Open Technique Septorhinoplasty Research Articles

Total Lower Lateral Cartilage Reconstruction in Multiple Revision Rhinoplasty Patients.

The aim of this study is to demonstrate a novel surgical technique of total lower lateral cartilage reconstruction using costal cartilage grafts in multiple revision rhinoplasty cases. Total lower lateral cartilage reconstruction technique was utilized in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023. Fourteen of the patients were female, and 10 were male. In this technique, we performed total lower lateral cartilage reconstruction in multiple revision cases where the support of both medial and lateral crura was poor. In cases where only the medial crus or only the lateral crus support was inadequate, we performed reconstruction only for the poorly supported portion. A new lower lateral cartilage was created with grafts obtained from the costal cartilage. The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. Multiple revision rhinoplasties present significant difficulties due to complicated nasal anatomy and weakened lower lateral cartilages. We have shown that successful results can be achieved in these complex cases with total lower lateral cartilage reconstruction using costal cartilage grafts. 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.

Use of lateral alar caudal graft to increase nasal tip definition in rhinoplasty

ObjectiveThe aim of this study is to demonstrate use of Lateral Alar Caudal Graft to increase nasal tip definition in primary or revision rhinoplasty cases. MethodLateral Alar Caudal Graft was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023 years. Fourteen of the patients were female and 10 were male. This technique was applied in revision or primary cases where the caudal part of the lateral alar crura of the lower lateral cartilage was lower in the vertical plane than the cephalic part. The Lateral Alar Caudal Graft was sutured over the caudal edge of the lateral alar crura of the lower lateral cartilage. ResultThe mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. ConclusionWe have successfully demonstrated that in primary or revision rhinoplasty cases, nasal tip definition will be enhanced by positioning the caudal level of the lateral alar crura of the lower lateral cartilage higher than the cephalic level using an onlay lateral alar crural graft and eliminated the need for alar rim graft.

Surgical correction of the lower lateral cartilage protrusion and external nasal valve pinching with lateral crural resection technique

ObjectiveThe aim of this study is to demonstrate a novel surgical technique in the treatment of lower lateral crural protrusion and external nasal valve pinching. MethodThe lower lateral crural resection technique was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2022. Fourteen of the patients were female and 10 were male. In this technique, excess part of crura's tail was excised from the lower lateral crura and placed in the same pocket. This area was supported with a diced cartilage and a postoperative nasal retainer was applied. We have corrected the aesthetic problem that occurs when the lower lateral cartilage is convex, and external nasal valve pinching that occurs when the lower lateral crural protrusion is concave. ResultThe mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. ConclusionA new surgical approach has been proposed for patients with lower lateral crural protrusion and external nasal valve pinching using the lateral crural resection technique.

The Long-Term Results Of Suture And Graft Techniques Used To Increase Tip Projection and Rotation In Open Technique Septorhinoplasty

Background: In this study, we aimed to evaluate the long-term results of suture and graft techniques used to increase tip projection and rotation in Open Technique Septorhinoplasty.
 Methods: In this study, the data of 89 patients who underwent Open Technique Septorhinoplasty were analysed retrospectively. The patients were divided into groups 1,2,3,4 and 5 according to the suture and graft techniques used. Preoperative and postoperative photographs of all patients included in the study at the 1st, 3rd, 6th, 12th, 36th and 60th months were analyzed. To measure and compare these techniques, tip projection and rotation losses were measured on all photographs using a computer program called Imagej.
 Results: A statistically significant increase was found between the preoperative mean Nasolabial Angle (NLA), Type Angle (TA), Byrd–Hobar Method (BHM) and Nasofacial Angle (NFsA) measurement values and the measurement values at 36th months postoperatively in Groups 1 and 4 (p < 0.05). In Group 2, a statistically significant increase was found between preoperative mean NLA, TA and BHM measurement values and postoperative 36th month measurement values (p < 0.05). In group 1 only, there was a statistically significant difference between the preoperative mean TA, BHM, Simons Method (SM), Goode Method (GM) and Powell-Modified Baum Method (PMBM) measurement values and the postoperative measurement values at 60th months (p < 0.05).
 Conclusions: Our results showed that suture techniques were more effective on projection and rotation than graft techniques in the long term.

