Morphological and functional evaluation of digital technology combined with endoscope-assisted surgery of crooked nose / 中华医学美学美容杂志

Objective:To explore the clinical effect of digital endoscopic-assisted one-stage rhinoplasty and septoplasty by using subjective and objective methods.Methods:Thirty-two patients with skeletal crooked nose and nasal septum deviated who underwent endoscopic-assisted rhinoplasty and septoplasty were included in this study from January 2015 to January 2020. This study used objective measurements such as 3D digital imaging technology and CT scans, as well as subjective measurements such as Visual Analogue Scale (VAS), Rhinoplasty Outcomes Evaluation (ROE) scale, Nasal Obstruction Symptom Evaluation (NOSE) and Functional Rhinoplasty Outcome Inventory (FROI-17) to evaluate the crooked nose morphology and nasal respiratory function before and after surgery.Results:Compared with preoperatively, postoperative 3D facial imaging results showed that the deviation distance and deviation angle of the crooked nose were significantly improved (both P<0.05), and the long-term effect of the operation was stable. Subjectively, the patient＇s appearance VAS score and ROE score were significantly higher than those before surgery, while the NOSE score and FROI-17 score of nasal congestion symptoms were lower than those before surgery. Conclusions:Endoscope-assisted one-stage rhinoplasty and septoplasty can achieve the purpose of repairing the nose appearance and improving the nasal respiratory function at the same time. Through a combination of subjective and objective evaluations, our study found that this procedure had the advantages of minimally invasive, stable effect and shorter recover time; meanwhile, this procedure has high patients＇ satisfaction and is worthy of clinical promotion.

Discussion on the micro-plastic operative treatment of nasal-septum deviation combined with crooked nose / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To explore the micro-plastic operative treatment of deviated nose combined with nasal septum deviation.@*METHODS@#We designed the incision at the caudal side of the nasal septum. The three-line reduction method for correcting nasal septum deviation was performed. The connection of the caudal nasal septum and the anterior nasal spine was reposited. The micro-plastic surgery with fixed suture was used to correct the deviated nose.@*RESULTS@#After the surgery, the nasal septum deviation was corrected, whose nasal function and symptoms improved without nasal adhesion, nasal septum perforation or other complications. Meanwhile, the nasal tips were in the middle place and nasal dorsums were straight. The aesthetic outcome was satisfactory.@*CONCLUSIONS@#Compared to the traditional orthopedic technique, the micro-shaping technique can be used for the homochromous operation of crooked nose combined with nasal septum deviation with less injury and lower risk. We suggest this micro-shaping technique be used in a rational way.

The Results of Unilateral Osteotomy to Correct the Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Osteotomy, usually carried out bilaterally, is a commonly performed procedure to correct the bony dorsum of deviated nose. However, it is an invasive maneuvers which can affect the stability of nasal bone and develop complications, such as, edema and ecchymosis. This study aims to evaluate the usefulness of unilateral osteotomy in correcting a deviated nose with various scoliosis. SUBJECTS AND METHOD: We studied 9 of the 69 patients who underwent corrective rhinoplasty with unilateral osteotomy to correct the bony nasal dorsum between 2010 and 2014. For patients whose bony nasal dorsum was corrected well after performing osteotomy on the convex side of the bony dorsum, the opposite side was not operated on; however, if correction was incomplete, osteotomy was additionally performed on the opposite side. For this study, patients who underwent bilateral osteotomy were excluded from the study. The improvement of correction was assessed by comparing the preoperative and postoperative photos. RESULTS: Of the nine patients treated with unilateral osteotomy, 5 cases were C or reverse C type deviations, 1 case was S type deviation and 3 were straight deviations. Five of the nine patients improved greatly and the rest improved significantly. None of the patients experienced worsening change postoperatively. CONCLUSION: Osteotomy is essential but invasive maneuver, so it is desirable to reduce the number of times to execute. By performing osteotomy on the convex side of the nose first, we can correct the deviated nose effectively while reducing the number of implementation.

