal stent to replace the lost columella and a columella prosthesis for a patient who had had reconstructive surgery for nasal valve collapse and a missing columella. The stent established a comfortable means of nasal air exchange that was also esthetically acceptable. The stent also provided the necessary support for the nasal tissue before further nasal reconstructive surgeries.
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Affiliation(s)
- Simindokht Zarrati
- Assistant professor, Maxillofacial Prosthodontist, Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Ali Manafi
- Associate Professor of Plastic Surgery, Iran University of Medical Science, Tehran, Iran
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24
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Hakimi AA, Standiford L, Chang E, Wong BJF. Development and Assessment of a Video-Based Intervention to Improve Rhinoplasty Informed Consent. Facial Plast Surg 2021; 37:585-589. [PMID: 33634455 DOI: 10.1055/s-0041-1722912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
There has been a growing interest in improving the informed consent process to ensure patients truly understand the benefits, risks, and alternatives of their procedures. Herein, we sought to describe the production of an educational video to supplement the traditional rhinoplasty informed consent process. Additionally, we evaluate satisfaction and risk recall among prospective rhinoplasty patients who participated in the video-assisted informed consent process. One author attended 30 rhinoplasty consultations where informed consent was performed and generated 65 questions related to the benefits, risks, alternatives, and general knowledge of rhinoplasty operations. A video of the senior author answering these questions was filmed and edited to 25 minutes. Prospective rhinoplasty patients watched the video before their initial consultation and were asked to complete two surveys assessing their satisfaction with the video-assisted process as well as their ability to recall risks discussed in the video. Understandability and actionability of the video was assessed by three independent reviewers using the Patient Education Materials Assessment Tool. Postvideo surveys were completed by 40 patients. Patients strongly agreed that the video informed them about rhinoplasty risks and benefits (4.90/5.00), effectively answered their questions and/or concerns (4.78/5.00), and provided adequate information before surgery (4.85/5.00). Participants strongly recommended that all prospective patients watch the video prior to surgery (4.97/5.00). Participants on average correctly answered 4.00 ± 0.877 out of five risk recall questions. There was no statistically significant difference in risk recall performance between college graduates (4.19 ± 0.602) and those who did not graduate college (3.79 ± 1.08), p = 0.076. No significant correlation was found between patient age and recall performance (r = -0.011), p = 0.943. The overall mean understandability and actionability scores for the video were 100%. Video-assisted informed consent for rhinoplasty may enhance and overcome limitations to the traditional verbal consent process by ensuring comprehensive, standardized, and readily understandable information.
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Affiliation(s)
- Amir Aaron Hakimi
- Department of Otolaryngology - Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California
| | - Lauren Standiford
- Department of Otolaryngology - Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California
| | - Edward Chang
- Department of Otolaryngology - Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California
| | - Brian Jet-Fei Wong
- Department of Otolaryngology - Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California.,Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Irvine, California.,Department of Bioengineering, University of California Irvine Henry Samueli School of Engineering, Irvine, California
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25
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Jamshidian Tehrani M, Asadi Khameneh E, Veisi A. Lacrimal Drainage System Problems After Rhinoplasty. Aesthetic Plast Surg 2021; 45:255-260. [PMID: 32869132 DOI: 10.1007/s00266-020-01929-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND To report case series of permanent nasolacrimal system problems following rhinoplasty METHODS: The documents of patients with epiphora and history of rhinoplastic surgery were reviewed. The data of patients with permanent epiphora (continued over 3 months or started after 3 months of post-rhinoplasty surgery) and lacrimal drainage system (LDS) problems were analyzed for demographics, the result of diagnostic probing and irrigation, findings of orbital and paranasal sinuses CT scan, abnormalities in nasal endoscopy, treatment, and follow-up data. RESULTS Forty-three patients with epiphora and history of rhinoplasty were referred to our clinic. Ten of them had permanent epiphora and LDS problems. In these patients, the mean time between rhinoplasty and initial symptoms of LDS problems was 10.3 ± 15.1 (range, 0-45 months) and the mean time between rhinoplasty and the LDS surgery was 22.2 ± 19.5 months (range 4-60 months). Diagnostic probing and irrigation test revealed canalicular stenosis in four (40%) patients, pus reflux in four (40%), clear reflux without passage in four (40%), and partial nasolacrimal duct obstruction (NLDO) in two (20%) of patients. DCR was performed in eight (80%) patients. Therapeutic probing and lacrimal intubation were performed in two (20%) patients. CONCLUSION A permanent injury of the LDS is one of the important complications of the rhinoplastic surgery that should be managed based on the onset and duration of the symptoms and the location of the injury. 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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Affiliation(s)
- Mansooreh Jamshidian Tehrani
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Asadi Khameneh
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Veisi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Labbafinejad Medical Center, Boostan 9 Street, Pasdaran Avenue, Tehran, 16666, Iran.
