ABSTRACT
As rhinoplasty becomes an increasingly popular procedure, the aesthetic expectations of both the facial plastic surgeon and the patient become more discriminating. Thus, the number of revision rhinoplasties increases. Of 697 rhinoplasties performed by the senior author (F.M.K.) during a three-year period, 18% of those procedures were revision surgeries. The senior author was the primary surgeon in 53% of those revision cases. This article presents an analysis of 126 consecutive revision rhinoplasty cases from that period, outlining the major deformities in a clinically meaningful system. Treatment of each problem category is discussed and representative cases are shown. The senior author's own revision rate and observations are discussed and compared with those in the medical literature.
Subject(s)
Rhinoplasty/methods , Adolescent , Adult , Female , Humans , Male , Middle Aged , Postoperative Complications , ReoperationABSTRACT
Auricular composite grafts are being used increasingly for repair of nasal deformities. Most commonly these grafts have been employed to repair alar rim and columellar defects secondary to trauma or tumor resection. A technique for reconstruction of the lateral crural area with auricular minicomposite grafts was used in a series of cases. Results have been satisfactory to alleviate the functional and cosmetic difficulties in patients requiring alar revision.
Subject(s)
Nose Deformities, Acquired/surgery , Rhinoplasty , Surgery, Plastic , Adult , Airway Obstruction/etiology , Airway Obstruction/surgery , Female , Humans , Nose Deformities, Acquired/complications , Nose Deformities, Acquired/etiology , Reoperation , Rhinoplasty/adverse effects , Rhinoplasty/methods , Surgical FlapsABSTRACT
Gillies' corner stitch (GCS) has been generally accepted for closure of skin flap tips because it is commonly believed that this stitch provides the best chance for survival of a flap tip that may have a compromised blood supply. There are no experimental data, however, to support such an assumption. To test the hypothesis that other stitches might be equally efficacious, we evaluated flap tip survival after closure with two different suture techniques, the GCS and a vertical loop stitch ( VLS ). Factors used to evaluate flap tip viability were the measurement of RBC movement in the flap tip by laser Doppler technique and measurement of the length of flap tip necrosis. In our model, the GCS is not superior to the VLS in terms of flap tip survival.
Subject(s)
Surgery, Plastic , Surgical Flaps , Suture Techniques , Animals , Face/surgery , Female , SwineABSTRACT
Nasal dermoid cysts with intracranial extension have been thought to be a rare entity. Seven new cases of nasal dermoid cyst with intracranial involvement were treated from 1975 through 1982 by combined otolaryngological-neurosurgical management. Preoperative radiological studies were helpful in predicting intracranial extension in only three cases. The extracranial lesion was resected by the otolaryngologist using surgical hemoclips to tag the dermoid remnant entering the cranium. These hemoclips were a helpful landmark for the neurosurgeon when resecting the intracranial extension through a bifrontal craniotomy approach. In four cases, the dermoid cyst entered the cranium through a persistent foramen cecum and lay within the falx in association with a bifid crista galli. We think that this entity is more common than was previously appreciated. Patients with a diagnosis of nasal dermoid should undergo polytomography or computed tomography of the glabellar area. Even when all x-ray studies are negative, neurosurgical preoperative evaluation and operative standby should be obtained before the otolaryngologist attempts the resection of a nasal dermoid cyst.
