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Pozzi M, Susini P, di Seclì D, Schettino M, Grimaldi L, Cuomo R, Roxo CW. Augmentation Rhinoplasty and Centrofacial Lipofilling: Our Experience (ARCL). J Clin Med 2024; 13:1965. [PMID: 38610730 PMCID: PMC11012668 DOI: 10.3390/jcm13071965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Augmentation rhinoplasty traditionally represents a serious challenge for plastic surgeons. The association with centrofacial lipofilling is a great approach to achieve harmonious, aesthetic results. The aim of this article is to describe our personal association between Augmentation Rhinoplasty and Centrofacial Lipofilling (ARCL) in non-Caucasian patients. Materials and Methods: In this study, we retrospectively reviewed patients treated with ARCL at our institution between January 2019 and December 2023. We described our personal approach and technique. At a minimum follow-up time of one year, post-operative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape and contour of the nose, and facial harmony and rejuvenation; finally, patients' satisfaction was investigated according to the ROE questionnaire and the modified S-GAIS. Results: A total of 307 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image and facial harmony, as the mean postoperative ROE and S-GAIS score show. None of the grafts extruded or collapsed. Wounds healed without reported major infection. Conclusions: This study has demonstrated that ARCL is a safe approach that contributes to improve functional and aesthetic outcomes, has a high patient satisfaction rate, and limited post-operative complications.
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Affiliation(s)
- Mirco Pozzi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (P.S.); (D.d.S.); (L.G.); (R.C.)
| | - Pietro Susini
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (P.S.); (D.d.S.); (L.G.); (R.C.)
| | - Davide di Seclì
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (P.S.); (D.d.S.); (L.G.); (R.C.)
| | - Michela Schettino
- Unit of Plastic and Reconstructive Surgery, CHIREC de Braine L’Alleud Hospital, 1410 Brussels, Belgium;
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (P.S.); (D.d.S.); (L.G.); (R.C.)
| | - Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (P.S.); (D.d.S.); (L.G.); (R.C.)
| | - Carlos Weck Roxo
- Instituto Carlos Roxo, Avenida Ayrton Senna n°1850, Rio de Janeiro 22775-003, RJ, Brazil;
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Moon H, Fung CY, Kim JH, Jang YJ. Changes in Nasal Tip Aesthetics Over Time Following Asian Tip Plasty. Laryngoscope 2024; 134:678-683. [PMID: 37318104 DOI: 10.1002/lary.30825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/28/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting. METHODS A total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three-dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1-month and 12-month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft. RESULTS The 1-month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post-operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single- and multi-layer tip grafts. CONCLUSIONS Increased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods. LEVEL OF EVIDENCE 4 Laryngoscope, 134:678-683, 2024.
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Affiliation(s)
- Hyun Moon
- Department of Otolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Chak Yuen Fung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Heon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Radivojevic N, Stojkovic G, Simic L, Tomanovic N. Surgical Resection of Nasal Chondroma via open Rhinoplasty Approach: A rare case Presentation and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:2548-2552. [PMID: 37636599 PMCID: PMC10447754 DOI: 10.1007/s12070-023-03661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/01/2023] [Indexed: 08/29/2023] Open
Abstract
Chondromas are benign tumors composed of mature hyaline cartilage tissue with well-defined boundaries that are commonly localised in the extremities with very few cases described in the head and neck region. We present a case of 57-year-old patient who consulted a specialist for an examination due to a change in the tip of the nose that persisted for the past 2 years. The clinical exam revealed a firm, tumor-altered tip of the nasal pyramid, with hyperemia of the skin above the mass. Biopsy was taken under local anesthesia; the histopathology analysis indicated a mesenchymal tumor producing the chondroid matrix suggestive of nasal type chondroma. Computerized tomography showed an ovoid, moderately inhomogeneous, sharply limited formation measuring 21 × 18 × 24 mm present mediosagitally at the top of the nasal pyramid. After preoperative preparation, the surgery was performed by open rhinoplasty approach. Tumor was completely excised with reconstruction of nasal septum and alar cartilage. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03661-0.
