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1.
Clin Plast Surg ; 49(1): 1-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782128

RESUMO

Requiring both high-level technical skills and artistic sense, rhinoplasty continues to be one of the most challenging procedures in plastic surgery despite its popularity. A thorough preoperative consultation of the rhinoplasty patient forms the foundation of a successful case. During the consultation, the physician should obtain a detailed medical and nasal history, understand the patient's areas of concern, conduct a nasal analysis, and evaluate the patient's candidacy for surgery. This article reviews the key functional, esthetic, and psychosocial considerations that should be taken into account during a preoperative consultation for a rhinoplasty patient.


Assuntos
Rinoplastia , Cirurgia Plástica , Estética , Humanos , Nariz/cirurgia , Cuidados Pré-Operatórios
2.
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
3.
Clin Plast Surg ; 49(1): 123-136, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782130

RESUMO

An understanding of anatomy and pathophysiology of the cleft nasal deformity is crucial to its management, including selection of correct surgical techniques for repair. Timing of intermediate and definitive rhinoplasty should be considered carefully, with definitive rhinoplasty occurring after management of facial skeletal deformities. At the time of definitive rhinoplasty, the septum, external and internal nasal valves, alar base malposition (and corresponding bony deficiency), and position and shape of the lower lateral cartilage and the columella all must be individually considered. Thorough knowledge of rhinoplasty techniques is crucial to address the cleft nasal deformity with optimal functional and aesthetic outcomes.


Assuntos
Fenda Labial , Rinoplastia , Cartilagem , Fenda Labial/cirurgia , Estética , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia
4.
Clin Plast Surg ; 49(1): 13-22, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782131

RESUMO

Photodocumentation is an essential part of a rhinoplasty surgeon's practice. Preoperative photographs are an indispensable device for patient counseling and surgical planning. Comparison of preoperative and postoperative photographs allow for outcome evaluation, which has a variety of applications-clinical, research, teaching, medicolegal. The ever-evolving technology of photography may seem daunting, but developing a basic understanding of this tool is imperative for a successful rhinoplasty practice. This article reviews the basic photographic principles, equipment, and techniques that are essential to produce high-quality and standardized patient photographs.


Assuntos
Rinoplastia , Humanos , Fotografação
5.
Clin Plast Surg ; 49(1): 137-148, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782132

RESUMO

To manage the deficient nasal dorsum, a thorough knowledge of dorsal augmentation techniques should be mastered by the rhinoplasty specialist. Indications for dorsal augmentation may arise in both primary and revision rhinoplasty presentations. To direct operative planning, a complete facial analysis, noting the importance of maintaining overall nasofacial balance, is essential. An array of techniques, including autologous and nonautologous (ie, allogeneic and synthetic) sources, have been used globally-each carrying its own advantages and disadvantages. The authors believe autologous grafts to be the optimal source for dorsal augmentation because of their biocompatibility and ability to produce natural and long-lasting outcomes.


Assuntos
Fáscia , Rinoplastia , Fáscia/transplante , Humanos , Nariz/cirurgia , Coleta de Tecidos e Órgãos , Transplante Autólogo
6.
Clin Plast Surg ; 49(1): 149-160, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782133

RESUMO

Today non-Caucasian patients comprise an important group of patients seeking rhinoplasty. The term non-Caucasian is used interchangeably to speak about patients of ethnic origin. It becomes important to understand the interplay of culture, race, and ethnicity when evaluating patients and defining what their aesthetic ideals are and what will be needed for surgery. An integrated approach and management of the non-Caucasian patient is presented in which medical and surgical options are explored. The final goal when treating non-Caucasian patients should be trying to help patients achieve their aesthetic ideal in the best possible fashion.


