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Schlegel L, Malani E, Belko S, Kumar A, Barbarite E, Krein H, Heffelfinger R, Hutchinson M, Pugliese R. Design, printing optimization, and material testing of a 3D-printed nasal osteotomy task trainer. 3D Print Med 2023; 9:20. [PMID: 37439899 PMCID: PMC10339601 DOI: 10.1186/s41205-023-00185-9] [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: 05/16/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND For difficult or rare procedures, simulation offers an opportunity to provide education and training. In developing an adequate model to utilize in simulation, 3D printing has emerged as a useful technology to provide detailed, accessible, and high-fidelity models. Nasal osteotomy is an essential step in many rhinoplasty surgeries, yet it can be challenging to perform and difficult to receive adequate exposure to this nuanced portion of the procedure. As it currently stands, there are limited opportunities to practice nasal osteotomy due to the reliance on cadaveric bones, which are expensive, difficult to obtain, and require appropriate facilities and personnel. While previous designs have been developed, these models leave room for improvement in printing efficiency, cost, and material performance. This manuscript aims to describe the methodology for the design of an updated nasal osteotomy training model derived from anatomic data and optimized for printability, usability, and fidelity. Additionally, an analysis of multiple commercially available 3D printing materials and technologies was conducted to determine which offered superior equivalency to bone. METHODS This model was updated from a first-generation model previously described to include a more usable base and form, reduce irrelevant structures, and optimize geometry for 3D printing, while maintaining the nasal bones with added stabilizers essential for function and fidelity. For the material comparison, this updated model was printed in five materials: Ultimaker Polylactic Acid, 3D Printlife ALGA, 3DXTECH SimuBone, FibreTuff, and FormLabs Durable V2. Facial plastic surgeons tested the models in a blinded, randomized fashion and completed surveys assessing tactile feedback, audio feedback, material limitation, and overall value. RESULTS A model optimizing printability while maintaining quality in the area of interest was developed. In the material comparison, SimuBone emerged as the top choice amongst the evaluating physicians in an experience-based subjective comparison to human bone during a simulated osteotomy procedure using the updated model. CONCLUSION The updated midface model that was user-centered, low-cost, and printable was designed. In material testing, Simubone was rated above other materials to have a more realistic feel.
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Affiliation(s)
- Lauren Schlegel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
- Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Eric Malani
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara Belko
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayan Kumar
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Barbarite
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Howard Krein
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Heffelfinger
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Morgan Hutchinson
- Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert Pugliese
- Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA
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Decision-Making in Middle Vault Reconstruction following Dorsal Hump Reduction in Primary Rhinoplasty. Plast Reconstr Surg 2020; 145:1389-1401. [PMID: 32195860 DOI: 10.1097/prs.0000000000006850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dorsal hump reduction during open rhinoplasty disrupts the continuity between the upper lateral cartilages and the dorsal septum. Options to reconstitute the midvault include primary closure of the upper lateral cartilages to the dorsal aspect of the septum, placement of spreader grafts, and creation of spreader flaps. The authors sought to clarify from highly experienced rhinoplasty surgeons their decision-making rationale for midvault reconstruction, distilling down the group consensus into algorithmic guidelines. METHODS A panel of internationally recognized rhinoplasty surgeons participated in a two-part organized communication method. An introductory summit consisted of open discussions on various topics in midvault reconstruction. The summit transcription was analyzed by thematic content analysis to develop a survey encompassing clinical scenarios for primary rhinoplasty, which was then individually administered to each panelist. Data gathered from both parts were used to generate technical guidelines and a decision-making algorithm. RESULTS The panelists identified the following anatomical features as pertinent to their selection of midvault reconstruction method: size of the dorsal hump reduction, width of the midvault relative to the upper vault, presence of dorsal angulation, and presence of nasal obstructive symptoms. Individual panelist preference was gathered from the 24-scenario survey divided into either cosmetic or functional rhinoplasty cases. CONCLUSIONS Management of the midvault after dorsal hump reduction is important to establish proper aesthetic relationships and to provide functional integrity of the internal valve. Our authors present an algorithmic approach to decision-making based on the systematic analysis practiced by senior rhinoplasty surgeons.
