Simultaneous Rhinoplasty Research Articles

Orthognathic patients with nasal deformities: case for simultaneous orthognathic surgery and rhinoplasty

Orthognathic surgery is a recognised way of correcting dentofacial deformities and it is common practice to treat problems that affect the chin simultaneously, while deferring or not treating nasal deformities. There is inadequate published information about the prevalence of nasal deformities in such patients, and our aim was to remedy this. We retrospectively studied 75 patients with dentofacial deformities to find out if there was an association between nasal and dentofacial abnormalities. Forty-six of the 75 patients (61%) had mild to prominent cosmetic nasal problems, of whom 27 had deformities of the nasal bridge, 22 of the lobule of the nasal tip, 20 of nasal width, 14 in the width of the alar base, and 11 of the columella; 8 presented with deviation of the nose, and 6 with abnormal nasal length. Skeletal classes II and III had only slightly varied emphasis on nasal deformities. In comparison 14 patients (19%) had problems with the chin that required, or had already had, genioplasty. We also studied 9 patients who had had corrective bimaxillary surgery with simultaneous rhinoplasty. We set no formal questionnaire, but all patients expressed satisfaction with the postoperative results.

Simultaneous orthognathic and nasal surgery: is there a place?

Facial balance involves components of the upper, middle and lower face. Orthognathic surgery can have a dramatic effect on facial aesthetics. Similarly, rhinoplasty can cause a major change in facial appearance. Can, or should simultaneous rhinoplasty and orthognathic surgery be performed?

Simultaneous Functional Endoscopic Sinus Surgery and Esthetic Rhinoplasty in Orthognathic Patients

Patients treated for dentofacial deformities may be predisposed to aggravated sinonasal disease postoperatively, particularly if concurrent rhinoplasty is performed. The authors present their experience with simultaneous rhinoplasty, maxillary/mandibular osteotomies, and functional endoscopic sinus surgery (FESS). Thirteen patients were treated with simultaneous rhinoplasty, maxillary/mandibular osteotomies, and FESS from January 2002 to December 2005. An operative algorithm for patients with dentofacial deformities requiring rhinoplasty was developed. The surgical procedure was performed under general anesthesia with nasotracheal intubation and maxillary/mandibular osteotomies first. Nasotracheal intubation was then converted to orotracheal intubation and FESS was performed. The third step was correction of the esthetic deformities of the nose through an open approach. In all cases, it was possible to successfully complete the combined operation. Median operation time was: 2 hours and 18 minutes for orthognathic bimaxillary surgery, 54 minutes for rhinoplastic surgery; and 23 minutes for FESS. All the patients had good esthetic and functional results and were free from symptoms consistent with previous rhinosinusitis. The combination of orthognathic surgery, rhinoplasty, and FESS in selected cases is safe and effective.

The Efficacy of Melilotus Extract in the Management of Postoperative Ecchymosis and Edema After Simultaneous Rhinoplasty and Blepharoplasty

Melilotus extract has been used as a folk medicine in inflammation-related therapy. This study was undertaken to determine the potential benefits of this herbal extract in treating postoperative ecchymosis and edema after simultaneous rhinoplasty and blepharoplasty. Augmentation rhinoplasty and double-eyelid blepharoplasty were performed in one procedure by the same surgeon on 46 patients. Postoperative edema and ecchymosis were evaluated independently by two investigators checking the upper eyelid, lower eyelid, and paranasal area at postoperative days 1, 4, and 7. Our data showed that the patients receiving melilotus extract (n = 16) had lower scores not only in upper-eyelid and lower-eyelid ecchymosis, but also in paranasal ecchymosis at postoperative day 7 when compared with those in the control group. No significant difference in postoperative ecchymosis was detected in the group receiving dexamethasone treatment (n = 16) when compared with the control group (n = 14) at postoperative days 1, 4, and 7. The mean scores of upper-eyelid, lower-eyelid, and paranasal edema at postoperative days 1 and 4 were significantly lower in the group receiving dexamethasone treatment (n = 16) than that in the control group. Although the scores of eyelid edema reduction in the patients receiving melilotus extract showed no difference when compared with the control group, paranasal edema was reduced much more at postoperative days 4 and 7 when compared with the control group. We suggest the appropriate use of melilotus extract based on its beneficial effects on the postoperative results after simultaneous rhinoplasty and blepharoplasty.

