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Chen C, Xiang G, Liu Q, Chen K, Wang H, Jin J, Huang Y, Deng X, Yang D, Yan F. Ultrasound-guided Serratus Anterior Plane Block, Along with Improved Parasternal Block, is Superior to Serratus Anterior Plane Block Alone in Relieving Pain for Rhinoplasty with Autologous Costal Cartilage. Aesthetic Plast Surg 2023; 47:1975-1984. [PMID: 36544049 DOI: 10.1007/s00266-022-03230-w] [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] [Received: 10/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rhinoplasty with autologous costal cartilage (ACC) is followed by severe pain in the chest. Ultrasound-guided (USG) serratus anterior plane block (SAPB), in combination with parasternal block (PSB), was earlier reported to be highly efficacious in relieving pain associated with thoracic anterior lateral surgery. However, it is unclear whether it is effective for pain relief after ACC harvest. METHODS Sixty-four patients, aged 18 to 60, who received rhinoplasty with ACC, were randomly separated into a SAPB+PSB or SAPB group. The analyzed parameters of both groups included the rest and coughing numerical rating scale (NRS) pain scores of the chest and the NRS pain scores of the nose at postoperative 2, 4, 8, 12, 24, and 48 hours, oral rescue analgesic usage, side effect incidence and patient satisfaction, etc. RESULTS: Thirty patients per group were recruited for analysis. The rest and coughing NRS scores of the chest and the NRS scores of the nose at postoperative 2, 4, 8, 12 h were lower in the SAPB+PSB group, compared to the SAPB group (all P < 0.05). However, these scores were comparable between the two groups at postoperative 24 and 48 h (all P > 0.05). Additionally, relative to the SAPB group, the oral rescue analgesic usage was drastically lower (P < 0.05), the postoperative nausea and vomiting (PONV) incidence was diminished (P < 0.05), and the patient satisfaction was markedly higher (P < 0.001) in the SAPB+PSB group. CONCLUSION USG-SAPB, in combination with improved PSB, is superior to SAPB alone in relieving pain after ACC harvest in rhinoplasty. LEVEL OF EVIDENCE II 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 .
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Affiliation(s)
- Chunmei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Guihua Xiang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Huan Wang
- Department of Rhinoplasty and Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Jing Jin
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Yan Huang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China.
| | - Fuxia Yan
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, North Li shi Road, Xi Cheng District, Beijing, 100037, China.
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Alosfoor M, Alkhalifah AA, Algadiem EA, Alarfaj AA, Alsalman A. Comparison Between Patient and Plastic Surgeon Aesthetic Analysis in Rhinoplasty Consultation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4948. [PMID: 37124390 PMCID: PMC10132709 DOI: 10.1097/gox.0000000000004948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 03/02/2023] [Indexed: 05/02/2023]
Abstract
The surgeon's aesthetic analysis of the nose is based on scientific measures of its proportions and dimensions. Because the primary aim of rhinoplasty is targeted at the patient's satisfaction with self-image, patients' perception and satisfaction are of paramount importance. The aim of this study was to evaluate surgeon versus patient nasal aesthetic analysis. Method A cross-sectional study was conducted on 57 primary rhinoplasty consultations during the period June and September 2017 at the Plastic Surgery Clinic in King Fahad Hospital-Hofuf. The surgeon and the patients were handed identical questionnaires before the consultations. The questionnaire has 27 components regarding the nasal appearance. Results The surgeon's and the patients' perceptions regarding reliability was assessed by Cohen's Kappa and Pearson's correlation coefficient. There was moderate agreement with the overall appearance of the nose (κ = 0.2-0.39). The most agreed-upon components were "dorsal hump" (κ = 0.6, P = 0.001) and "tip drops down" (κ = 0.41, P = 0.002). The columella and the suitability of the front part of the nose had the largest disagreement (κ = -0.06 and κ = -0.09, respectively). The level of agreement among most of the questionnaires' components was slight or nonexistent (κ = 0.004-0.39). Conclusions The surgeon and patients have a minimum agreement regarding the view of nasal appearance, mostly with the suitability of the front part and the columella. The parts of the nose agreed upon the most were "dorsal hump" and "tip drops down". Exploring the differences between patient and surgeon aesthetic analysis of the nose will aid in addressing the discrepancies and improving surgical outcome and satisfaction.