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Affiliation(s)
- Nemanja Radivojevic
- Clinic for Otorhinolaringology and Maxillofacial Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Stojkovic
- Clinic for Otorhinolaringology and Maxillofacial Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ljubica Simic
- Faculty of Medicine, Institute of Pathology, University of Belgrade, Belgrade, Serbia
| | - Nada Tomanovic
- Faculty of Medicine, Institute of Pathology, University of Belgrade, Belgrade, Serbia
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Muacevic A, Adler JR, AlZahrani AM, Obeid D, Alsinan TA, AlOtaibi AS. A Cosmetic Approach to Cheek and Nasal Hemangioma Utilizing Open Rhinoplasty in a 10-Year-Old Child: A Case Report. Cureus 2023; 15:e34185. [PMID: 36843783 PMCID: PMC9951550 DOI: 10.7759/cureus.34185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
Infantile hemangiomas are characterized as benign tumors of vascular tissue that arise from rapid endothelial cell proliferation followed by gradual involution, affecting 4% to 5% in infants and 2.6% to 9.9% in older children. Most of them resolve by the age of three years, negating the need for surgical intervention. However, intervention should be considered especially in cases with a high risk of recurrence. A female patient, aged 10 years, was referred to plastic surgery by her dermatologist due to the presence of a vascular mass in her face located at the junction between the nose and right cheek that had been present since infancy. The patient was diagnosed with infantile hemangioma based on MRI imaging of the face showing a benign vascular lesion measuring 9 x 12 mm. After the failure of multiple sclerotherapy sessions and informed discussion with the respective family, the patient underwent open rhinoplasty for surgical excision with no facial scarring other than the transcellular scar. This study presents a rare case of utilizing the open rhinoplasty technique in a relapsing facial hemangioma of a 10-year-old child. Results show a positive aesthetic outcome by minimizing facial scars. Considering the limited reported use of this technique, more clinical studies, especially comparing long-term effects across different age populations, are recommended to validate the efficiency and effectiveness of this technique.
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Akama T, Tsuda T, Terada R, Tanaka S, Tanaka H, Yoshitatsu S, Nishimura H, Inohara H. A Case of Traumatic Nasal Valve Stenosis Successfully Treated with Open Rhinoplasty and Z-Plasty. Ear Nose Throat J 2022:1455613221115100. [PMID: 35818845 DOI: 10.1177/01455613221115100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
External nasal deformity is common and can be treated surgically. It often occurs in conjunction with the development of the nasal septal cartilage, vomer, and vertical plate of the ethmoid bone but may be caused by trauma. Here, we present a case of external nasal deformity caused by trauma. A woman presented with nasal obstruction due to dysfunction of the nasal valve area and was referred to our department for treatment. No chronic rhinosinusitis or nasal septal deviation that causes nasal obstruction was noted at the initial examination. However, trauma-related scarring was observed in the nasal valve area, and a Cottle test yielded positive results. The patient underwent combined rhino- and Z-plasty surgery and is currently undergoing follow-up at an outpatient clinic.Although otolaryngologists generally use an endonasal approach to treat nasal obstruction, it is important to perform an appropriate evaluation of the external nose and to collaborate with a plastic surgeon, as necessary.
