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Taha M, AlZubaidi HAA, Alrezqi AAA, Alsulbi AMO, Alrashdi AAA, Alzubaidi AAK, Alqarni ASA. Adult Knowledge About Postoperative Complications of Rhinoplasty in the Western Region of Saudi Arabia. Cureus 2023; 15:e37183. [PMID: 37159787 PMCID: PMC10163213 DOI: 10.7759/cureus.37183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/11/2023] Open
Abstract
Background Rhinoplasty, a prevalent cosmetic surgical procedure worldwide, is not exempt from associated risks and complications, as with any other surgery. In light of the surging demand for rhinoplasty amongst young adults, it is imperative to acknowledge that the procedure can engender various complications that can be classified as either early or late complications. Examples of early complications include epistaxis and periorbital ecchymosis, while late complications may manifest as enophthalmos or septal perforation. The present study endeavors to gauge the knowledge of rhinoplasty complications among adult residents of the Western region of Saudi Arabia. Methods To achieve the research objectives, a cross-sectional study design was implemented, utilizing a self-administered online questionnaire. The study targeted male and female adults aged 18 years and above residing in the Western region of Saudi Arabia. The questionnaire comprised of 14 items, categorized into socio-demographic and rhinoplasty postoperative complications sections, respectively. Results The study gathered responses from a total of 968 participants, of which 60.95% fell within the age range of 18-30 years. The majority of participants identified as female (77.89%), and Saudi citizens constituted the vast majority of the respondents (96.28%). Among the participants, 22.62% expressed a desire to undergo rhinoplasty, whereas 77.38% indicated no interest in the procedure. Of those who sought rhinoplasty, the majority favored having the surgery performed by a skilled physician (81.74%). Notably, participants exhibited a relatively high level of awareness regarding the postoperative complications of rhinoplasty, with respiratory issues being the most widely recognized complication (66.63%). Conversely, headache, nausea, and vomiting were the least familiar complications (100%). Conclusion The study findings reveal a considerable knowledge gap among adults residing in the Western region of Saudi Arabia concerning rhinoplasty's possible postoperative complications. The results underscore the pressing need to establish comprehensive educational and awareness-raising programs to equip individuals contemplating the procedure with the requisite information to make informed decisions. Future research endeavors could delve into the underlying determinants that drive the desire for rhinoplasty and assess potential interventions geared toward augmenting individuals' comprehension and knowledge of the procedure.
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Omidvar S, Ebrahimi F, Amini N, Modir H, Kia MK, Rahmaty B, Zarei A. Comparing the Effect of Ketamine and Lidocaine on Agitation and Pain in Rhinoplasty: A Randomized Clinical Trial. J Cutan Aesthet Surg 2023; 16:107-113. [PMID: 37554677 PMCID: PMC10405540 DOI: 10.4103/jcas.jcas_205_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Background Emergence agitation (EA) is an important clinical problem that occurs during the initial period of recovery from anesthesia. This study aimed to determine the effects of ketamine and lidocaine administered on agitation level, postoperative pain, and hemodynamic changes in adults after rhinoplasty. Materials and Methods Totally 72 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were randomly divided into three groups including control group (n = 24), ketamine group (n = 24), and lidocaine group (n = 24). Twenty minutes before surgery completion, 1 ml saline was administered intravenously to the saline group, while 0.5 mg/kg ketamine or 1.5 mg/kg lidocaine was administered to two other groups. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). Postoperative pain was evaluated by Numerical Rating Scale that scored (from 0 to 10) every 10 min until the patients were discharged from PACU. Results There was a significant difference between EA level between ketamine (P = 0.049) and lidocaine (P = 0.019) groups compared to the control group, and there was a significant difference between pain level between the ketamine (P = 0.008) and lidocaine (P = 0.035) groups compared the to control group, while there was no significant difference between the level of agitation (P = 0.922) and level of pain (P = 0.845) after extubation between the ketamine and lidocaine groups. Conclusion Ketamine and lidocaine are highly effective in preventing EA and pain control. Further studies with a greater sample size and longer follow-up period are needed to confirm the current findings.