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Utilization of Rhinoplasty Worksheets among Practicing Facial Plastic Surgeons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3756. [PMID: 34476154 PMCID: PMC8382334 DOI: 10.1097/gox.0000000000003756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
Rhinoplasty is the most commonly performed procedure by facial plastic surgeons, yet many consider it the most complex and variable surgery performed. Yet no standardized surgical worksheet has been established to document the maneuvers and anatomical changes made despite the known high rate of revision surgery. This study aimed to assess the utility and utilization of rhinoplasty surgical worksheets amongst facial plastic surgeons, as well as the perceptions and attitudes toward standardization of a common rhinoplasty surgical worksheet. Method We distributed an online survey to all active members of the American Academy of Facial Plastic and Reconstructive Surgery, in order to assess trends in utilization of surgical worksheets and the willingness of physicians to adhere to a standardized worksheet to be included in patient's medical records. Results When surveyed, 84 of the 130 respondents reported using a surgical worksheet, with 63 of 84 mentioned using a variation of their own custom worksheets. Of the 84 surgeons, 45 used these worksheets "often" or "always" during follow-up appointments. However, 111 of the 130 reported "never" or "rarely" receiving a surgical worksheet from another provider for revision rhinoplasties. In total, 96 of the 130 respondents were "strongly in favor" or "in favor" of sharing worksheets with other providers and 87/130 were in favor of establishing a standardized rhinoplasty worksheet for all rhinoplasty patients. Conclusions A majority of respondents reported using surgical worksheets for rhinoplasties with very few reporting ever receiving other surgeons' worksheets prior to revision rhinoplasties. Roughly three fourths of respondents were in favor of sharing worksheets along with a majority in favor of a standardized worksheet. This would represent a significant change in practice along with potentially increased collaboration between surgeons and subsequent advancement of patient care.
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Haddady Abianeh S, Moradi Bajestani S, Rahmati J, Shahrbaf MA, Fatehi Meybodi A. Evaluation of Aesthetic and Functional Outcomes After Open Rhinoplasty: A Quasi-experimental Study by the Aid of ROE and RHINO Questionnaires. Aesthetic Plast Surg 2021; 45:663-669. [PMID: 32747985 DOI: 10.1007/s00266-020-01905-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Rhinoplasty is one of the common plastic surgery procedures which has a high rate in Iran. There are several tools for assessing the outcomes and quality of life after this surgical procedure which rhinoplasty outcome evaluation (ROE) questionnaire and rhinoplasty health inventory and nasal outcomes are two of them. The aim of this study was to investigate the aesthetic and functional outcomes of rhinoplasty by the aid of ROE and RHINO scales in patients who presented to a referral center in Iran. MATERIALS AND METHODS This prospective, quasi-experimental study was performed on patients who referred to the plastic surgery clinic of Imam Khomeini hospital complex during 2017 to 2019 and underwent open rhinoplasty. ROE and RHINO questionnaires were filled by patients before and 6 months after the surgery. Surgical outcomes and aesthetic satisfaction rate were evaluated in different age groups, genders and educational levels. The data were analyzed by version 21 of SPSS software. RESULTS ROE score increased from 51.27 ± 10.54 to 79.6 ± 9.67 (P < 0.001). In addition, RHINO score increased from 64.13 ± 11.43 to 83.36 ± 11.03 (P < 0.001). The most common satisfaction factors among patients in this study were "nose feels more natural" in 62% of patients and "tip rotation is good" in 32% of patients. Furthermore, the most common causes of dissatisfaction in patients were "nose too wide" in 25% of patients and "tip bulbous" in 25% of patients. CONCLUSION ROE and RHINO scales are effective for assessing rhinoplasty outcomes. The satisfaction rate of rhinoplasty is high in Iran and is related to the natural shape of the nose in addition to the tip rotation. 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 .
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Affiliation(s)
- Shahriar Haddady Abianeh
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Plastic and Reconstructive Surgery, Razi Hospital, Tehran University of Medical Sciences, Wahdat-e-Islami St., District 12, Tehran, Tehran Province, 1199663911, Iran
| | - Sohrab Moradi Bajestani
- Department of Plastic and Reconstructive Surgery, Razi Hospital, Tehran University of Medical Sciences, Wahdat-e-Islami St., District 12, Tehran, Tehran Province, 1199663911, Iran.
- Department of Plastic and Reconstructive Surgery, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Javad Rahmati
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Plastic and Reconstructive Surgery, Razi Hospital, Tehran University of Medical Sciences, Wahdat-e-Islami St., District 12, Tehran, Tehran Province, 1199663911, Iran
| | | | - Abolfazl Fatehi Meybodi
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Future Direction in Rhinoplasty: Functional Improvements for a Better Outcome. J Craniofac Surg 2020; 31:750-754. [PMID: 32209944 DOI: 10.1097/scs.0000000000006444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The nose plays both an aesthetic and functional role in the human body. Physiologically, the nose is an important part of the upper airway. Aesthetically, it is the central focal point of the face. Thus, rhinoplasty has evolved to be both an aesthetic and functional surgery, as the manipulation of the aesthetic subunits of the nose inadvertently leads to the functional alterations of the nose. While the aesthetic goals of rhinoplasty are well described in the literature, functional outcomes from rhinoplasty have been more challenging to delineate. Rhinoplasty can have an impact on the sense of smell, sleep apnea, oxygenation, cognitive function, cardiovascular function, and voice. We have systematically reviewed the current literature in regard to functional rhinoplasty and septoplasty to summarize current surgical maneuvers and their impact on nasal function, along with physiological and perceived functional changes from rhinoplasty.
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