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Salehi PP, Frants A, Friedman O, Sykes J, Nassif P. Safety in Rhinoplasty: Avoidance and Management of Complications. Facial Plast Surg Clin North Am 2024; 32:653-668. [PMID: 39341679 DOI: 10.1016/j.fsc.2024.06.008] [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] [Indexed: 10/01/2024]
Abstract
Rhinoplasty is one of the most popular operations in the world. Despite its popularity, rhinoplasty complications are common and stem from a myriad of issues both subjective and objective in nature. Complications of rhinoplasty include scar, asymmetries, irregularities, imperfections, nasal airway obstruction, skin ischemia or necrosis, nasal collapse, nasal deformity, and overcorrection or undercorrection of a perceived nasal irregularity. A thorough understanding of these potential complications, along with strategies for avoidance and management, is critical for ensuring patient safety and optimizing surgical outcomes.
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Affiliation(s)
- Parsa P Salehi
- SalehiMD Plastic Surgery, Newport Beach, CA, USA; NassifMD Plastic Surgery, 120 South Spalding Drive #301, Beverly Hills, CA 90212, USA.
| | - Anna Frants
- NassifMD Plastic Surgery, 120 South Spalding Drive #301, Beverly Hills, CA 90212, USA; Specialty Aesthetic Surgery, New York, NY, USA. https://twitter.com/DrAnnaFrants
| | - Oren Friedman
- Facial Plastic Surgery, Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jonathan Sykes
- Facial Plastic Surgery, University of California, Davis Medical Center, Davis, CA, USA; Sykes Fascial Plastic Surgery, Beverly Hills, CA, USA
| | - Paul Nassif
- NassifMD Plastic Surgery, 120 South Spalding Drive #301, Beverly Hills, CA 90212, USA; Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA. https://twitter.com/DrPaulNassif
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2
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Capelleras M, Soto-Galindo GA, Cruellas M, Apaydin F. ChatGPT and Rhinoplasty Recovery: An Exploration of AI's Role in Postoperative Guidance. Facial Plast Surg 2024; 40:628-631. [PMID: 38029791 DOI: 10.1055/a-2219-4901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The potential applications of artificial intelligence (AI) in health care have garnered significant interest in recent years. This study presents the first published exploration of ChatGPT, an AI language model, as a tool for providing postoperative guidance during rhinoplasty recovery. The primary objective was to shed light on the role of ChatGPT in augmenting patient care during the critical postoperative phase. Using the Rhinobase database, standardized questions were formulated to evaluate AI-generated responses addressing pain management, swelling, bruising, and potential asymmetries. Results demonstrated that ChatGPT has the potential to enhance patient education and alleviate emotional distress by providing general information and reassurance during the recovery process. However, the study emphasized that AI should not replace personalized advice from qualified health care professionals. This pioneering investigation offers valuable insights into the integration of AI and human expertise, paving the way for optimized postrhinoplasty recovery care.
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Affiliation(s)
- Marta Capelleras
- Department of Otolaryngology Head & Neck Surgery, Ege University, Izmir, Türkiye
| | | | - Marc Cruellas
- Department of Otorhinolaryngology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Fazil Apaydin
- Department of Otorhinolaryngology, Ege University Medical Faculty, Izmir, Türkiye
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3
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Sulaiman SY, Alnori H, Al-Talibi I, Goksel A. The Effect of Cannula Drain in Reducing Edema and Ecchymosis after Rhinoplasty. Facial Plast Surg 2024; 40:664-669. [PMID: 38267000 DOI: 10.1055/a-2253-5971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Rhinoplasty is one of the most common plastic surgeries and is commonly associated with postoperative edema, ecchymosis, and pain which play a role in patients' dissatisfaction. In this randomized comparative study, we discuss the effect of cannula drainage in the reduction of postoperative periorbital edema, ecchymosis, pain, and nasal obstruction after open structural septorhinoplasty. The study was conducted at a tertiary referral center from April to November 2022. We performed internal lateral osteotomy on all patients using the lateral saw and aided by lateral osteotome. At the end of the procedure, a cannula drain is prepared and inserted in the subperiosteal tunnel on the left side only. Patients were examined on the 1st, 3rd, 7th, 14th, and 21st days for periorbital edema, ecchymosis, pain, and nasal obstruction, and each side is scored separately. A total of 40 patients (80 sides in total) were recruited, 22 females (55%) and 18 males (45%), all of whom were adults (18-44 years old; mean age 29 years). The most frequent age group is those younger than 20 years representing 35% of the sample and the males forming 33.3%. The reduction in edema and pain was statistically significant in the drained sides (p = 0.000) during all the postoperative days. On the other hand, ecchymosis was lower on the drained side but statistically insignificant (p = > 0.29). Nasal obstruction was reduced significantly only on the seventh postoperative day (p = 0.000). The postoperative morbidities associated with rhinoplasty could have important functional and psychological effects on patients. This study demonstrates that inserting a cannula in the subperiosteal tunnel for drainage in rhinoplasty yields a significant clinical and statistical decrease in postoperative periorbital edema and pain with little effect on ecchymosis and nasal obstruction.