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26
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Invited Discussion on: "Lacrimal Drainage System Problems after Rhinoplasty". Aesthetic Plast Surg 2021; 45:261-262. [PMID: 32930835 DOI: 10.1007/s00266-020-01955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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27
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Martino C, Salzano F, Martino D, Ralli M, De Vincentiis M, Maranzano M, Greco A, Salzano G, Di Stadio A. A Prospective Randomized Trial of N-butyl-cyanoacrylate + Metacryloxysulfolane Adhesive versus Suture Alone for Grafting in Rhinoplasty: 9 year Follow-up. Ann Otol Rhinol Laryngol 2020; 130:483-489. [PMID: 32693615 DOI: 10.1177/0003489420943910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty. METHODS Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes. RESULTS All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ:P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time (P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery. CONCLUSION N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.
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Affiliation(s)
- Carmine Martino
- University Hospital of Salerno, Italy.,The nose clinic, rhinosurgery unit c/o check-up day-surgery Salerno, Italy
| | | | - Diletta Martino
- The nose clinic, rhinosurgery unit c/o check-up day-surgery Salerno, Italy
| | - Massimo Ralli
- Organ of Sense Department, La Sapienza University of Rome, Italy
| | | | - Massimo Maranzano
- Department of Oral Maxillo-Facial and Facial Plastic Surgery, University of Manchester, Manchester, UK
| | - Antonio Greco
- Organ of Sense Department, La Sapienza University of Rome, Italy
| | - Giovanni Salzano
- Head and Neck Department, Neurosciences, Reproductive and Odontostomatological Science, University Federico II, Naples, Italy
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28
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Rostami K, Shahaboddin MA, Niazi F, Karimi Rouzbahani A, Nadri S, Mahmoudvand H. The Effect of Hirodoid Cream on Ecchymosis and Edema around Eyes after Rhinoplasty. World J Plast Surg 2020; 9:128-134. [PMID: 32934922 PMCID: PMC7482541 DOI: 10.29252/wjps.9.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone in reduction of the periorbital edema and ecchymosis. METHODS Sixty patients who underwent primary rhinoplasty were randomly divided into 3 groups. Group H received hirudoid cream, 3 times per day for 5 days from postoperative-day (POD). Group D received 10 mg of dexamethasone IV, immediately before surgery; and group C (control) received neither dexamethasone nor hirudoid. Two surgeons who were unaware of administered medications rated the severity of edema and intensity of ecchymosis, on 2nd, 5th, and 7th POD. RESULTS On 2nd POD, the edema in group D was significantly lower than groups H and C; but there was no significant difference in severity and intensity of ecchymosis between 3 groups. On 7th POD, the intensity of ecchymosis was significantly lower in group H in comparison to group C. When the difference between 2nd and 7th POD was evaluated, the resolution of severity of edema and intensity of ecchymosis was significantly better in group H (p<0.001). CONCLUSION Hirudoid was shown to be effective in reducing edema and ecchymosis after rhinoplasty. The use of dexamethasone was effective in prevention of periorbital edema at early postoperative days, but it was not effective on resolution of ecchymosis.
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Affiliation(s)
- Khalil Rostami
- Department of Plastic and Reconstructive Surgery, Shahid Modares Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Shahaboddin
- Department of Plastic and Reconstructive Surgery, Shahid Modares Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Feizollah Niazi
- Department of Plastic and Reconstructive Surgery, Shahid Modares Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sedigheh Nadri
- Department of Surgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hormoz Mahmoudvand
- Department of Surgery, Lorestan University of Medical Sciences, Khorramabad, Iran
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