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Affiliation(s)
- Toshiyuki Akama
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
| | - Takeshi Tsuda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka UniversityGraduate School of Medicine, Suita City, Osaka, Japan
| | - Risa Terada
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
| | - Shohei Tanaka
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
| | - Sumiko Yoshitatsu
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Osaka City, Osaka, Japan
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Park H, Nam S, Jang YJ, Ku S, Choi SS. Negative pressure pulmonary edema in a patient undergoing open rhinoplasty: A case report. Medicine (Baltimore) 2021; 100:e24240. [PMID: 33429827 PMCID: PMC7793335 DOI: 10.1097/md.0000000000024240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is associated with serious postoperative complications. Compact nasal packing is always done after an open rhinoplasty procedure which makes it difficult to achieve positive pressure ventilation via a mask if NPPE arises. PATIENT CONCERNS A 21-year-old healthy man got an open rhinoplasty, septal perforation repair, and revisional septal reconstruction. After surgery, he became so agitated that it was difficult to calm him. We decided to remove the endotracheal tube. On arrival at the post-anesthesia care unit, he was cyanotic and his SpO2 had decreased to about 2%. We attempted positive pressure ventilation using mask bagging; however, it was ineffective due to the nasal packing. DIAGNOSES Negative pressure pulmonary edema. INTERVENTIONS Emergent reintubation was immediately done and Ambu bagging was commenced. A considerable pinkish secretion came out of the tube. A T-piece was applied to him using 15 L/min of oxygen supply. The patient was eventually transferred to the intensive care unit of our hospital. OUTCOMES On postoperative day (POD) 1, a decision was made to extubate, and the oxygen supply was shifted to 3L/min using a venturi-mask. On POD 2, a chest posteroanterior radiograph was taken and indicated no active lung lesion. The patient was subsequently discharged without any complications. He had no symptoms on POD 6, 11, and 18 at follow-up visits to our outpatient clinic. LESSONS Anesthesiologists should be alert to the possibility of NPPE and its treatment because of its rapid onset but positive clinical outcome if there is a proper intervention. In nasal surgery cases in particular, early re-intubation should be conducted and extubation should be done to fully awaken the patients.
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Affiliation(s)
| | - Sugeun Nam
- Department of Anesthesiology and Pain Medicine
| | - Yong Ju Jang
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungwoo Ku
- Department of Anesthesiology and Pain Medicine
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Abstract
Introduction Vocal changes after rhinoplasty have been poorly investigated, although this surgical procedure is nowadays one of the most requested. The production of voice largely depends on the anatomy and the size of the pyramid and the nasal cavity. The authors report 51 cases of both closed and open rhinoplasty and propose a 2-year report to analyze potential effective changes on voice. Materials and Methods Fifty-one patients were enrolled and evaluated from September of 2012 to January of 2018. All patients were studied before and 2 years after surgery. Vocal changes were assessed with an objective and a subjective evaluation. The first one allowed to perform the measurement of the intensity and frequency of vowel sound ("a") and nasal consonant sounds ("n" and "m"). For the subjective evaluation, our modified version of Voice Handicap Index Score allowed us to evaluate every single characteristic of the personal perception of voice. Results The objective evaluation showed an increased frequency of production of the consonant sounds in 62% of cases and an increased frequency of production of the vowel sound in 68% of cases. The subjective evaluation allowed us to notice significant changes after surgery (P = .044). No significant differences were noticed between closed and open approach. Conclusion Reduction rhinoplasty technique proved to induce several alterations on vocal pattern. The surgeon should always inform patients about the potential effects on the voice, particularly when such changes may produce influences on the working life.
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Okur Mİ, Gökdemir O, Karasu N, Yildirim AM. Comparison of nasal senses following open and closed rhinoplasty. Turk J Med Sci 2016; 46:287-90. [PMID: 27511486 DOI: 10.3906/sag-1405-52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/04/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The objective of this study was to compare the postoperative changes taking place in the nasal senses of patients who underwent a rhinoplasty through the open or closed incision method. MATERIALS AND METHODS In a prospective study, 15 patients had a closed rhinoplasty surgery and 15 others had an open one. By pinpointing 9 spots in the nose, a sensory assessment was made by means of Semmes-Weinstein monofilaments prior to the surgery and 1 week and 1, 3, and 6 months after the surgery. RESULTS In the open and closed groups, there was hypoesthesia 1 week after the surgery compared with the preoperative period (P = 0.01 and P = 0.016). In the first week a sense reduction in the upper columella was observed in the open group when compared with the closed one (P = 0.035). There were no other significant differences between the groups in the nasal regions at other times. CONCLUSION It was ascertained that there was reduced sensation in the upper columella in the open incision group in the first postoperative week. The sensation was reduced in both groups in the first postoperative week. The nasal sensation recovered after the first month.
