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1.
Clin Plast Surg ; 49(1): 111-121, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782129

RESUMO

The crooked nose is a challenging esthetic and functional problem. The surgeon must carefully evaluate baseline facial asymmetry as well as whether deviation stems from the upper third, middle third, or lower third of the nose. Surgical intervention should be tailored accordingly, with techniques geared toward addressing each deviated section. Modified dorsal preservation techniques represent a newer means to address deviations. Operative results must be measured, ideally through patient-reported outcomes measures, to quantify overall success.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Estética , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Resultado do Tratamento
2.
Facial Plast Surg Clin North Am ; 29(4): 611-624, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34579841

RESUMO

Typical Asian deformed nose has many different types: concave nasal dorsum, low nasal dorsum, wide nasal dorsum, deviated nose, convex nasal dorsum, saddle nose, short-nose deformity, and deformities involving irreversible damage of skin/soft tissue envelop are the most representative ones. The key concept in Asian rhinoplasty is augmentation in all different forms of nasal deformities. Augmentation of the nose consists of framework, tip, and dorsal augmentation. Septal extension grafting and tip grafting are 2 maneuvers with profound importance in augmentation of lower two-thirds of the Asian nose. Dorsal augmentation is central concept in beautifying all different types of deformed noses, even the hump nose.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia
3.
Rhinology ; 59(4): 340-351, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34350430

RESUMO

OBJECTIVES: To systemically review and compare post-septoplasty complications between total nasal packing and other techniques. METHODOLOGY: We searched electronic databases (PubMed, Scopus, and Cochrane Library) and additional sources. The most recent search was on November 30th, 2020. Randomized controlled trials (RCTs) comparing adverse events after post-septoplasty nasal packing versus other techniques were included. The outcomes were adverse events, including respiratory distress, oxygen desaturation, pain severity, bleeding, hematoma, sleep disturbance, infection, crusting, epiphora, dysphagia, perforation, adhesion, and residual septal deviation. RESULTS: There were 47 studies (4,087 participants) in this systematic review. Nasal packing was more likely to cause adverse events than other techniques. There were significant increases in respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. There were no statistically significant differences in oxygen desaturation, bleeding, hematoma, infection, perforation, and residual septal deviation. Subgroup analysis found that trans-septal suture was less likely to cause post-operative complications compared with total nasal packing. CONCLUSION: Nasal packing after septoplasty was more likely to cause adverse events, including respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. Furthermore, there were no benefits of nasal packing in preventing bleeding, hematoma, and residual septal deviation when compared with other techniques. Routine nasal packing after septoplasty should be avoided. Trans-septal suture should be considered instead.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Epistaxe/etiologia , Epistaxe/prevenção & controle , Humanos , Septo Nasal/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Técnicas de Sutura
4.
Artigo em Chinês | MEDLINE | ID: mdl-34304534

RESUMO

Objective:To analyze the clinical effect of nasal endoscope-assisted nasal columella approach in the correction of nasal septum deviation and crooked nose deformity. Methods:The clinical data of 33 patients with deviation of nasal septum with crooked nose deformity in First Affiliate Hospital of Air Force Military Medical University from January 2016 to June 2019 were collected. All patients underwent surgery under general anesthesia. Nasal columella inverted "V" incision was used to expose and release. The deviated nasal septum cartilage and bone were removed with the assistance of nasal endoscope. Twelve(36.4%) patients underwent osteotomy of nasal bone and frontal process of maxilla at the same time, 13(39.4%) patients used autologous nasal septum to reshape the tip, back and external nose. Results:During a follow-up of 18 months to 60 months, 30(90.9%) patients were satisfied with the improvement of postoperative nasal function, 3(9.1%) patients were basically satisfied; 23(69.7%) patients were satisfied with the appearance of the nose after operation, 8(24.2%) patients were basically satisfied, and 2(6.1%) patients were dissatisfied. No postoperative complications such as nasal adhesion, nasal septum perforation, nasal septum hematoma and nasal dorsal collapse occurred in all patients. Conclusion:The nasal endoscope-assisted nasal columella approach and the correction of nasal septum deviation and crooked nose deformity can solve the nasal deformity and nasal ventilation function at the same time, realize the unity of cosmetology and function, and reduce the frequency and cost of surgical treatment at the same time. The effect is good, and the patients benefit greatly.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Endoscópios , Endoscopia , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia
5.
J Plast Reconstr Aesthet Surg ; 74(10): 2744-2750, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34266802