Correction of Tilted Cartilaginous Nasal Dorsum with Clocking Suture Single Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Deviated nose is a commonly encountered deformity, and the correction of deviated nose is the most difficult part of septorhinoplasty. Generally, additional cartilaginous graft is required for straightening the deviated segment. However, there are many cases where sufficient cartilage grafts are not available due to revision surgery or cases with small cartilage. In such cases, tilted cartilaginous dorsum should be corrected without grafting. The purpose of this study is to evaluate the usefulness of clocking suture single technique for cartilaginous deviation by analyzing the surgical results of cases who underwent corrective rhinoplasty without any cartilaginous graft. SUBJECTS AND METHOD: From June 2009 to June 2016, 43 patients with tilted cartilaginous dorsum were corrected with clocking suture single technique. Cases underwent additional graft for straightening dorsum were excluded. The patients' medical records and facial photographs were analyzed to assess surgical outcomes and complications. Surgical outcomes were graded as excellent, fair and poor according to patients' satisfaction and evaluation by two physicians. RESULTS: Mean follow up period was 15.4 (5-39) months. There were 39 patients (90.7%) with excellent result, 3 patients (7.0%) with fair results, and 1 patient (2.3%) with poor result. Augmentation was performed with expanded polytetrafluoroethylene or septal cartilage in 26 patients (60.5%) and dorsal hump was removed in 22 patients (51.2%). Concomitant augmentation didn't affect surgical results. No postoperative complication such as infection or inflammation were found. CONCLUSION: The clocking suture single technique is an effective surgical method for the correction of dorsal cartilaginous deviation.

Correction of the Deviated Nose in Korean Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The surgical techniques based on the classification system based on Western individuals for the correction of deviated nose should be modified because of the differences in the anatomy of the nose for Korean individuals. To evaluate the usefulness of a classification system that has been designed for the esthetics and deviated nose of Korean individuals, we used that to analyze the surgical outcomes of rhinoplasty for deviated nose for 76 Korean patients. SUBJECTS AND METHOD: Seventy six patients who underwent rhinoplasty for deviated nose between January 2010 and June 2016 were reviewed retrospectively. All patients were classified with Jang's classification system and surgical techniques were analyzed according to the classification. Surgical outcomes were evaluated based on the preoperative and postoperative photo taken of the patient's nose. The degree of nasal deviation, tip projection index, nasofrontal angle and columellar-labial angle were measured. RESULTS: Deviated nose was classified into type I (34%), type II (26%), type III (13%), type IV (9%), and type V (17%). Preoperative and postoperative anthropometric measurements revealed that the mean degree of deviation changed from 8.84° to 3.01° (p < 0.01); the tip projection index changed from 0.54 to 0.58 (p < 0.01), and the degree of nasofrontal angle changed from 131.55° to 133.14° (p < 0.01). Aside from the residual deviations, complications included a shifting of the dorsal graft, an inverted V-deformity from the depression of the middorsum after the spreader graft and incomplete hump removal. CONCLUSION: Analysis based on the said classification system and personal esthetics showed good surgical outcomes for rhinoplasty to correct deviated nose. Therefore, it would be helpful to treat Korean patients for the correction of deviated nose by using both classification system and personal esthetics that are based on Korean individuals.