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Affiliation(s)
| | - Haitham Alnori
- Department of Surgery, College of Medicine, University of Mosul, Mosul, Iraq
| | - Islam Al-Talibi
- Department of ENT Surgery, Al-Jamhuri Teaching Hospital, Mosul, Iraq
| | - Abdulkadir Goksel
- Department of ENT Facial Plastic Surgery, RinoIstanbul Clinic, Istanbul, Türkiye
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Behroozian T, Ripan V, Kim P, Yuan M, Gallo L, Ulhman K, McRae M, Podolsky D, Ahmad J. Assessment of Harms Reporting Quality in Randomized Controlled Trials of Aesthetic Rhinoplasty: A Systematic Review. Aesthet Surg J Open Forum 2024; 6:ojae057. [PMID: 39114319 PMCID: PMC11304942 DOI: 10.1093/asjof/ojae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Background Rhinoplasty is one of the most common aesthetic plastic surgery procedures. Complications can lead to both aesthetic and functional impairments. The Consolidated Standards of Reporting Trials (CONSORT) Harms statement was developed to promote improved reporting of harm across randomized controlled trials (RCTs). Objectives The aim of this systematic review is to assess harms reporting quality across RCTs on aesthetic rhinoplasty. Methods A literature search was conducted in Ovid MEDLINE and Embase databases (January 1, 2005 to August 4, 2023). RCTs which compared 2 or more interventions in rhinoplasty with primarily aesthetic indications and assessed patient-important outcomes were included. The reporting quality was assessed by following a 40-item checklist endorsed by the 2022 CONSORT Harms Extension update. Results A total of 58 RCTs met the inclusion criteria. Fifteen RCTs addressed harms of treatment in some capacity. Overall, the reporting quality across RCTs was poor, with a median CONSORT Harms score of 33% (range, 16%-83%). A reporting adherence of ≥50% was met by only 8 studies. There was no significant difference in reporting adherence between studies based on journal endorsement of CONSORT or industry vs nonindustry funding sources (P > .05). A high journal impact factor was significantly associated with a higher reporting quality (P = .044). Conclusions CONSORT Harms reporting adherence was poor across the majority of included RCTs. Future trials on aesthetic rhinoplasty should aim to follow the reporting recommendations endorsed by the CONSORT Harms statement to increase transparency and minimize heterogeneity in harms reporting across studies. Level of Evidence 1
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jamil Ahmad
- Corresponding Author: Dr Jamil Ahmad, 1421 Hurontario Street, Mississauga, ON, Canada L5G 3H5. E-mail: ; Instagram: @drjahmad
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Benites C, Awan MU, Patel H, Pandit S, Shifchik A, Harmon S, Malisetyan T, Angel S, Goldrich D, Demory ML. An examination of antibiotic administration in septorhinoplasty: A systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104333. [PMID: 38677149 DOI: 10.1016/j.amjoto.2024.104333] [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: 02/08/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Septoplasty and rhinoplasty are common otolaryngological procedures, often combined as septorhinoplasty (SRP), offering aesthetic and functional benefits. These surgeries are believed to potentially risk postoperative infections due to natural bacterial flora in the nares. This study evaluates the effectiveness of prophylactic antibiotics in reducing post-surgical infection complications. MATERIALS AND METHODS A systematic review was conducted using PubMed, Cochrane, and Web of Science, adhering to PRISMA guidelines, focusing on antibiotic use in septoplasty, rhinoplasty, and SRP. The study included randomized control trials, single/double-blind studies, retrospective chart reviews, and prospective cohort studies, excluding pediatric, non-human research, or studies with inaccessible data. Postoperative infection rates were analyzed utilizing R software as a form of Statistic. RESULTS From 697 articles, 15 studies were chosen for meta-analysis, involving 2225 patients, with 1274 receiving prophylactic antibiotics and 951 as controls. The meta-analysis indicated an odds ratio of 0.65 (95 % CI: [0.23, 1.89]), showing no significant protective effect of prophylactic antibiotics. DISCUSSION The study found no significant infection rate reduction with prophylactic antibiotic use. Notable were inconsistencies in study designs, antibiotic administration timing, and varied surgical practices. Antibiotic use risks were considered. Study limitations include potential biases and the retrospective nature of many studies. CONCLUSIONS This review and meta-analysis found no substantial evidence supporting prophylactic antibiotics' effectiveness in reducing postoperative infection rates in septoplasty, rhinoplasty, and SRP, indicating a need to reevaluate practices and develop evidence-based guidelines. Future research should focus on comprehensive, randomized control studies, covering both preoperative and postoperative stages.
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Affiliation(s)
- Cristina Benites
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Muhammad Usman Awan
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Heli Patel
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Saket Pandit
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Anastassia Shifchik
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Skylar Harmon
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Tatevik Malisetyan
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Samuel Angel
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - David Goldrich
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Pennsylvania State University, United States of America.
