Daño nasal por abuso de cocaína. Reporte de caso clínico / Nasal damage cocaine abuse. Case report

La cocaína proviene de la hoja de coca, es una sustancia que cuando se consume por la vía inhalatoria puede producir lesiones graves a nivel nasal, con lesiones que se inician a nivel de la mucosa, perforación septal, con pérdida del soporte a nivel de la punta nasal, retracción alar, compromiso de y retracción de ambas alas, planos de cobertura y piso de fosas nasales. La reconstrucción es un desafío para el cirujano plástico. Abarcando un arsenal terapéutico que va desde solo confeccionar un marco cartilaginoso para soporte de la columela y dorso nasal con costilla, hasta cobertura interna y externa con colgajos más sofisticados. Creemos que estos pacientes para su tratamiento deben presentar conocimiento de que es un camino largo que requiere muchos tiempos quirúrgicos y que en estadios avanzados la cobertura de mucosa es el mayor desafío.

Cocaine comes from the coca leaf, it is a substance that when consumed by inhalation can cause serious injuries to the nose. With lesions that start at the level of the mucosa, septal perforation, with loss of support at the level of the nasal tip, alar retraction, compromise and retraction of both wings, coverage planes, and floor of the nostrils. Reconstruction is a challenge for the plastic surgeon. A therapeutic arsenal that goes from just making a cartilaginous framework to support the columella and nasal dorsum with rib, to internal and external coverage with more sophisticated flaps. We believe that in order to treat these patients, they must be aware that it is a long road that requires many surgical times and that in advanced stages mucosal coverage is the greatest challenge

[Optimization of the method for the postoperative treatment following rhinoplasty]. / Optimizatsiia metodiki vedeniia posleoperatsionnogo perioda posle rinoplastiki.

This article was designed to report the results of analysis of the dynamics of oedema of the soft tissues of the external nose and the adjacent facial structures in different periods following rhinoplasty. The metric characteristics were calculated and the integral index of tissue oedema was determined for 374 patients allocated to two groups. The main group was comprised of 286 (86.5%) patients who underwent the postoperative rehabilitative treatment making use of the proposed method. The remaining 88 (23.5%) patients constituted the group of comparison. The analysis of the data obtained has demonstrated that the compliance with the newly developed algorithm for the postoperative rehabilitation permits to considerably reduce the severity of the inflammatory reaction of the organism to the post-surgical trauma and to shorten the duration of the postoperative rehabilitation.

The Art of Camouflage: When Can a Revision Rhinoplasty Be Nonsurgical?

Rhinoplasty surgery is known to have revision rates up to 20%. Surgical revisions include the risk of anesthesia and scarring. The skilled injector may offer nonsurgical alternatives to patients when considering revision surgery. Injections can be done to improve symmetry or improve/camouflage deformities that are possibly too minor for surgery but bothersome to the patient. Injections can be performed using different filler materials, but these treatments also carry inherent risks.

Avaliação da equimose após osteotomia nasal lateral contínua interna e externa na rinoplastia aberta / Ecchymosis evaluation after internal and external continuous lateral nasal osteotomy in open rhinoplasty

INTRODUÇÃO: O objetivo é avaliar a presença de equimose com 7 e 15 dias após osteotomia nasal lateral interna e externa na rinoplastia aberta. Métodos: Análise prospectiva, dos pacientes submetidos à rinoplastia aberta, com osteotomia nasal lateral com total de 15 pacientes. Os pacientes foram alocados em dois grupos. Aqueles submetidos à osteotomia nasal lateral externa formaram o grupo A (n = 6) e os submetidos à osteotomia interna, o grupo B (n = 9). Foram avaliados com 7 e 15 dias de pós-operatório e registrada a presença ou ausência de equimose. Resultados: Dentro do grupo A evidenciamos no 7º dia de pós-operatório 3 (50%) pacientes com equimose e 3 (50%) sem alteração na tonalidade da pele. Com 15 dias de pós-operatório, o mesmo grupo apresentava 2 (25%) pacientes com equimose e 4 (75%) sem alteração. Já no grupo B foram identificados no 7º dia após o procedimento 3 (33,4%) pacientes com presença de equimose e 6 (66,6%) sem alteração. O mesmo grupo após 15 dias do procedimento apresentou 1 (11,1%) paciente com equimose e 8 (88,9%) sem alteração. Conclusão: Apesar da fratura interna apresentar menor incidência de equimose no sétimo e décimo quinto dias de pós-operatório, não houve relevância estatística na comparação entre as técnicas.