An initial survey of septorhinoplasty in crooked nose deformities

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Crooked  nose  deformity  is  a  commonly  seen  reason  for  septorhinoplasty  in  the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of  patients  with  crooked  nose  deformities  who  underwent  septorhinoplasty,  and  to  describe the different types of crooked nose by their level of deviation and surgical management in our institution.<br /><strong>METHODS:</strong><br /> <strong>  Design:</strong> Case Series<br />  <strong> Setting:</strong> Tertiary Public University Hospital<br /> <strong> Participants:</strong> A chart review of all patients with a crooked nose deformity who were admitted  at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.<br /><strong>RESULTS:</strong> A total of 21 patients underwent septorhinoplasty for crooked nose deformity  in  the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21patients  (76%) underwent  open  rhinoplasty,  while  the  rest underwent an endonasal approach. Twelve (57%) underwent intervention  on  the  nasal  fracture after at least a year (old or  neglected  fracture) as compared to the 9 (43%) who had  immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader  and camouflage, followed closely by dorsal onlay, and columellar strut grafts.<br /><strong>CONCLUSION:</strong> The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle  third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general. </p>

Manejo del dorso nasal: experiencia del Departamento de Otorrinolaringología del Hospital Clínico de la Pontificia Universidad Católica de Chile / Management of the nasal dorsum: Hospital Clínico de la Pontificia Universidad Católica de Chile, ENT Department experience

Introducción: Un dorso recto es uno de los principales objetivos para los pacientes que se realizan una rinoseptoplastía. Sin embargo, una resección dorsal excesiva puede traer consecuencias estéticas y funcionales. Objetivos: Describir la experiencia del Departamento de Otorrinolaringología del Hospital Clínico de la Pontificia Universidad Católica de Chile en el manejo del dorso nasal. Material y método: Estudio retrospectivo descriptivo. Se revisaron los protocolos quirúrgicos de los pacientes sometidos a una rinoseptoplastía entre enero de 2010 y junio de 2011. Resultados: Se recopiló un total de 153 pacientes, 67% mujeres. La edad promedio fue de 27,5 años. El abordaje fue abierto en el 78%%. Más del 95%% requirió resección dorsal osteocartilaginosa y osteotomías. El injerto espaciador fue el injerto dorsal más frecuente (51%%). En 101 mujeres y 47 hombres se realizó trabajo de punta nasal (p <0,05). Discusión: En nuestra experiencia el abordaje abierto nos permite obtener una visión más clara de la anatomía. La septoplastía, importante en el manejo de la obstrucción nasal, nos permite además obtener injertos de buena calidad. En pacientes de riesgo de colapso valvular, es importante una resección dorsal conservadora y considerar los injertos espaciadores.

Introduction: A right dorsum is one of the main objectives for patients who undergoes to rhinoseptoplasty. However, excessive dorsal resection can bring aesthetic and functional consequences. Aim: To describe the experience in the management of the nasal dorsum by the Hospital Clínico de la Pontificia Universidad Católica de Chile, ENT Department. Material and method: Retrospective study. All patient's surgical protocols of rhinoseptoplasty between January 2010 and June 2011 were reviewed. Results: 153 patients were collected, 67%% of them were women. The average age was 27.5 years. The open approach was performed in 78%%. Over 95%% of patients required dorsal osteocartilaginous resection and osteotomies. The spreader graft was the most commonly used dorsal graft (51%%). In 101 women and 47 men, nasal tip work were performed (p <0.05). Discussion: In our experience the open approach allows us to obtain a clear vision of the nasal anatomy. Septoplasty is important in the management of the nasal obstruction, and it permits to obtain good quality grafts. In patients at risk of valvular collapse is important a conservative dorsal resection and spreader grafts.

Correction of bent cartilaginous vault / 中华医学美学美容杂志

Objective To seek a method to correct the bent cartilaginous vault.Methods This study included 18 patients (12 women,6 men,aged 18-45 years) suffering from the bent cartilaginous vault with the various degrees of nasal obstruction from January 2005 to December 2009.A open surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the dorsum or nasal tip.The approach depended on full mobilization of deviated cartilage,removal of the deviated part of the quadrangular cartilage,followed by straightening of a caudal septal extension graft and its fixation in the corrected position.Rhinoplasty was performed to correct bent cartilaginous vault.Results A satisfactory result was gained in all clinical cases,except a septum still to remain light tilt (not affect the breathing function).Follwing-up for 3-24 months,all cases dorsum of nose was straighten and nasal septum situated mediately.All patients indicated cosmetic satisfaction of nasal dorsum and tip and improvement in nasal obstruction.No nasal deformity and septum tresis was found in all patients.Conclusions ()pen rhinoplasty is a helpful technique in the treatment of the bent cartilaginous vault.Septal surgery is necessary in the patients with cartilage framework,not only to improve breathing but also to achieve a straight,symmetrical and external nose as well.