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Miroshnychenko A, Rae C, Wong Riff K, Forrest CR, Goodacre T, Swan MC, Slator R, Goldstein J, Thoma A, Harman K, Klassen A. A Prospective Study to Examine Responsiveness and Minimally Important Differences (MIDs) for the CLEFT-Q Scales Following Three Cleft-Specific Operations. Cleft Palate Craniofac J 2023; 60:413-420. [PMID: 34904896 PMCID: PMC10018053 DOI: 10.1177/10556656211064479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to examine internal responsiveness and estimate minimally important differences (MIDs) for CLEFT-Q scales. In this prospective cohort study, participants completed the CLEFT-Q appearance and health-related quality of life (HRQL) scales before and six months after cleft-related surgery. Seven cleft centres in Canada, USA and UK participated. Patients were ages 8-29 years with CL/P. Patients underwent rhinoplasty, orthognathic or cleft lip scar revision surgery. Internal responsiveness was examined using Cohen's d effect sizes (ESs) based on the following interpretation: 0.20-0.49 small, 0.50-0.79 moderate and ≥ 0.80 large. MIDs were estimated using two distribution-based approaches. Participants had a rhinoplasty (n = 31), orthognathic (n = 21) or cleft lip scar revision (n = 18) surgery. Most participants were males (56%) and aged 8-11 years (41%). Following rhinoplasty, ESs were larger for the nose (0.92, p = 0.001) and nostrils (0.94, p < 0.001) scales than for the face scale (0.51, p = 0.003). MIDs ranged between 6.2-10.4. For orthognathic surgery, larger ES was observed for the jaws scale (1.80, p < 0.001) compared with the teeth (1.16, p < 0.001), face (1.15, p = 0.001) and lips (0.94, p < 0.001) scales. MIDs ranged between 5.9-14.4. In the cleft lip scar revision sample, the largest ES was observed for the nose scale (0.76, p = 0.03), followed by lips (0.58, p = 0.009) and cleft lip scar (0.50, p = 0.043) scales. MIDs ranged between 6.4-12.3. CLEFT-Q detected change in key outcomes for three cleft-specific surgeries, providing evidence of its responsiveness. Estimated MIDs will aid in interpreting this PROM.
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Assiri H, Abdelkader W, Alfallaj R, Alarimah Y, AlMajed H, Alarfaj A. The Association Between Nasal Skin Thickness and Body Mass Index in Preoperative Rhinoplasty Patients: A Prospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231162506. [PMID: 36877163 DOI: 10.1177/01455613231162506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES Skin quality plays a major role in aesthetics, particularly in determining the success of rhinoplasty. Efficient preoperative estimation of nasal skin thickness can improve postoperative results and patient satisfaction. This study aimed to report on the relationship between nasal skin thickness and body mass index (BMI) as a possible tool to measure skin thickness preoperatively among rhinoplasty patients. METHODS This prospective cross-sectional study targeted patients who visited a rhinoplasty clinic at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, between January 2021 and November 2021, and agreed to participate in the study. Data on age, sex, height, weight, and Fitzpatrick skin types were collected. The participant visited the radiology department and underwent ultrasound nasal skin thickness measurement for the five different nasal points. RESULTS The study included 43 participants (16 males and 27 females). The average skin thickness of the supratip area and the tip was significantly higher in males than in females (P < 0.05). The average BMI of the participants was 25.8 ± 5.26 Kg/m2. Participants with a normal BMI or less represented 50% of the study sample, whereas overweight and obese represented one-quarter (27.9%) and one-fifth (21%), respectively. CONCLUSION BMI was not associated with nasal skin thickness. Differences in nasal skin thickness were found between the sexes.
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Alan MA, Yücel H. Functional and Aesthetic Outcomes of Asymmetric Dorsal Preservation for Correction of I-Shaped Crooked Nose Deformity. Turk Arch Otorhinolaryngol 2023; 61:14-19. [PMID: 37583976 PMCID: PMC10424583 DOI: 10.4274/tao.2023.2022-12-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 08/17/2023] Open
Abstract
Objective The study was designed to evaluate the effectiveness of the asymmetric dorsal preservation technique for correcting I-shaped crooked nose deformity (CND). Methods Patients with I-shaped CND who underwent asymmetric dorsal preservation in the period from September 2020 to September 2021 were included in this retrospective study. The Rhinomanometry and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was used to assess the outcomes. Deviation angle (DA) measurements were used to evaluate the degree of crookedness. The results were recorded both preoperatively and 12 months postoperatively. Results Twenty-three patients were included in the study. Total nasal airflow and long-side nasal airflow were significantly higher 12 months postoperatively (p=0.001 each). Total nasal resistance, long-side nasal resistance, SCHNOS scores and DA measurements were significantly lower 12 months postoperatively (p<0.001 each). Conclusion Asymmetric dorsal preservation is a successful alternative technique for correcting I-shaped CND and achieving optimal aesthetic and functional outcomes.
