aRTiCLE | RHInOplasTy |
surgeon might undertake when performing a
rhinoplasty procedure: ■ Rasping is commonly used to remove a bony dorsal hump on the nasal bridge, or may smooth the hump down to be less noticeable ■ spreader grafts are useful in patients who have short nasal bones, long upper‑lateral cartilage, thin skin, and narrow noses ■ Cephalic resection is a rhinoplasty technique that removes a tip of the cartilage to help narrow the nasal tip. This is more often used to make the nose look longer ■ a strut is a rectangular piece of cartilage, which is placed between the medial crura of the nasal tip to make it look rounder and elevated ■ plumping grafts are placed beneath the skin if the nasolabial angle is acute or retracted. With this technique, the patient’s own cartilage is placed through the incisions inside the nose at the base ■ Osteotomies are used to reduce the nasal hump, fix a twisted nose, and help with an overly wide nose.
The risks of rhinoplasty although rhinoplasty is usually considered to be safe and successful, complications can arise and unpredictable results are possible with rhinoplasty, as well as with any other surgery. some of the most common risks include bruising, swelling, blood clots, and infection.
Patients and methods This study examined 64 patients operated on between 2002 and 2008, with an average follow‑up period of 2 years. all patients were of Middle Eastern origin, and the male to female ratio was approximately 1 : 3. Only those patients who had the characteristic arabic nasal features were included. Those with a twisted nose as a result of trauma were excluded. The authors tried to avoid operating on patients with excessively thick seborrheic skin owing to risks of excessive postoperative swelling, scarring, and poor cosmetic results. During the last preoperative counselling session,
Cephalic resection is a rhinoplasty technique that
removes a tip of the cartilage to help narrow the nasal tip. This is more often used to make the nose look longer.
46 ❚ October 2011 |
prime-journal.com
Figure 3 Pre- (A and B) and postoperative (C and D) images demonstrating correction of an excessively long nose with a dorsal hump
photographs were taken. These are of value to compare pre‑ and postoperative results, to avoid litigation, and for research purposes. Owing to religious and cultural beliefs in the Middle East, photographs, especially those of females, are particularly difficult to obtain. plain lateral and occipitomental films were ordered for the majority of patients preoperatively. preoperative routine labs were requested, with emphasis on the coagulation profile. all procedures were carried out under general
anaesthetic with prophylactic antibiotic coverage in the form of a single intravenous injection of 1 gm ceftriaxone during induction. Hypotensive anaesthesia was not encouraged. no local vasoconstriction or local anaesthesia was injected as the authors found that it did not help to significantly reduce intraoperative bleeding, as well as avoiding the rebound bleeding that may occasionally occur after vasoconstriction. postoperative pain was easily managed with parenteral and oral non‑steroidal anti‑inflammatory drugs (nsaIDs). 4-0 Vicryl® was used for any intranasal sutures. Before beginning the rhinoplasty procedure, any other
intranasal problems were addressed. a symptomatic markedly deviated nasal septum was encountered in 12 cases and was corrected with standard septoplasty techniques. The authors used a transfixion incision from the outset, rather than the classic hemitransfixion incision, as this allowed for better assessment and planning of the procedure which followed. any excised cartilage was preserved in saline. although preserved cartilage is an excellent material for use as spreader grafts and struts, its use has declined as a result of fears of prion transmission. Enlarged, allergic inferior turbinates were found in five cases and were reduced using submucosal coblation. silastic nasal septal splints were used in all cases, and a
6 mm Merocel nasal tampon was inserted into both nasal cavities. The tampon was removed the following day while The silastic splint was left in place for 1 week. Externally, an aluminium dorsal nasal splint was used to support and protect the bony pyramid, and was left in place for 7–10 days. a number of problems can often be encountered
during this type of surgery, but there are management techniques available to the physician.
Long nose In certain cases, the nose may appear longer than normal in relation to the rest of the face. This may be the result of
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