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1.
Oral Maxillofac Surg Clin North Am ; 35(1): 127-137, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36336595

RESUMO

While primary cleft lip nasal deformity has been well described, secondary cleft lip nasal deformity reflects the combination of residual deformity that follows primary operative maneuvers and growth-related nasal distortions. Secondary cleft lip nasal deformities are further associated with underlying skeletal and dentofacial abnormalities along with soft tissue constriction adding to the complexity of the deformity and posing major aesthetic and functional challenges to the multidisciplinary care team. Definitive rhinoplasties are performed to address these deformities and improve the quality of life in cleft patients following skeletal maturity and ideally after all underlying skeletal discrepancies have been corrected by orthognathic surgery. Maxillary advancement with or without mandibular setback is often required after careful planning and orthodontic preparation. Patients with cleft lip benefit tremendously from definitive rhinoplasty irrespective of inevitable residual discrepancies that remain and adjuvant therapies could enhance the overall outcome.


Assuntos
Fenda Labial , Fissura Palatina , Cirurgia Ortognática , Rinoplastia , Humanos , Fenda Labial/cirurgia , Qualidade de Vida , Estética Dentária , Nariz/cirurgia , Nariz/anormalidades , Palato/cirurgia , Fissura Palatina/cirurgia
2.
Oral Maxillofac Surg Clin North Am ; 35(1): 115-126, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36336598

RESUMO

Orthognathic surgery is a well-recognized method to correct dentofacial deformities. The main goal of orthognathic surgery is to improve soft tissue change. Soft tissue changes to the nose have been well documented. Simultaneous rhinoplasty during orthognathic surgery can be performed to correct existing inherent nasal deformities and also the unfavorable changes that arose from the maxillary surgery. Challenges for concurrent nasal surgery with jaw surgery include preoperative, perioperative, and postoperative which can be overcome with meticulous planning and experience. In complex cases, rhinoplasty can be staged in the last 6 months after the orthognathic surgery.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Rinoplastia , Humanos , Rinoplastia/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Nariz/anormalidades
3.
Clin Plast Surg ; 50(1): 133-140, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36396252

RESUMO

To explore a pyriform aperture augmentation method that is suitable for Asian patients with mid-face concavity, we designed a novel prosthesis to perform pyriform aperture augmentation. Three different rhinoplasty schemes are designed according to the degree of mid-face concavity: (1) simple implantation around the pyriform aperture, (2) implantation around the pyriform aperture and augmentation rhinoplasty is performed concurrently, and (3) implantation around pyriform aperture combined with nasal extension technique. Comprehensive rhinoplasty with pyriform aperture augmentation can substantially improve the aesthetic relationship between nasal and facial areas. This technique is suitable for comprehensive rhinoplasty of Asian patients with mid-face concavity.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Nariz/cirurgia , Asiáticos , Próteses e Implantes
4.
Clin Plast Surg ; 50(1): 141-149, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36396253

RESUMO

The demands of the revision rhinoplasty in Asian populations are increasing nowadays. Rhinoplasty-related complications frequently occurred in clinical practice, for example, implants deviation, extrusion, infection, nasal contraction deformities, and skin necrosis after primary or multiple surgeries. To obtain a successful revision rhinoplasty in Asian, early detection, prompt management, and appropriate treatment of complications are essential for minimizing postoperative adverse consequences. In revision rhinoplasty for Asian patients, autologous tissues play an important role as new support grafts for nasal structure reconstruction.