Introduction: The objective is to evaluate the presence of ecchymosis 7 and 15 days after internal and external lateral nasal osteotomy in open rhinoplasty. Methods: A prospective evaluation of 15 patients who underwent open rhinoplasty with lateral nasal osteotomy was conducted. The patients were allocated into two groups. Those who underwent external lateral nasal osteotomy were included in group A (n = 6), while those who underwent internal osteotomy were included in group B (n = 9). The patients were evaluated on postoperative days 7 and 15, and the presence or absence of ecchymosis was recorded. Results: In group A, we observed that on postoperative day 7, 3 patients (50%) had ecchymosis and 3 (50%) showed no changes in skin color. On postoperative day 15, the same group had 2 patients (25%) with ecchymosis and 4 (75%) without changes. On the other hand, in group B, 3 patients (33.4%) had ecchymosis and 6 (66.6%) showed no changes on postoperative day 7. In the same group, 1 patient (11.1%) had ecchymosis and 8 (88.9%) showed no changes 15 days after surgery. Conclusion: Despite the lower incidence of ecchymosis in internal fractures on postoperative days 7 and 15, no statistical significance was observed between the two techniques.

[The potential of physiotherapy after rhinoplasty]. / Vozmozhnosti fizioterapii posle rinoplastiki.

This article presents the results of the evaluation of the effectiveness of physiotherapy during the postoperative period following rhinoplastic surgery based on the analysis of the dynamics of the clinical symptoms in 374 patients divided into two groups. The main group was comprised of 286 (86.5%) patients who had undergone the comprehensive postoperative rehabilitation with the use of the chosen physiotherapeutic procedures while the group of comparison consisted of 88 (23.5%) patients treated othrerwise. The method in question included the microcurrent lymphatic drainage, the magneto-laser treatment, and ultraphonophoresis. The data obtained give evidence of the significant differences between the two groups of the patients in terms of reduction of oedema of the nasal and facial soft tissues on days 10-12 and 30-35 after the treatment as well as of subcutaneous hemorrhage and pain in the external nose on days 10-12. These effects were more pronounced in the patients of the main group. The local subcutaneous compaction was documented in both groups (though it was more pronounced in the patients of the comparison group; p<0.05) after the disappearance of the bulk of the swelling approximately on days 10-12. It is concluded that the results of the study confirm the effectiveness of the staged performance of various physiotherapeutic procedures during the postoperative period after rhinoplasty.

[The influence of rhinoplasty on the physical and mechanical properties of the skin of the external nose]. / Rinoplastika i fiziko-mekhanicheskie svoistva kozhi naruzhnogo nosa.

This article was designed to report the results of the measurement of the surface acoustic wave velocity in the skin of the external nose following rhinoplastic surgery based on the analysis of the postoperative conditions in 374 patients. The patients were divided into two groups, one comprised of 286 (86.5%) patients who underwent the newly developed rehabilitative treatment and the group of comparison composed of 88 (23.5%) patients who received a different treatment during the postoperative period. The analysis has demonstrated the significant reduction in the velocity of the surface acoustic waves in the skin of the external nose of the patients of the main study group within 1 and 6 months after the surgical intervention. The change was especially well apparent at the sites with the relatively thicker skin underlain by the subcutaneous adipose tissue. This result can be regarded as giving evidence of the effectiveness of the proposed physiotherapeutic treatment that allowed to achieve the rapid decrease of postoperative oedema and prevent the subsequent excessive cicatrization.

