Effect of Dorsal Preservation Techniques on Septum Strength: An Experimental Animal Study.

This experimental animal model study investigates the impact of different methods employed in preservation rhinoplasty (PR) on the strength of the nasal roof, focusing on three techniques: high strip, low strip, and intermediate strip. Using 15 lamb heads as surgical models, the study addresses key questions related to the strengths of each PR techniques, the influence of septal cartilage harvesting on septum strength, and the effectiveness of spreader grafts for stability. The research involves detailed dissection steps and measurements at various nasal points, evaluating the resistance at each stage. Results indicate that the low strip technique demonstrates the most significant reduction in strength. Furthermore, the combination of PR techniques with structural grafts, specifically spreader grafts, is assessed, revealing the classical rectangular spreader graft to be more effective in stabilizing the dorsum. Despite the limitation of using the lamb heads as models, this study offers valuable insights into the effects of PR on nasal septum strength and provides a foundation for further research on the biomechanics of preservation techniques.

Peroperative Cooling in Rhinoplasty: Does it Differ?

The main causes of ecchymosis and edema are osteotomy (bone manipulation), dissection of subcutaneous tissue, and skin manipulation in the rhinoplasty procedure. Eyelid edema following surgery can potentially affect visual acuity, particularly during the initial twenty-four hours after the procedure. These may also delay the patient's return to their normal social life therefore hampering their quality of life. Various surgical and medical methods have been reported to address these issues. This study aimed to compare the effects of using cold saline (0-4 °C) versus room temperature saline (20-25 °C) irrigation throughout the surgery on postoperative edema, ecchymosis, and pain. Fifty patients who underwent open-approach primary rhinoplasty between August 2022 and August 2023 at a tertiary academic center were included. Fifty patients were randomly divided into two groups depending on using cold saline (0-4 °C) (group 1) or room temperature saline (20-25 °C) (group 2) during surgical site irrigation. Patients were assessed for pain, edema, and bruising using a VAS (Visual Analog Scale) on the second and seventh postoperative days. Visual analog score (VAS) was used for subjective outcome analyses. Each patient scored the severity of their periorbital ecchymosis on day two and seven. Periorbital ecchymosis was also evaluated on the second and seventh postoperative days using the SPREE (Surgeon Periorbital Rating of Edema and Ecchymosis) scale. On the second postoperative day, the VAS pain score in group 1, where cold water was used, was found to be statistically and significantly different from the control group (group 2) (p < 0.05). However, there was no statistically significant difference between both groups when comparing the VAS pain scores on the seventh postoperative day. Regarding the VAS ecchymosis score on the seventh postoperative day, there was a statistically significant difference favoring group 1 (p < 0.05). The SPREE scale data also indicated that group 1 had significantly lower scores on the seventh day (p < 0.05). While the SPREE scores on the second day were lower in group 1 than in group 2, this difference did not reach statistical significance (p = 0.061). The findings from our study show that cold saline irrigation may contribute to intraoperative hemostasis by inducing local vasoconstriction. We observed that intraoperative bleeding decreased with the use of cold saline. This approach has the potential to improve patient satisfaction and overall quality of life by reducing postoperative ecchymosis without significantly increasing the cost of the surgical procedure.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 .

Turkish Validation of the Standardized Cosmesis and Health Nasal Outcomes Survey.