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Miroshnychenko A, Rae C, Riff KW, Forrest C, Goodacre T, Swan M, Slator R, Goldstein J, Thoma A, Harman K, Klassen A. Psychometric Validation of the CLEFT-Q Patient Reported Outcome Measure: A Prospective Study to Examine Cross-Sectional Construct Validity. Cleft Palate Craniofac J 2023; 60:327-335. [PMID: 34919453 PMCID: PMC9900191 DOI: 10.1177/10556656211062837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE CLEFT-Q is a condition-specific patient-reported outcome measure (PROM) for patients with cleft lip and/or palate (CL/P). The aim of this study was to examine the cross-sectional construct validity of the CLEFT-Q scales. DESIGN Construct validity was assessed through a prospective study that tested hypotheses regarding correlations of scores with other PROMs that measure related constructs. SETTING Seven cleft centres in Canada, the USA, and UK were involved. PATIENTS/PARTICIPANTS Patients were aged eight to 29 years with CL/P. INTERVENTIONS Before undergoing rhinoplasty, orthognathic, cleft lip scar revision, and alveolar bone graft, participants were asked to complete the following PROMs: CLEFT-Q (9 scales), Child Oral Health Impact Profile (socio-emotional subscale) and Cleft Hearing Appearance and Speech Questionnaire (features 1 subscale). MAIN OUTCOME MEASURE(S) The correlation coefficients examining the relationship between the scales were the main outcome measures. Correlations (Spearman) were calculated and interpreted as follows: <0.3 weak, 0.30 to 0.50 moderate, ≥0.50 strong. RESULTS Participants (n = 177) were mostly male (61%) and aged between eight and 11 years (42%). Overall, 38 of 52 (73%) hypotheses tested were supported. More specifically, 20 of 26 (77%) hypotheses about correlations between the appearance scales were supported, two of three (67%) hypotheses about correlations between the health-related quality of life scales were supported, and 16 of 23 (70%) hypotheses about correlations between the appearance and health-related quality of life scales were supported. CONCLUSIONS Cross-sectional construct validity of the CLEFT-Q scales adds further evidence of the psychometric properties of this instrument.
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Taha MA, Hall CA, Zylicz HE, Barham WT, Westbrook MB, Barham MJR, Stevenson MM, Zito BA, Barham HP. Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty. EAR, NOSE & THROAT JOURNAL 2023; 102:175-180. [PMID: 33559494 DOI: 10.1177/0145561320983940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate and compare the costal cartilage lateral crural strut graft's (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. METHODS This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. RESULTS While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort's preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. CONCLUSION The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.
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Giammarioli G, Liberti A. Non-surgical rhinoplasty technique: An innovative approach for nasal reshaping with hyaluronic acid fillers. J Cosmet Dermatol 2023. [PMID: 36751855 DOI: 10.1111/jocd.15669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Nonsurgical rhinoplasty has become increasingly popular among patients who want to improve the aesthetic aspects of their nose and do not accept the risks and/ or cost of surgical rhinoplasty. The main goal of the current paper was to present the preliminary aesthetic and clinical outcomes of an innovative injection technique for nose sculpturing with hyaluronic acid (HA) filler. METHODS Retrospective analysis of a prospective clinical registry of patients who attended one of the study centers and were candidates for non-surgical nose reshaping between October 2019 and November 2020. A 25 mg/mL HA filler was administered, in all the cases, by using a syringe with a fixed microneedle (30G/8mm). All patients were injected at three key nose points with the following order: (1) Tip (maximum HA injected 0.2 mL); (2) columella (maximum HA injected 0.3 mL); and (3) Radix and Dorsum (maximum HA injected 0.3 mL). Degree of patient satisfaction with the treatment was assessed by using a five-points Likert scale. The primary endpoint was the degree of patients' satisfaction 12 months after treatment. RESULTS One-hundred-and-one patients (91 women) were included in the study. Fifty-six (56%) patients underwent a unique treatment-session and 44 (44%) subjects needed an additional touch-up. Eighty-five (84.2%) patients were very satisfied with the treatment results. Six (5.9%) patients reported moderate adverse events, which were successfully controlled with medical therapy. CONCLUSIONS Our nose sculpturing technique, by using hyaluronic acid filler, was an effective, predictable, and relatively safe procedure, that obtained a high degree of patient satisfaction.
