Perforating osteotomies in rhinoplasty.

While perforating lateral osteotomies have been previously described by other authors, most of the current literature emphasizes only sliding lateral osteotomies. Therefore, we present our experience with 106 consecutive rhinoplasties performed with perforating lateral osteotomies with a minimum 2-year follow-up. The perforating lateral osteotomy technique used in these rhinoplasties is described in detail and is compared with those techniques previously reported for perforating lateral osteotomies in rhinoplasty. Anatomical considerations are discussed. The results with the perforating lateral osteotomy technique have been excellent and are also presented. We think that perforating lateral osteotomies are an important and useful part of the rhinoplasty armamentarium.

Endoscopic paranasal sinus surgery: radiographic evaluation of severe complications.

PURPOSE: To report our experience with the radiographic evaluation of severe complications resulting from the functional endoscopic sinus surgery (FESS) procedure. PATIENTS: Ten major complications were reviewed retrospectively. FINDINGS: Ten major complications occurred. Eight of 10 had injury to the floor of the anterior cranial fossa, fovea ethmoidalis (roof of the ethmoid sinus), or roof of the sphenoid sinus. Six patients presented with meningitis or rhinorrhea, two presented with headache and massive pneumocephalus; one patient who presented with meningitis had a large nasal frontal encephalocele. Noncontrast brain CT that included the paranasal sinuses adequately evaluated the source of pneumocephalus. Thin-section coronal CT accurately predicted the site of leak in five patients. Both coronal sinus CT and MR imaging were useful to confirm the nasal encephalocele. Two of 10 had vascular injury secondary to FESS. One patient presented with subarachnoid hemorrhage seen on noncontrast CT and cerebral angiography demonstrated an aneurysm of the anterior cerebral artery. The second patient suffered severe intraoperative hemorrhage. Emergency angiography revealed a pseudoaneurysm of the cavernous carotid artery, and balloon occlusion of the artery was performed. No deaths occurred in this series. CONCLUSION: Radiologists should be familiar with the rare, but potential complications of this commonly performed procedure in order to help direct the work-up in an efficacious manner.