The objective of this study is to provide a valid and reliable Turkish version of the original Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). The SCHNOS questionnaire was translated from English to Turkish using standardized guidelines. Participants completed the questionnaire twice, with an interval of 7 to 10 days. Reliability and validity analyses were performed based on these answers. Differences between the rhinoplasty and control groups, the internal consistency of the instrument (Cronbach's alpha coefficient), and the strength of association between the two repeated measures (Pearson's correlation coefficient) were analyzed. Of the 188 included individuals (106 females, 82 males; mean age 28 ± 8.4 years), 97 were in the rhinoplasty group and 91 were in the control group. The mean total SCHNOS scores were 0.6 ± 0.4 and 29.4 ± 8.9 in the control and rhinoplasty groups, respectively, and there was a statistically significant difference in total scores between the groups (p < 0.001). The internal consistency reliability of the scale was found to be highly significant (Cronbach's alpha = 0.96, with a lower 95% confidence interval of 0.89). The test-retest correlation value was 0.95 for the total score, and each item had a strong test-retest correlation, ranging from 0.92 to 0.96. The Turkish version of the SCHNOS is a valid and reliable scale for evaluating both functional and cosmetic outcomes in Turkish-speaking patients undergoing rhinoplasty.

Effect of Injectable Platelet-Rich Fibrin on Diced Cartilage's Viability in Rhinoplasty.

Diced cartilage is one of the most widely used camouflage technique in rhinoplasty. Its variable resorption rate creates issues in postoperative time period. Platelet-rich fibrin is an autologous concentrated blood derivative containing growth factors that accelerate tissue healing. The authors evaluate the effect of injectable platelet-rich fibrin (I-PRF) on the viability of diced cartilage, which has been used for dorsum camouflage in rhinoplasty. Forty patients were randomly divided into two groups based on dorsal camouflage grafts: diced cartilage with I-PRF (study group) and diced cartilage without I-PRF (control group). Cartilage graft thickness was measured by linear superficial tissue ultrasound at the postoperative first week and the third month in both groups. The mean cartilage graft thickness loss between the first-week and third-month ultrasound measurements was 0.58 ± 0.21 mm in the study group and 0.82 ± 0.35 mm in the control group. There was significant volume loss in the control group. I-PRF was successful in reducing the resorption rate of diced cartilage on nasal dorsum by either increasing the viability or keeping its form. Sticky cartilage is an easily applicable and reliable technique that may be used to camouflage dorsal irregularities in rhinoplasty.

The Effect of Platelet-Rich Fibrin on Nasal Skin Thickness in Rhinoplasty.

The study hypothesized the potential positive effects of platelet-rich fibrin (PRF) in postoperative rhinoplasty patients, such as better wound healing, less dead space, and less edema. The authors assessed PRF for nasal dorsum camouflage and studied its potential effects on nasal dorsal skin in rhinoplasty. Thirty-eight patients who underwent open approach primary rhinoplasty were categorized into two groups: nasal dorsal PRF group and control group. PRF membrane was used for nasal dorsum camouflage and laid over the bony dorsum and cartilage framework of the supratip area. Skin and subcutaneous soft tissue thickness were measured by linear superficial tissue ultrasound at the pre- and postoperative first week and the third month in both groups. Mean skin thickness over the supratip area was significantly higher in the control group in the first-week control. There were no significant differences in both first-week and third-month controls' nasal dorsum mean skin thickness measurements between the two groups. Regarding PRF complications, we encountered no complications in either group, including scarring, hematoma, infection, skin discoloration, and acne. The authors present the application of PRF membrane over the bony dorsum and cartilage framework of the supratip area. They observed its positive effect on postoperative edema, especially in the early postoperative period. Long-term investigations have to be performed to evaluate its potential effect on the rhinoplasty procedure. This was a level of evidence 3 study.

The Joint Tip Graft: A Joint Support for Rim, Facet and Infratip Lobule in Rhinoplasty.