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An Y, Shu F, Xie L, Zhen Y, Li X, Li Y. Use of nasal septal bone to straighten septal L-Strut in correction of east Asian short nose: A retrospective study. J Cosmet Dermatol 2023; 22:1825-1834. [PMID: 36718843 DOI: 10.1111/jocd.15643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/13/2022] [Accepted: 01/08/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND The perpendicular plate of ethmoid (PPE) was used to correct short noses in rhinoplasty in Asians, but the safe harvest of the plate and the assessment of its clinical application has been perplexing to plastic surgeons. AIMS To explore how to safely cut the perpendicular plate of ethmoid bone and evaluate its application effect. PATIENTS/METHODS A finite element model was established to guide the clinical operation. A total of 30 patients with short noses were selected. Among them, 15 patients used autologous septal cartilage to lengthen the nasal tip, and 15 patients used the PPE to strengthen the L-shape nasal septum. The differences in the esthetic parameters of the nose, complications, and patients' satisfaction were compared between the two groups. RESULTS Significant differences were noted in the nasal dorsal length (p = 0.001), Goode's ratio (p = 0.001), and nasofrontal angle (p = 0.003) after rhinoplasty, and no significant differences were noted in any of the esthetic parameters between the two groups. The symptoms of nasal obstruction in the experimental group were significantly lighter than those in the control group (p = 0.04). There was no statistically significant difference in the doctors' assessment of outcomes between the two groups (p = 0.48). CONCLUSION The safest region to harvest the PPE is in the middle and lower third. Rhinoplasty improves the esthetics of the patient's nose. The PPE used to strengthen the L-shape nasal septum structure has a smaller probability of nasal septal deviation with the time in Asian short noses.
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Schlegel L, Kumar A, Christopher V, Belko S, Barbarite E, Pugliese R, Krein H, Hutchinson M, Heffelfinger R. Tap-Tap: Learning Endonasal and Percutaneous Nasal Osteotomy Techniques on 3D-Printed Midface Models. Otolaryngol Head Neck Surg 2023; 168:1580-1583. [PMID: 36939489 DOI: 10.1002/ohn.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/17/2022] [Indexed: 02/04/2023]
Abstract
Nasal osteotomy is one of the most challenging steps of rhinoplasty. Lack of hands-on training and confidence with this procedure adds to the complexity for learners and trainees. As three-dimensional (3D) printing becomes increasingly accessible, simulation on 3D printed models has the potential to address this educational need in a safe, reproducible, and clinically realistic manner. The simulation session described in this communication, which utilized our low-cost, 3D-printed nasal osteotomy ($12.37) task trainer, produced both educational and confidence benefits for trainees. Here we describe the design, organization, curriculum, and pilot data for a 3D-printed nasal osteotomy task trainer for the simulation of endonasal and percutaneous nasal osteotomy.
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Zhu X, Zhang B, Huang Y. Trends of rhinoplasty research in the last decade with bibliometric analysis. Front Surg 2023; 9:1067934. [PMID: 36684203 PMCID: PMC9852505 DOI: 10.3389/fsurg.2022.1067934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
Background As rhinoplasty (RP) with different requirements is becoming more and more popular in the latest decade, this study aims to quantitatively and qualitatively explore the trends in RP research, depict research hotspots, and point out the future direction with a bibliometric analysis. Methods All RP literature studies in the last decade (from 2012 to 2021) were retrieved from the Web of Science Core database. Annual output, institutions, authors, journals, and most-cited literature studies were analyzed by bibliometric tools, including CiteSpace, bibliometric online platform, bibliometrix R language kit, BICOMB, and gCLUTO. Results A total of 2,590 RP research studies dated between 2012 and 2021 were included according to our criterion. As for the country, the United States, Turkey, and Korea maintained the top three in RP research. As for the institutions, the University of California, Irvine, Stanford University, and University of Ulsan ranked top three in RP research publications based on article counts. Professor Rhorich RJ, Most SP, and Jang YJ were the most contributed authors according to article counts and citation number. The top journals were The Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery, and Aesthetic Surgery Journal. The 10 most-cited literature studies were also listed explicitly in this study. Finally, biclustering analysis on the most frequent keywords were conducted which helped us to identify seven hotspot clusters in RP research. Conclusions We comprehensively summarized the publication information of RP literature studies in the past decade, highlighted the current status and trends over time, and provide guidance for in-depth research direction on RP for the future.