Assuntos
Rinoplastia , Humanos , Rinoplastia/efeitos adversos , Reoperação , Próteses e Implantes , Asiáticos , Transplante Autólogo
5.
Facial Plast Surg Clin North Am ; 31(1): 1-11, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396280

RESUMO

Renewed interest in dorsal preservation rhinoplasty (DPR) stems from theoretic esthetic and functional advantages over conventional hump resection. DPR fundamentally consists of en bloc dorsal lowering via a combined septal resection and mobilization of the bony pyramid. Several technical modifications exist, allowing for the expansion of DPR indications. Although studies suggest success with these techniques, comparative data to conventional hump resection are limited. Challenges and stigmata of DPR include a radix step-off, hump recurrence, supratip saddling, and widening of the midvault. The fusion of structural techniques with preservation ideology will facilitate the incorporation of DPR into clinical practice.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Estética
6.
Facial Plast Surg Clin North Am ; 31(1): 107-117, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396281

RESUMO

Severe septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework, septal deformities require correction to insure a straight nose. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid. In certain cases, the association of a correct septoplasty and dorsal preservation allows the treatment of the crooked nose and at the same time gives natural results with rapid postoperative recovery. The aim of this article was to underline the versatility of the dorsal preservation technique for the correction of severe septal deviation.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Cicatrização
7.
Facial Plast Surg Clin North Am ; 31(1): 119-129, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396282

RESUMO

The subdorsal cantilever graft (SDCG) is a costal cartilage graft that is positioned below the nasal dorsum to control the position of the nasal bones and middle nasal vault. SDCG type A is used to raise the middle nasal vault and caudal nasal bones to correct the saddle nose deformity. SDCG type B can be used to raise the entire dorsum of the nose (radix, bony vault, and middle vault) in the ethnic augmentation rhinoplasty patient. This article will discuss the indications and technique of the SDCG in dorsal preservation rhinoplasty.


Assuntos
Cartilagem Costal , Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Resultado do Tratamento , Rinoplastia/métodos , Deformidades Adquiridas Nasais/cirurgia , Nariz/cirurgia , Cartilagem Costal/transplante
8.
Facial Plast Surg Clin North Am ; 31(1): 13-24, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396283

RESUMO

The rapid resurgence of interest in performance of dorsal preservation (DP) rhinoplasty techniques in recent years has come with scarcity of data for long-term outcomes. In this article, the authors aim to contribute to preservation rhinoplasty (PR) literature by providing long-term follow-up with dorsal preservation, specifically presenting data related to superior strip DP functional and esthetic complications, followed by a detailed analysis of the same.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Seguimentos , Estética
9.
Facial Plast Surg Clin North Am ; 31(1): 131-142, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396284

RESUMO

Brazil has always been a fertile place for plastic surgery techniques, especially cosmetic, and it was not different in rhinoplasty. In Brazil surgeons started using the dorsal preservation rhinoplasty in the 1970s. Techniques have changed, the problems and contraindications were challenged, and solutions proposed. As a result, indications were expanded to almost every kind of nose. Surface working executed with power tools, such as the piezoelectric device and the power drill, complemented the techniques and allowed for refinement in execution. Today the Brazilian preservation techniques are adopted and improved by many surgeons around the world.


Assuntos
Rinoplastia , Humanos , Brasil , Rinoplastia/métodos , Nariz/cirurgia
10.
Facial Plast Surg Clin North Am ; 31(1): 143-154, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396285

RESUMO

Ultrasonic rhinoplasty and ultrasonic septoplasty reshape the nasal bones using piezoelectric instruments specifically developed for these operations. They allow the realization of precise osteotomies under direct visual control after having performed first an open or closed extended approach, but also ostectomies and rhinosculpture. Piezoelectric instruments preserve bone stability by not damaging bone support structures and avoiding unwanted fractures. They allow precise control of nasal bone movements, their orientation, and their final position. The different inserts of ultrasonic rhinoplasty and ultrasonic septoplasty are detailed, with their scope of action. The applications to dorsum preservation and structural remodeling of dorsum are presented.