Drainage tube use for the reduction of postoperative ecchymosis in rhinoplasty

Postoperative healing after rhinoplasty can have a negative impact on patient quality of life. In our study, we aimed to reduce postoperative edema and ecchymosis by applying a minidrain system. We evaluated this intervention's benefit on postoperative morbidity by observing the patient with left and right sides, intervention side and control side respectively. All surgeries were performed using a piezo device with an open technique septorhinoplasty. We only used a left-sided minidrain system through the osteotomy lines just in front of the piriform aperture for all patients with no other intervention on the right side of the same patient. Use of a drain on the left side was associated with a statistically significant decrease in ecchymosis at postoperative day 7 (P<0.05). We found that using a minidrain system through internal osteotomy lines was effective in reducing the amount of ecchymosis by day seven after surgery.

Supratip suture and skin scoring technique in the patient with thick skin in rhinoplasty

ObjectiveThe aim of this study is to demonstrate a new surgical technique to achieve ideal nasal tip rotation and projection with nasal supratip angle in patients with thick skin. MethodSupratip suture and skin scoring technique was used in 24 patients who underwent open technique septorhinoplasty operation between the years 2019 and 2022. In this technique the nose skin was thinned with scissors. Scoring and supratip sutures were applied to the skin. Kenacort (Triamcinolone 8 mg) was injected into the supratip area without closing the skin. Fourteen of the patients were female and 10 were male. ResultThe mean age of the patients was 22. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. ConclusionA new surgical approach has been proposed to create the desired dimensions with nasal tip rotation and projection and supratip angle in patients with thick skin using the supratip suture and skin scoring technique.

Assessment of Acute and Chronic Pain after Open Technique Septorhinoplasty: Should We Really Be Concerned about This Topic?

Assessment of Acute and Chronic Pain after Open Technique Septorhinoplasty: Should We Really Be Concerned about This Topic?

An Innovative and Easy Dome Holding Technique for Transdomal Suture in Rhinoplasty.

Suture tip plasty is one the most used methods in nasal tip surgery. Transdomal suture (TDS) used for this purpose is utilized for providing the dome symmetry, thinning the nasal tip, and enhancing the nasal tip projection and rotation. However, there are not sufficient visual data on what the dome position should be during TDS. In this study, it was aimed to be directive in tip plasty and to define the convenient dome holding technique during TDS. Patients, 510 male and 621 female at the age of 18 to 50 years, who underwent the open technique septorhinoplasty between the years of 2003 to 2015 were included in the authors' study. The length of the patient follow-up varies between 1 and 10 years. Patients, on which the lateral crural strut graft was used and which underwent dome division/vertical dome division in tip surgery, and patients who were diagnosed with the alar cartilage asymmetry and underwent dome excision for any pathological reason to demonstrate the effectiveness of the TDS holding technique. During the TDS, the dome area was administered with 5/0 polydioxanone by being held at an angle close to the cranial in the posterior and the caudal in the anterior with a dentated forceps. In this study according the authors' pre and postoperative conclusions, the authors consider that this is a sufficient visual data on what the dome position should be during TDS by presenting video.

Figure-of-Eight Suspension Suture in Open Technique Septorhinoplasty.

The aim of this study was to describe a novel surgical suture technique for achieving ideal nasal tip rotation and projection with nasal supratip angle. The figure-of-eight suspension suture (FOESS) technique was used in 68 patients who underwent open technique septorhinoplasty operation between the years 2013 and 2015. Fifty-four of the patients were female and 14 were male. The mean age of the patients was 28.2. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to the FOESS technique. Satisfactory results were obtained in the postoperative period after surgery. The FOESS technique generated power against the anterior-inferior tensile strength of the alar cartilages. Thus, it can be possible to shape the nasal tip rotation and projection in the desired dimensions. In addition, this technique helps us to create supratip break point and angle.

Dorsal Augmentation of Saddle Nose Deformity With Toothpick-Shaped Costal Cartilage Grafts in the Secondary Septorhinoplasty.