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Wei H, Xu X, Wan T, Yang Y, Zhang Y, Wu Y, Liang Y. Correction of narrow nostril deformity secondary to cleft lip: indications for different surgical methods and a retrospective study. Front Pediatr 2023; 11:1156275. [PMID: 37206975 PMCID: PMC10188927 DOI: 10.3389/fped.2023.1156275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background Cleft lip and/or palate (CLP) can lead to severe nasolabial deformities that significantly affect the appearance of the patient. Among all types of nasolabial deformities, narrow nostril deformities are the most troublesome, causing poor and unstable surgical outcomes. The purpose of this study was to develop an algorithm for surgical method selection for revision of narrow nostril deformities secondary to CLP based on retrospective clinical data. Materials and methods Patients with narrow nostril deformities secondary to CLP were enrolled in the study. Before surgery, patients' clinical data were collected and the width of the nasal floor and the length of the alar rim were measured. Surgical methods were determined according to the measurements. After surgery, a nostril retainer was applied for 6 months to consolidate and maintain the nostril shape. The surgical method and postsurgical changes were recorded for the final summary of the algorithm to select surgical methods for narrow nostril deformities. Results The data from 9 patients were analyzed. According to the width of the nasal floor and the length of the alar rim, correct surgical methods were determined. Four patients received nasolabial skin flaps to widen the soft tissue of the nasal floor. Three patients received upper lip scar tissue flaps to treat the narrow nasal floor. For the short alar rim, free alar composite tissue flap or narrowing of the nostril of the noncleft side was recommended. Conclusion The width of the nasal floor and the length of the alar rim are critical elements to consider when selecting the correct surgical method for revising narrow nostril deformities secondary to CLP. The proposed algorithm provides a reference for selecting surgical methods in future clinical practice.
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The Effect of the Vertical Alar Resection (VAR) Technique on Tip Stability; Long-Term Results. SISLI ETFAL HASTANESI TIP BULTENI 2022; 56:473-481. [PMID: 36660382 PMCID: PMC9833345 DOI: 10.14744/semb.2022.24603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/16/2022]
Abstract
Objectives Main properties of nasal tip are the nasal tip projection (NTP), the nasal tip rotation (NTR), and the definition. Its surgery is difficult due to anatomic variations, pathologies, and various surgery possibilities. The ideal technique must also provide good results in long-term. The aim of the study was to analyze long-term results of vertical alar resection (VAR) technique in rhinoplasty. Methods Forty-eight patients who underwent rhinoplasty operations that VAR method was used by senior author between 2001 and 2017 were included into the study (42 women and six men). The mean age of patients was 35.5 years (range 18-56 years). Mean post-operative follow-up period was 86.8 months (range 25-225 months). We analyzed pre=operative, early, and late post-operative photographs of patients. NTP and NTR changes in years were objectively evaluated. Patients also completed Rhinoplasty Outcome Evaluation questionnaire in their last control visit. Results Mean NTP (through Goode Method) was changed from 0.60 in early to 0.59 in late post-operative control, mean nasofacial angle from 29.4 in early to 28.7 in late post-operative control. Mean nasolabial angle (NLA) changed from 97.3 to 94.5 and Tip rotation angle (TRA) from 35.2 to 35.4 between early and late post-operative control. Differences between early and late post-operative measures of NTP and NLA were significant (p<0.001 for all), but TRA did not changed significantly (p>0.001). Conclusion VAR is a useful method for modifications of lateral crura and nasal tip. With VAR, we can control NTP and NTR, length of lateral crus and nose; get satisfying and long lasting results.
