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The use of spreader flaps (SFs) is very helpful in middle vault reconstruction. The aim of the study was to evaluate the versatility of Apaydin classification of SFs on a patient population. This was a retrospective analysis which included 120 rhinoplasty cases. Thorough preoperative planning adhering to precision profileplasty principles was conducted for all patients. The study employed six primary variants of SFs. SFs' types were utilized as follows: type 1 in 41 patients (34.2%), type 2 in 2 patients (1.7%), type 3A in 38 patients (31.7%), types 3B and 3D in 10 cases each (8.3%), type 3C in 2 cases (1.7%), type 4 in 5 cases (4.2%), type 5 in 7 cases (5.8%), and type 6 in 5 cases (4.2%). This study highlights that different SF techniques should be tailored according to the need of the patient when dealing with middle vault reconstruction during reduction rhinoplasty.
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A well-healed scar extends beyond a mere superficial concern, reflecting the precision and care underlying the surgery. This study addresses the lack of recent literature on the complete closure technique for external rhinoplasty scars, emphasizing its potential impact on patient satisfaction and overall aesthetic quality. The main purpose of this article was to introduce and assess the efficacy of a novel closing suture technique for external rhinoplasty and emphasize on 12 specific steps for wound closure. A cohort of 104 patients who underwent external rhinoplasty utilizing the proposed closing suture technique were evaluated. Standardized photographic documentation and scar assessment were performed using the Vancouver-Manchester scale, considering notching, skin level differences, pigmentation, and overall appearance. The surgical approach involved a combination of vertical mattress and interrupted simple sutures, creating an effective closure framework. Analysis revealed an absence of poor scars, with 83.6% classified as good. Note that 65.5% of the good scars achieved a perfect 6-point score. While one moderate scar scored 3 points, the majority demonstrated optimal outcomes. Clinical photographs further illustrated the technique's success, showcasing imperceptible scars and reinforcing the efficacy of the complete closure approach. Our study introduces and assesses the efficacy of the complete closure technique for external rhinoplasty scars. The approach consistently yields positive outcomes, with an emphasis on almost imperceptible scars. While not achieving a 100% imperceptible scar rate, this study underscores the need for ongoing research to refine techniques and enhance patient satisfaction in external rhinoplasty. The proposed technique contributes significantly to scar management practices and encourages further exploration within the evolving landscape of rhinoplasty.
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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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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.
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The septocolumellar sutures are very helpful to obtain planned rotation and projection. The goal of this study is to revitalize the septocolumellar techniques described before and present an easy new classification for these sutures, and to present their multiple uses on the same patient as a new option for surgeons. Eighty patients were involved in this retrospective study. All the patients were females except one. A detailed preoperative preparation was performed on all patients by following the principles of precision profileplasty. In this study, five main types of septocolumellar sutures were used. Type 4 septocolumellar suture was used in 39 cases, type 3 in 33, type 2 in 22, type 1 in 5, and type 5 in 2 cases. In 21 cases, more than one suture was used. In conclusion, the new practical classification presented in this study gives the surgeon powerful tools to reshape the tip during surgery.
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Postoperative complications in rhinoplasty require prompt intervention for optimal outcomes. ChatGPT, an artificial intelligence (AI) tool, offers potential for assisting in postoperative care.This study aims to assess ChatGPT's effectiveness in providing guidance for various rhinoplasty complications.Different complication scenarios were input into ChatGPT. Responses were categorized into "Contact Surgeon" or "Follow Postoperative Instructions."ChatGPT consistently advised immediate surgeon contact for infection. For other complications, it recommended monitoring and adhering to instructions while suggesting surgeon contact if concerns persisted.ChatGPT shows promise in aiding patients' postoperative care by accurately identifying cases necessitating communication with surgeons or emergency care. This research underscores AI's potential in enhancing patient-centered care and contributes to the evolving landscape of health care practices.