| | - Michelle L Demory
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
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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; 26:456-462. [PMID: 38350143 DOI: 10.1089/fpsam.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Stein MJ, Yuksel SS, Harrast J, Taub PJ, Matarasso A, Gosain AK. Clinical Practice Patterns and Evidence-Based Medicine in Rhinoplasty: A 10-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. Aesthetic Plast Surg 2024; 48:1312-1320. [PMID: 37605029 DOI: 10.1007/s00266-023-03599-2] [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: 05/24/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The American Board of Plastic Surgery (ABPS) has collected data on cosmetic surgery from member surgeons since 2003. These data offer valuable information on national trends in clinical practice. OBJECTIVES The present study was performed to analyze trends in rhinoplasty over the last decade. METHODS Tracer data were compared between two cohorts 2012-2016 (early cohort "EC") and 2017-2021 (recent cohort "RC"). Data included patient demographics and surgical techniques. Results were considered in the context of current EBM-based guidance in the plastic surgery literature. RESULTS Data from 730 rhinoplasties (270 EC and 460 RC) were analyzed. The median age was 30 years, and the most common patient concern was the nasal dorsum (79%). In the RC group, fewer patients voiced concerns about tip projection (58% vs 43%, p = 0.0002) and more complained of functional airway problems (38% vs 49%, p = 0.004). An open approach was most common (83%). Septoplasty (47% vs 52%, p = 0.005), caudal septum repositioning (14% vs 23%, p = 0.002), and tip rotation maneuvers (32% vs 49%, p < 0.0001) became more popular. There was also an increase in the use of spreader grafts (35% vs 45%, p = 0.01) and columellar strut grafts (42% vs 50%, p = 0.04), while there has been a decrease in alar base resection (17% vs 10%, p = 0.007) and non-cartilaginous dorsum/radix augmentation (9% vs 4%, p = 0.02). CONCLUSIONS ABPS tracer data provide an excellent resource for the objective assessment of procedures in plastic surgery. The present study is the first to highlight evolving trends in rhinoplasty over the last 10 years. 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)
- Michael J Stein
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Selcen S Yuksel
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA
| | - John Harrast
- Data Harbor Solutions, American Board of Plastic Surgery, Philadelphia, PA, USA
| | - Peter J Taub
- American Board of Plastic Surgery and Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Alan Matarasso
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA.
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8
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Wong EHC, D'Souza A. Myomodulation Using Botulinum Toxin in Septorhinoplasty for Crooked Noses: Introducing the Concept and Application of Nasal Muscle Imbalance Theory. Facial Plast Surg 2024; 40:52-60. [PMID: 36878680 DOI: 10.1055/a-2047-7179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
The role of septorhinoplasty for adequate correction of deviated nose is well documented, but the rationales and patterns for recurrences after proper rhinoplasty remain unclear. There has also been little attention given to the influence of nasal musculatures on the stability of nasal structures after septorhinoplasty. The aim of this article is to propose our nasal muscle imbalance theory, which may explain the potential reason for redeviation of the noses in the initial period after septorhinoplasty. We postulate that in a chronically deviated nose, the nasal muscles on the convex side will be stretched and develop hypertrophy after prolonged period of increased contractile activity. On the contrary, the nasal muscles on the concave side will undergo atrophy due to reduced load requirement. In the initial period of recovery after a septorhinoplasty to bring the nose back to midline, this muscle imbalance is still uncorrected with unequal pulling forces on the nasal structure because the stronger nasal muscles on the previously convex side is still hypertrophied and exert stronger forces compared with the previously concave side, therefore increasing the risk of redeviation of the nose back to the preoperative side until muscle atrophy occurs in the convex side and a balanced nasal muscle pull is achieved. We believe that postseptorhinoplasty botulinum toxin injections can be used as an adjunct in rhinoplasty surgery to effectively block the pulling actions of the stronger or overacting nasal muscles by speeding up the atrophy process while allowing patient's nose to heal and stabilize in the desired position. However, further studies to objectively confirm this hypothesis is required, which include comparing topographic measurements, imaging and electromyography signals before and after injections in postseptorhinoplasty patients. The authors have already planned a multicenter study to further evaluate this theory.
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Affiliation(s)
- Eugene Hung Chih Wong
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Alwyn D'Souza
- Institute of Medical Sciences, Canterbury Christ Church University, Kent, United Kingdom
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9
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Swamy V, Phelan AL, Abdelrahman A, Albert MG. Limited Incision Rhinoplasty: An Approach for All Primary and Revision Cases. Aesthetic Plast Surg 2024; 48:407-412. [PMID: 38148360 DOI: 10.1007/s00266-023-03778-1] [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: 10/10/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Rhinoplasty was one of the most frequently performed aesthetic surgeries in the USA in 2022. Traditionally, the open approach has been preferred by the majority of surgeons often due to familiarity and ease of visualization. However, patient interest in closed and preservation rhinoplasty is driving a resurgence in the popularity of endonasal techniques. We present a series of 100 consecutive endonasal primary and revision rhinoplasty cases using bilateral isolated modified rim incisions. METHODS One-hundred consecutive patients underwent closed rhinoplasty via isolated modified rim incisions at a single-surgeon private practice. The senior author performs 100% endonasal rhinoplasty. A retrospective chart review was performed from 06/25/20 to 09/21/22. Information on demographics, complications, and need for revision was collected. RESULTS Eighty-four patients underwent primary rhinoplasty, 11 underwent secondary rhinoplasty, 4 underwent tertiary rhinoplasty, and 1 underwent quaternary rhinoplasty. Isolated modified rim incisions were used in all cases except in cases of septoplasty when a unilateral Killian incision was added, or in cases of lateral osteotomy when vestibular stab incisions were added. Post-operatively, six (6.0%) patients required revision, all of which were performed under local anesthesia. CONCLUSION Limited incision rhinoplasty is a reliable surgical approach that produces predictable results with a low revision rate. This technique is highly effective in minimizing soft tissue disruption to ensure safe, reliable, and effective outcomes in primary and revision rhinoplasty. It is an easier technique to learn compared to traditional endonasal and even arguably open rhinoplasty, thus lending itself to widespread adoption especially among novice rhinoplasty surgeons. 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)
- Viswanath Swamy
- Department of Plastic Surgery, Michigan State University College of Human Medicine, 15 Michigan ST NE, Grand Rapids, MI, 49503, USA
| | - Alannah L Phelan
- Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, 210 E. 64th Street, 950 Park Ave, New York, NY, 10065, USA
| | - Amani Abdelrahman
- Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, 210 E. 64th Street, 950 Park Ave, New York, NY, 10065, USA
| | - Mark G Albert
- Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, 210 E. 64th Street, 950 Park Ave, New York, NY, 10065, USA.