Balanced Rhinoplasty in an Oriental Population

In Taiwan, augmentation rhinoplasty and double-eyelid blepharoplasty are the most popular aesthetic procedures. Although aesthetic concepts vary for different races, the current concept of nasal and facial beauty shows a tendency to correspond to that for white people. The authors present their 10-year experience with a simple and practical approach of simultaneous blepharoplasty and rhinoplasty. This study enrolled 255 consecutive patients who underwent simultaneous rhinoplasty and blepharoplasty between January of 1996 and December of 2005. All were Chinese in ethnic origin. The patients in the series were predominantly women. Only 10 were men. Five of the cases involved congenital palpebral anomalies including congenital entropion, congenital ptosis, and Down syndrome. A total of 245 patients had an adequate follow-up period longer than 5 years. The patients' satisfaction and postoperative complications were recorded. Among the 245 patients receiving the balanced rhinoplasty, there were no cases of implant extrusion, displacement, or infection. Most of the patients (230/245 cases, 94%) were satisfied with their nasal and periocular shape. The authors believe that simultaneous blepharoplasty and rhinoplasty are a simple and reliable method for effecting better results for Asians.

Osseous genioplasty in facial aesthetic surgery – a personal perspective reviewing 54 patients

The chin is an important and often neglected feature of facial balance. Genioplasty is a useful procedure in aesthetic surgery and often can be combined with other procedures to obtain an optimal aesthetic outcome. A retrospective case note review of the senior author's (BMJ) experience of aesthetic genioplasty over an 11-year period was undertaken. Cases with non-aesthetic indications for genioplasty were excluded and overall 64 patients were included in this study. Our technique of intraoral osseous genioplasty is described and discussed. A total of 54 patients underwent osseous genioplasty, eight underwent alloplastic genioplasty and two underwent removal of a chin prosthesis only. Most of the patients who had an osseous genioplasty had a sliding advancement correction. Four of these patients required secondary surgery, five had additional minor complications and there were seven cases of transient numbness. Nine patients had a genioplasty alone, 26 had one additional procedure and 19 had more than one, with an average of 2.9 additional procedures. Twenty-four patients had a simultaneous rhinoplasty and 18 had a facelift. Osseous genioplasty is our preferred technique for its versatility and long-term stability compared to alloplastic methods. If performed correctly it provides excellent results with a high degree of patient satisfaction and few long-term complications.

Primary Correction of Unilateral Cleft Lip Nasal Deformity in Asian Patients: Anthropometric Evaluation

Previously it was thought that primary correction of nasal deformity in cleft lip patients would cause developmental impairment of the nose. It is now widely accepted that simultaneous correction of the cleft lip nasal deformity has no adverse effect on nasal growth. Thus, the authors tried to evaluate the results of primary correction of cleft lip in Asian patients. Of 412 cases of cleft lip, 195 cases were corrected by means of the conventional method from June of 1992 to June of 1997, and 217 cases were corrected by simultaneous rhinoplasty from July of 1997 to October of 2001. The average patient age was 3 months. Photographs and anthropometric evaluation were used to evaluate the results. Nasal tip projection, columellar length, and nasal width were measured in 60 randomized normal children, 30 randomized children treated with the conventional method, and 30 randomized children with primary nasal repair. Data were analyzed using t tests, and the level of significance was 5 percent (p < 0.05). In cases of simultaneous repair, nasal tip projection and columellar length were increased 24.8 percent and 28.8 percent, respectively. Nasal width was increased 12.3 percent in the cases of simultaneous repair and 12.6 percent in the cases without primary rhinoplasty. Simultaneous repair of cleft lip and nasal deformity in Asian patients showed that more symmetry of nostril and nasal dome projection and better correction of buckling and alar flaring were achieved. More balanced growth and development of the alar complex was achieved, and no interference with nasal growth was encountered.

Esthetic management of extraction sites delayed to immediate loading protocols

will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present newer treatment approaches and technical modifications, as well as the clinical and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed: 1. Genioplasty A. Porous block HA and HTR augmentations B. Tenon and mortise osseous genioplasty 2. Anterior mandibular subapical osteotomy 3. Mandibular body osteotomy A. Anterior B. Posterior 4. Mandibular ramus sagittal split modifications A. Ramus and inferior border osteotomy B. Rigid fixation 5. Maxillary osteotomy modification A. Maxillary step osteotomy and rigid fixation B. Porous block HA grafting 6. Double jaw surgery A. Selective alteration of the occlusal plane B. Surgical sequencing of the maxilla and mandible C. Model surgery modifications 7. Simultaneous orthognathic surgery and rhinoplasty A. Surgical sequencing B. Rhinoplasty techniques Implementation of these techniques by the experienced, skilled surgeon, coupled with accurate diagnosis and treatment planning, should provide optimal functional and esthetic outcomes for our patients.

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbé flap revisited.