Nasal osteotomy for rhinoplasty

The osteotomy for rhinoplasty is a useful method to make the nasal bony pyramid get narrow, correct the deviated nose and prevent the open roof deformity after hump nose resection. The osteotomy for rhinoplasty is divided medial osteotomy, lateral osteotomy and transverse osteotomy. If the osteotomy is well done, it produces very effective and esthetic results. However, the osteotomy has problems that precise operation is often impossible for the difficulty of the access and that the possibility of the complication is very high. We report our clinical experience about the osteotomy for rhinoplasty.

Nasal Obstruction in Patients with Deviated Nose

BACKGROUND AND OBJECTIVES: The objectives of the study are to investigate the incidence and characteristics of nasal obstruction and their association with the types and direction of external deviation among patients with a deviated nose. MATERIALS AND METHODS: Eighty-eight patients with a deviated nose without mucosal diseases in the nose from January 2004 to July 2005 were retrospectively reviewed. The overall incidences of nasal obstruction were assessed. Incidences of nasal obstruction by the types and direction of deviation in the external nose and by the direction of the septal deviation were also assessed. RESULTS: Seventy-two patients (81.8%) were found to suffer from various degrees of nasal obstruction. Left sided obstruction was more dominant irrespective of the direction of external nose. There was no relationship between the dominant sides of nasal obstruction and the type and the direction of the deviation of external nose. Among patients with a linear shaped deviated nose, the septum tends to deviate to the opposite side of the direction of the external nose. CONCLUSION: Nasal obstruction is commonly found among patients with a deviated nose. But not all patients suffer from nasal obstruction. To attain good aesthetic and functional results, a rhinoplastic surgeon should pay particular attention to this common findings among patients with deviated nose.

Correction of Deviated Nose: Importance of Rasping of Non-affected Side Nasal Bone Flap and Trimming of Non-affected Side Dorsal Septum

A total of 21 patients were operated. Via a columellar labial incision, the upper lateral cartilages were separated from the septum. A submucous resection of the septal cartilage was carried out. After rasping the convex lateral nasal wall of the unaffected side, a low-to-low lateral nasal osteotomy was conducted. Along the deviated dorsal line at the bony vault passing the submucous tunnel, a paramedian nasal osteotomy was performed. The convex side of the nasal bone flap was contoured by rasping. The convex side of the "T"-shaped dorsal septum was trimmed. A total direct septal extension graft of the septal cartilage was done and the alar cartilages were suspended to it. The postoperative results were evaluated by photogrammetric analysis processed by a "neon glow" filter in Adobe Photoshop. The distance from the nasal midline to the most deflective point at 5 levels was measured, and the proportion indices were obtained in regard to intercanthal distance. The results revealed improvement in all levels (p < 0.05), although not perfect. In summary, this technique can result in a clinically good-looking in spite of a slight deflection that still exists.