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Townsend A, Tepper OM. Virtual Surgical Planning and Three-Dimensional Printing in Rhinoplasty. Semin Plast Surg 2022; 36:158-163. [PMID: 36506278 PMCID: PMC9729057 DOI: 10.1055/s-0042-1755463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent developments in three-dimensional (3D) imaging technology offer a more comprehensive means of assessing facial features. 3D printing allows for the transition of planning from simply a preoperative tool to an intraoperative device with the use of tools such as 3D-printed cutting guides, marking guides, or positioning guides. With the advent of 3D printing technology, 3D surface images can now be used to generate new medical models, devices, or tools to assist with rhinoplasty during preoperative, intraoperative, and postoperative phases. In the field of rhinoplasty, 3D printing can be applied in three main areas: (1) reference models, (2) surgical guides, and (3) nasal splints. The value of 3D imaging extends far beyond the benefits of "conversion" during a preoperative consultation and has the potential to greatly enhance the overall treatment of rhinoplasty patients with enhanced communication and personalized devices that can be used during surgery and in the postoperative phase.
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Dattilo LW, Workman AD, Xiao R, Shaye DA, Lee LN, Lindsay RW, Bhattacharyya N. Rhinoplasty Patients Do Not Have Higher Rates of Antidepressant, Anxiolytic, and ADHD Medication Use. Laryngoscope 2022; 132:2368-2369. [PMID: 35218561 DOI: 10.1002/lary.30075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 12/16/2022]
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Waters CM, Stepp WH, Conduff J, Balakrishnan S, Bu R, Oldenburg AL, Kimbell JS, Shockley WW, Clark JM. Anatomic Optical Coherence Tomography (aOCT) for Evaluation of the Internal Nasal Valve. Laryngoscope 2022; 132:2148-2156. [PMID: 34894356 PMCID: PMC9187776 DOI: 10.1002/lary.29979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To establish the utility of anatomic optical coherence tomography (aOCT) in evaluating internal nasal valve (INV). STUDY DESIGN Anatomic specimen imaging study. METHODS Fresh-harvested human specimen heads were evaluated using both computed tomography (CT) imaging as well as using aOCT. Scans were performed at three time points: 1) After septoplasty for cartilage harvest, 2) after placement of butterfly graft (BFG), and 3) after placement of bilateral spreader grafts (SG). Imaging data were then converted into 3D models of the nasal airway. CT- and aOCT-generated models were compared by both static volumetric analysis and computational fluid dynamics (CFD) to predict nasal resistance and pressure. RESULTS Scans using aOCT showed comparable results to CT in terms of volumetric parameters both before and after intervention. Analysis of aOCT data by CFD demonstrated decrease in pressure after SG or BFG intervention. No statistically significant difference was observed when comparing CT- and aOCT-generated calculations of pressure or resistance. CONCLUSION The INV can be imaged in a static fashion using aOCT technology. Advantages over traditional CT imaging include lack of exposure to radiation and rapid scan time. In addition, in-office use is possible as aOCT technology develops. Further investigation will be necessary to define the role of aOCT in the dynamic evaluation of this vital component of the nasal airway. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2148-2156, 2022.
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Garaycochea O, Rodríguez Van Strahlen C, Rojas-Lechuga MJ, Alobid I. How to Improve the Outcomes of Anterior Septal Perforations Repair With Combined Flaps. Laryngoscope 2022. [PMID: 36317778 DOI: 10.1002/lary.30447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
The combination of a partial inverted edges with an either extended anterior ethmoidal flap or greater palatine artery flap, in which the anterior incision includes contralateral mucosa (ZigZag anterior flap-incision). Laryngoscope, 2023.
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93
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Sun Y, Lei S, Qiu F, Zuo C, Fan P, Long J, Tan W. Application of septal extension grafts with auricular cartilage in rhinoplasty. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1392-1397. [PMID: 36411690 PMCID: PMC10930372 DOI: 10.11817/j.issn.1672-7347.2022.220296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Indexed: 06/16/2023]
Abstract
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.