Assuntos
Rinoplastia , Estética , Grupos Étnicos , Humanos , Nariz/cirurgia
7.
Clin Plast Surg ; 49(1): 161-178, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782134

RESUMO

Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal excess or deficiency, vertical excess or deficiency, cephalic malposition or caudal malposition of alar base, wide or narrow nostril sills, and columellar base deformities. Columellar base should be addressed before alar base resections. Correction of columellar base deformities and positioning of medial crural footplates should be the primary step of nasal base surgery to attain aesthetic ideals of the columellar base and improve external nasal valve function. The most common deformities requiring alar base modification include wide nasal base, alar flaring, large nostril size, and asymmetries of nostrils or alae. There are 3 basic types of excision on alar base surgery. (1) Alar wedge excision, (2) nostril sill excision, and (3) combined alar wedge and nostril sill excision. The alar wedge excision is an elliptical excision placed in the alar crease that is used to reduce the size and shorten the vertical length of alar lobule and correct the excessive flaring on the frontal view. Nostril sill excision is the technique which is used to decrease interalar distance and nostril sill length, and reduce the size of nostril. The combined alar wedge and nostril sill excision is used in cases with wide alar base and additionally, there is excessive flaring and large alar lobule.


Assuntos
Procedimentos Ortopédicos , Rinoplastia , Estética , Humanos , Cavidade Nasal , Septo Nasal/cirurgia , Nariz/cirurgia
8.
Clin Plast Surg ; 49(1): 179-189, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782135

RESUMO

Rhinoplasty is widely regarded as one of the more technically challenging surgeries, owing in part to the many possible short- and long-term complications that can arise. Although severe complications are uncommon, unforeseen complications can lead to esthetic and functional compromise, patient dissatisfaction, and need for revision surgery. The rhinoplasty surgeon must be prepared to counsel patients and identify and manage the range of complications that may result from this procedure. This article reviews some of the most frequently encountered complications related to rhinoplasty and their management approaches.


Assuntos
Rinoplastia , Estética , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação , Rinoplastia/efeitos adversos
9.
Clin Plast Surg ; 49(1): 191-195, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782136

RESUMO

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.


Assuntos
Rinoplastia , Humanos , Isquemia , Nariz/cirurgia
10.
Clin Plast Surg ; 49(1): 23-31, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782137

RESUMO

Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.


Assuntos
Obstrução Nasal , Rinoplastia , Humanos , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Nasofaringe , Qualidade de Vida
11.
Clin Plast Surg ; 49(1): 33-47, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782138

RESUMO

Endonasal rhinoplasty is a minimally invasive approach in which esthetic and functional improvements are made solely through intranasal, without transcolumellar, incisions and with limited soft tissue and skeletal disruption. In addition to intentionally limiting surgical dissection, the rhinoplasty surgeon must preoperatively recognize and surgically correct 4 common anatomic variants which predictably create all 3 patterns of secondary deformity. In combination, respecting these principles gives the surgeon greater predictability in achieving esthetic and functional improvements, and the ability to limit the adverse effects of skin contractility and postoperative scar contracture, thus reducing the risk of secondary deformity, patient dissatisfaction, and reoperation.


Assuntos
Rinoplastia , Cirurgia Plástica , Estética , Humanos , Septo Nasal/cirurgia , Reoperação
12.
Clin Plast Surg ; 49(1): 49-59, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782139

RESUMO

The nose is a complex three-dimensional structure with critical structural and functional roles; its relationship to surrounding structures is, in part, responsible for a harmonious, pleasing visage as a whole. There are many variables and dimensions that can be adjusted to alter the esthetic appearance, structural components, and functional role of the nose and many tools and maneuvers available to the rhinoplasty surgeon to adjust these numerous variables. Although every rhinoplasty operation should be individualized, a systematic order and algorithm may be helpful in operative planning as well as establishing a logical progression of steps and maintaining stability. While each adjustment may have a primary anticipated effect, it will invariably have a secondary impact.


Assuntos
Rinoplastia , Algoritmos , Humanos , Nariz/cirurgia
13.
Clin Plast Surg ; 49(1): 61-70, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782140

RESUMO

Controlling the nasal tip to achieve excellent structural and cosmetic outcomes is challenging in rhinoplasty surgery. A strong foundation and understanding of the nasal tripod complex and the various methods for restoring tip support mechanisms when disrupted either from surgery or other means is critical. The columellar strut graft, septal extension graft, and tongue-in-groove suture technique are well-described methods to control and support the nasal tip. There are advantages and disadvantages to each method, but one should be comfortable with the nuances of each to master nasal tip surgery.