Total Septal Cartilage Reconstruction in the Severely Deviated Nose

BACKGROUND AND OBJECTIVES: Surgical correction of the severe septal deviation associated with the twisted nose is a difficult surgical challenge. Many maneuvers have been devised to correct and maintain correction of a severely deviated nose, especially a deviated caudal septum or a dorsally deviated L-shaped strut. But few of these reported techniques have corrected and maintained correction satisfactorily. Total septal cartilage reconstruction is a technique by extramucosal excision of the cartilaginous septum (total harvest of deviated septum) and replacement as a free graft (reinsertion of surgically straighten septum). We evaluated the validity of total septal cartilage reconstruction with regard to functional results as well as aesthetic results. MATERIALS AND METHODS: This retrospective study reviewed the patients' records in case of total septal cartilage reconstruction for a severely deviated nose. Information included the patient's age, sex, pre/postoperative gross view, pre/postoperative acoustic rhinometry, and subjective satisfaction rate as well as complications. Ten patients underwent total septal cartilage reconstruction from 1996 to 1999. Their age ranged from 17 to 46 years. 8 patients were men and 2 patients were women. RESULTS: All patients noted marked improvement of nasal blockade. Aesthetic improvement of the nose was obtained in all patients. No infections, hematoma, graft extrusions, saddle nose deformity, or distortion occurred in this series. CONCLUSION: Total septal cartilage reconstruction is a good technique suitable for those patients in whom severe obstruction, especially high in the vault in combination with severe deviation of the external nose so that more conservative techniques are insufficient to achieve the desired results.

Clinical Study on the Correction of Nasal Deviation: Using Open Septorhinoplasty

No abstract available.

Endoscopic-assisted correction of deviated nose

Owing to the complexity of the deviated structures and the septal deformities accompanying the external nasal deformities, the complete correction of the deviated nose is regarded as a difficult one. The approach to the nasal bone and osteotomy in classic corrective rhinoplasty is almost blind technique, where the results depends on the feeling by surgeon's hand. To overcome these drawback, endoscopic-assisted corrective rhinoplasty and septoplasty performed for 8 cases of deviated nose between January 1996 and May 1997. Average follow-up period was 10 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection and septal deviation. The postoperative courses were satisfactory in most of cases with few complications. It appears that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum what is causing deformity, and the immediate effect of the corrective measures used. The use of endoscope in corrective rhinoplasty will provide expanded field of vision, direct manipulation of lesions, and better aesthetic an6 functional results.

Endoscopic-assisted correction of deviated nose

Owing to the complexity of the deviated structures and the septal deformities accompanying the external nasal deformities, the complete correction of the deviated nose is regarded as a difficult one. The approach to the nasal bone and osteotomy in classic corrective rhinoplasty is almost blind technique, where the results depends on the feeling by surgeon's hand. To overcome these drawback, endoscopic-assisted corrective rhinoplasty and septoplasty performed for 8 cases of deviated nose between January 1996 and May 1997. Average follow-up period was 10 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection and septal deviation. The postoperative courses were satisfactory in most of cases with few complications. It appears that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum what is causing deformity, and the immediate effect of the corrective measures used. The use of endoscope in corrective rhinoplasty will provide expanded field of vision, direct manipulation of lesions, and better aesthetic an6 functional results.

Corrective Rhinoplasty Through the Correction of Combined Deformities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, the demand for corrective rhinoplasty has increased due to a higher frequency of accidents as well as improved socioeconomic status. Thus, there is an increased interest in the correction of deviated noses in the otorhinolaryngologic field. This study offers a clinical analysis of our experiences in the corrective rhinoplasty and makes a case that the simultaneous correction method by the exteral approach is suitable for combined deformities of the nose. MATERIALS AND METHODS: A retrospective study was performed on 69 patients who underwent corrective rhinoplasty during the last four years. Initially, patients were put under general anesthesia, and the procedures were performed through the external approach. Following the initial corrective rhinoplasty was a simultaneous correction of combined deformities of the nose such as deviated noses with saddle deformity or hump nose or camouflage of the deviation with one or two straight layered cartilage on the nasal dorsum. RESULTS: Satisfactory results were achieved in most cases except in the two cases of incomplete correction, one case of cosmetical unsatisfaction and one case of intermittent nasal obstruction. CONCLUSION: Deviated noses frequently have combined deformities. For better results, it is necessary to correct combined deformities simultaneously. The authors obtained satisfactory results through simultaneous correction of complicated deformities using the external approach.