Indications, Stability, and Surgical Outcomes of Using Osteochondral Nasal Septal Graft as a Septal Extension Graft in Rhinoplasty Patients: A Prospective Cohort Study.

Septal extension graft (SEG) is an adaptable tool that controls, supports, and stabilizes the nasal tip projection, rotation, length, and shape. Recent studies comparing SEGs to more conventional columellar strut grafts found that SEGs provided improved results. This prospective cohort study included 66 patients divided into 2 groups based on their indications. Group 1 was patients who underwent septorhinoplasty using osteochondral septal extension graft (OSEG), and group 2 underwent septorhinoplasty using cartilaginous SEG. The main reason for undergoing OSEG was insufficient septal cartilage (P<0.001). The outcomes were not significantly different between both groups, with the % of patients who experienced positive outcomes ranging from 78.8% to 97%. The OSEG is a safe, valid, and effective option in septorhinoplasty that can be used in patients with insufficient cartilaginous septum.

Measurement of Nasal Skin Thickness and Body Mass Index in Preoperative Rhinoplasty Patients Utilizing Computed Tomography Scanning and Ultrasound Techniques: A Prospective Comparative Study.

One of the most important indicators of rhinoplasty success is nasal skin thickness. Nasal thickness can lead to irregularities over the osseocartilaginous framework among patients with thin nasal skin and difficulty making tip work changes in patients with thick nasal skin. This study aimed to compare different objective methods. These include computed tomography (CT) and ultrasound (US) techniques, and report the relationship between nasal skin thickness and body mass index (BMI). A prospective cross-sectional study that included all patients at the rhinoplasty clinic (King Abdul-Aziz University Hospital), Riyadh, Saudi Arabia, between December 2022 and March 2023. Age, sex, and Fitzpatrick skin type were collected from the patients' histories and physical examinations. Body mass index was calculated for the subjects. The study sample included 29 patients. The median age of the patients was 25 years (interquartile range: 20-32 y). Most of the included patients were Saudi (89.7%, n = 26). Females represented 62.1% of the study sample. The average BMI was 25.6 ± 4.95 kg/m 2 . The highest correlation was observed between the US and CT tip ( r = 0.544, P < 0.01) and rhinion ( r = 0.525, P < 0.01) measurements. Body mass index was not associated with any US or CT measurements when BMI was used as a continuous or ordinal variable. The correlation between the US and CT measurements was highest for rhinoin and tip measurements, whereas supratip measurements were not correlated ( r = -0.029, P = 0.88). The correlation between mid-dorsum and nasion measurements was low (~0.3). The correlation between nasal skin thickness using CT and US varies depending on the nasal point and location. Body mass index was not associated with nasal skin thickness.

Perception of Rhinoplasty Outcome Utilizing Patients' Photography.

BACKGROUND: Patient satisfaction with rhinoplasty results is evaluated in a manner of subjective and qualitative values, and to a certain degree, it can indicate successful outcomes in rhinoplasty. METHODS: The present study was a descriptive study that assessed the rhinoplasty outcome of adult patients who underwent septorhinoplasty between January 2015 and August 2023 at a single center in Saudi Arabia utilizing Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores pre-operatively, postoperatively, and postoperatively with showing the patients their photo before surgery. RESULTS: The comparison of Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores showed statistically significant with P value of 0.000 when comparing these scores pre-operatively, postoperatively, and postoperatively with showing the patient their photos before surgery. CONCLUSION: Presenting patients with pre-operative images may help them recognize changes in their clinical appearance and, consequently, score higher on the postoperative satisfaction scale. It can help the surgeon to increase patient satisfaction postoperatively.

Modified Alar Base Reduction: A Novel Technique.

BACKGROUND: Alar base reduction (ABR) surgery is one of the rhinoplasty techniques used to reduce alar flaring, nasal base width, or both. It is crucial for rhinoplasty surgeons to understand and analyze the type of nasal base deformity to achieve satisfactory results and avoid complications. OBJECTIVES: The objective of this study is to describe a novel technique of ABR that addresses alar flaring while avoiding violation of the nostril marginal rim. METHODS: This prospective cohort study included patients with alar flaring who underwent rhinoplasty or septorhinoplasty with ABR using our modified technique. Demographic data, clinical history, aesthetic concerns, and preoperative and postoperative photographs were collected for each patient. The surgical outcome was assessed using subjective scar evaluation scores at 3 and 6 months, the Stony Brook Scar Evaluation Scale at 6 months, and an overall appearance satisfaction score. RESULTS: A total of 8 patients were included in the study. Subjectively, the majority of patients (75%) reported satisfactory scar appearance at the 6-month follow-up. The mean Stony Brook score was 4.7 (SD=0.74). Nostril symmetry was achieved in all patients. Seventy-five percent of the participants expressed satisfaction with the overall appearance. CONCLUSIONS: Our modified ABR technique demonstrates promising results in correcting alar flaring while achieving nostril symmetry with an acceptable scar. Further studies with a larger sample size are needed to evaluate the feasibility of the technique and compare it to other classical techniques. LEVEL OF EVIDENCE: Level IV.

Facial Angles in Arabian Women Seeking Rhinoplasty.