RESUMO

BACKGROUND: Even a small amount of bleeding during nose surgery can impair the surgeon's vision, prolong the duration of operation, and affect surgery quality; therefore, various techniques have been proposed to control the bleeding. The aim of this study was to compare the efficacy of the local use of tranexamic acid (TXA) in the dry field of surgery. METHOD: This randomized, double-blinded, controlled trial was conducted in the operation room of Imam Reza Hospital, Tehran, Iran, from January 10, 2016 to February 8, 2017. Sixty patients with age range from 20 to 60 years and the American Society of Anesthesiologists physical status classes I candidates who require septoplasty enrolled. Patients were randomized through white and black cards to receive either syringes. Thirty patients in the intervention group received lidocaine + adrenaline + TXA and 30 patients in the control group received lidocaine + adrenaline. Bleeding volume accumulated in the suction chamber, the nasopharyngeal pack, and hemodynamic variations were measured. Surgeon's satisfaction scores and suitability of operation field were obtained from the surgeon by using the Likert scale and Boezaart grading scale, respectively. RESULTS: The intervention group had a higher score of surgeon satisfaction [4.1 vs 3.16 in the control group (P = 0.001)] and fewer hemodynamic variations. The mean bleeding volume in the intervention was 187.23 ± 54.61 mL and in the control group was 341.22 ± 49.17 mL (P = 0.001). The mean Boezaart score (suitability of operation field) in the intervention group was 1.8 (score range: 1-3) and in the control group was 2.53 (score range: 2-4) and it was statistically significant (P = 0.001). CONCLUSION: The local use of TXA + lidocaine + adrenaline is associated with reduced bleeding, greater surgeon satisfaction, reduced need for Karpol injection, and better hemodynamic stability.


Assuntos
Antifibrinolíticos/administração & dosagem , Septo Nasal/cirurgia , Qualidade da Assistência à Saúde , Rinoplastia/normas , Ácido Tranexâmico/administração & dosagem , Administração Tópica , Pressão Arterial/efeitos dos fármacos , Atitude do Pessoal de Saúde , Perda Sanguínea Cirúrgica/prevenção & controle , Volume Sanguíneo , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Duração da Cirurgia
6.
Plast Reconstr Surg ; 148(1): 66-70, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181604

RESUMO

BACKGROUND: The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the "Pisa Tower concept." METHODS: From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up. RESULTS: The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery. CONCLUSIONS: The authors' opinion is that the association of "swinging door" septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Satisfação do Paciente , Rinoplastia/métodos , Adolescente , Adulto , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Septo Nasal/lesões , Septo Nasal/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Rinoplastia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
7.
Ann Plast Surg ; 86(5): 501-507, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33939652

RESUMO

ABSTRACT: Rhinoplasty is one of the most common and challenging surgeries in aesthetic plastic surgery. Among rhinoplasty operations, dorsal hump reduction and septal deviation surgeries are quite common. In the present research, the author describes new approaches in which let-down and crossbar techniques are used in patients with simultaneous dorsal hump and septal deviation deformations. The records of the patients were accessed from a private practice. According to the inclusion and exclusion criteria, 36 patients were included. Two approaches were defined according to patients' needs. Patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) questionnaire before and 12 months after surgery. The follow-up periods ranged between 14 and 21 months. The ROE scores ranged between 80 and 100 points after 1 year. The initial median ROE score was 55.5, and it increased to 90.5 points at 12 months after surgery (P < 0.001). Patient satisfaction was excellent for 90% of the included patients. The present research is the first to demonstrate the successful results of the combination of crossbar and let-down techniques in patients with septal deviation and nasal hump. Plastic surgeons will be able to solve these challenging problems without relapse with the combination of crossbar and let-down techniques.