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Affiliation(s)
- Mehmet İhsan Okur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Onur Gökdemir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Necmettin Karasu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine,Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Alpagan Mustafa Yildirim
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine,Afyon Kocatepe University, Afyonkarahisar, Turkey
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Abstract
It is universally accepted that correction of cleft lip nose deformity remains a formidable challenge for any cleft surgeon. The nose is a prominent part of the face, and hence a masterly executed cleft lip repair directs the beholders' eyes from the deformed lip to the deformed nose. A deformed nose that results from unilateral cleft of the lip and palate is likened to a tent whose one side is depressed. Many investigators believe that the deformity of the nose is produced by the malpositioning of essentially normal structures, on the other hand some cleft surgeons contend that it is the intrinsic defects in nasal structures that result in cleft nasal deformity. Depressed and hypoplastic bony scaffolding is the most important aspect of cleft nose deformity and addressing this aspect of cleft nose deformity is the secret of success of a perfect secondary rhinoplasty. Controversy still exists on timing of cleft nasal deformity. Proponents of delayed nasal repair suggest that altering the cartilages in early nasal repair at the time of lip repair would complicate future corrective nasal surgeries if the primary repair would prove unsatisfactory. The correction of nasal deformity could be performed with closed or open technique. This paper highlights one such challenging unilateral cleft lip nasal deformity in a adult patient treated by secondary rhinoplasty by open technique.
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Affiliation(s)
- M Baskaran
- Department of Oral and Maxillo Facial Surgery, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
| | - I Packiaraj
- Department of Oral and Maxillo Facial Surgery, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
| | - S Gidean Arularasan
- Department of Oral and Maxillo Facial Surgery, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
| | - T K Divakar
- Department of Oral and Maxillo Facial Surgery, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
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Abstract
BACKGROUND Closed reduction and splinting are generally recommended in the acute management of nasal fractures. Although open reduction is recommended for more severe nasal fractures, immediate functional and cosmetic open rhinoplasty following nasal fractures has not been described for Asian noses. OBJECTIVES The authors document their experiences with combining open reduction of acute nasal fractures with simultaneous cosmetic correction of preexisting aesthetic concerns in an Asian population. METHODS Twenty-five Asian patients underwent primary functional and cosmetic open rhinoplasty immediately following acute nasal fracture. Grafts consisted of autologous material, including septum, concha, rib, and deep temporal fascia. Prior to opening the nose, anatomical reduction of the bony vault fractures was performed. Spreader grafts were used to stabilize the fractured or dislocated dorsal septum as well as to straighten the nose. Aesthetic refinement of the nose included lengthening, refining the tip, and increasing tip projection and was performed according to the patients' aesthetic desires. Patient satisfaction was subjectively reported on a 1 to 10 scale. RESULTS Mean follow-up was 17 months (range, 10-24 months). Twenty-three patients rated the results of their procedures as 7 or higher. Functionally, all patients were breathing as well or better postoperatively compared with their preinjury functional state. One patient (4%) underwent a secondary filler procedure for a slight dorsal irregularity. CONCLUSIONS Immediate cosmetic and functional open rhinoplasty is safe, predictable, and effective in Asian patients. LEVEL OF EVIDENCE 4.
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Abstract
We report a case of a toothbrush head lodged into the nasal cavity, which required an external rhinoplasty for retrieval. A review of the literature on management strategies in case of nasal foreign bodies is presented.
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Affiliation(s)
- Pavan M Patil
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Greater Noida, Uttar Pradesh, India
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