Functional Role of Scroll Reconstruction in Open Rhinoplasty.

BACKGROUND: The scroll area of the nose is important for breathing; thereby, its reconstruction can improve the nasal patency. OBJECTIVE: To evaluate the effect of scroll reconstruction on breathing in patients following open rhinoplasty. METHODS: Using the prospective controlled study design, we enrolled a cohort of patients undergoing open rhinoplasty. The patients were randomly divided into two groups (each group with n = 14). The predictor variable was scroll reconstruction (yes/no). The main outcome variables include pre- and postoperative third-month peak nasal inspiratory flowmeter (PNIF) value (ml/min) and 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). Appropriate statistics were computed, and a P < 0.05 was considered significant. RESULTS: There was no demographic difference between both groups. Scroll reconstruction was associated with significantly improved PNIF post-surgery (P = 0.047). However, postoperative mean SCHNOS-O and SCHNOS-C was not different between the study and control groups (P = 0.58) CONCLUSIONS: This study suggests that scroll reconstruction helps improve nasal patency during forced inspiration in open rhinoplasty patients and provides a similar aesthetic outcome compared to the non-scroll-reconstructed group. Future research works should be done in a larger patient cohort. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of A Well-Known Technique with Ultrasound: Dorsal Grafting in Rhinoplasty.

OBJECTIVE: We aimed to evaluate the survival of a well-known camouflage technique using ultrasound imaging of the graft through the nasal dorsum and supratip. MATERIAL AND METHOD: Twenty-two patients (8 women and 14 men) who underwent primary rhinoplasty performed by the same surgeon in Isparta, Turkey, between December 2013 and February 2015, were evaluated in this retrospective study. We used the remaining pieces of harvested septal cartilage during rhinoplasty as autologous graft material and venous blood mixture as a scaffold in a Turkish Delight fashion. We used a 10- to 14-MHz broadband linear ultrasound probe (Toshiba Aplio MX ultrasound system, Toshiba Medical Systems, Tustin, California). The mean total skin thickness values through bone (nasal dorsum) and cartilage (upper lateral cartilage) were calculated for each patient. Data were recorded for statistical analysis. We evaluated the patients pre- and postoperatively on the seventh day, first month, sixth month, and just before the end of the first year using ultrasonography. We made detailed ultrasonographic images of the skin and the underskin through the bone sculpture and compared the measurements. All patients were scanned at the same time of day to exclude diurnal variation of dermal edema. Patients who presented for primary functional rhinoplasty were included in the study. RESULTS: Nasal dorsum cartilage was significantly thicker on the seventh postoperative day, but the difference was not statistically significant in the sixth month after surgery compared with baseline values. There was no statistically significant difference between preoperative measures and measures in the sixth month. The difference in supratip thickness was significantly greater on the seventh postoperative day, and there was a large difference at the first month compared with preoperative values, but this did not reach significance. There was no significant difference in supratip thickness between pre- and postoperative values at the sixth month. CONCLUSION: This method can be easily performed to reduce visual and tactual irregularities on the dorsum of the nose and can promote perfection on the dorsal esthetic line, but it is not sufficient for augmentation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Association of Skin Thickness With Alar Base Reduction in Patients Undergoing Lateral Crural Repositioning and Strut Grafting.

IMPORTANCE: Knowing the operation plan is important for rhinoplasty surgeons to prevent unpredictable results. OBJECTIVES: To investigate the frequency of alar base resection in patients with different skin thickness who underwent lateral crural repositioning and lateral crural strut graft and to evaluate the results in the context of the current literature. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series study included 621 patients who underwent primary open septorhinoplasty by the same surgeon between January 1, 2012, and June 30, 2015. From the surgical notes, operation type (lateral crural repositioning [LCrep] with lateral crural strut grafting [LCSG] and with or without alar base resection) and skin type were recorded. Study participants' skin types were determined intraoperatively and divided into 3 groups: (1) thick skin (the tip definition was limited by skin thickness and subcutaneous tissue), (2) thin skin (the tip cartilage was visible and could be observed despite overlying soft tissue and skin), and (3) normal skin (the tip cartilage during the procedure had no effect on the tip definition). MAIN OUTCOMES AND MEASURES: The rate of alar base resection according to the type of operation performed and patient skin thickness. RESULTS: Of the 621 patients in the study, 95 (15.3%) were men and 526 (84.7%) were women. Lateral crural repositioning with LCSG was performed in 319 surgical procedures (51.4%), and alar base reduction was performed in 329 (53.0%). The rate of alar base resection differed significantly on the basis of whether LCrep with LCSG was performed (odds ratio [OR], 1.82; 95% CI, 1.32-2.50; P < .001). In patients with thin skin, there was no significant difference in the incidence of alar base resection associated with LCrep with LCSG (OR, 2.034; 95% CI, 0.912-4.539; P = .08). In patients with thick skin, a significant difference in the frequency of alar base resection was associated with the application of LCrep with LCSG (OR, 1.995; 95% CI, 1.228-3.241; P = .005). In patients with normal skin, LCrep with LCSG had no significant association with the frequency of alar base resection (OR, 1.557; 95% CI, 0.930-2.607; P = .09). CONCLUSIONS AND RELEVANCE: The necessity of alar base reduction after LCrep with LCSG is greater in patients with thick skin than in patients with thin and normal skin. This study is the first to our knowledge to examine this topic in rhinoplasty. LEVEL OF EVIDENCE: 3.

