ABSTRACT
Brazil has always been a fertile place for plastic surgery techniques, especially cosmetic, and it was not different in rhinoplasty. In Brazil surgeons started using the dorsal preservation rhinoplasty in the 1970s. Techniques have changed, the problems and contraindications were challenged, and solutions proposed. As a result, indications were expanded to almost every kind of nose. Surface working executed with power tools, such as the piezoelectric device and the power drill, complemented the techniques and allowed for refinement in execution. Today the Brazilian preservation techniques are adopted and improved by many surgeons around the world.
Subject(s)
Rhinoplasty , Humans , Brazil , Rhinoplasty/methods , Nose/surgeryABSTRACT
Nasal dorsal preservation surgery was described more than 100 years ago, but recently has gained prominence. Our objective is to show the surgical technique, the main indications and counterindications, and the complications. It is a technique that does not cause the detachment of the upper lateral cartilage (ULC) from the nasal septum, and has the main following sequence: preparation of the septum and its resection can be at different levels (high or low, i.e., SPAR [septum pyramidal adjustment and repositioning] A or B); preparation of the pyramid; transversal osteotomy; lateral osteotomy(s); and septopyramidal adjustment. The result is a nose with a lower radix than the original, a deprojection of the nasal dorsum tending to maintain its original shape; an increase in the interalar distance (IAD) and enlargement of the nasal middle â ; and loss of projection of the nasal tip and roundness of the nostrils. Thus, the ideal candidate is the one who benefits from such side effects, that is: tension nose, that is, high radix with projected dorsum, projected anterior nasal septal angle (ANSA), narrow middle â , narrow IAD, thin nostrils and straight perpendicular plate of the ethmoid (PPE), and, depending on the characteristics, the deviated nose. The counterindications are low radix, irregularities in the nasal dorsum, ANSA lower than rhinion, and a wide middle â . And the main stigmas are: a nose with a very low radix, middle â enlarged, residual hump, and saddling of the supratip area. Other issues of this technique are: the shape of the radix; the need or not to remove PPE; wide dorsum; irregular dorsum; ANSA lower than rhinion; weak cartilages; long nasal bone; deviated PPE; and obsessive patient. We conclude that this is a great technique for noses with characteristics suitable to it; care must be taken with the stigmas it can cause.
Subject(s)
Rhinoplasty , Humans , Nasal Bone , Nasal Cavity , Nasal Septum/surgery , Nose/surgery , Osteotomy , Rhinoplasty/adverse effectsABSTRACT
Introdução: A cirurgia conservadora do dorso nasal baseiasena aplicação dos princípios de Cottle. O termo S.P.A.R.(Reposicionamento e Ajuste do Septo Piramidal), visa àconservação do dorso nasal sem que haja desinserção dacartilagem nasal lateral superior do septo nasal, ao contrário darinoplastia clássica. Objetivo: Descrição da técnica cirúrgicado SPAR. Método: Descrever os passos cirúrgicos utilizados erealizar revisão de literatura sobre os tratamentos cirúrgicos paratratamento do dorso nasal. Resultados: Descrição da técnicacirúrgica conservadora do dorso nasal pelo S.P.A.R. Discussão:Trata-se de uma forma de rinoplastia menos invasiva, porém nãomenos efetiva, não sendo necessárias técnicas adicionais parareconstrução nasal, além da preservação de estruturas essenciaisnasais. Trata-se de uma alternativa do tratamento em relaçãoàs técnicas tradicionais. Conclusão: É uma evolução do pushdown e das demais cirurgias conservadoras, tornando se umatécnica mais moderna e pode ser indicada para a maior partedos tipos nasais. São necessários mais estudos, principalmentecomparativos, que mostrem o seguimento tardio, sequelas,complicações e seus resultados em longo prazo. Palavraschave:septo nasal; Cartilagens nasais; procedimentos cirúrgicosOtorrinolaringológicos; Rinoplastia.
