Dichotomy of rhinoplasty practice: from the conference floor to the operating room.

Advancements in surgical techniques and improvements in clinical practice inevitably lag behind scientific progress and peer-led opinion. The rapid rise and fall in the popularity of rhinoplasty techniques makes scientific evidence-gathering and education a daunting task. Students of rhinoplasty face a long and steep learning curve, and need to acquire sound analytical tools to critically evaluate both literature contributions and operative reports shown in conferences. Such a complex learning process requires continuous self-examination, and must account for the increasingly sophisticated and intricate wishes of rhinoplasty patients whose desires do not always coincide with what surgeons have been taught and practiced. In contemporary practice, the developing rhinoplasty surgeon must be also familiar with the range of racial features, as the broad variety of nasal anatomies and beauty canons are truly staggering, and one formula does not fit all cases.The complex set of circumstances that lead to disharmony between scientific progress and clinical practice is addressed, and a utilitarian plan to remedy this awkward dichotomy is suggested.

A guide to the assessment and analysis of the rhinoplasty patient.

The science and art of facial analysis have made giant strides in the past 50 years. In addition to excellent technical knowledge about the anatomy of the region and the numerous surgical options available, the rhinoplasty surgeon must demonstrate meticulous care in the planning and execution of this difficult and demanding operation to minimize the real risks posed to the patient and to maximize the likelihood of a successful procedure and of obtaining the ultimate goal: the happy patient. Although imaging and computer analysis have provided a new technological dimension to this process, the surgeon's clinical acumen, technical prowess, and communication skills remain paramount in their importance.

Surgical management of the distorted caudal septum.

PURPOSE OF REVIEW: This article reviews the current trends in the surgical approach to the caudal septum, and its importance in rhinoplasty. The evolution of rhinoplasty techniques over the past half century has changed the emphasis from excessive cartilage resection, and a plethora of grafts and sutures, to a more conservative approach that seeks to maintain the function of the nose and create a naturally beautiful, 'not-operated' look. RECENT FINDINGS: New anatomical studies continue to shed light on the importance of soft-tissue support, and the mechanical properties of the caudal septum. When applied to surgical techniques, these new findings emphasize the principles of adequate preoperative history and examination, nasendoscopy, and facial analysis. On the basis of these clinical findings, a unique, tailor-made rhinoplasty game plan can be created for each patient that should not be used for another operation. Several techniques have emerged from the natural evolution of rhinoplasty that produce controlled, reversible effects in a predictable, stepwise manner. SUMMARY: The caudal septum plays a key role in nasal airflow, provides support for the nasal tip, and affects the alar-columellar relationship. Deviation at the caudal septum creates some of the commonest problems in aesthetic rhinoplasty.Through new anatomical knowledge and advances in rhinoplasty techniques, the vast majority of these problems can be approached through an endonasal/hybrid rhinoplasty approach. Hybrid rhinoplasty refers to a distillation of best of both worlds of external and endonasal surgery over the past 40 years.The key to a successful outcome relies on adequate clinical examination, nasendoscopy, detailed surgical facial analysis, and a well planned surgical game plan. VIDEO ABSTRACT: SDC 1 (http://links.lww.com/COOH/A9).

Anterior ethmoidal artery septal flap for the management of septal perforation.

OBJECTIVES: To achieve long-term closure of nasal septal perforations and to describe our surgical technique for repairing septal defects. METHODS: We describe 11 patients who underwent endoscopic repair of anterior septal perforations with a unilateral septal flap pedicled by the anterior ethmoidal artery. The patients were followed up for a period of 12 to 132 months (median follow-up, 51 months). RESULTS: There were no complications after surgery. All cases of septal perforation remained closed for the duration of follow-up. CONCLUSION: Closure of a perforated nasal septum through an endonasal technique can be achieved with a unilateral mucosal flap based on the anterior ethmoidal artery.

Schwannoma of the inferior turbinate: case report and review of literature / Schwannoma de corneto inferior: relato de caso e revisão da literatura

Schwannomas of the sinonasal tract are rare entities that are amenable to local resection. We present a 69 year old woman with a schwannoma of the inferior turbinate that was successfully resected. Schwannomas arising from the inferior turbinate are very infrequent.

Schwannomas do trato nasossinusal são condições raras, passíveis de ressecção local. Apresentamos o caso de um paciente de 69 anos de idade com schwannoma de corneto inferior, que foi ressecado com sucesso. São muito raros os casos relatados de schwannoma originando-se do corneto inferior.