BACKGROUND: The authors of this study have developed a novel graft called the 'The Joint Tip Graft' which adds support to the lateral crus, camouflages the tip grafts, supports the facet and adds volume to the nasal tip as a single graft. The aim of this study was to define and introduce the tripod graft. METHODS: Thirty patients who underwent primary rhinoplasty at a tertiary academic center were included. Patients were randomly assigned into two groups according to the grafts used: group 1: Joint tip graft was additionally used, and group 2: Joint tip graft was not used. All patients were photographed by a photographer who is familiar with medical photography. Preoperative and postoperative sixth month photographs were taken for analysis. The brightest point of the infratip lobule and the darkest point of the facets were selected and analyzed with computer software. The luminance ratio of facet to infratip lobule was calculated to overcome light and head position differences. RESULTS: Mean infratip luminance scores were 112.20 ± 5.72 and 109.73 ± 7.13 in groups 1 and 2, respectively (p > 0.05). Mean facet luminance scores were 101.33 ± 4.91 and 89.27 ± 5.11 in groups 1 and 2, respectively (p < 0.05). Facet/infratip luminance ratios were calculated for each group. Mean facet/infratip luminance ratios were 0.90 ± 0.01 and 0.82 ± 0.16 for groups 1 and 2, respectively (p < 0.05). CONCLUSIONS: The joint tip graft is a novel graft that is easy to harvest and apply. It spans both of the alar cartilages, supports the facet area and creates a smooth gradual light shadow transition. Additionally, it acts as a camouflage over the tip grafts. 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 .

The Effect of Mild Hypocapnia on Postoperative Ecchymosis in Rhinoplasty.

PURPOSE: Ecchymosis and edema are the most common complications in patients following rhinoplasty in the early postoperative period. Vasoconstriction created by hypocarbia may have a positive effect on postoperative ecchymosis. The aim of this study was to evaluate the effect of mild hypocapnia induced in rhinoplasty on the severity of periorbital ecchymosis. METHODS: The study was carried out retrospectively in the digital photographs (control group and study group) of 31 participants who underwent open technical rhinoplasty between January and March 2019. During the operation, partial carbon dioxide pressure in the study group was kept in the range of 32 to 38 mmHg and in the control group between 42 and 46 mmHg and this was confirmed by arterial blood gas measurements taken during the operation. Measuring the brightness and shadows of digital photos Digital color meter was used in MacOS X as a computer software. RESULTS: The mean ratio of periorbital ecchymosis to forehead brightness was 0.84 ± 0.05 in the study group and 0.81 ± 0.03 in the control group. There was no significant difference between the study and control groups (P > .05). CONCLUSION: This study investigates the potential role of hypocapnia on postoperative ecchymosis during rhinoplasty. The severity of ecchymosis was less in the patients with induced mild hypocapnia regarding both subjective and objective evaluations, but this difference didn't reach statistical significance compared to the normocapnic control group.

Paramedian Forehead Flap in Large Nasal Skin Defects: Twenty-years' Experience.

Objective: Skin cancers occur most commonly in the head and neck region where the nose is the most commonly affected unit. The nose is the part of the face that is most exposed to trauma, sunlight, and other environmental factors. From the aesthetic and functional point of view, reconstruction of the defects occurring after skin cancer removal creates a great challenge for the surgeon. In this retrospective study, we present the success rates achieved in the past 20 years with paramedian forehead flaps used for repairing large defects of the nose. Methods: The study included 62 patients who underwent paramedian forehead flap due to nasal skin tumor [basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] in Ege University Faculty of Medicine Otolaryngology Department between 2000 and 2020. Data on follow-up time, patients' age and gender, defect sizes, and tumor types were obtained retrospectively from patient files, histopathologic examination results and patient photographs. Additional diseases such as diabetes, hypertension, and coronary artery disease that could affect flap success, were noted. Results: Out of 62 patients 29 (46.8%) were female and 33 (53.2%) were male. Their mean age was 61.4 (range: 46-88) years. Mean follow-up period was 125.6 (8-244) months. Of the 62 patients 33 (53.2%) were operated on for BCC and 29 (46.8%) for SCC. Four patients (6.5%) had recurrences during their follow-up. There was no loss of the paramedian forehead flap. Conclusion: Paramedian forehead flap is a reliable option in the reconstruction of larger defects of the nose even in smokers and elderly patients who have comorbid diseases.