Resultados de rinoplastia abierta en pacientes portadores de deformidades nasales / Results of open rhinoplasty in patients with nasal deformities

Fundamento: La rinoplastia es un procedimiento quirúrgico para solucionar problemas estéticos o funcionales. Aunque es rechazado por muchos cirujanos debido a la incisión externa de la columela, es muy útil en casos difíciles.Objetivo: describir los resultados de rinoplastia abierta en pacientes con deformidades nasales.Métodos: se realizó un estudio descriptivo, de 55 pacientes operados en el periodo 2005-2012 en el hospital Gustavo Aldereguía Lima, de Cienfuegos, mediante la técnica de rinoplastia abierta. Las variables analizadas fueron: edad, sexo, color de la piel y tipo de incisión.Resultados: la mayoría de los pacientes fueron menores de 30 años, siendo la edad mínima 14 años y la máxima 50 años. El tipo de incisión más utilizado fue la de V invertida. En ninguno de los pacientes operados se presentó queloide. El 100 por ciento de los pacientes manifestó un alto grado de satisfacción respecto al resultado de la operación.Conclusión: la rinoplastia abierta ofrece una serie de ventajas que garantizan al cirujano el éxito de la intervención quirúrgica. Si se adoptan las medidas necesarias el riesgo quirúrgico es mínimo, al igual que las probabilidades de aparición de cicatriz queloide, la cual es más frecuente en pacientes mestizos y negros, quienes también son los que más demandan este tipo de cirugía en la serie estudiada(AU)

Foundation: Rhinoplasty is a surgical procedure to solve aesthetic and functional problems. Although it is refused by many surgeons due to the external incision of the columella, it is highly useful in difficult cases.Objective: To describe the results of open rhinoplasty in patients with nasal deformities.Methods: A descriptive study was realized, of patients operated through the technique of open rhinoplasty in the period 2005-2012 in the Hospital Gustavo Aldereguía Lima. Cienfuegos. The variables analyzed were: age, sex, race, and type of incision.Results: Most of the patients were under 30 years old; the lowest age was 14 and the maximum 50 years old. The type of incision mostly used was inverted V. In none of the operated patients a keloid appeared. The 100 percent of patients manifested a high degree of satisfaction with respects to the results of the operation.Conclusion: Open rhinoplasty offers a series of advantages which guarantee the success of the surgical intervention to the surgeon. If the necessary measures are adopted the surgical risk is minimal, similarly the probabilities of appearance of a keloid scar which is more frequent in mestizo and black patients who are also those who demand this type of surgery in the studied series(AU)

Resultados de rinoplastias de la punta nasal en Cienfuegos / Results of rhinoplasties of the nasal tip in Cienfuegos

Fundamento: La rinoplastia de la punta nasal es una de las cirugías estéticas más difíciles y desafiantes a las que se enfrenta el cirujano dedicado a las deformidades nasales. Objetivo: exponer los resultados de la rinoplastia realizada a pacientes con deformidades nasales. Métodos: se realizó un estudio descriptivo de los resultados obtenidos en 145 pacientes, a los cuales se realizó cirugía para corregir deformidades nasales. Fueron atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, en un periodo de 10 años. Resultados: en 56 pacientes la cirugía estuvo encaminada a estrechar la punta nasal; en 45 pacientes a la rotación de la punta nasal; y en 44 pacientes a la proyección de la punta nasal. Se utilizó la técnica del estandarte con injerto de cartílago del septo y de la oreja. Conclusiones: en el periodo analizado, las rinoplastias realizadas en la provincia Cienfuegos tuvieron resultados satisfactorios, ya que se logró satisfacer las expectativas de los pacientes, con una reducción de los costos y de los riesgos para estos debido al uso de anestesia local(AU)