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It is important to assess the patient satisfaction with shape and function by patient-reported outcome measures (PROMs) following structural or dorsal preservation rhinoplasty (DPR) techniques on the middle nasal vault. To analyze the results of different middle vault rhinoplasty techniques with multiple PROMs and compare their differences according to the findings of PROMs. Four different techniques were performed for the middle vault: spreader graft, L-strut graft, DPR with high strip (DPRwHS), DPR with low strip. The outcomes were evaluated preoperatively, 2 and 12 months postoperatively with the following PROMs: Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation, and Standardized Cosmesis and Health Nasal Outcomes Survey. This study included 129 patients. All techniques provided significant improvements in all PROMs (p < 0.001), except DPRwHS in NOSE. Between postoperative short- and longer-term, no significant differences were observed in DPR groups (p > 0.05), unlike structural techniques. In this comparative study of different middle nasal vault rhinoplasty techniques, we did not detect a difference in the improvement of the patient-reported outcomes of DPR techniques from as early as 2 months to 1 year postoperative.
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Obstrucción Nasal , Rinoplastia , Estética Dental , Humanos , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugía , Tabique Nasal/cirugía , Nariz/cirugía , Medición de Resultados Informados por el Paciente , Rinoplastia/efectos adversos , Rinoplastia/métodos , Resultado del TratamientoRESUMEN
It is very crucial to know the biomechanics of the septal cartilage and adjacent structures during septoplasty. The aim of this study was to investigate the strength changes of different L-strut models after mucoperichondrium elevation, application of septal extension grafts and spreader grafts on an experimental lamb model. Ten lamb heads were dissected according to a dissection protocol and septal resistances were measured with the newton meter at six zones. Three different L-strut types were designed, and all the L-strut models were created at different widths of 15mm, 10mm, and 5mm. In addition, effects of two different types of septal extension grafts and spreader grafts were compared. After mucoperichondrium elevation and harvesting the septum cartilage, there was a significant decrease in the septum resistance (p <0.05). As the width of the L-strut decreased, the septum strength decreased significantly (p <0.05). There was no significant difference between three chondrotomy types at different widths (p >0.05). There was no significant difference between the overlapping SEG and end-to-end SEG in terms of septum resistance (p >0.05). This was the first study to measure septal resistance in lamb heads. The mucoperichondrium and L-strut width were important structures for maintaining septal resistance. Chondrotomy style was not crucial, but as the width of the L-strut increased, the septal resistance increased. The septal extension grafts regardless of suturing style and the spreader grafts added strength to the caudal septum.
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Implantes Dentales , Rinoplastia , Ovinos , Animales , Tabique Nasal/cirugía , Fenómenos Biomecánicos , Rinoplastia/métodos , CartílagoRESUMEN
Septoplasty and rhinoplasty are difficult operations to learn and teach. Many modalities have been proposed to make the teaching process of these operations easier. In this study, it was investigated if lamb heads were good training models to teach septoplasty and rhinoplasty to trainees or experienced surgeons. In the first part of the study, 21 lamb heads were dissected according to a dissection protocol and several anatomical distances were measured to compare them with human cadavers. In the second part, eight lamb heads were dissected and different preservation rhinoplasty techniques were practiced. The study on 21 lamb heads used showed that the lateral crura were 17.8 × 11.6, the average interdomal distance was 8.1 mm, and the average domal width was 3.7 mm. The average length of the upper lateral cartilages was 31.1 mm laterally and 21.2 medially. The average length of the nasal bones was 63.9 mm, and the width was 16 mm. In the second part of the study, 8 lamb heads were used to experience where high-strip techniques were used in 5 and the Cottle technique in 3. This study revealed that lamb heads should be considered as an excellent training model for septoplasty and rhinoplasty. Its very low cost, ease of availability, and close similarity to the human cadavers can be counted as the main advantages. This study also proved that it was not only a tool for beginners, but also a very helpful tool for experienced surgeons to try new methods.
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Rinoplastia , Animales , Ovinos , Humanos , Rinoplastia/métodos , Nariz/cirugía , Cartílago , Hueso Nasal/cirugía , Cadáver , Tabique Nasal/cirugíaRESUMEN
OBJECTIVE: This study reveals that the cartilage chips can be a good solution for camouflage and augmentation in rhinoplasty. METHODS: In this study, 64 patients who had undergone rhinoplasty from 2014 to 2019 were retrospectively studied. The average age was 31. Forty-nine patients had primary and 15 revision rhinoplasties. Cartilage chips were cut into less than 0.5-mm thickness dimensions changing from 2 to 10 mm. They were used to fill deep radix, depressions at the key area, supratip area, around the grafts to prevent their visibility at the tip. In addition, they were used in the fascia for augmentation. The cartilage chips were sculpted from the septal cartilage in 47, rib in 16, and ear cartilage in one case. RESULTS: They were applied on the radix in 25, middle vault in 37, supratip area in 32, and on the tip in 12 cases. In 30 cases, cartilage chips were mixed with cartilage dust for better fixation and camouflage. They were placed in the fascia in three cases for dorsal augmentation. Complications were seen in three cases in the form of irregularities. CONCLUSION: Cartilage chips are found to be a powerful solution in terms of camouflage and augmentation.