Assuntos
Rinoplastia , Humanos , Ultrassom , Nariz/cirurgia , Osso Nasal , Osteotomia
11.
Facial Plast Surg Clin North Am ; 31(1): 155-170, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396286

RESUMO

Experiencing great worldwide scientific excitement, the number of nose preservation surgeries has increased rapidly, promoting a considerable percentage of drawbacks and complications, causing many surgeons to recoil and return to classic resective techniques. In this study, we develop concepts that allow us to operate noses with preservation rhinoplasty that were previously considered to be among the absolute contraindications. Redefining new dorsal aesthetic lines, controlling the nasal lateral wall and the naso-facial groove surfaces, avoiding mid-vault widening and being precise in the design of bony and cartilaginous nasal profile, avoiding any type of irregularity, are strategies that will be presented.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Septo Nasal/cirurgia , Estética , Cartilagem , Cavidade Nasal
12.
Facial Plast Surg Clin North Am ; 31(1): 25-43, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396287

RESUMO

Preservation rhinoplasty entails the preservation of the supportive ligaments, preservation of the cartilage structure, and preserving the anatomy of the nasal dorsum. The preservation methods I use are described in this article.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Nariz/cirurgia , Ligamentos/cirurgia
13.
Facial Plast Surg Clin North Am ; 31(1): 45-57, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396288

RESUMO

Classical dorsal preservation rhinoplasty is typically done with impaction osteotomies (push/let down) and a low septal strip. These approaches are potentially highly destabilizing maneuvers in the architecture of the nasal pyramid. This is one of the reasons why these approaches did not have a popular acceptance in the 1960s and 1970s. More recently, the surgeon interested in preservation rhinoplasty has the possibility to do so with surface techniques with more control and, if needed, is easily converted to the standard structured techniques if the surgeon does not feel safe with the procedure.


Assuntos
Septo Nasal , Rinoplastia , Humanos , Septo Nasal/cirurgia , Rinoplastia/métodos , Osteotomia/métodos
14.
Facial Plast Surg Clin North Am ; 31(1): 59-71, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396289

RESUMO

Preservation rhinoplasty represents a growing shift in rhinoplasty philosophy toward preserving structurally sound anatomy and reshaping existing nasal structures into esthetic and functional ideals. It is fast gaining popularity owing to the theoretic functional and esthetic benefits of preserving the dorsal keystone area and dorsal esthetic lines. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose to the dorsum, as well as enables greater ease of powered instrument access. The addition of the Piezo-electric device, with its range of rhinoplasty inserts, enables more precise and accurate management of the osseocartilaginous vault, reduces the risk of surface irregularities, and hence optimizes the overall surgical outcome.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Resultado do Tratamento , Nariz , Estética
15.
Facial Plast Surg Clin North Am ; 31(1): 73-106, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396290

RESUMO

Dorsal preservation involves eliminating the dorsal hump by performing reduction while preserving the patient's natural dorsal anatomy. This can involve surface manipulation or foundational techniques or a combination of both. When surgeons begin performing dorsal preservation, there are important factors to consider to avoid complications. In an effort to inform surgeons on how to avoid unfavorable outcomes, I will discuss my first 20 cases where I performed dorsal preservation. I review less than ideal outcomes and how these issues can be prevented.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos
16.
Ann Plast Surg ; 89(6): 637-642, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416690

RESUMO

BACKGROUND: Nasal bone fractures are the most common type of facial fracture. Nasal bone fractures often occur in combination with septal cartilage fractures, because the nasal septal cartilage acts as a vertical strut and provides structural support for the nose and bilateral nasal airway. However, the treatment for nasal septal cartilage fracture remains controversial, and if untreated, nasal septal cartilage fracture can lead to various complications, such as nasal obstruction and posttraumatic nasal and septal deformity. This study aimed to evaluate the effectiveness and safety of our procedure in which septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. METHODS: Between January 2017 and November 2020, 21 patients with nasal septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. The severity of the septal cartilage fracture was graded from 0 to 3 according to the computed tomography septal grading system. The numeric graded scale of nasal septal cartilage fracture was evaluated preoperatively and 6 months postoperatively using a computed tomography scan. RESULTS: Of 21 patients with septal cartilage fractures, 12 were treated with a polycaprolactone (PCL) mesh plate, and 9 were treated with a polydioxanone (PDS) plate. In the PDS plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.50 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.25, P = 0.023). In the PCL mesh plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.00 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.50, P = 0.034). The effectiveness of the PCL mesh plate and that of the PDS plate group according to the septal grading scale were 1.45 (SD, 0.522) and 1.18 (SD, 0.603), respectively. However, these differences were not statistically significant. CONCLUSIONS: Our study shows that septoplasty using absorbable plates provides satisfactory and safe clinical outcomes in patients with nasal septal cartilage fractures.


