Septorhinoplasty Surgery Research Articles

The MiRa scale, a new standardised scale for evaluating nasal deformities before and after septorhinoplasty: A prospective study comparing patient satisfaction and the surgeon's assessment.

The objective was to assess the reliability of a new standardised scale for evaluating nasal anomalies in order to compare the surgeon's assessment and patient satisfaction. Monocentric prospective cohort study. First, we validated the reliability of the MiRa scale; then, we compared the surgeon's assessment and patient satisfaction. Fifty-two patients underwent septorhinoplasty surgery and gave their written consent before inclusion. Primary outcome measurement was to validate the reliability of the MiRa scale: two observers analysed all records twice. Intra-observer reproducibility and interobserver reproducibility were evaluated using the intraclass correlation coefficient (ICC). Secondary outcome measurement was to compare the surgeon's assessment and patient satisfaction: MiRa and ROE (Rhinoplasty Outcome Evaluation) scores were established for each patient prior to and 6 months after surgery. Using the MiRa scale, ICC for intra- and interobserver reproducibility was, respectively, 95.4% and 96%, showing no statistical difference (P=.70, P=.45). Good correlation scores were, respectively, 93% and 92%. Mean ROE scores were 7.1/24 (SD=11.3) before and 19.3/24 (SD=17.3) after surgery (P<.05). We found an increase in MiRa and ROE scores of +19.75% and +51.25% (P<.05), respectively. The average postoperative ROE score in the primary septorhinoplasty group was 20.4 (SD=14.4) and 17.2 (SD=23.1) in the secondary septorhinoplasty group (P<.05). MiRa scale is a reliable, standardised tool to evaluate surgical outcome in septorhinoplasty surgery. It provides an objective and reproducible score. The surgeon's assessment was more critical than patient satisfaction. Patient satisfaction is more difficult to achieve in cases involving a secondary septorhinoplasty.

Impact of developing a multidisciplinary coded dataset standard on administrative data accuracy for septoplasty, septorhinoplasty and nasal trauma surgery.

This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy. An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken. A total of 200 septoplasties, 109 septorhinoplasties, 57 complex septorhinoplasties and 116 nasal fractures were analysed. There were 76 (14.4 per cent) changes to the primary diagnosis. Septorhinoplasties were the most commonly amended procedures. The overall audit-related income change for nasal surgery was £8.78 per patient. Use of a multidisciplinary coded dataset standard revealed that nasal diagnoses were under-coded; a significant proportion of patients received more precise diagnoses following the audit. There was also significant under-coding of both morbidities and revision surgery. The multidisciplinary coded dataset standard approach can improve the accuracy of both data capture and information flow, and, thus, ultimately create a more reliable dataset for use outcomes and health planning.

Comparison of Nasal Mucociliary Function before and after Septorhinoplasty Surgery Using Saccharin Test.

Background:This study was carried out to compare mucociliary function (MCF) of nasal cavity before and after septorhinoplasty surgery by saccharin test.Materials and Methods:This study was carried out on 70 patients who needed septorhinoplasty surgery in Kashani and Alzahra Hospital during 2013–2014 to measure MCF. Saccharin test was performed on the patients before surgery and on three more intervals 1 day, 1 week, and on month after ward and the readings were recorded. Saccharin test is performed by placing saccharin granules on the anterior part of inferior turbinate and the time the patient feels the sweet taste is recorded the normal range is below 30 min.Results:Mean of test for each time interval was obtained and comparison of measurements was made reading were mean of saccharin test before surgery (7.74 ± 1.65 min) the day after surgery (7.75 ± 1.7 min), on week after surgery (15.04 ± 3.4), and 1 month after surgery (8.49 ± 2.08 min). The readings before surgery did not have statistically significant difference with the readings 1 day after surgery P = 0.99, but comparison of test results at other time intervals were significant (P < 0.001). A relative increase in saccharin test time was seen in a period of 1 month after surgery the rise was more noticeable in the 1st week compared to 1 month after surgery.Conclusion:This study in the period after septorhinoplasty surgery MCF undergoes slight impairment that gradually progresses to normal values during 1 month after surgery.

Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?

Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered. We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84. Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist. Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group. The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD.

Effects of remifentanil, nitroglycerin, and sevoflurane on the corrected QT and Tp-e intervals during controlled hypotensive anesthesia

Study objectiveControlled hypotension is a preferred method in various surgical operations, but limited data are available for the effects of drug combinations that are used to ensure the desired level of hypotension on cardiac repolarization. DesignRandomized, prospective, double-blinded study. PatientsThe study comprised 65 patients undergoing septorhinoplasty surgery under general anesthesia. InterventionsGroup S received sevoflurane inhalation alone, group R received sevoflurane and remifentanil, and group N received sevoflurane and nitroglycerine in a way that a mean arterial pressure of 60 ± 5 mm Hg was achieved. MeasurementsElectrocardiogram was performed before induction (T1), 30 minutes after induction (T2), and 5 minutes after extubation (T3). Corrected QT (QTc), QT dispersion (QTd), and corrected Tp-e (Tp-ec) intervals and Tp-e/corrected QT (Tp-e/QTc) ratio were calculated. Main resultsQTc prolongation was observed at T2 and T3 in all groups, but only QTc prolongation at T2 was statistically significant in group S (P> .05). Significant prolongation of QTd interval at T2 and T3 was observed in group S (P< .05). In all groups, Tp-ec decreased at T2. However Tp-ec decrease was not statistically significant in group S (P= .103) and group R (P= .058). Tp-e/QTc was significantly decreased on T2 in all 3 groups, and it was returned to baseline at T3 (P< .05). ConclusionThe present study demonstrated that none of the 3 hypotensive anesthesia methods has an overall negative effect on Tp-e and Tp-e/QTc. Therefore, we conclude that all 3 methods can be used safely in terms of proarrhythmic risk, but increased sevoflurane consumption may require more attention due to significant prolongation of QTc and QTd.

Revision Rates and Risk Factors of 175 842 Patients Undergoing Septorhinoplasty.

Estimates of the rate of revision septorhinoplasty and the risk factors associated with revision are unknown because the current published literature is limited to small, retrospective, single-surgeon studies with limited follow-up time. To determine the rate of revision for septorhinoplasty surgery and to determine the risk factors associated with revision. Retrospective cohort analysis of 175 842 patients undergoing septorhinoplasty between January 1, 2005, and December 31, 2009, from the Healthcare Cost and Utilization Project's State Inpatient Databases, State Ambulatory Surgery and Services Databases, and State Emergency Department Databases from California, Florida, and New York. Revisit information for these patients was then collected from the 3 databases between January 1, 2005, and December 31, 2012, with a minimal follow-up time of 3 years; and study analysis done January 1, 2005, to December 31, 2012. Revision surgery after an index septorhinoplasty was the main outcome measure, and the rate of revision was calculated within subgroups of patients based on different demographic and clinical characteristics. A multivariable model was then used to determine independent risk factors for the performance of revision surgery. The study cohort comprised 175 842 participants who underwent septorhinoplasty procedures; mean (SD) age was 41.0 (15.3) years, and 57.0% were male. The overall revision rate for any septorhinoplasty procedure was 3.3% (5775 of 175 842) (99% CI, 3.2%-3.4%). After separating the patients into primary septorhinoplasty and secondary septorhinoplasty groups, the primary group had an overall revision rate of 3.1% (5389 of 172 324), while the secondary group had an overall revision rate of 11.0% (386 of 3518). Patient characteristics associated with an increased rate of revision include younger age (5.9% [633 of 10 727]), female sex (3.8% [2536 of 67 397]), a history of anxiety (3.9% [168 of 4350]) or autoimmune disease (4.4% [57 of 1286]), and surgery for cosmetic (7.9% [340 of 4289]) or congenital nasal deformities (8.9% [208 of 2334]). The study results, derived from a large cohort of patients with long follow-up time, suggest that the rate of revision septorhinoplasty is low, but certain patient characteristics are associated with higher revision rates. These data provide valuable preoperative counseling information for patients and physicians. This study also provides robust data for third-party payers or government agencies in an era in which physician performance metrics require valid risk adjustment before being used for reimbursement and quality initiatives. 3.