Saddle nose deformity is a challenging complication of septoplasty or septorhinoplasty, characterized by underprojected cartilaginous dorsum. Nasal dorsal augmentation is a significant part of reconstructive surgery of saddle nose deformities. In this study, the authors aimed to discuss the results of using toothpick-shaped costal cartilage grafts in nasal dorsal augmentation of saddle nose deformity. Twelve patients who underwent nasal dorsal augmentation due to moderate to severe saddle nose deformity secondary to the previous septoplasty or septorhinoplasty were retrospectively reviewed. Costal cartilage grafts prepared in the shape of toothpicks were used in all patients. Costal cartilage was used as toothpick-shaped free grafts in 12 patients (female: 7, male: 5) with a mean age of 42 (range: 24-56) for dorsal augmentation in the secondary septorhinoplasty. All patients had a history of previous surgery (septoplasty, n = 9; and septorhinoplasty, n = 3). All patients were operated under general anesthesia with open technique septorhinoplasty. The mean follow-up was 18 (range: 9-48) months. In only 1 of the 12 patients, a postoperative complication was observed including an infection of the tip area in the second postoperative week. None of the patients experienced donor site complications or major graft resorption. All patients were satisfied with functional and esthetic outcomes. No revision surgery was needed in any patient. Toothpick-shaped costal cartilage grafts are useful in nasal dorsal augmentation of moderate to severe saddle nose deformity. This technique offers smooth camouflage, satisfactory accordance with the recipient region, and shorter operation time. In addition, it avoids the side effects from wrapping techniques such as foreign body reaction or additional donor site morbidities.

How can periorbital oedema and ecchymose be reduced in rhinoplasty?

Oedema and ecchymose are frequent morbidities of septorhinoplasty, a facial surgical procedure for reforming the shape and functions of the nose. Periorbital oedema (PO) and periorbital ecchymose (PE) are normal occurrences, but are undesirable for patients undergoing the procedure for aesthetic purposes. The present study examined 65 patients who underwent open technique septorhinoplasty for aesthetic and functional complaints. Patients were divided into two groups: Group 1 patients underwent lateral osteotomy following tip plasty, at the end of the surgical operation; Group 2 patients underwent lateral osteotomy before tip plasty, at the beginning of the surgical operation. Patients were followed on the postoperative first, third and seventh days. PO and PE values of patients were scored from 0 to 4. The plastering time (Pt) was significantly shorter for Group I than Group II (p<0.05). The total surgical time (T) showed no significant difference (p>0.05). The PO value at the first, third and seventh days was significantly smaller for Group I than Group II (p<0.05). The PE value at the first, third and seventh days was also significantly smaller for Group I than Group II (p<0.05). The obtained data indicate that performing a lateral osteotomy in the final stages of surgery, and subsequently applying a nasal plaster and splint as rapidly as possible, decreases PO and PE in the postoperative period.

Effects of Spreader Grafts on Olfactory Function in Septorhinoplasty

Following rhinoplasty, the cross-sectional parts of the nose may be significantly reduced, and nasal air movement and olfaction may be altered. Studies on olfactory function after surgical procedures are quite limited and have largely focused on sinus surgery or septoplasty. The objective of this study is to assess the consequences of spreader grafts on olfactory function. This prospective study was conducted at the Gaziosmanpaşa Taksim Education and Research Hospital, Department of Otolaryngology, from January 2014 to June 2015. In total, 68 patients who had undergone an open-technique septorhinoplasty were included. In 35 patients, bilateral spreader grafts were included with the open septorhinoplasty (group 1), and 33 patients underwent open septorhinoplasties without spreader grafts (group 2). The age and gender distributions of the patients in the two groups did not differ (p > 0.05). Preoperative threshold, discrimination, and identification values in both groups did not differ (p > 0.05). In groups 1 and 2, postoperative threshold values were significantly higher than preoperative values (p < 0.05). The change in threshold, discrimination, and identification level was significantly higher postoperatively versus preoperatively in group 1 (p < 0.05); however, the changes in discrimination and identification values did not significantly differ between in group 2 (p > 0.05). Our study demonstrates the superior widening effect of spreader grafts over the nasal valve and favorable results in olfactory function in primary septorhinoplasty patients. This journal requires that the 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.

Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis.

The present study aimed to compare edema and ecchymosis in the early and late postoperative periods following the application of different surgical techniques (open and endonasal) and different types of lateral osteotomy (internal and external). The files and photographs of a total of 120 patients whose records were regularly maintained/updated and who underwent septorhinoplasty operation with the same surgeon were retrospectively evaluated. Sixty-nine (57.5%) patients were women and 51 (43.5%) were men. The patients were divided into 4 different groups according to the operations they underwent as follows--Group I: open technique septorhinoplasty + internal/continuous lateral osteotomy; Group II: endonasal rhinoplasty + internal/continuous lateral osteotomy; Group III: open technique septorhinoplasty + external/perforating lateral osteotomy; and Group IV: endonasal rhinoplasty + external/perforating lateral osteotomy. Postoperative edema and ecchymosis, and lateral nasal wall mucosal damage because of osteotomy were evaluated. Postoperative second day edema and ecchymosis scores were statistically significantly better in patients in Group II compared with the patients in Group I (P = 0.010 and P = 0.004, respectively). Postoperative first day edema and postoperative seventh day ecchymosis scores were statistically significantly better in the patients in Group IV compared with the patients in Group III (P = 0.025 and P = 0.011, respectively). Intraoperative bleeding was similar in all groups. The nasal tip was more flexible in patients who underwent closed technique rhinoplasty. Unilateral mucosal damage occurred in 3 patients (4%) with internal lateral osteotomy, whereas no mucosal damage was present in patients with external osteotomy. The difference in the rate of edema and ecchymosis in the early postoperative period between the closed technique rhinoplasty and the open surgical approach was statistically significant, whereas osteotomy did not cause a significant difference. According to these results, the authors suggest endonasal surgery to prevent the development of edema and ecchymosis, whereas the choice of lateral osteotomy should be dependent on the experience of the surgeon.

Does septoplasty improve the quality of life in children?

ObjectivesThe aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS). MethodsOnly pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery. ResultsThirty-five patients with a mean age of 13.4±2.8 (8–16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9±2.1. Improvement in NOSE score was correlated with patient satisfaction. ConclusionSeptoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.

Comparison of Preincisional Infiltrated Levobupivacaine and Ropivacaine for Acute Postoperative Pain Relief After Septorhinoplasty

Background To maintain a high standard of patient care, it is essential to provide adequate pain management in patients who undergo nasal surgery. Levobupivacaine and ropivacaine are relatively new long-acting local anesthetics. Objective The aim of this study was to compare the analgesic effect and blood loss of preincisional levobupivacaine HCl 0.25% and ropivacaine HCl 0.375% in patients undergoing septorhinoplasty. Methods Sixty American Society of Anesthesiologists (ASA) I and II patients (18–55 years old) who were scheduled for elective open technique septorhinoplasty under general anesthesia were recruited for this study. The anesthetic technique was standardized for both groups. Preoperative and postoperative hemoglobin levels were recorded for all patients. Patients were assigned randomly to 1 of 2 study groups, and preincisional surgical field infiltration with 5 mL of 0.5% levobupivacaine plus 5 mL of 0.9% saline (group L; n = 30) or 5 mL of 0.75% ropivacaine plus 5 mL of 0.9% saline (group R; n = 30) was performed by the same surgeon. The degree of pain was measured by visual analogue scale (VAS) for pain and recorded at multiple time points in all patients after surgery. Results The analgesic effect at 2 hours in the postanesthesia care unit (PACU) and at 24 hours postoperatively did not differ significantly between the 2 local anesthetics ( P > 0.05). Pain scores of patients decreased after the 24 hours in levobupivacaine group and ropivacaine group when compared with 0-minute VAS values, and this was statistically significant ( P < 0.05). No significant difference was observed between groups with respect to the preoperative and postoperative hemoglobin ( P = 0.767 and 0.824, respectively) values. Conclusions Local tissue infiltration with 0.25% levobupivacaine or 0.375% ropivacaine is similarly effective in reducing the postoperative pain associated with septorhinoplasty.