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10
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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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11
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Yong M, Hollemon D, Baxter J, Hirst A, Bryning S, Fox A, Smith G, Hughes R, Brandolini G, Wolf S, Ow R. Economic impact analysis of a minimally invasive temperature-controlled radiofrequency device versus nasal surgery for the treatment of nasal airway obstruction in the United States. J Med Econ 2024; 27:708-714. [PMID: 38581156 DOI: 10.1080/13696998.2024.2340385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To determine the economic impact of a minimally invasive temperature-controlled radiofrequency (TCRF) device for treating nasal airway obstruction (NAO). METHODS A budget impact model was developed for two scenarios: a reference scenario of functional rhinoplasty surgery with concomitant septoplasty and inferior turbinate reduction (ITR) performed in the hospital outpatient department where TCRF is not an available treatment option and a new scenario consisting of in-office TCRF treatment of the nasal valve and ITR. A payor perspective was adopted with a hypothetical population plan size of one million members. Costs were estimated over a time horizon of 4 years. The eligible population included patients with severe/extreme NAO and nasal valve collapse (NVC) as the primary cause or significant contributor. Data inputs were sourced from targeted literature reviews. Uncertainty within the model structure and input parameters was assessed using one-way sensitivity analysis. RESULTS The introduction of a TCRF device resulted in population-level cost savings of $20,015,123 and per-responder average cost savings of $3531 through a 4-year time horizon due to lower procedure costs and complication rates of the device relative to the surgical comparator. Results were robust when varying parameter values in sensitivity analyses, with cost savings being most sensitive to the prevalence of NAO and estimated response rates to functional rhinoplasty and TCRF. CONCLUSIONS In patients with severe/extreme NAO, with NVC as the primary or major contributor, introducing TCRF with ITR as a treatment option demonstrates the potential for significant cost savings over functional rhinoplasty with septoplasty and ITR.
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Affiliation(s)
| | | | | | | | | | - Aimee Fox
- Adelphi Values PROVE, Bollington, UK
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12
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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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13
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Nocini R, Arietti V, Barausse E, Torroni L, Trotolo A, Sanna G. Proposal for Perioperative Pharmacological Protocol for the Reduction in Early Complications in Orthorhinoseptoplasty: Five Years of Experience. J Pers Med 2023; 13:1330. [PMID: 37763098 PMCID: PMC10532652 DOI: 10.3390/jpm13091330] [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: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Septorhinoplasty is a crucial intervention in functional and aesthetic facial surgery. Although rare and usually manageable, complications could lead to disfiguring consequences. There is no universal protocol for perioperative management in the literature. The aim of this article is to analyze the surgical complications in patients who underwent open rhinoseptoplasty and were treated in the perioperative period with the standardized protocol used in our department, in order to propose it as a standardized protocol for a more global application. METHODS The patients included underwent rhinoplasty between 2017 and 2022 and were managed with the same treatment protocol. Perioperative and intraoperative data, as well as possible complications, were collected. RESULTS A total of 129 patients were included, 73% of which reported either mild or no complications. Abnormal scar healing was the most frequent complaint (9%), followed by edema (6.2%), nasal dyspnea (3.9%), infection (2.3%), and bleeding (2.3%). No severe complications were reported. CONCLUSIONS Our protocol appears to be effective in minimizing complications such as infection and bleeding, although it is very difficult to compare the results with the literature.
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Affiliation(s)
- Riccardo Nocini
- Unit of Otolaryngology, Head and Neck Department, AOUI University of Verona, 37100 Verona, Italy
| | - Valerio Arietti
- Unit of Otolaryngology, Head and Neck Department, AOUI University of Verona, 37100 Verona, Italy
| | - Eleonora Barausse
- Unit of Maxillo-Facial Surgery, Head and Neck Department, AOUI University of Verona, 37100 Verona, Italy (A.T.)
| | - Lorena Torroni
- Unit of Epidemiology and Medical Statics, Department of Diagnostics and Public Health, AOUI University of Verona, 37100 Verona, Italy;
| | - Alessandro Trotolo
- Unit of Maxillo-Facial Surgery, Head and Neck Department, AOUI University of Verona, 37100 Verona, Italy (A.T.)
| | - Giangiacomo Sanna
- Unit of Maxillo-Facial Surgery, Head and Neck Department, AOUI University of Verona, 37100 Verona, Italy (A.T.)