Double-Blind Comparison of Ultrasonic and Conventional Osteotomy in Terms of Early Postoperative Edema and Ecchymosis.

BACKGROUND: Edema and ecchymosis are common complications of rhinoplasty. Modifications to osteotomy may reduce edema and ecchymosis and ameliorate postoperative discomfort in patients who undergo rhinoplasty. OBJECTIVES: The authors performed osteotomy with conventional instruments or with an ultrasonic device and compared these methods with respect to the severities of ecchymosis and edema in the early postoperative period. METHODS: Fifty-six patients who underwent primary rhinoplasty with medial oblique, low-to-high internal osteotomy performed conventionally or with an ultrasonic device were evaluated in a prospective study. Photographs of the patients on postoperative days 3 and 7 were scored for ecchymosis and edema by 2 physicians who did not perform the operations and were blinded to the osteotomy procedure. RESULTS: Ecchymosis scores on postoperative days 3 and 7 and edema scores on postoperative day 3 were significantly higher for the 22 patients who underwent conventional osteotomy than for the 34 patients who underwent ultrasonic osteotomy, as scored by both examiners. Edema scores on postoperative day 7 were significantly higher for conventional than for ultrasonic osteotomy as assessed by 1 examiner but were not significantly different as determined by the other examiner. CONCLUSIONS: The results of this comparative study suggest that rhinoplasty with ultrasonic osteotomy is associated with less edema and ecchymosis in the early postoperative period than is rhinoplasty with conventional osteotomy. LEVEL OF EVIDENCE: 3 Therapeutic.

Aesthetic and Functional Results of Lateral Crural Repositioning.

IMPORTANCE: Thin or cephalically malpositioned lateral crura cause nasal obstruction by depressing nasal valves and decrease patient satisfaction with rhinoplasty as a result of nostril asymmetry and alar collapse. OBJECTIVE: To demonstrate the aesthetic and functional efficacy of lateral crural repositioning with lateral strut grafting in patients with cephalic malposition of the lateral crura undergoing primary septorhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: We prospectively selected 80 patients with lateral crural malposition who underwent primary septorhinoplasty performed by the same surgeon from December 1, 2013, through May 30, 2014. The surgeon measured the angle between the lateral crura and midline intraoperatively with a goniometer to confirm malposition (angle, ≤30°). Data analysis was performed from March 13 to 23, 2015. INTERVENTION: All the patients underwent primary rhinoplasty with the open approach. Lateral crural repositioning with lateral crural strut graft was used in all selected patients. MAIN OUTCOME AND MEASURES: Preoperative and 6- and approximately 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation (NOSE) scale (range, 0-20; decreased scores indicate improved functional results) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaire (range, 0-24; increased scores indicate improved aesthetic results). RESULTS: Seventy-five of 80 patients were confirmed to have cephalic malposition intraoperatively. Four patients were excluded owing to selection of different surgical techniques, leaving 71 patients for analysis. The mean (SD) and median postoperative NOSE scores at 6 months (3.18 [3.12] and 2.0) and 12 months (0.39 [1.07] and 0) showed significant improvement compared with the preoperative scores (6.96 [5.10] and 7.0) (P < .01 for each comparison). The mean (SD) and median postoperative ROE scores also showed significant improvement at 6 months (21.06 [3.82] and 23.0) and 12 months (23.12 [2.09] and 24.0) compared with preoperative scores (7.03 [3.70] and 6.0) (P = .001). However, the changes from preoperative to 12-month postoperative scores (mean [SD] and median) were not significantly different between patients with normal (NOSE scores, 8.41 [4.59] and 90 to 0.28 [0.79] and 0, respectively; ROE scores, 6.97 [3.24] and 6.0 to 23.31 [1.91] and 24.0, respectively) and thin (NOSE score, 6.59 [5.09] and 8.0 to 0.11 [0.33] and 0, respectively; ROE scores, 7.76 [3.82] and 7.0 to 23.29 [1.72] and 24.0, respectively) skin types and those with thick skin types (NOSE scores, 5.52 [5.42] and 4.0 to 0.72 [1.54] and 0, respectively; ROE scores, 6.60 [4.16] and 6.0 to 22.80 [2.53] and 24.0, respectively) (P > .05). CONCLUSIONS AND RELEVANCE: Lateral crural repositioning is a useful and versatile technique to achieve successful functional and aesthetic results in a 1-year follow-up. We detected no significant difference by skin type in improvement of nasal function and aesthetic satisfaction. LEVEL OF EVIDENCE: 3.

Prolene mesh mentoplasty.

Augmentation mentoplasty is a cosmetic surgical procedure to correct chin retrusion or microgenia which usually requires placement of an alloplastic material over the pogonion, and which results in increased chin projection and a more aesthetically balanced facial profile. Polypropylene mesh is easy to purchase, widely available in a general hospital and most commonly used by general surgeons. In this series of 192 patients, we wanted to demonstrate our simple mentoplasty technique using prolene mesh that can easily be combined with a rhinoplasty procedure, with possible causes of infection and the rationale for using prolene mesh in such procedures.