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Crosara PFTB, Nunes FB, Rodrigues DS, Figueiredo ARP, Becker HMG, Becker CG, Guimarães RES. Rhinoplasty Complications and Reoperations: Systematic Review. Int Arch Otorhinolaryngol 2016; 21:97-101. [PMID: 28050215 PMCID: PMC5205520 DOI: 10.1055/s-0036-1586489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/18/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction This article is related to complications of rhinoplasty and its main causes of reoperations. Objectives The objective of this study is to perform a systematic review of literature on complications in rhinoplasty. Data Synthesis The authors conducted a survey of articles related to key terms in the literature by using three important databases within 11 years, between January 2002 and January 2013. We found 1,271 abstracts and selected 49 articles to this review. Conclusion The main results showed that the number of primary open rhinoplasty was 7902 (89%) and 765 closed (11%) and the percentage of reoperations in primary open complete rhinoplasties was 2.73% and closed complete was 1.56%. The statistical analysis revealed a value of p = 0.071. The standardization of terms can improve the quality of scientific publications about rhinoplasty. There is no difference between primary open or closed rhinoplasty techniques in relation to reoperations.
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Affiliation(s)
| | - Flávio Barbosa Nunes
- Ophthalmology and Otorhinolaryngology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Danilo Santana Rodrigues
- Ophthalmology and Otorhinolaryngology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Celso Goncalves Becker
- Department of Ear Nose and Throat, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Wulkan M, Sá AJDA, Alonso N. Modified technique to increase nostril cross-sectional area after using rib and septal cartilage graft over alar nasal cartilages. Acta Cir Bras 2013; 27:713-9. [PMID: 23033133 DOI: 10.1590/s0102-86502012001000008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/15/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. METHODS A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad(®); 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". RESULTS There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.
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Lohuis PJFM, Faraj-Hakim S, Knobbe A, Duivesteijn W, Bran GM. Split Hump Technique for Reduction of the Overprojected Nasal
Dorsum. ACTA ACUST UNITED AC 2012. [DOI: 10.1001/archfaci.2012.606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter J. F. M. Lohuis
- Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Zeist, Zeist (Drs Lohuis, Faraj-Hakim, and Bran); and Leiden Institute of Advanced Computer Science, Leiden University, Leiden (Drs Knobbe and Duivesteijn), the Netherlands
| | - Sara Faraj-Hakim
- Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Zeist, Zeist (Drs Lohuis, Faraj-Hakim, and Bran); and Leiden Institute of Advanced Computer Science, Leiden University, Leiden (Drs Knobbe and Duivesteijn), the Netherlands
| | - Arno Knobbe
- Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Zeist, Zeist (Drs Lohuis, Faraj-Hakim, and Bran); and Leiden Institute of Advanced Computer Science, Leiden University, Leiden (Drs Knobbe and Duivesteijn), the Netherlands
| | - Wouter Duivesteijn
- Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Zeist, Zeist (Drs Lohuis, Faraj-Hakim, and Bran); and Leiden Institute of Advanced Computer Science, Leiden University, Leiden (Drs Knobbe and Duivesteijn), the Netherlands
| | - Gregor M. Bran
- Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Zeist, Zeist (Drs Lohuis, Faraj-Hakim, and Bran); and Leiden Institute of Advanced Computer Science, Leiden University, Leiden (Drs Knobbe and Duivesteijn), the Netherlands
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Abstract
PURPOSE OF REVIEW The demand for cosmetic procedures has increased dramatically over the past few years, in part fueled by the prevalence of cosmetic 'makeover shows', increased media coverage on television and easy accessibility to the Internet. This growing social acceptance of aesthetic surgery has caused an increasing number of women and men to undergo elective noninvasive and invasive procedures to enhance their appearance. As the number of patients interested in cosmetic surgery increases and the number of physicians performing these procedures increases, the risk of complications invariably also rises. An article focusing on the prevention of complications in facial plastic surgery, therefore, is clearly appropriate in the current era. RECENT FINDINGS One of the recurring themes in the literature is preventing complications before they occur. Proper patient selection, a thorough understanding of the anatomy and adhering to proper techniques are some of the methods mentioned to avoid unfavorable outcomes. SUMMARY The literature is replete with articles that focus on the newest techniques for facial rejuvenation. Only through careful analysis of the pitfalls of cosmetic procedures, however, can the facial plastic surgeon adopt principles to help prevent complications.
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Affiliation(s)
- Carlo P Honrado
- Division of Facial Plastic and Reconstructive Surgery, New York Medical College, Valhalla, New York, USA
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