Complications of the external (combination) rhinoplasty approach.

More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.

External (combination) rhinoplasty approach for trans-sphenoidal adenectomy.

The external (combination) rhinoplasty approach and the sublabial approach to trans-sphenoidal adenomectomy have been used at this institution for seven years. A summary of experience with the external (combination) rhinoplasty technique in 10 patients is reported; and a comparison is made between this approach and the sublabial approach in 12 patients. Advantages unique to this approach are: the distance to the sphenoid sinus is decreased allowing greater ease of instrumentation, the Hardy speculum may be opened widely to increase exposure, uniquely this allows synchronous cosmetic or reconstructive septorhinoplasty, and this technique is also invaluable for revision surgery--especially when septal cartilage has been removed by a previous sublabial approach. Disadvantages of this technique are the external incision across the columella, which leaves an imperceptible scar of no clinical significance, and postoperative nasal tip edema, which resolves with time.

Autologous fascia grafts in head and neck plastic surgery.

Using an experimental animal model, we studied the stability of the size (gross morphology) and structure (histomorphology) of the fascia autograft. Fascia from a rabbit's leg was grafted in the subcutaneous tissue of the ear and abdomen and also into the intra-abdominal cavity. The weight and size of the autograft were recorded during the study period. Our findings showed that the size of the autograft remained stable, but there was a substantial weight reduction. Microscopic examination of histopathologic sections disclosed that there was no inflammatory response to the fascia. It also appeared to maintain its histomorphologic structure. Clinical trials with patients receiving facial plastic surgery are also reported. We believe a fascia autograft can be used to augment facial areas. We base this conclusion on the findings from previous reports, our animal experiment, and clinical trials.