Pharyngeal Packing during Rhinoplasty: Advantages and Disadvantages.

Controversy remains as to the advantages and disadvantages of pharyngeal packing during septorhinoplasty. Our study investigated the effect of pharyngeal packing on postoperative nausea and vomiting and sore throat following this type of surgery or septorhinoplasty. This clinical trial was performed on 90 American Society of Anesthesiologists (ASA) I or II patients who were candidates for septorhinoplasty. They were randomly divided into two groups. Patients in the study group had received pharyngeal packing while those in the control group had not. The incidence of nausea and vomiting and sore throat based on the visual analog scale (VAS) was evaluated postoperatively in the recovery room as well as at 2, 6 and 24 hours. The incidence of postoperative nausea and vomiting (PONV) was 12.3%, with no significant difference between the study and control groups. Sore throat was reported in 50.5% of cases overall (56.8% on pack group and 44.4% on control). Although the severity of pain was higher in the study group at all times, the incidence in the two groups did not differ significantly. The use of pharyngeal packing has no effect in reducing the incidence of nausea and vomiting and sore throat after surgery. Given that induced hypotension is used as the routine method of anesthesia in septorhinoplasty surgery, with a low incidence of hemorrhage and a high risk of unintended retention of pharyngeal packing, its routine use is not recommended for this procedure.

Comparison of the analgesic effects of Post-operative Morphine, Pre-emptive and Post-operative Paracetamol in Septorhinoplasty Surgery

Background: According to previous studies there are some different opinions on the pre-emptive effects of paracetamol in controlling post-operative pain, we aimed to compare the analgesic effects of pre-emptive paracetamol with post-operative paracetamol and morphine in patients undergoing septorhinoplasty.&#x0D; Materials and methods: A hundred and six patients aged 15 to 50 were divided into 3 groups. One received 1 g paracetamol 30 minutes before the operation, another group received 1 g paracetamol after the surgery and the control group received 3 mg morphine sulfate in the recovery room after the surgery. The pain severity was recorded for each patient using a 10 slot table. Any signs of nausea and vomiting (N/V) or apnea were closely observed and recorded. Patients with pain score 5 or more received 2 mg morphine intravascularly.&#x0D; Results: There was not any significant difference between the groups in total pain score and N/V (p&gt;0.05). Post-operative morphine intake was significantly lower in pre-emptive group (P&lt;0.05). None of the patients experienced apnea during the study. &#x0D; Conclusion: We concluded that pre-emptive paracetamol can lower the opium consumption in post-operative period but pre-emptive paracetamol cannot reduce the post-operative acute pain noticeably.

Patient reported outcome measures in septorhinoplasty surgery.

Surgical procedures incorporating a cosmetic element such as septorhinoplasty and otoplasty are currently under threat in the National Health Service (NHS) as they are deemed to be procedures of 'limited clinical benefit' by many primary care providers. Patient reported outcome measures (PROMs), which assess the quality of care delivered from the patients' perspective, are becoming increasingly important in documenting the effectiveness of such procedures. The Rhinoplasty Outcomes Evaluation (ROE) questionnaire, a validated PROM tool, was used to assess patient satisfaction in 141 patients undergoing septorhinoplasty surgery over a 90-month period at the University Hospital Southampton NHS Foundation Trust. Overall, 100 patients with a mean follow-up period of 36 months completed the study. The mean ROE score was 73.3%. In addition, 75% of patients questioned were happy with the final result of their operation and 83% would undergo the procedure again if required. These benefits occurred irrespective of age, sex and primary versus revision surgery, and were maintained for up to 71 months following surgery. This study has shown that patients are generally satisfied with their functional and cosmetic outcomes following septorhinoplasty surgery. These results help support the case for septorhinoplasty surgery to continue being funded as an NHS procedure.