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94
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Buile D, Pilmane M, Akota I. Evaluation of the Multiple Tissue Factors in the Cartilage of Primary and Secondary Rhinoplasty in Cleft Lip and Palate Patients. Pediatr Rep 2022; 14:419-433. [PMID: 36278554 PMCID: PMC9590111 DOI: 10.3390/pediatric14040050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Cleft lip and palate (CLP) is one of the craniofacial defects. The objective of this study was to identify the differences in appearance between the tissue factors in cartilage of CLP patients after primary and secondary rhinoplasty. Immunohistochemistry was performed with MMP-2, MMP-8, MMP-9, TIMP-2, IL-1α, IL-10, bFGF, and TGFβ1. The quantification of the structures was performed using a semi-quantitative census method. MMP-2, -9, IL-1a, and bFGF demonstrated higher number of positive cells in patients, while the number of MMP-8, IL-1a, -10 and TGFβ1 cells was higher or equal in the control subjects. The only statistically significant difference between CLP-operated patients was found in the TIMP-2 group, where the primary CLP patient group had a higher number of TIMP-2 positive chondrocytes than the secondary CLP patient group (U = 53.5; p = 0.021). The median value of the primary CLP group was ++ number of TIMP-2 positive chondrocytes compared to +++ in the secondary CLP group. No statistically significant difference was found between primary and secondary rhinoplasty patients for other tissue factors. Commonly, the rich expression of different tissue factors suggests a stimulation of higher elasticity in cleft affected cartilage. The statistically significant TIMP-2 elevation in primary operated cartilage indicates an impact of the selective tissue remodeling for hard tissue.
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95
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Gupta R, John J, Ranganathan N, Stepanian R, Gupta M, Hart J, Nossoni F, Shaheen K, Folbe A, Chaiyasate K. Outcomes of Closed versus Open Rhinoplasty: A Systematic Review. Arch Plast Surg 2022; 49:569-579. [PMID: 36159386 PMCID: PMC9507448 DOI: 10.1055/s-0042-1756315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case–control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.
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96
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Radman M, Pourhoseinali L. Effect of rhinoplasty on changing body images in candidates for surgery. J Family Med Prim Care 2022; 11:5535-5539. [PMID: 36505585 PMCID: PMC9731004 DOI: 10.4103/jfmpc.jfmpc_2116_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/04/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background According to statistics, the number of rhinoplasty applicants is increasing. Rhinoplasty is performed to improve the nose shape fit into the face. Objective The main objective of this study was to determine the effect of rhinoplasty on changing body images in rhinoplasty candidates. Methods The statistical population of the present prospective study, including those referring to the Otorhinolaryngology Clinic of Rafsanjan University of Medical Sciences (Iran) with complaints of dissatisfaction with the appearance of the nose and demand for rhinoplasty, completed Body Image Concern (BIC) Inventory and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and 6 months after surgery at the clinic. Data were analysed using SPSS software version 16 using Mann-Whitney U and Wilcoxon tests at a significance level of 0.05. Results In total, 95 subjects were examined, of which 85 (89.5%) were women and 57 (60%) were single. There was no difference in the mean scores of BIC and Y-BOCS between women and men as well as between single and married subjects (p < 0.05). The Wilcoxon test results showed that the mean score of post-operative Y-BOCS was significantly increased in the rhinoplasty subjects (p < 0.001). Moreover, the mean score of post-operative BIC was significantly decreased in the rhinoplasty subjects (p < 0.001). Conclusions The results of this study demonstrated that the rhinoplasty could improve the body image status and increase the obsessive thoughts and actions in an individual. Therefore, psychological primary care for avoiding pointless surgical plan and pre-operative psychological counselling, is suggested to examine the individual's psychological status and to assess the individual's expectations of surgery along with the necessary explanations.
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97
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Rodriguez CA, Al-Sakkaf AM, Verbauvede M. Rhinoplasty with Recycled Dorsum Preservation: Technique and Outcomes. Arch Plast Surg 2022; 49:563-568. [PMID: 36159370 PMCID: PMC9507450 DOI: 10.1055/s-0042-1756314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/18/2022] [Indexed: 10/27/2022] Open
Abstract
Rhinoplasty is one of the first surgical procedures described with evidence in the history of medicine. At first, these were performed for the reconstruction of traumatic defects caused by punishments, sequels of war, and then it had been reused after suffering from diseases such as syphilis. Many techniques have been developed from the need of aesthetics outcomes in this field. The objective of our work is to describe a modified approach of recycled dorsum preservation procedure that we have proposed as a safe and reliable technique. In this work, we have showed that this technique has a marked advantage of preserving the natural tissue with satisfactory postoperative result. We had no functional complications up to date. We recommend that every specialist in the field of rhinoplasty should be able to use it as a reproducible and feasible alternative.
