Complications of the external (combination) rhinoplasty approach.

More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.

The external (combination) rhinoplasty approach for the problem nose.

The external (combination) rhinoplasty approach has gradually gained acceptance as an approach to expose the nasal infrastructure. Its wide exposure has sharpened diagnostic skills by correlating pre-operative clinical impressions with specific anatomic deformities found at surgery. Its wide access has greatly increased as well as simplified the range of surgical maneuvers used in reconstruction. Following a review of the external approach, attention is focused on some of the problem nasal deformities where this approach has been helpful in obtaining good results. Nasal valve obstruction, nasal tip problems, nasal pyramid depression, and the crooked nose are discussed in terms of pathological anatomy and techniques of repair.

Transseptal, transsphenoidal hypophysectomy via the external rhinoplasty approach.

The external rhinoplastic method provides a rapid and convenient route for transseptal transsphenoid surgery of the pituitary gland. This procedure offers several practical advantages over the conventional subnasal approach and should be seriously considered by rhinologists active in this area.