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Rinoplastia , Humanos , Adulto , Rinoplastia/métodos , Estudios Retrospectivos , Cartílago Auricular , Fascia/trasplante , Trasplante AutólogoRESUMEN
Different treatment modalities have been applied for nonmelanoma skin cancers (NMSCs) of the head and neck area. One of the most important points after surgical treatment is the selection of appropriate reconstruction methods. The aim of this study is to investigate the efficacy and feasibility of the use of both defect size reduction with sutures and secondary healing with delayed reconstruction with full-thickness skin grafts in NMSC patients. In total, 18 (42.8%) male and 24 (57.2%) female patients with NMSC were operated. Defect size was measured both after excision and just before repair, and the approximate defect area was calculated with ImageJ software. Reconstruction was performed after 14 days in all patients in the second session, using free skin grafts. There were 18 (42.8%) male and 24 (57.2%) female patients. The mean age was 70.5 (45-82) years. The mean follow-up period was 40.3 (16-68) months. The mean defect area measured after excision was 8.44 ± 1.91 cm2. After 14 days of delay, the mean defect area was 5.51 ± 1.28 cm2 (34.8% reduction) (p < 0.05). Defect-reduction methods applied during the first session, together with proper interval prior to placement of graft, have been shown to be beneficial and acceptable methods, providing an advantage in reconstruction with free skin graft.
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Procedimientos de Cirugía Plástica , Neoplasias Cutáneas , Anciano , Procedimientos Quirúrgicos Dermatologicos , Femenino , Humanos , Masculino , Cuello , Neoplasias Cutáneas/cirugía , Trasplante de PielRESUMEN
Photography for preoperative analysis and follow-up is indispensable for the facial plastic surgeon. The use of strobe flash units, light-emitting diode (LED) lamps, and their position related to axis of the patient can affect the nasal contours and nasal measurements. The aim of this study was to compare the rhinoplasty pictures taken under three different lighting settings and two different positioning at 30- and 45-degree angles, and with direct measurements taken by caliper from the subjects. Standardized rhinoplasty pictures from 10 patients were taken in frontal view in a studio. These pictures were taken under three different lighting settings: built-in flash of the camera, two strobe flashes, and two LED continuous lights placed at 30 to 45 degree angles to the patient. All the pictures were uploaded to Rhinobase 2.0. In five subjects, direct measurements were done by using a Vernier caliper and compared with the computer measurements. In this study, when comparing the light sources and the angles without taking single flash into account, no relation was found between strobe lights at 30 and 45 degrees and between LED lights at 30 and 45 degrees regarding tip width, base bony width, dorsum width, interalar width, and nasal length. However, a statistically significant difference was found when the angle was changed from 30 to 45 degrees for tip width, interalar width and nasal length. The use of two LED continuous lights or two strobe lights in a studio setting has given similar results. Changing the angles of the light sources from 30 to 45 degrees affected only the tip width and the interalar width; otherwise the rest of the nasal measurements did not show any significant changes. The pictures taken at 45-degree angles to the subject showed the closest values to the direct measurements done on the patient.
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Rinoplastia , Cara , Humanos , Iluminación , Nariz/cirugía , FotograbarRESUMEN
In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them.
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Rinoplastia , Encuestas y Cuestionarios , Humanos , Resultado del TratamientoRESUMEN
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.
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Técnicas Cosméticas , Rinoplastia , Adulto , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Turquía , Adulto JovenRESUMEN
After rhinoplasty, during the first 24 hours, the patients should be closely monitored for pain and discomfort, nausea and vomiting, and cool compresses must be applied regularly to decrease edema and ecchymosis. In the early postoperative period of the first month, the sutures, cast, and splints are usually removed during the first week. Then the patient is followed-up at 1, 3, 6, and 12-month intervals routinely to observe healing. In the meantime, any kind of intranasal and extranasal complications should be noted. The outcome measures such as ROE, NOSE, or SCHNOS should be used 3 to 6 months after surgery. If the patient is closely followed-up, then any unwanted complication or dissatisfaction can be solved after 6 to 12 months.