The purpose of this retrospective study was to review the method of using the Abbé flap for correction of secondary bilateral cleft lip deformity in selected patients with tight upper lip, short prolabium, lack of acceptable philtral column and Cupid's bow definition, central vermilion deficiency, irregular lip scars, and associated nasal deformity. A total of 39 patients with the bilateral cleft lip nasal deformity received Abbé flap and simultaneous nasal reconstruction during a period of 6 years. Mean patient age at the time of the operation was 19.1 years, and ranged from 6.6 to 38.5 years. The average follow-up period was 1.8 years. Fourteen patients had prior orthognathic operations. The Abbé flap was designed 13 to 14 mm in length and 8 to 9 mm in width and contained full-thickness tissue from the central lower lip, with a slightly narrow reverse-V caudal end. The prolabium, including the scars and central vermilion, was excised. Lengthening procedures of the upper lip segments were performed if vertical deficiency existed. Part of the prolabial skin was preserved and mobilized for columellar elongation, if indicated. Open rhinoplasty was carried out with or without cartilage graft for columella and nasal tip reconstruction. Reduction of the alar width and nostrils was achieved by a Z-plasty or excision of scar tissue at the nostril floor. The Abbé flap was then transposed cephalad, insetting into the median defect and sutured in layers. The results demonstrated no flap problems or perioperative complications. Seven patients needed further minor revisions on the nose and/or lip. Laser treatment was used to improve the lip scars in three patients. The patients were satisfied with the final outcome and found the lower lip scars acceptable. In conclusion, the described technique of Abbé flap and simultaneous rhinoplasty is an effective reconstructive method for select patients with bilateral cleft lip and nasal deformity.

Experimental study of the safety of simultaneous nasal and Le Fort I osteotomies.

This study evaluated the risk of unfavorable fractures extending to adjacent structures from nasal osteotomies during simultaneous rhinoplasty and Le Fort I osteotomy. Sixteen nasal osteotomies (medial and lateral) were performed in conjunction with Le Fort I osteotomy on eight fresh cadaver heads. Skin and soft tissue of the face were removed and the patterns of fracture along the nasal bones and the presence of unfavorable fractures extending from the nasal osteotomies toward the orbit, skull base, and the maxillary osteotomy site were assessed. All 16 nasal osteotomies were successfully performed with a single pass of the osteotome. The nasal bones were easily mobilized in every instance. There were 11 (69%) complete fractures and five (31%) greenstick fractures at the superior aspect of the nasal bones. There were no unfavorable fractures extending from the nasal fracture sites toward the skull base, orbit, or the maxillary osteotomy site. Simultaneous Le Fort I osteotomy and nasal osteotomies can be performed without significant risk of unfavorable fractures or extension of the fracture lines to adjacent structures.

Simultaneous Secure Endoscopic Sinus Surgery and Rhinoplasty

Simultaneous Secure Endoscopic Sinus Surgery and Rhinoplasty

Simultaneous rhinoplasty procedures in orthognathic surgery

22 septorhinoplasties were performed in conjunction with orthognathic surgery, and followed for at least 12 months. No significant difference could be established between 15 cases done with a LeFort I and 7 cases done with isolated sagittal split osteotomies. Rigid bicortical fixation of the mandible was required to change the endotracheal tube from nose to mouth. Plating of the maxilla is recommended to achieve a stable bony support for the nose. Patient satisfaction and perception were surveyed. Clinical results are presented with pre- and post-operative photographs, along with mean data for the total group.

Simultaneous rhinoplasty procedures in orthognathic surgery

22 septorhinoplasties were performed in conjunction with orthognathic surgery, and followed for at least 12 months. No significant difference could be established between 15 cases done with a LeFort I and 7 cases done with isolated sagittal split osteotomies. Rigid bicortical fixation of the mandible was required to change the endotracheal tube from nose to mouth. Plating of the maxilla is recommended to achieve a stable bony support for the nose. Patient satisfaction and perception were surveyed. Clinical results are presented with pre and post-operative photographs, along with mean data for the total group.

Rhinoplasty in the thick-skinned nose

The results of dermabrasion of the nose for correction of the thick skin are presented. The procedure was associated in some cases with simultaneous rhinoplasty and with bone grafting to the dorsum. This new application of an old technique has been followed by good results in well-selected cases. Poor results were related to inadequate judgment or poor technique.

Correction of deviated nose. Interim septal surgery vs combined approach.

Management of commonly encountered septal deviations is related to the timed performance of rhinoplasty for the correction of the deviated nose. Deviations of the septum, limited to the vomerine perpendicular plate in the area of the floor of the nose, can generally be corrected simultaneously with a rhinoplasty, as well as deviations of the caudal septum. However, if shortening of the septum is to be avoided, and if the supportive capabilities of the caudal septum have been compromised, postponement of the rhinoplasty is recommended. Deviations of the ventral-caudal septurn can occasionally be performed simultaneously with a rhinoplasty especially in patients with long noses and prominent bony cartilaginous humps. Frequently, it is advantageous to perform the septal surgery as a preliminary procedure followed, after an interval of time, by a rhinoplasty. In patients with extensive deviations involving the entire septum, simultaneous rhinoplasty is not recommended.