Assuntos
Nariz , Rinoplastia , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Próteses e Implantes , Técnicas de Sutura
14.
Clin Plast Surg ; 49(1): 81-95, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782142

RESUMO

Dorsal hump reduction is one of the most common techniques used in modern rhinoplasty, yet it carries a high propensity for untoward aesthetic and functional sequelae, as evidenced by a nontrivial revision rate. Component dorsal hump reduction with stepwise deconstruction and manipulation of component parts allows for an adaptable and precise approach to variances in anatomy and in desired aesthetic result. Secondary changes must be anticipated and addressed at the index operation to avoid negative results and prevent the need for revision. Adequate reconstruction of the midvault is paramount to achieving optimal aesthetic and functional outcomes.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Estética , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia
15.
Clin Plast Surg ; 49(1): 97-109, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782143

RESUMO

There has been a resurgence in dorsal preservation rhinoplasty (DPR) caused by theoretic aesthetic and functional advantages compared with conventional hump takedown rhinoplasty. Classically, the push-down and let-down maneuvers have been described for management of the bony nasal vault. There have been a variety of modifications in the septal resection that is a requisite for dorsal lowering in DPR. Partial dorsal preservation techniques, including cartilage-only preservation, have also been described. Although several studies have reported aesthetic and functional success with a variety of techniques, few have used objective or patient-centered subjective measures.


Assuntos
Rinoplastia , Cartilagem , Estética , Humanos , Septo Nasal/cirurgia
16.
Facial Plast Surg Clin North Am ; 30(1): 23-30, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809884

RESUMO

This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment.


Assuntos
Rinoplastia , Fraturas Cranianas , Humanos , Osso Nasal , Septo Nasal/cirurgia , Estudos Retrospectivos , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/cirurgia
17.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 56(11): 1174-1178, 2021 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-34749456

RESUMO

Objective: To evaluate the application of island flap and combined flap in one-stage reconstruction of nasal alae defects after external nasal tumor resection. Methods: Data of 11 patients with perforating or full-thickness defects of the alae after nasal tumor resection in XuanWu Hospital, Capital Medical University between June 2016 and February 2021 were analyzed retrospectively. There were 7 males and 4 females, and the ages ranged from 51 to 89 years. Island flap, island flap combined with nasolabial flap or V-Y advancement flap, and island flap combined with bilobed flap were applied according to the range of defects. Descriptive statistical method was applied to analyze the treatment effects. Results: All flaps of the 11 patients were successful survival and the incisions were primary healing. Being followed up for 5 to 59 months, the patients had satisfying appearance and ventilation function, and no tumor relapsed. Conclusion: For the patients with nasal alae defects after external nose tumor resection, selecting suitable island skin flap or combined skin flap can be used to reconstruct the ideal nasal appearance and function of the nose.


Assuntos
Neoplasias Nasais , Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/cirurgia , Neoplasias Nasais/cirurgia , Estudos Retrospectivos , Transplante de Pele , Retalhos Cirúrgicos
18.
J Craniofac Surg ; 32(8): 2671-2676, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727469