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14
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Mizrachi M, Layous E, Dror AA, Yakir O, Bader A, Sela E. Periorbital Ecchymosis Post Closed Rhinoplasty: Natural History, Risk Factors, and Validation of a New Scoring System. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5112. [PMID: 37448765 PMCID: PMC10337704 DOI: 10.1097/gox.0000000000005112] [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: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 07/15/2023]
Abstract
Postrhinoplasty periorbital ecchymosis is an inevitable side effect contributing to patients' psychological aspect and early postoperative morbidity. Efforts are constantly being made to reduce ecchymosis using different methods with varying success. To evaluate treatment response, it is mandatory to have a reliable score. Several studies suggest other scoring systems, but none has been postrhinoplasty-specific, validated, and accepted. This study aimed to demonstrate the natural history of postrhinoplasty ecchymosis, find potential risk factors for worsening patterns, and suggest a useful and reliable periorbital ecchymosis scoring system for postrhinoplasty follow-up. Methods This prospective study included 183 patients who underwent closed rhinoplasty by the same surgeon and the same principle method. Photographs of the periorbital ecchymosis were taken on postoperative days 1, 2, and 7. The periorbital area was divided into quarters, and three independent physicians assigned the dominant color of each quarter. Results There were no significant variations between the three physicians' scoring. The interobserver consistency defined as an excellent scoring system reliability, according to our statistical analysis. The postoperative ecchymosis demonstrated a consistent pattern of spread over time, dominating the medial quarters on early postoperative days 1 and 2, following into the lower lateral quarters in postoperative day 7. We found no correlation between patient demographics and clinical characteristics to ecchymosis patterns and temporal spread. Conclusions Our study suggests a reliable and easy-to-use postrhinoplasty ecchymosis scoring system. This scoring method can be used for postrhinoplasty ecchymosis assessment and as a research-validated tool to quantify different perioperative treatments to reduce ecchymosis and estimate mid-face trauma.
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Affiliation(s)
- Matti Mizrachi
- From the Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Eli Layous
- From the Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Amiel A. Dror
- From the Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Orly Yakir
- Statistical Analysis Division, Galilee Medical Center, Nahariya, Israel
| | - Ahmad Bader
- From the Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Eyal Sela
- From the Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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15
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Akbarpour M, Jalali MM, Akbari M, Nasirmohtaram S, Haddadi S, Habibi AF, Azad F. Investigation of the effects of intranasal desmopressin on the bleeding of the patients during open septorhinoplasty: A randomized double-blind clinical trial. Heliyon 2023; 9:e17855. [PMID: 37455992 PMCID: PMC10344754 DOI: 10.1016/j.heliyon.2023.e17855] [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: 04/22/2022] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives Rhinoplasty is one of the most common cosmetic surgeries in the world. Lack of adequate local homeostasis may lead to excessive bleeding during the operation, which increases the time of operation and recovery period, and the prevalence of complications. This study investigated the effects of nasal desmopressin on the quality of the surgical field and the volume of bleeding during rhinoplasty. Materials and methods This double-blind randomized clinical trial was performed on 120 patients aged 18-40 years who were candidates for rhinoplasty. Patients were randomly divided into three groups: low-dose desmopressin group and high-dose desmopressin group and placebo group. Hemodynamic changes and surgical field based on BOEZAART criteria, and the volume of bleeding were calculated. Results In this study 115 women (95.8%) and 5 men (4.2%) participated. The mean age of patients was (27 ± 6.8). Bleeding volume in high dose desmopressin group was (21.7 cc ± 12.3), (27.7 cc ± 12.3) in low dose group, and (38.3 cc ± 12.3) in the placebo group, The difference in blood volume among the three groups was statistically significant with p < 0.005. Clean surgical field according to BOEZAART classification was marginally significant in both desmopressin groups. The differences in blood pressure, heart rate, blood and urine sodium, and hemoglobin before and after surgery between groups there not statistically significant. Conclusion Based on the results of the present study topical nasal spray desmopressin can reduce surgical field bleeding during rhinoplasty. To generalize the results to other surgeries in the ENT field it is recommended to conduct studies.
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Affiliation(s)
- Maliheh Akbarpour
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mir-Mohammad Jalali
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Akbari
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sevil Nasirmohtaram
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Faghih Habibi
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Azad
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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16
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Melancon CC, Challapalli S, Kridel RWH. The Use of Acellular Human Dermis as a Dorsal Camouflaging Graft in Rhinoplasty. Facial Plast Surg Aesthet Med 2023; 25:220-224. [PMID: 36637866 DOI: 10.1089/fpsam.2021.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Acellular human dermis (AHD) has many uses in rhinoplasty, but its long-term use as a camouflaging graft has not been adequately described. Objective: To measure the long-term outcomes (infections/contour irregularities) of AHD used as a camouflage graft in rhinoplasty. Methods: A retrospective study of 91 patients who underwent rhinoplasty requiring AHD as a camouflage graft for a 20-year time period (2000-2020) was performed. Complications, revisions, and long-term outcomes were assessed. Surgical technique for AHD use as a dorsal and tip camouflage graft was described in detail and illustrated using intraoperative photography. Results: Of the 91 patients who required AHD in their rhinoplasties, 70 (77%) were performed in revision cases to thicken thinned and scarred skin envelopes. Only 1% had postoperative contour problems that were attributable to AHD, and only 3% had resorption of the AHD. Four percent had postoperative infections, all of which resolved with a single course of oral antibiotics. Patients were followed a mean of 3.8 years. Conclusions: AHD can be a safe, effective, and readily available option for use in thickening the nasal skin envelope in rhinoplasty.
