Piezo-Assisted Dorsal Preservation in Rhinoplasty: When and Why.

BACKGROUND: Preservation rhinoplasty philosophy with its "down techniques" is currently undergoing a renaissance. Its goal is to spare and preserve noble nasal structures such as ligaments, nerves and vessels, reducing to a minimum local tissue manipulation and avoiding the drawbacks and pitfalls associated with classic dorsal reconstruction techniques often resulting in irregularities which often lead to an increased rhinoplasty revision rate. METHODS: In this article, we reviewed 107 consecutive cases in which a variety of preservation techniques were used. Indications, surgical techniques and complications are also described. RESULTS: All reported procedures showed low complication rates with good cosmetic and functional outcomes. CONCLUSIONS: Tailoring the surgical technique is essential in rhinoplasty. Authors have developed and present an anatomy-based diagram to help surgeons in choosing the right approach for dorsal surgery. 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 .

Spreader Graft Easy and Stable Fixation.

The original spreader graft described by Sheen was dissecting a sub perichondrial flap along the anterior edge of the septum and inserting the grafts in place and occasionally, fixing them with a mattress suture. Although it has been done usually with mattress suture, it has some disadvantages as the instability of the graft while it is being fixated and others. We present a different fixation method with a simple running suture instead.

Cutaneous leiomyomatosis and parotid pleomorphic adenoma.

We present a case of cutaneous leiomyomas (CL) arising in a pleomorphic adenoma (PA) of the parotid gland. PA and CL are benign tumors arising from the parotid gland and the erector pilli muscle, respectively. They both have a benign clinical course and in most cases leiomyomas are multiple in nature. PAs of the parotid are the most frequent benign tumors of the major salivary glands. To our knowledge this is the first case of PA with CL.

Cephalo-crural suture: a new way to deal with supratip fullness.

BACKGROUND: Supratip fullness is a common postoperative problem in rhinoplasty. There are approaches designed to reduce or augment the underlying framework and/or reduce the "dead space" between the skin and the cartilaginous structure, but these fail to create a stable midline framework in the supratip area. OBJECTIVE: In this report, a technique is described to surgically obtain a clinically desirable supratip breakpoint by creating, in the midline, a stable, symmetric, "stronger," well-shaped cartilaginous framework (flat or concave as needed) in the supratip area, with maximum preservation of the native alar cartilage. METHODS: An open approach was used for maximum preservation of the lateral crura by means of sutures and excision of only the overlapping midline lateral crura. A suture was placed between the preserved lateral crus, running caudally to both middle crura and back cephalically to the opposite lateral crus at the same level, and was tightened as needed. By doing this, a flat or concave supradomal structure was created in the midline. RESULTS: The procedure was performed in 20 primary open rhinoplasty patients with a minimum follow-up of 9 months. A pleasing supratip contour was obtained in all cases. The patients were satisfied and no functional complaints were noted. CONCLUSIONS: The use of the cephalo-crural suture improves the likelihood of obtaining a clinically acceptable supratip breakpoint, with good supratip contour and maximum preservation of nasal anatomy and physiology.