Assuntos
Fraturas de Cartilagem , Rinoplastia , Fraturas Cranianas , Humanos , Septo Nasal/cirurgia , Fraturas de Cartilagem/cirurgia , Cartilagens Nasais/cirurgia , Rinoplastia/métodos , Fraturas Cranianas/cirurgia
17.
J Craniofac Surg ; 33(8): 2619-2624, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409845

RESUMO

Rhinoplasty is one of the most common surgical intervention among all surgeries in esthetic and plastic surgery procedures. The alar bases have important roles in terms of overall appearance of the nose and the functionality but the research so far which focused specifically on alar base surgery can be considered as insufficient. In the present study, the author aims to demonstrate the beneficial effects of performing Y-V flaps in reduction of the alar base during preservation rhinoplasty procedures. The present study was designed as a retrospective. The inclusion criteria consisted of the following: having a preservation rhinoplasty, having an intervention to alar base during rhinoplasty, and being willing to share the medical data and images for medical purposes. According to inclusion and exclusion criteria, the data of 223 patients were screened. The Rhinoplasty Outcome Evaluation (ROE) scores was found between 80 and 100 points after 1 year. The initial ROE score increased significantly after 12 months of surgery (P<0.001). Rate of satisfaction was excellent in 89.76% according to ROE scale. Present alar base reduction method will present an easy way for alar base reduction procedures related to the Y-V flap. This method will serve a simple and safe way for surgeons for reducing alar base and obtaining better cosmetic and functional results during rhinoplasty surgeries. Level of Evidence: Level III, therapeutic study.


Assuntos
Estética Dentária , Rinoplastia , Humanos , Estudos Retrospectivos , Retalhos Cirúrgicos , Rinoplastia/métodos , Nariz
18.
J Craniofac Surg ; 33(8): 2406-2410, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409865

RESUMO

BACKGROUND: Primary rhinoplasty (PR)at the time of cleft lip repair is controversial. We previously performed a systematic review that supported PR during unilateral cleft lip repair. We now aim to determine whether the same idea translates to care of patients with bilateral cleft lip. METHODS: A systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines. PubMed and Embase databases were searched for studies that met our inclusion criteria: (1) English language, (2) human subjects, (3) rhinoplasty at the time of bilateral cleft lip repair, and (4) evaluation of nasal outcome. Studies were excluded in case of: (1) inclusion of a large proportion of syndromic patients, (2) case reports, (3) editorials, (4) letters, (5) reviews, and (6) exclusive to unilateral clefts. Out of 281 studies that showed up on initial search, 12 were included in our review. Research quality and level of evidence rating were determined for each study. RESULTS: Of the 12 included studies, 9 supported PR at the time of bilateral cleft lip repair; 8 studies evaluated nasal growth and found no restriction over time; 4 studies followed 158 patients to an average of 15 years and showed 77% did not need secondary rhinoplasty. CONCLUSION: Although the available literature supports PR in patients with bilateral cleft lip with respect to subjective and objective outcomes, nasal growth, and reducing the need for secondary/revision rhinoplasty, there are significant limitations, necessitating large volume studies.