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Affiliation(s)
- C Claire Melancon
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, Texas, USA
- Facial Plastic Surgery Associates, Houston, Texas, USA
| | - Sai Challapalli
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, Texas, USA
| | - Russell W H Kridel
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, Texas, USA
- Facial Plastic Surgery Associates, Houston, Texas, USA
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17
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Saadoun R, Solari MG, Rubin JP. The Role of Autologous Fat Grafting in Rhinoplasty. Facial Plast Surg 2023; 39:185-189. [PMID: 36100254 DOI: 10.1055/a-1942-2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Rhinoplasty is one of the most popular aesthetic surgeries worldwide and often includes grafting techniques to achieve optimal results. One of these grafting techniques is autologous fat transfer, which has been used to increase volume, camouflage irregularities, and/or improve the quality of the nasal skin-soft tissue envelope. Moreover, minimally invasive approaches for altering the nasal appearance have recently increased and become known as "liquid" or "nonsurgical rhinoplasty." These nonsurgical approaches include altering the nasal appearance with filler injection to induce volumetric changes in lieu of extensive surgery. The use of fat grafting as a filler is favorable to achieve well-balanced aesthetic results without compromising the nasal skin-soft tissue envelope. This capability is partly because of the regenerative potential of fat grafts, serving to improve the quality of surrounding soft tissues. In contrast, commercial injectable fillers are inert. This article highlights the role of fat grafting in surgical and nonsurgical rhinoplasty to provide surgeons with an overview of the potential of these vastly abundant, biocompatible, and cost-effective grafts.
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Affiliation(s)
- Rakan Saadoun
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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18
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Defining Our Terms: Are Postoperative Complications Adequately Defined in the Rhinoplasty Literature? Aesthetic Plast Surg 2022; 47:1155-1161. [DOI: 10.1007/s00266-022-03155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/17/2022] [Indexed: 11/01/2022]
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19
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Seo MG, Choi EK, Chung KJ. Delayed inflammatory response evoked in nasal alloplastic implants after COVID-19 vaccination: A case report. World J Clin Cases 2022; 10:8298-8303. [PMID: 36159519 PMCID: PMC9403671 DOI: 10.12998/wjcc.v10.i23.8298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/09/2022] [Accepted: 07/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Delayed inflammatory reactions (DIRs) in alloplast rhinoplasty are a rare complication that may occur several months to years after surgery. The exact causes and mechanisms are unclear, but several triggering factors, including infections, trauma, dental procedures, and vaccination, have been reported.
CASE SUMMARY A 39-year-old male patient who had undergone augmentation rhinoplasty 8 years ago had DIRs after the administration of the first dose of the mRNA Pfizer coronavirus disease 2019 (COVID-19) vaccine. He suddenly had tender, erythematous swelling on his face 6 d after vaccination. As there was no improvement in the patient’s condition after the conservative treatment, surgical removal of an alloplastic nasal implant was performed. Immediately after the surgery, the DIRs and accompanying symptoms ameliorated rapidly. A histological study conducted during surgery was fibrosis and small fragments of the hyaline cartilage.
CONCLUSION The correlation between DIRs and COVID-19 vaccination has not been reported yet and the exact mechanism is unclear. Because the uncontrolled inflammatory reactions on the nose leave serious sequelae, surgeons should be conscious of the correlation between COVID-19 vaccines and DIRs associated with nasal alloplastic implants. And further histological or microbiological studies should be performed to determine the cause of DIRs.
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Affiliation(s)
- Min-Gi Seo
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu 42415, South Korea
| | - Eun Kyung Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu 42415, South Korea
| | - Kyu Jin Chung
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu 42415, South Korea
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20
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Utilization of Leech Therapy after Rhinoplasty. Plast Reconstr Surg 2022; 149:1090e-1095e. [PMID: 35383721 DOI: 10.1097/prs.0000000000009096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of medicinal leeches in modern reconstructive surgery is well-described. Leech therapy after rhinoplasty has not been previously well-characterized. METHODS The medical records of all patients who underwent open rhinoplasty by a single surgeon over a 4-year period were reviewed. Patient demographics, including age, sex, medical comorbidities, number of previous rhinoplasty surgeries, time to utilization of leech therapy, adjunct therapies used, resolution of skin changes, and smoking status, were recorded. Operative reports were reviewed for pertinent information, including number of tip grafts used, graft materials used, and placement of septal extension grafts or "unicorn" grafts. RESULTS Between April of 2016 and March of 2020, 545 patients underwent rhinoplasty performed by the senior author (P.S.N.). Of these patients, 39 (7.2 percent) underwent leech therapy postoperatively. The mean age of included patients was 47.4 years. Of the patients who required leech therapy, 34 (87.2 percent) had undergone revision rhinoplasty. The mean number of previous rhinoplasties was 3.4. The mean number of tip grafts used was 2.6. Thirty-three patients (84.6 percent) had either a traditional septal extension graft or unicorn graft placed. Nine patients (23.1 percent) were former smokers. Complete resolution of skin color changes was seen in 38 patients (97.4 percent). There were no major complications after leech therapy. CONCLUSIONS Leech therapy is a useful tool for the rhinoplasty surgeon, particularly in the setting of complex revision rhinoplasty, in patients who have undergone multiple previous nasal surgical procedures, or in patients who require significant cartilage grafting to reconstruct the nasal tip or lengthen the nose. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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21
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Tham T, Bhuiya S, Wong A, Zhu D, Romo T, Georgolios A. Clinical Outcomes in Dorsal Preservation Rhinoplasty: A Meta-Analysis. Facial Plast Surg Aesthet Med 2022; 24:187-194. [PMID: 35172105 DOI: 10.1089/fpsam.2021.0312] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Dorsal preservation rhinoplasty (PR-D) attempts to preserve as much of the native nasal anatomy as possible when performing a hump reduction, but clinical outcomes are unclear. Objective: In patients undergoing PR-D rhinoplasty, this article investigates the rates of complications and revisions. Methods: This meta-analysis was prospectively registered on the PROSPERO database. The Pubmed, Embase, and Scopus databases were searched. Pooled incidence was calculated in a meta-analysis within a random-effects model. Results: Twenty-two studies representing a cohort of 5660 patients were included in this study. Postoperative hump recurrence rates (4.18%, 95% confidence interval [CI]: 2.41-6.40%), rates of revision rhinoplasty (3.48%, 95% CI: 1.77-5.74%), rates of postoperative nasal deviation (1.13%, 95% CI 0.37-2.28%), and rates of infection (1.89%, 95% CI: 0.35-4.62%) were all found to be low. Conclusion: PR-D has low rates of revision surgery, residual or recurrent hump, postoperative nasal deviation, and postoperative infection.