Assuntos
Deformidades Adquiridas Nasais , Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Estética , Humanos , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia
10.
Int J Oral Maxillofac Surg ; 50(11): 1435-1439, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33678491

RESUMO

Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the superficial temporal artery is an ideal option for a full-thickness nasal alar defect. However, the pedicle length and the discrepancy in artery diameter between the recipient vessel and flap pedicle continue to be major problems for free auricular composite tissue transfer. Considering that the angular artery is occasionally absent and the course of the infraorbital segment of the facial vein is constant, there are often no suitable vessels around the recipient site for anastomoses to the short pedicle of the flap. In the absence of a suitable recipient artery, an infraorbital segment of the facial vein measuring 2.5cm in length was taken as a graft for the anastomosis of the superficial temporal artery and superior labial artery. End-to-end anastomosis was performed easily. The flap was inset to reconstruct the contralateral ala. The facial vein graft for anastomosis of the superficial temporal artery and branch of the facial artery is a reliable and easy method to resolve the problem of a short pedicle and large artery discrepancy for nasal ala reconstruction with a vascularized composite helical rim flap.


Assuntos
Deformidades Adquiridas Nasais , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Humanos , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Retalhos Cirúrgicos , Veias
12.
Aesthet Surg J ; 41(11): 1231-1241, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33739380

RESUMO

BACKGROUND: Rhinoplasty in older adults requires unique consideration of the aging nose. OBJECTIVES: The purpose of this study was to systematically review the literature pertaining to rhinoplasty in the aging population, review the senior author's experience, and describe techniques aimed at addressing age-related features. It was hypothesized that consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes. Furthermore, it was hypothesized that rhinoplasty is more commonly performed for posttraumatic and functional indications than for aesthetic reasons. METHODS: A literature review including publications describing rhinoplasty in patients over 55 years old was conducted. Additionally, a retrospective review of the senior author's cases was performed. Pre- and postoperative photographs were used to compare anthropometric changes. Demographic factors, surgical indications, and operative details were collected. RESULTS: Nine articles met the study criteria. Manifestations of the aging nose included soft tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, and worsening dorsal hump. Twenty-seven patients were included in this institutional review. Primary indication for rhinoplasty was posttraumatic deformity in 17 (63%) patients and nasal obstructive symptoms in 10 (37%) patients. Tip refinement and ptosis were addressed through tip grafts (70%), columellar struts (26%), and caudal septal extension grafts (67%). Nasal obstruction was relieved through septoplasty (96%), turbinate ablation (85%), and spreader grafts (70%). CONCLUSIONS: This study presents a systematic review of rhinoplasty in the older adult as well as a retrospective review of the senior author's patients. Unique considerations specific to this population should be integrated into treatment planning.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Idoso , Humanos , Pessoa de Meia-Idade , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Estudos Retrospectivos , Rinoplastia/efeitos adversos , Resultado do Tratamento
13.
J Craniofac Surg ; 32(7): e623-e626, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33770030

RESUMO

BACKGROUND: Augmentation rhinoplasty had become increasingly popular among Asians. Failure to recognize nasal deviation before surgery may engender unsatisfactory outcomes because the deviation becomes prominently visible after surgery due to the central position of the nose. Ideal nasal radix positioning has yet to be addressed. The head position affects facial asymmetry judgements; however, its effect on rhinoplasty has never been studied. This study determined the ideal nasal radix position in facial fluctuating asymmetry and investigated the effects of the natural head position (NHP) on nasal deviation perceptions. METHODS: A survey was conducted to compare different head and nasal radix horizontal positions using images of patients who underwent augmentation rhinoplasty. Images were retouched using editing software to adjust the head and nasal radix positions. The survey was performed using questionnaires involving 3 plastic surgeons and 3 laypersons, who were asked to determine the presence of nasal deviation and select the ideal nasal radix position among the retouched images. RESULTS: Twenty patients who underwent primary rhinoplasty were included in this study. The recognition of nasal deviation was significantly higher in the NHP than in the compensatory head position. The surgeons and the laypersons considered the midsagittal line the most appropriate position of the nasal radix. CONCLUSIONS: Facial analysis for augmentation rhinoplasty should be performed with the patient's head in the NHP to prevent nasal deviation masking. The preferred nasal radix position in facial fluctuating asymmetry is the midsagittal line.Level of Evidence: Level V, descriptive study.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Face , Assimetria Facial/diagnóstico por imagem , Assimetria Facial/cirurgia , Humanos , Nariz/diagnóstico por imagem , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia
14.
Artigo em Chinês | MEDLINE | ID: mdl-33540975

