HOW TO PREVENT COMPLICATIONS DURING THE APPLICATION OF NASAL PLASTER (THE SPIDER MANEUVER)

External Splinting Is Not Mandatory After All Rhinoplasties: A Prospective Randomized Trial

BACKGROUND

Although casts or external splint materials are commonly applied on the external nose after rhinoplasty, their beneficial effects have not been previously demonstrated in controlled studies.

METHODS

A total of 40 adult patients who underwent primary rhinoplasty were included in this prospective study. The patients were randomized into 2 groups to use an external splint or not after surgery. Only surgical taping was applied to the nasal dorsum of the patients for whom external splints were not used. The periorbital edema and ecchymosis levels of the patients were recorded on the second and seventh days after surgery. Moreover, all patients had a computed tomography scan at the third postoperative week to measure the distance between the beginning of the osteotomy line on the right and left sides and the midline.

RESULTS

On the second and seventh postoperative days, the levels of periorbital edema and ecchymosis were significantly lower in the patients with taping than in the patients with splints (P < 0.05 for each). No statistically significant difference was observed in terms of the difference in the distance between the beginning of the osteotomy line on the right and left sides to the midline between the group with external splints and that with tape (P = 0.661).

CONCLUSIONS

External splinting may not be used in cases where osteotomy is not performed or in patients where the osteotomies are sufficiently stable. Thus, the disadvantages of external splinting are avoided, and at the same time, periorbital edema and ecchymosis are less common.

Fractures of the Nasal Bones: Is External Splinting Really Warranted?

BACKGROUND

It has been advocated that reduction of nasal bone fractures should be followed by internal packing and/or external splinting. Despite the ample literature concerning the advantages and limitations of various splint types, the necessity and effectiveness of external splinting has not been well documented.

OBJECTIVE

To present the authors' experience and review the literature on treatment of nasal bone fractures, focusing on the indications and effectiveness of external splinting following closed reduction.

STUDY DESIGN

Retrospective analysis and literature review.

PATIENTS AND METHODS

Medical records of all patients, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica between January 2010 and December 2016 for facial trauma including nasal bone fractures, were retrospectively reviewed. Patient demographic data, fracture type, applied treatment, complications, and final outcome were registered.

RESULTS

A total of 77 patients (58 males; 19 females) were included in the study. The age range was 18 to 65 years (mean, 37.8). Closed reduction without external splinting was performed in 63 patients and open reduction with internal fixation in 6; 8 severely comminuted fractures were treated with closed reduction and external splinting. The mean follow-up was 4.8 months. All severely comminuted fractures presented complications.

CONCLUSIONS

External splinting following closed reduction of nasal bone fractures should not be used routinely but only in selected patients with severe comminution. Since the pertinent literature is inconclusive on the indications and effectiveness of external splinting, randomized controlled studies are warranted to fully elucidate the issue.

Simultaneous fat removal with suture upper blepharoplasty

BACKGROUND

Suture blepharoplasty for double eyelids is one of the most common aesthetic plastic surgery procedures in Asia. Because the technique of celebrity arcade suture blepharoplasty is effective and reliable, it has gained in popularity over the past 10 years. During this period, a significant group of patients has requested double-eyelid suture blepharoplasty combined with correction of upper eyelid puffiness. In the past, upper eyelid fat removal was performed primarily by an open excision technique, which could result in a visible scar and a prolonged recovery period. Fat removal performed simultaneously with suture blepharoplasty was a technique not considered. The reported technique is introduced to achieve simultaneous fat removal and suture blepharoplasty for double eyelids.

METHODS

The operative design is almost the same as that of the celebrity arcade suture blepharoplasty technique. The difference is that the lateral incision should be longer (3-4 mm) and placed 5-mm medially to the vertical line of the lateral canthus. From this lateral incision, a bulky fat pad can be removed with cauterization.

RESULTS

From June 2001 to December 2011, 79 of 807 patients who received celebrity arcade suture blepharoplasty also had simultaneous fat removal. No complications of hematoma, granuloma, or transient dry-eye symptoms occurred.

CONCLUSIONS

The results show that fat removal simultaneous with celebrity arcade suture blepharoplasty is a reliable and easily duplicated technique for patients who request correction of puffy eyelids and suture blepharoplasty for double eyelids.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A new technique of upper eyelid blepharoplasty using the orbicularis muscle flap

BACKGROUND

Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. The orbicularis muscle flap technique provides good results for patients with atonic skin and an atonic orbicularis muscle when there is excessive fullness in the lateral aspect of the upper lid. This flap also can be used to contain a prominent lacrimal gland or retro-orbicularis oculi fat (ROOF) without dangerous removal of the last one.

METHODS

A total of 30 patients underwent upper lid blepharoplasty through a supratarsal incision approach. Dissection of the orbicularis muscle flap was made 5-8 mm above the supratarsal fold. Before the muscle flap suspension, the excess skin and fat pad were removed. The flap suspension was achieved with its rotation and motion of a tunnel in the suborbicularis plane, which anchored it on the periosteum of the orbital lateral rim of the frontal bone with a permanent suture.

RESULTS

This technique restores the sharp and crisp tarsal folds and pretarsal show with deepening of the orbitopalpebral sulcus. The orbicularis muscle flap also can be proposed for cases with a ptosis of the lateral upper lid. The authors believe this technique reduces the risk for "rounding" of the eyelid and produces better contact of the lid with the ocular globe.

CONCLUSIONS

The orbicularis muscle flap procedure is a feasible technique that can be used reliably to reshape the lateral upper lid. It would be a useful addition to the armamentarium of the plastic surgeon who is called on to perform upper blepharoplasty.