Augmentation Grafts in Septorhinoplasty: Our Experience

Augmentation of nasal tip and/or dorsum forms the keystone of any Septorhinoplasty surgery. The grafts available for augmentation are numerous and varied. Choice of the graft depends upon the type of augmentation required, patient characteristics and, most importantly, the surgeon. In this article, we would like to present our experience with various augmentation grafts. In our experience, autografts are best grafts for augmentation. But in cases of revision surgeries or deficiency of autografts, allografts can be used. Our choice of allograft is Poly Diaxone Sheath or PDS.

Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery.

There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.

Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery

There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.

External nasal valve collapse: validation of novel outcome measurement tool

We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.

External nasal valve collapse: validation of novel outcome measurement tool.

We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.

Correlation of Bacterial Biofilm Grade with Clinical Features in Chronic Rhinosinusitis

Objective: The aim of this study was to determine the presence of bacterial biofilms in chronic rhinosinusitis (CRS) without polyps using scanning electron microscope (SEM) and to investigate whether there was correlation between grade of biofilm formation and clinical features of patients. Methods: This was a prospective observational study with two groups: the first group was composed of 20 CRS patients undergoing endoscopic sinus surgery (ESS) and the control group included 15 patients without CRS, undergoing septoplasty or septorhinoplasty surgery. Clinal data were recorded preoperatively; mucosal samples and culture materials were obtained intraoperatively. Specimens were investigated for detection of biofilms with SEM. A biofilm grading system from grade 0 to 4, according to biofilm prevalence on the surface, was proposed. Symptom score, allergy presence, previous ESS history, Lund-Mackay computed tomography (CT) score and culture results of patients were compared according to biofilm grade. Results: Biofilm formation was found in 16/20 (80%) CRS patients, yet none in 15 controls. Among CRS group, number of patients without biofilms (n=4) was too low to compare CRS patients with and without biofilms with each other, statistically. However, higher biofilm grades (grade 3 and 4) seemed to correlate with previous ESS and culture positivity but not with preoperative symptom score, Lund-Mackay CT score or allergy. Conclusion: A grading system for biofilms is essential and it should be established in order to perceive CRS pathophysiology and find new treatment targets.

Two different endotracheal tube manufacturing defects

Introduction: Although manufacturing defects related to airway equipment are not so common in practice, it risks the safety of the airway. Prompt recognition of equipment malfunction can prevent life threatening complications. Case Series: Case 1: A 25­year­old patient had anesthesia induction for septorhinoplasty surgery. After the patient was ventilated via mask and intubated without problem, peak and plateau pressures increased above 35 cm H 2 O on controlled ventilation. It was noticed that the anesthetic reservoir bag did not maintain adequate compliance in a setting of high peak and plateau pressure and was thought to be due to a faulty endotracheat tube (ETT) connecter. We noticed that lumen of ET tube connector was narrow and connecter has been changed. After this change the relaxation of the balloon and a decrease in the ventilator pressures were noted. Case 2: A 45­year­old female patient had anesthesia induction for hysterectomy. After induction it was noted that there was a leak in the circuit, which was traced to the connection between the ETT and the inflation tube. An opening at the point of the connection of the EET with the inflation tube was detected. ETT was changed and anesthesia was maintained with no further problems. Conclusion: Difficult ventilation after successful endotracheal intubation can be due to equipment failure such as faulty ETT connecter and faulty inflation tube.

Is the Sino‐Nasal Outcome Test‐22 a suitable evaluation for septorhinoplasty?