RESUMO

Objective:To investigate the clinical application value of orthopedic surgery for traumatic crooked nose after autologous nasal septum deflected cartilage shaping. Methods:Twelve patients with obsolete traumatic nasal septum deviation and nasal septum deviation were selected. The nasal septal nasal threshold inverted L incision was assisted by endoscopy, and the nasal dorsal deformity filling area was established along the incision. The excised nasal septal cartilage was shaped and implanted in the dorsal nasal area of the deviated depression to correct the nasal distortion, and the external nasal fixation was performed after satisfaction. Results:The patients were satisfied with the operation results. After a follow-up of more than 1 year, no complications occurred. Conclusion:This method is simple, easy to operate; solves the problem of nasal septum deviation affecting nasal ventilation, allows the deformed nose to be corrected. This method is suitable for popularization and application in the majority of grassroots hospitals.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Endoscopia , Humanos , Cartilagens Nasais , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Resultado do Tratamento
15.
Facial Plast Surg ; 37(2): 205-210, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33634453

RESUMO

Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry is identified in advance and expectations realistic, the correction of nasal deformities can improve perceived facial asymmetry. In the aging face, aside from soft tissue and bony resorption that can amplify facial asymmetry, there are specific surgical challenges to the aging nose; the normal tip support mechanisms deteriorate with age giving rise to distinctive changes to the aging nose-typically tip ptosis and a hanging columella; bone quality becomes more brittle and skin overlying this area becomes thinner. There is also weakening of the external nasal valve thus causing functional impairment too. As a result, rhinoplasty techniques used in younger patients may not be suitable in the aging nose. In this article, the authors describe their experience and outline the evidence on the management of the aging patient with facial and nasal asymmetry.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Envelhecimento , Assimetria Facial/cirurgia , Humanos , Nariz/cirurgia , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia
17.
Aesthetic Plast Surg ; 45(4): 1693-1702, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33399951

RESUMO

INTRODUCTION: Rhinoplasty is one of the most common aesthetic surgeries, and dorsal hump reduction surgery is the most commonly applied type of surgery in Western countries. Every patient should be considered challenging based on the negative outcomes of this surgical procedure. Thus, aesthetic and plastic surgeons attempt to provide the safest and best resulting rhinoplasty techniques. OBJECTIVES: While performing dorsal preservation techniques in patients who had hump deformity but did not have septal deviation, deviation occurs due to surgery. In the present research, the author defines new suturing techniques for overcoming deviation associated with dorsal preservation surgeries. METHODS: Data from patients who underwent dorsal preservation rhinoplasty for the nasal hump were evaluated. Patients who had nasal hump deformities without nasal deviation deformities were included. Following these inclusion and exclusion criteria, the records of 43 patients were assessed. All patients included in the study completed the Rhinoplasty Outcome Evaluation questionnaire before surgery and at their one-year follow-up appointment. New suturing approaches such as "8" shaped and loop sutures were assessed. RESULTS: The median Rhinoplasty Outcome Evaluation score before surgery was 60.6. The median score after one year of surgery was 90.8. The Rhinoplasty Outcome Evaluation score significantly increased after surgery (p<0.001). Patient satisfaction was excellent in 90.47% of the included patients. CONCLUSIONS: These "8" suturing approaches present surgeons overcoming the possibility of deviation, which is associated with dorsal preservation techniques, such as push-down and let-down procedures in non-deviated noses. Further studies are needed to confirm the preliminary results of the present research. 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 .