The purpose of this study is to determine the average values of the angular nasal anthropometric variables in Arabian women seeking rhinoplasty and compare them with the normal values. A total of 150 female patients, who underwent rhinoplasty between January 2018 and November 2021, were enrolled in this study. The exclusion criteria were a history of nasal trauma, previous rhinoplasty, and a cleft nose. Data were obtained from standardized digital photographic images. Lateral and basal views were analyzed using landmarks defined by a single observer and measurements were performed using Adobe Photoshop Software SC6. All data were analyzed using SPSS version 21 software (IBM) and compared with the normal values obtained from a previous study. All facial angles, except for the nasofrontal angles, were significantly different between the surgical and nonsurgical normal groups. The values (means±SDs) in the surgical group were as follows: nasofacial angle, 29.7±3.4 degrees; nasofrontal angle, 146.2±2.8 degrees; glabella-nasal angle, 169.8±5.8 degrees; nasolabial angle, 113.5±11 degrees; nasomental angle, 130.6±6 degrees; nasal tip angle, 102.3±8 degrees; ala-slope angle, 95.4±13.6 degrees. The nose characteristics of Arabian women seeking rhinoplasty were as follows: (1) shallow radix, (2) under the projected tip, and (3) normal tip rotation. Surgical planning is important upon consideration of any procedure or modification of the nose among Arabian women.

Description of Novel Technique for Managing Insufficient Nasal Skin Volume.

A short nose is a common esthetic problem faced by facial plastic surgeons. Rhinoplasty of the short nose has been recognized as a complex procedure to perform for achieving satisfactory results. The authors presented 4 cases of short nose in 4 Saudi men who underwent rhinoplasty using septal extension graft and closure the skin with secondary intention as an option to control skin tension after graft placement and to increase nose skin volume to prevent skin retraction, which may occur postoperatively during the healing process. Furthermore, the authors have also discussed the surgical outcomes of these 4 cases and overall satisfaction. Finally, the authors reviewed the literature to identify published papers on correcting the short nose technique.

A Novel Technique for Spreader Flap by Folding the Dorsal Hump in Patients Undergoing Primary Rhinoplasty.

OBJECTIVES: We describe our novel modified spreader flap, which involves keeping the large cartilaginous septal T hump attached to the upper lateral cartilages to increase the thickness and length of the flap. Our objectives were to assess hump reduction and recurrence, nasal axis deviation, dorsal width, internal nasal valve grade, and Rhinoplasty Outcome Evaluation (ROE) score preoperatively and one year postoperatively. MATERIALS AND METHODS: In a prospective study that included 21 patients who met the criteria, patients were followed up for 1 year after surgery, with an assessment of the dorsal projection, tip projection, axis deviation, dorsal width, and internal nasal valve grade. In addition, the modified Cottle maneuver and Rhinoplasty Outcome Evaluation score were also performed and obtained, respectively. RESULTS: Our novel technique was performed in 20 patients (95.2%). In 1 additional patient, we added a regular auto-spreader flap on the contralateral side. One year postoperatively, the axis was found in the midline in all patients (100%). Assessment of internal valve collapse showed that collapse was reduced to grade 0 in 13 patients (61.9%) and grade 1 in 8 patients (38.1%). There were no hump recurrences or visible irregularities. The results showed a statistically significant difference between the pre- and postoperative values in dorsal projection, dorsal width, and rhinoplasty outcome evaluation score. CONCLUSIONS: This novel technique shows promising statistically significant results in reducing dorsal hump projection and width, correcting axis deviation, and improving internal nasal valve and rhinoplasty outcome evaluation score, while being less cartilage and time-consuming.

Indications, Techniques, and Postoperative Outcomes of Temporalis Fascia Grafting in Rhinoplasty.

OBJECTIVES: To investigate the indication, site, techniques, and complications at the donor and recipient sites of temporalis fascia grafting in rhinoplasty, and patients' satisfaction with the surgical outcomes. METHODS: This retrospective cohort study was performed at King Abdulaziz University Hospital, Saudi Arabia, between January 2015 and January 2020. The predictor variable was the temporalis fascia in different forms. Reported variables comprised individuals' satisfaction, dorsal nasal irregularities, and contour definitions. Moreover, further variables were considered, including age, gender, the reason behind surgery, surgical type, and graft size and site. A rhinoplasty doctor, other than a surgeon, has assessed the dorsal augmentation findings by inspecting and palpating the dorsum. Data analyses were achieved through SPSS. RESULTS: A total of 69 patients were enrolled in this study; 44.9% of them underwent rhinoplasty with the temporalis fascia in cartilage wrapped by the temporalis fascia form, 43.5% in a blanket form, and 11.6% in a ball form. The average subject satisfaction outcome score was 10.44 preoperatively and 19.72 postoperatively ( P = 0.001).No dorsal irregularities were detected by inspection in all forms of the temporalis fascia, whereas 3 patients with the blanket and 2 patients with the cartilage wrapped by the temporalis fascia had irregularities, which were detected on palpation. CONCLUSIONS: In rhinoplasty, the temporalis fascia is a favorable choice for nasal reconstruction since it is simple in harvesting and can be made in different forms and shapes for many purposes.

Surgical Neck Emphysema Post Elective Tonsillectomy: Case Report and Literature Review.

Neck emphysema after tonsillectomy surgery is very rare. We present a case documenting the conservative management of a post-tonsillectomy neck swelling, accompanied by crepitus. Computed tomography revealed a large air density at the region of the right masticator space and the masseter muscle, proximal to other deep neck spaces and muscles. Further investigations of her associated symptoms resulted in an additional diagnosis of systemic lupus erythematosus. We have also explored the signs and symptoms associated with such cases, along with a discussion of the literature published on surgical emphysema post-tonsillectomy.

Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review.

Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species (Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.