The Complicated Changes of External Nose after Corrective Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Rhinoplasty is not a simple technique but a series of interrelated, interdependent surgical maneuvers performed consequently. Each maneuver should be calculated to correct the total nasal deformity by creating a series of small defects or repositioning various anatomic components that must ultimately fit together. The purpose of this study is to review undesirable complicated changes that occur in the external nose following corrective rhinoplasty and to provide useful reference for better practice in rhinoplasty. MATERIALS AND METHODS: We have carried out 42 cases of corrective rhinoplasty from January, 1994 to December, 1998. We have observed complicated changes of the external nose after corrective rhinoplasty by conducting serial photogaphic documentation and analyses, questionnaires which were answered by the patients and the surgeons. RESULTS: We analyzed the various undesirable complicated changes and found out that the most common changes were widening of the nasal dorsum. The major causes of this nasal widening were the failure of perfect osteotomy, inadequate postoperative contouring, aging process of patients' nose, and the lack of ability of surgeon to predict the healing dynamics. CONCLUSION: To prevent and to minimize such undesirable changes following corrective rhinoplasty, surgeons need to gain skillful surgical techniques and adequate postoperative contouring skills. Most importantly, a thorough appreciation and understanding of the healing dynamics of rhinoplasty should be recognized.

Clinical Analysis of Epistaxis : Result of the Recent 10 Years / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis is a common occurrence and most of us have at least one episode in a life time. These episodes are usually minor events and resolved spontaneously, although those who need help can be admitted. It is important to know about etiologic factors of each case of epistaxis, sex and age distribution of patients, bleeding site, seasonal incidence and methods of management. MATERIAL AND METHOD: We performed a retrospective study of epidemiology, etiology and control methods and their effectiveness in patients of epistaxis who visited Korea Veterans Hospital out-patient department in otolaryngology and emergency room from January, 1990 to December, 1999. RESULTS: It was more prevalent in male and commonly occured in the left nasal cavity. Incidence of epistaxis was the greatest in the month of May and the least in August. Among the age groups of patients, it was most prevalent among the fifties followed by the twenties. The most common cause was idiopathic, with the local causes being more attributable. It was found to easily occurr in the convex side with septal deformity. Kiesselbach's area was the most common bleeding site, although when compared with previous reports, the incidence rate has been decreasing. Recurrent bleeding was more common in posterior epistaxis. Most cases were adequately managed with anterior nasal packing (65.4%), but in the minority, posterior nasal packing and blood transfusion were needed. CONCLUSION: Incidence of bleeding have increased and the most frequent bleeding sites have become more variable, because of the increasing rate of air pollution, cerebrovascular accidents and heart diseases. Epistaxis easily occurred when the atmospheric changes were severe. Further prospective studies are mandatory to clarify the correlation between epistaxis and multifactorial causes.

Evaluation of Augmentation Rhinoplasty and Tip Surgery Using Cartilage Autograft by Standardized Lateral View of Photodocumentation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Nasal tip projection and dorsal realignement are important defining features of nasal profile. Recently, the use of rhinoplasty has increased by rhinologic surgeons and good cosmetic results have been reported. But, sufficient analysis of postoperative results is not presented in augmentation rhinoplasty. We aimed to evaluate the augmentation rhinoplasty using pre- and postoperative lateral view under similar conditions. MATERIALS AND METHODS: We performed 22 cases of augmentation rhinoplasty with cartilage auteograft (8 males and 14 females, aged 21 to 53 years) between September 1997 and August 1998. Using lateral view, pre- and postoperative nasofrontal, nasofacial, nasolabial, nasal tip rotational angle, and height of nasion, depth of the nasion, tip projection, tip angle were analysed. RESULTS: The increment of nasofrontal angle was 3.3degreesin males and 3.8degrees in females. The increment of height of the nasion was 1.4 mm in males and 2.1 mm in females, and the increment of tip projection was 1.3 mm in males and 1.7 mm in females, and the increment of tip angle was 1.6degreesin males and 2.1degreesin females. The increment of nasofacial angle was 2.9degrees in males and 3.9degrees in females, and the increment of nasolabial angle was 0degrees in males and 1.6degreesin females. The increment of nasal tip rotational angle was 0.2degrees in males and 0.7degreesin females, respectively. CONCLUSION: We achieved good cosmetic results by cartilage autograft and hoped to increase the efficacy of augmentation rhinoplasty in future, based on this study.