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Affiliation(s)
- Tristan Tham
- Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Sabreen Bhuiya
- Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Amanda Wong
- Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Daniel Zhu
- Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Thomas Romo
- Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA
| | - Alexandros Georgolios
- Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.,Poplar Bluff Regional Medical Center, Poplar Bluff, Missouri, USA
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22
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A systematic analysis of surgical interventions for the airway in the mature unilateral cleft lip nasal deformity: a single case study. Int J Comput Assist Radiol Surg 2022; 17:41-53. [PMID: 34080126 PMCID: PMC8636526 DOI: 10.1007/s11548-021-02396-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Individuals with unilateral cleft lip nasal deformity (uCLND) often require rhinoplasty in adolescence to correct nasal obstruction. The intent of this study is to identify sites of greatest nasal obstruction and evaluate the effects of isolated and combinations of simulated surgical procedures on these sites using computational fluid dynamics (CFD). METHODS Computed tomography imaging of an adolescent subject with uCLND was converted to an anatomically accurate three-dimensional nasal airway model. Initial analysis was performed to identify anatomic sites of obstruction based on CFD computed resistance values. Virtual surgery procedures corresponding to common uCLND surgical interventions were simulated. Resulting airspace models were then analyzed after conducting airflow and heat transfer simulations. RESULTS The preoperative model had 21 obstructed sites with a nasal resistance of 0.075 Pa s/mL. Following simulated surgical procedures with functional interventions alone and in combinations, the three virtual surgery models with most improved nasal airflow were inferior turbinate reduction (ITR) with posterior septoplasty (resistance = 0.054 Pa s/ml, reduction in 14 of 21 obstructed sites), ITR with anterior septoplasty (resistance = 0.058 Pa s/ml, reduction in 8 of 21 obstructed sites), and ITR with both anterior and posterior septoplasty (resistance = 0.052 Pa s/ml, reduction in 17 of 21 obstructed sites). CONCLUSION This study introduces a new technique for analysis of the impact of different simulated surgical interventions on uCLND-induced nasal obstruction. In this subject, simulated septoplasty with ITR on the non-cleft side provided maximal relief of nasal obstruction. The proposed technique can be further studied for possible utility in analyzing potential surgical interventions for optimal relief of nasal obstruction in patients with uCLND.
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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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24
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Blau JA, Marcus JR. Commentary on: Comparison of Changes in Nasal Skin Sensation After Primary and Revision Rhinoplasty Procedures Using Semmes-Weinstein Monofilament Testing. Aesthet Surg J 2021; 41:NP1301-NP1302. [PMID: 33829246 DOI: 10.1093/asj/sjab169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jared A Blau
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Jeffrey R Marcus
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
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25
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Ong AA, Kelly A, Castillo GA, Carr MM, Sherris DA. Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States. Aesthet Surg J 2021; 41:1132-1138. [PMID: 33331894 DOI: 10.1093/asj/sjaa380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When complications following rhinoplasty occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction. OBJECTIVES The aims of this study were to identify motives for seeking medical malpractice litigation after rhinoplasty, and to examine outcomes of malpractice litigation after rhinoplasty in the United States. METHODS The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes. RESULTS Twenty-three cases were identified between 1960 and 2018, located in 12 US states; 70% of the plaintiffs were female. Otolaryngologists were cited in 11 cases, whereas 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved "technical" errors (69.6%), "unsatisfactory" outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. The main contributing factor in cases alleging malpractice was poor aesthetic outcome/disfigurement (60.7%). CONCLUSIONS Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The principal reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient's surgical expectations, and obtaining detailed informed consent while maintaining frequent and caring communication with the patient.
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Affiliation(s)
- Adrian A Ong
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andrew Kelly
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David A Sherris
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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26
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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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27
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Jiang A, Chamata ES, Bressler FJ. Revision Rhinoplasty: With Introduction of a Novel Preoperative Assessment Classification System. Semin Plast Surg 2021; 35:78-87. [PMID: 34121943 DOI: 10.1055/s-0041-1727271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Revision rhinoplasty presents several complex surgical challenges. Proper patient selection for revision rhinoplasty, along with thorough preoperative examination and surgical planning, is key to achieving ideal outcomes. Along with achieving a high level of understanding of primary rhinoplasty techniques, surgeons performing revision rhinoplasty must understand and diagnose deformities created by the primary surgery. A systematic approach to diagnosing rhinoplasty deformities assists in forming a suitable surgical plan. A classification system based on nasal analysis, described here, may be used to differentiate the degree of difficulty of the surgery as well as assist in surgical planning. Surgeons have a multitude of options available in their armamentarium for addressing common nasal deformities encountered during revisional surgery, and a stepwise surgical approach may facilitate the creation of an optimal aesthetic and functional result.