Background: the rhinoplasty of the nasal tip is one of the most difficult and challenging plastic surgeries the surgeon dedicated to the nasal deformities faces. Objective: exposing the results of the rhinoplasty accomplished to patients with nasal deformities. Methods: a descriptive study of results obtained in 145 patients who had a surgery to correct nasal deformities. They were attended at Dr Gustavo Aldereguía Lima University General Hospital of Cienfuegos, in a period of 10 years. Results: in 56 patients surgery was headed for embracing the nasal tip; in 45 patients to the rotation of the nasal tip; and in 44 patients to the projection of the nasal tip. The technique of the banner with graft of cartilage of the septum and the ear was used. Conclusion: in the analyzed period, the rhinoplasty accomplished in the province of Cienfuegos had satisfactory results, because the patients expectations were satisfied with a reduction of the costs of risks for them due to the use of local anesthesia(AU)

[Certain peculiarities of rhinoseptoplasty in children].

This paper reports the results of examination and treatment of children presenting with deviation of the nasal septum. All of them underwent septoplasty simultaneous with rhinoplasty, vasotomy of inferior nasal concha, and correction of bullous middle nasal concha (if indicated). It is recommended that the data obtained be taken into consideration during rhinoseptoplastic surgey in children.

Validation of a questionnaire assessing patient's aesthetic and functional outcome after nasal reconstruction: the patient NAFEQ-score.

In determining patient satisfaction with functional and aesthetic outcome after reconstructive surgery, including nasal reconstruction, standardised assessment instruments are very important. These standardised tools are needed to adequately evaluate and compare outcome results. Since no such instrument existed for nasal reconstruction, a standardised evaluation questionnaire was developed to assess aesthetic and functional outcome after nasal reconstruction. Items of the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ) were derived from both the literature and experiences with patients. The NAFEQ was validated on 30 nasal reconstruction patients and a reference group of 175 people. A factor analysis confirmed the arrangement of the questionnaire in two subscales: functional and aesthetic outcome. High Cronbach's alpha values (>0.70) for both subscales showed that the NAFEQ was an internally consistent instrument. This study demonstrated that the NAFEQ can be used as a standardised questionnaire for detailed evaluation of aesthetic and functional outcome after nasal reconstruction. Its widespread use would enable comparison of results achieved by different techniques, surgeons and centres in a standardised fashion.

Skin excision revision rhinoplasty.

A technique of skin excision revision rhinoplasty is described for application in patients undergoing rhinoplasty. This group of patients includes those with soft-tissue polly beak deformities and a variety of other difficult post-rhinoplasty deformities. Horizontal nasal dorsal skin excision affects tip elevation and eliminates supratip fullness, while vertical midline nasal dorsal skin excision enhances tip definition, decreases dorsal height, and eliminates supratip fullness. We describe several patients who underwent either horizontal or vertical nasal dorsal skin excision for a variety of cosmetic deformities following conventional closed and open rhinoplasty. The techniques presented herein are meant to be added to the list of techniques available to the revision rhinoplasty surgeon rather than to replace existing techniques.

External septorhinoplasty in the cleft lip nose.

When the entire septum as well as the cartilaginous vault are exposed to direct vision by degloving the nasal covering, the complete extent of the deformities in cleft lip nose can be clarified. The septal cartilage is hollowed out leaving an L-shaped anterosuperior portion, whereas the intranasal structures are simultaneously altered to ensure the patency of the nasal airway. An adequate-sized piece is cut from the removed cartilage and is fitted to the anterior part of the remaining cartilage to enforce the columella, which acts as a strut to keep both lower lateral cartilages symmetrical and to create a nasal tip. Thus, a new cartilaginous pyramid with symmetrical nostrils is reconstructed. If the anterosuperior portion of the cartilage is deviated, the concave surface is scored to allow it to be straightened before the strut is fitted. Satisfactory cosmetic and functional results were obtained in most patients with adult cleft lip nose, including those associated with deviation, without any major complications.