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Cuidados Posteriores , Cuidados Posoperatorios , Complicaciones Posoperatorias/terapia , Rinoplastia , Estética , Humanos , Complicaciones Posoperatorias/prevención & controlRESUMEN
After hump removal in reduction rhinoplasty, one of the main steps is to rebuild the middle vault. Spreader grafts have long been the main tool for the surgeon. Within the last two decades, the spreader flaps have started to be very popular as well. In accordance with the experience and technical preferences of the surgeon, there are many different options. In this article, the spreader grafts are classified as traditional, modified, splinting, and reconstructive. The spreader flaps are designed in accordance with their relationship with the septum and the spreader grafts.
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Cartílagos Nasales/trasplante , Rinoplastia/métodos , Colgajos Quirúrgicos , Humanos , Colgajos Quirúrgicos/clasificaciónRESUMEN
During rhinoplasty, the most stressful areas of the nasal cartilaginous septum are at the key area and anterior nasal spine. A stable fixation of the caudal septum to respond to these stresses is of utmost importance. The prerequisite for a successful fixation is a well-prepared recipient bed for caudal septum and suture fixation. The bed can be opened by using scissors, osteotome, or powered instrumentation. Simple or multiple sutures passing from the bone and/or surrounding soft tissues are used for fixation. At the key area, if a complete separation of the L-strut occurs, it should be sutured to nasal bones and upper lateral cartilages. The septum should be supported by splinting spreader grafts to increase stability. To prevent dorsal irregularities, a dorsal onlay camouflage graft should be used. The best way is to take cautions to prevent such a mishap. That is why a dorsal segment of 12 to 15 mm should be preserved, at least at the key area, and part of the mucoperichondrium should stay attached to the septum.
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Tabique Nasal/cirugía , Rinoplastia/métodos , Cartílago/trasplante , Humanos , Ilustración Médica , Rinoplastia/instrumentación , Técnicas de SuturaRESUMEN
BACKGROUND: Basal cell carcinoma (BCC) in central facial locations and tumors with positive margins are at a higher risk of recurrence. The most effective treatment is total excision, which includes an adequate pathological margin. OBJECTIVE: To evaluate the outcome of the patients who underwent surgery for BCCs of the head and neck and of those who had positive surgical margins where Mohs surgery is not available. METHODS: This study was conducted at Ege University Medical School between 2004 and 2014. One hundred thirty patients with 154 BCC who underwent surgical excision were included. In the histopathologic report, the existence of positive margin, BCC subtype, localization of the tumor, and distance of margins to the tumor were evaluated. RESULTS: Twenty-three lesions (14.9%) of 22 patients revealed positive surgical margins. Six patients (26.1%) had recurrences on the surgical site. The BCC subtypes of recurrent patients were reported to be multifocal superficial in 2 (33.3%), infiltrative (16.7%) in 1, and micronodular (50%) in 3. CONCLUSION: Patients with superficial multifocal or micronodular tumors should undergo reoperation because of high recurrence rates.
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Carcinoma Basocelular/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Cutáneas/cirugía , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/epidemiología , Carcinoma Basocelular/patología , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/cirugía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
The first aim of this study was to evaluate the survival of the patients who underwent surgery due to lip squamous cell carcinoma (SCC). Furthermore, the predictive value of the prognostic factors regarding overall outcome was also assessed. The secondary objective was to justify the need of a prophylactic neck dissection according to the tumor size. One hundred and one cases with lip SCC were included in this study. The data regarding prognostic factors and survival were retrospectively collected. The 5-year survival rate was found to be 82.1%. Among the multiple prognostic factors, only age and disease stage had significant impact on survival (p < 0.05). Lymph nodes were positive in two (3.0%) T1, 3 (11.5%) T2, one (16.6%) T3 and 3 (100%) T4 patients. In Turkish population, the 5-year survival rate was found to be 82.1%. Age and disease stage were independent factors which have significant impact on survival. In geriatric population, the 5-year survival rate was 69.6%. There was an increased prevalence of the disease among women in the geriatric population. We suggest elective neck dissection and aggressive treatment for T2 tumors especially if the patient has multiple risk factors such as high tumor thickness and poor prognostic indicators such as increased age.