Assuntos
Fenda Labial , Rinoplastia , Humanos , Fenda Labial/cirurgia , Rinoplastia/métodos , Nariz/cirurgia , Reoperação , Bases de Dados Factuais
19.
J Craniofac Surg ; 33(8): 2567-2572, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409874

RESUMO

BACKGROUND: Intermediate rhinoplasties are performed during preschool to reduce the patients' psychosocial burden. At our institution, limited dissection of the cartilages followed by suspension and interdomal sutures was performed through an alar rim incision on the cleft side to minimize the risk of iatrogenic nasal growth restriction. However, the long-term outcomes of "limited intermediate rhinoplasty" through skeletal growth are uncertain. MATERIALS AND METHODS: A retrospective review of all unilateral complete cleft lip and/or palate patients who underwent definitive rhinoplasty was performed. To avoid the confounding effect of primary rhinoplasty, only the patients who did not receive primary rhinoplasty were included in the analysis. The maneuvers performed during definitive rhinoplasty were analyzed and compared between patients who underwent intermediate rhinoplasty and those who did not. RESULTS: A total of 60 Korean patients (27 female and 33 male) underwent definitive rhinoplasty at the average age of 20.6 years old (17.1-25.5). Forty-three (71.6%) patients previously underwent intermediate rhinoplasty. A combination of 6 maneuvers was performed based on the deformity of each subunit (alar medialization, interdomal with suspension sutures, nostril sill depression correction, septoplasty, osteotomy, and hump rasping). The average number of maneuvers performed during definitive rhinoplasty was significantly higher in the intermediate group (3.31 versus 2.1, P=0.012). Alar medialization and nostril sill depression correction were more frequently performed in the intermediate group, while the frequencies of other maneuvers were not statistically different. CONCLUSION: While intermediate rhinoplasty improves the patients' psychosocial well-being, the effects of "limited intermediate rhinoplasty" manipulating only the cartilages do not seem to last until skeletal maturity. A more comprehensive dissection allowing the release of the lower lateral cartilage in the hinge area along with septoplasty may be more effective in providing longer-lasting effects.


Assuntos
Fenda Labial , Fissura Palatina , Doenças Nasais , Rinoplastia , Humanos , Masculino , Feminino , Pré-Escolar , Adulto Jovem , Adulto , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Resultado do Tratamento , Doenças Nasais/cirurgia
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(10): 1392-1397, 2022 Oct 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-36411690

RESUMO

OBJECTIVES: Rhinoplasty is one of the most common cosmetic surgeries in China. Septal extension grafts (SEG) have been widely used in rhinoplasty, but there are few reports on SEG derived from ear cartilage. This study aims to explore the effectiveness and stability of auricular cartilage nasal SEG transplantation in Chinese rhinoplasty. METHODS: A retrospective analysis of 35 rhinoplasty patients admitted from September 2019 to March 2022 has been conducted. Among them, 29 patients underwent rhinoplasty for the first time and 6 patients underwent rhinoplasty with the age of 18-32 (average 22.4) years old. The postoperative follow-up was 3-28 (average 18.5) months. The improvement of the nose shape was observed. The changes of the nose tip angle, nasolabial angle, and nasofrontal angle were compared between before and after the operation, and the complications were recorded. RESULTS: All patients who underwent rhinoplasty with a septal extension grafts constructed from the concha cavity and concha cartilage showed significant improvement in nasal contour. The preoperative nasal tip angle, nasolabial angle, and nasofrontal angle were significantly improved compared with 3 months after operation (all P<0.001), and there was no significant difference between 3 months and 14 months after operation (all P>0.05). The appearance of nasal cavity was satisfactory in 32 patients after operation. Columella deviation occurred in 2 patients and 1 patient complained of downward rotation of the nasal tip, which was satisfied after readjustment of the graft. CONCLUSIONS: The simplified SEG derived from auricular cartilage can provide stable support for the nasal tip, the nasal shape is natural after operation, and minimal trauma of unilateral auricle cartilage transplantation remains.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Humanos , Adulto Jovem , Adulto , Cartilagem da Orelha/transplante , Estudos Retrospectivos , Septo Nasal/transplante
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