ABSTRACT
Recognition and correction of septal abnormalities in rhinoplastic surgery has been a constant evolution aided by the development of an in depth anatomic understanding of the nose and the refinement of techniques based on the pertinent anatomy. Whether the deformity presents a functional, aesthetic, or combined problem, the authors prefer a single stage technique that separates the structural components of the nose, isolating the deformities present, and then reconstructing the components to effect a desirable result in terms of airway and appearance. Although no two nasal surgeries are identical, there are characteristic deformities that are noted to be generally more problematic. We briefly review normal septal anatomy as it pertains to the septorhinoplasty operation and then discuss our approach to specific septal variations that we have found to have a significant impact with regard to achieving satisfactory functional and aesthetic results.
Subject(s)
Nasal Septum/surgery , Rhinoplasty/methods , HumansABSTRACT
The objective of this study was to measure the effect of a single, preoperative 10 mg dose of dexamethasone on postoperative edema associated with rhinoplasty. This was a randomized, double-blind prospective study conducted in a military academic tertiary referral center. Twenty men, aged 18 to 45 years, were enrolled in the study over 28 months. All 20 men underwent rhinoplasty with osteotomy. Preoperative magnetic resonance imaging scans were obtained on the morning of surgery and postoperative scans were obtained within 48 hours. Postoperative edema was quantified as the difference in soft tissue thickness (mm) between the pre- and postoperative scans. Contrary to our expectations, the rhinoplasty patients who received dexamethasone had increased postoperative edema (p < 0.02) when compared to patients not receiving dexamethasone. This is the first objective, double-blind study that shows an increase in postoperative edema after rhinoplasty with a single preoperative dose of dexamethasone.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Dexamethasone/adverse effects , Edema/etiology , Nose Diseases/etiology , Rhinoplasty/adverse effects , Adolescent , Adult , Analysis of Variance , Anti-Inflammatory Agents/administration & dosage , Dexamethasone/administration & dosage , Double-Blind Method , Edema/diagnosis , Edema/prevention & control , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nose Diseases/diagnosis , Nose Diseases/prevention & control , Preoperative Care , Prospective StudiesABSTRACT
Large upper lip defects that include the surrounding aesthetic subunits of the midface are difficult to reconstruct. Abbé flaps have been a popular method of dealing with small upper lip defects but, as classically described, they are insufficient for larger defects. We performed cadaver injections to evaluate the vascular territory supplied by the inferior labial artery with particular attention to the submental area. Extended Abbé flaps were then designed and used in combined upper lip and midfacial reconstruction. Three cases and guidelines for the use of the extended Abbé flap are presented.