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Lee SB, Min HJ. A case study of an undetected expanded polytetrafluoroethylene implant material mimicking a nasal dorsal hump. EAR, NOSE & THROAT JOURNAL 2022:1455613221121496. [PMID: 36041824 DOI: 10.1177/01455613221121496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Augmentation rhinoplasty using alloplastic materials is a relatively standard procedure in Asian patients. Expanded polytetrafluoroethylene (ePTFE) is one of the commonly used alloplastic materials because it has a high biocompatibility and is easy to handle. Recently, a patient who had previously undergone augmentation rhinoplasty using ePTFE as the implant material visited our clinic. She had the implant material surgically removed after three years and visited our clinic with a nasal dorsal hump. The patient underwent revision rhinoplasty at our institution. Unexpectedly, we found some ePTFE material that was not identified on the preoperative X-rays. After removing the ePTFE material, the nasal dorsal hump was corrected, and we did not need to perform a nasal dorsal hump reduction.
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Turhal G, Öztürk A, Berber V, Sergin D, Göde S. The Effect of Mild Hypocapnia on Postoperative Ecchymosis in Rhinoplasty. Ann Otol Rhinol Laryngol 2022:34894221118452. [PMID: 35959955 DOI: 10.1177/00034894221118452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Ecchymosis and edema are the most common complications in patients following rhinoplasty in the early postoperative period. Vasoconstriction created by hypocarbia may have a positive effect on postoperative ecchymosis. The aim of this study was to evaluate the effect of mild hypocapnia induced in rhinoplasty on the severity of periorbital ecchymosis. METHODS The study was carried out retrospectively in the digital photographs (control group and study group) of 31 participants who underwent open technical rhinoplasty between January and March 2019. During the operation, partial carbon dioxide pressure in the study group was kept in the range of 32 to 38 mmHg and in the control group between 42 and 46 mmHg and this was confirmed by arterial blood gas measurements taken during the operation. Measuring the brightness and shadows of digital photos Digital color meter was used in MacOS X as a computer software. RESULTS The mean ratio of periorbital ecchymosis to forehead brightness was 0.84 ± 0.05 in the study group and 0.81 ± 0.03 in the control group. There was no significant difference between the study and control groups (P > .05). CONCLUSION This study investigates the potential role of hypocapnia on postoperative ecchymosis during rhinoplasty. The severity of ecchymosis was less in the patients with induced mild hypocapnia regarding both subjective and objective evaluations, but this difference didn't reach statistical significance compared to the normocapnic control group.
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Kadakia N, Nguyen C, Motakef S, Hill M, Gupta S. Is Irradiated Homologous Costal Cartilage Reliable? A Meta-Analysis of Complication Rates in Rhinoplasty. Plast Surg (Oakv) 2022; 30:212-221. [PMID: 35990389 PMCID: PMC9389060 DOI: 10.1177/22925503211011973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 08/03/2023] Open
Abstract
Background: Irradiated homologous costal cartilage (IHCC) may be a convenient, cost-effective and efficient alternative source of graft material in rhinoplasty; however, a systematic review and meta-analysis on this topic have not been previously performed. Objectives: We sought to summarize and pool data on complications associated with the use of IHCC grafting in rhinoplasty. Methods: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We conducted PubMed, Cochrane, Embase, Web of Science database searches, and screened articles using specific inclusion and exclusion criteria. Pooled complication rates were analyzed using a random-effects model. Results: Of the 13 studies that met criteria for systematic review, 11 studies involving 1017 patients, with 1956 IHCC grafts used, were included in the meta-analysis. Mean follow-up across all studies was 47 months. Overall, the pooled complication rates were 1.14% (95% CI: 0.3%-2.0%) for resorption, 0.5% (95% CI: 0.1%-0.9%) for warping, 1.2% (95% CI: 0.3%-2.1%) for infection, 1.0% (95% CI: 0.1%-2.0%) for mobility, and 0.8% (95% CI: 0.1%-1.6%) for graft removal or replacement. No allergic reactions or systemic disease associated with IHCC use were reported in any of the studies. Conclusions: The overall complications associated with IHCC use in rhinoplasty were very low. Costal cartilage allografts are an area of renewed interest that may represent an alternative to autologous costal cartilage grafting in rhinoplasty due to their low complication rates, convenience, cost-effectiveness, and elimination of donor-site complications.
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