Open Roof Deformity Research Articles

Correction of Hump Nose Using Radix Augmentation with Silicone

Background and ObjectivesZZHump resection by osteotome or rasp is a commonly used surgical technique in hump correction. However, during this procedure, the structure of the osseous-cartilaginous framework is altered and may lead to an open roof deformity or dorsal irregularity. So we preserved the hump as much as possible, and then augmented the radix with silicone. We compared this result to that of the hump resection group. Subjects and MethodZZWe retrospectively studied 21 patients who underwent rhinoplasty with hump correction. We classified the patients into two groups by operation technique; hump preservation and hump resection. The result of surgery was evaluated by comparing nasal measurements on pre and postoperative photos. Patient’s satisfaction about cosmetic results were investigated using the visual analogue scale (VAS). All results were statistically tested. ResultsZZThe hump preservation group (N=13) had 12 cases (92.3%) of isolated hump type and one pseudo hump type (7.7%), whereas the hump resection group (N=8) had 5 cases (62.5%) of generalized hump type and 3 isolated hump type (37.5%). The preoperative nasofrontal angle in hump preservation (129.4° ±10.6) was significantly lower than that in the hump resection group (139.3° ±8.2). The nasion/nasal tip depth ratio in the hump preservation group (0.22±0.1) was also lower than that in the hump resection group (0.29±0.1) preoperatively; but there was no significant difference between the two groups. VAS was improved significantly in both groups after surgery. ConclusionZZHump preservation and radix augmentation can be an effective and less complicated surgery for patients who have an acute nasofrontal angle with an isolated hump. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:486-90 Key WordsZZRhinoplasty·Augmentation.

Rhinoplasty for the multiply revised nose

Purpose To evaluate the problems encountered on revising a multiply operated nose and the methods used in correcting such problems. Patients and methods The study included 50 cases presenting for revision rhinoplasty after having had 2 or more previous rhinoplasties. An external rhinoplasty approach was used in all cases. Simultaneous septal surgery was done whenever indicated. All cases were followed for a mean period of 32 months (range, 1.5–8 years). Evaluation of the surgical result depended on clinical examination, comparison of pre- and postoperative photographs, and degree of patients' satisfaction with their aesthetic and functional outcome. Results Functionally, 68% suffered nasal obstruction that was mainly caused by septal deviations and nasal valve problems. Aesthetically, the most common deformities of the upper two thirds of the nose included pollybeak (64%), dorsal irregularities (54%), dorsal saddle (44%), and open roof deformity (42%), whereas the deformities of lower third included depressed tip (68%), tip contour irregularities (60%), and overrotated tip (42%). Nasal grafting was necessary in all cases; usually more than 1 type of graft was used in each case. Postoperatively, 79% of the patients, with preoperative nasal obstruction, reported improved breathing; 84% were satisfied with their aesthetic result; and only 8 cases (16%) requested further revision to correct minor deformities. Conclusion Revision of a multiply operated nose is a complex and technically demanding task, yet, in a good percentage of cases, aesthetic as well as functional improvement are still possible.

Management of the severe bulbous nasal tip using porous polyethylene alloimplants.

Reliable outcomes in correction of the severely bulbous nasal tip remain elusive. Reduction and binding of the tip cartilages result in a partial external nasal valve collapse. If a concurrent dorsal hump reduction is accomplished and osteotomies are completed to close the open roof deformity, then a severe constriction of the external valve may result. This is best avoided by resection of the residual lower lateral cartilages and substitution with external valve batten implants. The tripod of nasal tip supports is then rigidly reconstituted. When autogenous graft materials are considered inadequate or undesirable, the surgeon may safely use porous polyethylene alloimplants to support the external nasal valve. A dependable surgical technique based on extensive experience with these materials is outlined.

Iceberg of the nose.

Often in rhinoplasty, adequate osteotomies and mobilization of the nasal bones fail to close the dorsum--leaving an open roof deformity. Preexisting conditions and certain anatomical relationships contribute to this problem. The various methods of correcting the deformity are discussed and the author's approach presented.