RESUMO

ABSTRACT: Long-term follow-up results of many surgical techniques for lip adhesion are unavailable. Thus, we report the surgical results of patients who underwent lip adhesions performed by a single surgeon. We retrospectively analyzed two-dimensional photographs of 29 patients aged 1 year who underwent lip adhesion and definite lip repair. Among these patients, we analyzed the photographs of 20 patients aged 6 years who underwent secondary rhinoplasty. The ratio of the cleft side length to the noncleft side length was calculated. Only the upper lip length in the photographs of 1-year-olds was measured; both the upper lip and nose lengths were measured in the photographs of 6-year-olds. Lip width, vermilion height, and medial lip height on the cleft and non-cleft sides of 1-year-olds were not significantly different; the alar base width ratio was 1.17 ±â€Š0.15, and the lateral lip height ratio was 0.91 ±â€Š0.09 (P < 0.001). No significant differences were observed in lip width and vermilion height between the cleft and non-cleft sides of the upper lip of 6-year-olds; the alar base width ratio was 1.22 ±â€Š0.16, medial lip height ratio was 1.11 ±â€Š0.11, and lateral lip height ratio was 0.89 ±â€Š0.09 (P < 0.05). There were no significant differences in the alar projection and nasal dome height on the cleft side of the nose; the nostril height and width ratios were 0.82 ±â€Š0.11 and 1.31 ±â€Š0.21 (P < 0.001), respectively. These consecutively performed lip adhesions for patients with wide unilateral complete cleft lip resulted in excellent long-term results. Therefore, lip adhesion for wide unilateral complete cleft lip is a reasonable alternative to presurgical molding.


Assuntos
Fenda Labial , Fissura Palatina , Rinoplastia , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Lábio/cirurgia , Nariz/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
19.
J Craniofac Surg ; 32(8): 2812-2815, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727483

RESUMO

BACKGROUND: In unilateral cleft nasal deformity, the skeletal, and cartilaginous framework of nose is deformed. The anterior nasal spine (ANS) is usually displaced to the non-cleft-side. In cleft orthognathic surgery, ANS relocation can help correct the deviated ANS and nasal septum and might lead to an improved esthetic and functional outcome. METHODS: Patients with unilateral cleft lip who underwent two-jaw orthognathic surgery between July 2016 and July 2020 were reviewed retrospectively. During conventional two-jaw orthognathic surgery, the ANS was separated from the maxilla. The separated ANS with the attached septum was fixed on the maxillary midline by wiring. Computed tomography scan was used to measure the septal deviation angle and septal deviation from the midline. RESULTS: The septal deviation from the maxillary midline decreased following surgery (preoperative versus postoperative: 4.6 ±â€Š1.0 mm versus 3.2 ±â€Š1.2 mm; P = 0.016). The coronal septal deviation angle was widened after ANS relocation, although the transverse septal deviation angle remained unchanged (coronal septal deviation angle, preoperative versus postoperative: 146.7 ±â€Š12.6 versus 159.8 ±â€Š7.6; P = 0.01; transverse septal deviation angle, preoperative versus postoperative: 156.5 ±â€Š11.7 versus 162.8 ±â€Š7.7; P = 0.128). CONCLUSIONS: This study suggests that simultaneous ANS relocation with orthognathic surgery is a viable option for cleft-related deformities, considering the resultant caudal septum straightening and stable structural support observed in the long-term.


Assuntos
Fenda Labial , Fissura Palatina , Cirurgia Ortognática , Rinoplastia , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética Dentária , Humanos , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Estudos Retrospectivos
20.
HNO ; 69(12): 1019-1032, 2021 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-34762159

RESUMO

With increasing age, structures of the internal and external nose change. Many elderly patients complain about rhinitis with nasal obstruction, endonasal crusting, epistaxis, intermittent rhinorrhea, and olfactory disorders. These symptoms are mainly caused by atrophy of the mucosa and the olfactory epithelium, but may also be an expression of drug side effects. Additionally, there are changes in the shape of the nose (continuous growth, altered elasticity of supporting structures) and in the dermis, which may develop tumors due to its sun-exposed position. These multiple internal and external changes of the nose can be summarized by the collective term "aging nose," whose treatment options are complex. These range from conservative (nasal care, medication changes, hemostatic measures) to surgical lines of therapy (septorhinoplasty, tumor excision, vascular ligation) and will require further scientific study in the future.


Assuntos
Obstrução Nasal , Transtornos do Olfato , Rinite , Rinoplastia , Idoso , Humanos , Obstrução Nasal/cirurgia , Nariz/cirurgia
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