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Affiliation(s)
- Austin Jiang
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward S Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Fred J Bressler
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas
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Constantian MB. What We Have Lost by Forgetting Endonasal Rhinoplasty. Facial Plast Surg 2021; 38:66-69. [PMID: 34102689 DOI: 10.1055/s-0041-1730386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mark B Constantian
- Department of Surgery, University of Wisconsin-Madison Center for Health Systems Research and Analysis, Madison, Wisconsin.,Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.,Private Practice, Nashua, New Hampshire
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Glener AD, Marcus JR. Invited Discussion on: Septorhinoplasty and Septoplasty-Outcomes of a Large Cohort Using Autologous Versus Homologous Cartilage 1999-2019. Aesthetic Plast Surg 2021; 45:615-616. [PMID: 33118085 DOI: 10.1007/s00266-020-02019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Adam D Glener
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, United States
| | - Jeffrey R Marcus
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, United States.
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Factors Involved in the Decision of Iranian Men to Undergo Rhinoplasty: A Grounded Theory Study. Plast Surg Nurs 2021; 41:86-94. [PMID: 34033632 DOI: 10.1097/psn.0000000000000366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Undergoing a rhinoplasty can affect an individual's mental health either positively or negatively, depending upon how he or she perceives the results. Because of the impact that rhinoplasty may have on an individual's mental health and the cost of this surgery, it is important to understand the reasons that men decide to undergo rhinoplasty and the challenges they face when making the decision to have a rhinoplasty. Using a grounded theory method, we collected data by conducting interviews with 20 participants. We analyzed the data and initially obtained 684 initial codes. After we removed duplicate codes and carefully analyzed participants' interviews, a total of 497 codes remained. We developed these codes into 10 main categories and 32 subcategories. We found that the causal factors affecting the decision of Iranian men to undergo rhinoplasty included the following 5 categories: a lack of confidence; a desire to improve their appearance; a desire for attention from others; a need to keep up with the Joneses (i.e., a desire to show that one is as good as other people by getting what others have and doing what others do); and persuasion by others. Intervening factors affecting the decision of Iranian men to undergo rhinoplasty included the following 4 categories: family challenge; social atmosphere; financial problems; and unwanted consequences. Iranian men make the decision to undergo rhinoplasty by overcoming and ignoring these intervening factors. The primary variable in participants' decision to undergo rhinoplasty was the desire to improve their appearance.
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Li Z, Shi R, Wu H, Yan P. First Identification of a Patient with Prosthesis-Related Infection Caused by an MCR-1.1-Producing ST131 Escherichia coli After Rhinoplasty. Infect Drug Resist 2021; 14:249-257. [PMID: 33531821 PMCID: PMC7847383 DOI: 10.2147/idr.s295801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The most common procedure of rhinoplasty is the implantation of a synthetic prosthesis. However, the complications, especially postoperative infection, could lead the suboptimal aesthetic outcome, economic losses and health threats. There is currently little literature providing an incidence of rhinoplasty infection and microbiological and antimicrobial resistance situations. METHODS Therefore, we performed a retrospective observational study which included 173 patients who received a rhinoplasty from 1 January 2015, to 31 December 2019, in the department of plastic surgery of a tertiary hospital in Guangzhou, China. The samples from the infection site were collected and performed the bacterial culture. The antimicrobial susceptibility testing was performed by VITEK and minimum inhibition concentration testing. The whole-genome sequencing was performed by Illumina Hiseq4000 platform. RESULTS We found that eight (4.6%) patients were infected by S. aureus (6), E. raffinosus (1) and E. coli (1), of which are susceptible to most antimicrobials. Remarkably, E. coli RS1231 was resistant to colistin and polymyxin B which conferred by mcr-1.1 locating on an IncI2 plasmid with 59,170-bp sequence length. Through sequence comparison, we speculate that the pRS1231S-MCR-1 was derived from animal sources. Besides, E. coli RS1231 belongs to ST131 O25:H4-fimH22 pandemic subclone and phylogroup B2, which can induce a broad variety of infections. CONCLUSION Our study provided a rhinoplasty infection incidence, microbiological and antimicrobial resistance prevalence data, and revealed, to our knowledge, the first case of postoperative infection of rhinoplasty by mcr-1.1-positive, highly susceptible, and remarkably virulent E. coli isolate.
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Affiliation(s)
- Zhehao Li
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Ran Shi
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Hao Wu
- Department of Otolaryngology, Hospital of Honghe State Affiliated to Kunming Medical University, Southern Central Hospital of Yunnan Province, Mengzi, People’s Republic of China
| | - Ping Yan
- Emergency Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
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Preservation Dorsal Hump Surgery: A Changing Paradigm. Oral Maxillofac Surg Clin North Am 2020; 33:51-59. [PMID: 33246547 DOI: 10.1016/j.coms.2020.09.013] [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: 11/23/2022]
Abstract
Preservative dorsal hump surgery is an old approach that has revitalized recently. Preservation rhinoplasty aims to shape the existing structures instead of resection/reconstruction approaches. A thorough understanding of the applied anatomy of the nose is the backbone of preservative hump surgery. In preservative hump surgery keystone works as a joint, and by lowering this joint the hump is eliminated.
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