It is becoming increasingly important for clinicians to demonstrate the impact of their interventions. The Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire is a disease-specific questionnaire involving 22 symptoms combining rhinologic issues with general health issues. We evaluated the SNOT-22 score as a quality-of-life outcome measure in septorhinoplasty surgery. Outcome research. We carried out a prospective case series in 76 patients undergoing septorhinoplasty. Their SNOT-22 scores were compared pre- and postoperatively. We also recorded individual symptom scores to study the impact of surgery. To check its reliability, the SNOT-22 score was correlated to patient-reported symptoms on a visual analogue scale. Patients were screened for comorbid conditions. Interactions with the surgical technique and/or with the initial sinonasal disease were sought. The SNOT-22 is a reliable and responsive outcome measure in septorhinoplasty surgery. Septorhinoplasty was especially effective at addressing nasal obstruction, discharge, olfaction, related sleep disturbance, and emotional symptoms such as embarrassment or frustration. Comparison to the visual analogue scale instrument confirmed the outcome measured by the SNOT-22. The SNOT-22 could be used in routine clinical practice to highlight the impact of nasal disease in each patient and to measure the outcome and the effectiveness of the surgical intervention.

Functional and Aesthetic Results After Augmentation Rhinoplasty

IntroductionAugmentation rhinoplasty could be defined as the method whose goal is to increase the dimensions of the nasal pyramid, both the dorsum and the tip. For a long time, surgeons have used different kinds of materials that have often been the object of discussion.The aim of this study is to report our experience with augmentation septorhinoplasty, emphasising the type and nature of the grafts employed and the ensuing complications. Materials and methodsThis is a retrospective study describing the medical history of 188 patients who underwent septorhinoplasty surgery in our department over a period of 12 years, from January 1998 to April 2009. Of these patients, 42 underwent augmentation septorhinoplasty, which is the object of our study. ResultsIn 66% of the cases (28/42), quadrangular autologous cartilage was the “onlay” graft most widely employed; we used a single graft in 22 (85.7%) cases and a double one in the other 6 (21%).In 14 patients, it was necessary to use grafts of synthetic material: in all the cases Gore-Tex® was chosen, in 12 (28.5%) patients as the only graft material and in 2 (4.7%) used together with septal cartilage. ConclusionsNasal dorsum reconstruction requires the knowledge of different methods and surgical procedures, as well as the use of different types of grafts according to the needs of each patient. The ideal graft, which exists only as a concept, would be the one combining biocompatibility, a low complication rate and results that remained stable for a long time.At present, autologous cartilage, and more precisely septal cartilage, is still the first option for augmentation rhinoplasty. If septal cartilage is not available, we always turn to conchal cartilage grafts, from one or both sides depending on the amount of cartilage required.

Resultados funcionales y estéticos tras rinoplastia de aumento

Introduction Augmentation rhinoplasty could be defined as the method whose goal is to increase the dimensions of the nasal pyramid, both the dorsum and the tip. For a long time, surgeons have used different kinds of materials that have often been the object of discussion. The aim of this study is to report our experience with augmentation septorhinoplasty, emphasising the type and nature of the grafts employed and the ensuing complications. Material and method This is a retrospective study describing the medical history of 188 patients who underwent septorhinoplasty surgery in our Department over a period of 12 years, from January 1998 to April 2009. Of these patients, 42 underwent augmentation septorhinoplasty, which is the object of our study. Results In 66% of the cases (28/42), quadrangular autologous cartilage was the “onlay” graft most widely employed; we used a single graft in 22 (85.7%) cases and a double one in the other 6 (21%). In 14 patients, it was necessary to use grafts of synthetic material: in all the cases Gore-Tex® was chosen, in 12 (28.5%) patients as the only graft material and in 2 (4.7%) used together with septal cartilage. Conclusions Nasal dorsum reconstruction requires the knowledge of different methods and surgical procedures, as well as the use of different types of grafts according to the needs of each patient. The ideal graft, which exists only as a concept, would be the one combining biocompatibility, a low complication rate and results that remained stable for a long time. At present, autologous cartilage, and more precisely septal cartilage, is still the first option for augmentation rhinoplasty. If septal cartilage is not available, we always turn to conchal cartilage grafts, from one or both sides depending on the amount of cartilage required.

Prophylactic vs Postoperative Antibiotic Use in Complex Septorhinoplasty Surgery: A Prospective, Randomized, Single-blind Trial Comparing Efficacy

Prophylactic vs Postoperative Antibiotic Use in Complex Septorhinoplasty Surgery: A Prospective, Randomized, Single-blind Trial Comparing Efficacy