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Estética , Humanos , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/efeitos adversos , Suturas , Resultado do Tratamento
18.
Aesthetic Plast Surg ; 45(3): 1197-1200, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33403422

RESUMO

BACKGROUND: There are increasing reports of the effects of SARS-CoV-2 on olfactory function, with a significant number of patients reporting anosmia as a symptom. However, our knowledge and understanding of the virus's complete impact on the nose remains poor. This report describes a unique patient case to demonstrate how COVID-19 may be associated with rhinoplasty complications such as septal perforation. CASE REPORT: This is a case report of a previously healthy patient who underwent septorhinoplasty in 2018. She had frequent follow-up including intranasal examinations without evidence of the septal perforation for the 2 years following her operation. In March 2020, the patient was noted to have symptoms suggestive of COVID-19, but testing was not recommended by the pediatrician. Soon after her symptoms resolved, she experienced a sudden onset of whistling and physical examination revealed a perforation in the septum which rapidly enlarged over the ensuing weeks. She tested positive for the COVID-19 antibody. After confirming that she no longer had an active infection via antigen testing, she underwent repair of her septal perforation without complications. CONCLUSION: This case report illustrates a septorhinoplasty complication that may be associated with COVID-19. Further study into this virus's impact on vascularity and wound healing, specifically in the nose, is recommended. LEVEL OF EVIDENCE V: 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.


Assuntos
COVID-19 , Deformidades Adquiridas Nasais , Rinoplastia , Feminino , Humanos , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/efeitos adversos , SARS-CoV-2 , Resultado do Tratamento
19.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431532

RESUMO

Woakes' syndrome (WS) is a rare entity, defined as severe recalcitrant nasal polyposis with consecutive deformity of the nasal pyramid. WS occurs mainly in childhood and its aetiology remains unclear. We report a case of a 68-year old woman, with aspirin-exacerbated respiratory disease, who presented with recurrent nasal polyposis and progressive broadening of the nasal dorsum. CT scan revealed extensive bilateral nasal polyposis and diffuse osteitis, with anterior ethmoidal calcified lesions. The patient underwent revision endoscopic sinus surgery and nasal pyramid deformity was successfully managed without osteotomies.


Assuntos
Sinusite Etmoidal/diagnóstico , Pólipos Nasais/diagnóstico , Deformidades Adquiridas Nasais/etiologia , Administração Intranasal , Idoso , Biópsia , Endoscopia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/patologia , Seio Etmoidal/cirurgia , Sinusite Etmoidal/complicações , Sinusite Etmoidal/patologia , Sinusite Etmoidal/terapia , Feminino , Glucocorticoides , Humanos , Mucosa Nasal/diagnóstico por imagem , Mucosa Nasal/patologia , Mucosa Nasal/cirurgia , Pólipos Nasais/complicações , Pólipos Nasais/patologia , Pólipos Nasais/terapia , Recidiva , Síndrome , Tomografia Computadorizada por Raios X
20.
Aesthet Surg J ; 41(8): 905-918, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-33506865

RESUMO

BACKGROUND: Revision rhinoplasty in patients with multiple prior surgeries is among the most challenging procedures in facial plastic surgery. Evaluating patient satisfaction in this unique patient population is important in determining which technique is effective. OBJECTIVES: The aim of this study was to determine the outcomes of total nasal skeletal reconstruction in patients with severe post-rhinoplasty deformity due to multiple previous revision surgeries. METHODS: A retrospective medical record analysis of ambulatory surgery and hospital databases was performed relating to rhinoplasty patients between April 2014 and December 2018. Patient demographics, surgical technique, and functional and aesthetic outcome assessment data were retrieved. Patients' functional satisfaction was measured with the Nasal Obstruction Symptom Evaluation (NOSE) instrument, and the Rhinoplasty Outcome Evaluation (ROE) instrument was used to evaluate cosmetic results. RESULTS: A total of 253 revision rhinoplasties were extracted. Of these, 25 patients were revision cases with total skeletal reconstruction. The patients had undergone a mean of 3.2 previous rhinoplasties. Mean [standard deviation] preoperative ROE and NOSE scores were 6.36 [3.69] and 80.33 [12.02], respectively. Septum, tip, dorsum, and side walls were reconstructed in all cases. The mean postoperative ROE and NOSE scores after 1 year were 17.27 [4.67] and 53.33 [19.80], respectively, which represented a statistically significant improvement (P < 0.001). CONCLUSIONS: Having the knowledge and experience to perform total nasal skeletal reconstruction by rebuilding an unsalvageable nose leads to long-standing satisfactory functional and aesthetic results.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Estética , Seguimentos , Humanos , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia , Satisfação do Paciente , Estudos Retrospectivos , Rinoplastia/efeitos adversos , Resultado do Tratamento
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