Skin Care and Treatments of Melbourne Dermatology - Plastic Surgery — Procedures/Protocols/Topics

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Plastic Surgery — Procedures/Protocols/Topics

Plastic Surgery — Procedures/Protocols/Topics

Wednesday, 14 December 2005

Nasal Tip Overprojection

Algorithm of Surgical Deprojection Techniques and Introduction of Medial Crural Overlay

Peyman Soliemanzadeh, MD; Russell W. H. Kridel, MD.

Arch Facial Plast Surg. 2005;7:374-380.

Objectives

To discuss the evaluation of the overprojected nasal tip, present an algorithm of various treatments for deprojection of the nasal tip, and introduce our experience of greater than 10 years with medial crural overlay.

Design

Retrospective review of a large sequential series of patients undergoing rhinoplasty who were treated with various deprojection techniques by the senior author (R.W.H.K.) from January 1, 1991, through December 31, 2002. Patients underwent preoperative and postoperative evaluation during this period on a regular basis to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction. Medical records and photographic documentation were reviewed. The occurrence of postoperative complications and secondary revision procedures were noted. We used the information obtained to evaluate and expound on an algorithmic paradigm for treatment of nasal tip overprojection.

Results

From 1991 to 2002, 130 cases used 1 or more of the senior author’s preferred methods for deprojection. Ten patients were excluded owing to the primarily reconstructive nature of their surgery. Of the remaining 120 patients, 3 (2.5%) underwent minor revision of dorsal irregularities and another 5 (4.2%) underwent tip revision. Only 9 patients (7.5%) required concomitant alar base reduction. One patient had postoperative epistaxis, and there were no cases of postoperative functional complaints.

Conclusions

Deprojection of the overprojected nasal tip can be accomplished successfully with a handful of properly used techniques. Once proper analysis has been accomplished, an algorithm can be used to help simplify the approach to deprojection. These techniques offer sound functional approaches to effect deprojection while controlling the level of rotation. The beneficial effects observed using this algorithm are attested to by the minimal number of complications, the relatively low number of patients requiring revision, and the overall long-term patient satisfaction with their results.

Author Affiliations

Division of Facial Plastic Surgery, Department of Otolaryngology— Head and Neck Surgery, The University of Texas Health Science Center, Houston.

Wednesday, 14 December 2005

Nasal Vestibular Stenosis - Postoperative Management

The Custom-Made Vestibular Device.

Dirk-Jan Menger, MD; Peter J. F. M. Lohuis, MD, PhD; Steven Kerssemakers, MD; Gilbert J. Nolst Trenité, MD, PhD

Arch Facial Plast Surg. 2005;7:381-386.

Objective

To evaluate the effect of a custom-made postoperative vestibular device on the occurrence and severity of restenosis.

Design

This was a retrospective study conducted at the Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery of the Academic Medical Center. In this tertiary care center between January 1994 and December 2000, 52 patients treated for nasal vestibular stenosis received a vestibular device directly postoperatively, with the intention to decrease the risk of restenosis. The vestibular device was composed of thermoplastic acrylic material and had a lumen to facilitate breathing. The shape of the device was custom-made within 1 week after surgery and was subsequently worn by the patient for 12 weeks (6 weeks continuously and 6 weeks only during the night). After this period, the occurrence and severity of restenosis of the nasal vestibule were evaluated and the necessity for a potential adjuvant operation was assessed.

Results

Preoperatively, of the 52 patients, 38 (73%) had severe stenosis, 13 (25%) had moderate stenosis, and 1 (2%) had mild stenosis. Postoperatively, 15 (29%) of the patients had mild restenosis, 1 had a case of moderate stenosis, and 1 had a case of severe stenosis. Only the latter patient required a subsequent revision. Functional improvement was noticed in 51 (98%) of the patients, whereas 49 (94%) of the patients showed aesthetic improvement after the initial procedure.

Conclusions

In case of surgical treatment of vestibular stenosis, the use of a custom-made vestibular device may help prevent restenosis. In addition to functional improvement, the device may also improve the aesthetic result. The device does not seem to have any negative adverse effects, was easy to make, and was comfortable for the patient to wear.

Author Affiliations

Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Academic Medical Center, Amsterdam, the Netherlands.

Tuesday, 17 January 2006

Midfacial Reconstruction - Use of Precontoured Positioning Plates and Pericranial Flaps to Optimize Aesthetic and Functional Outcomes

Yadranko Ducic, MD, FRCSC; Lance E. Oxford, MD

Arch Facial Plast Surg. 2005;7:387-392.

Objectives

To present our experience with reconstruction of midfacial defects using "precontoured positioning plates" with or without pericranial flaps and to describe our technique in detail.

Methods

Thirty-two consecutive patients with midfacial defects subsequent to oncologic resection that were reconstructed primarily with cranial bone grafts and precontoured positioning plates were reviewed for type of defect, functional outcome, complications, and postoperative appearance.

Results

Primary reconstruction of all defects in this series was performed. Defects involved the orbital rim, orbital floor, or both in 28 patients (88%), the body of the zygoma in 24 patients (75%), and extended to the skull base in 16 patients (50%). Pericranial flaps were used to cover the bone grafts in 22 patients (69%). Postoperative radiotherapy was performed in 22 patients (69%), preoperative radiotherapy in 5 (16%), and the other 5 (16%) had no radiotherapy. There were no intraoperative complications, and postoperative complications included plate exposure (n = 2), ectropion (n = 3), and partial bone graft loss or resorption subsequent to completion of radiotherapy (n = 2). Postoperatively, appearance was excellent in 24 patients, fair in 6 patients, and poor in 2 patients. Secondary reconstructive procedures were performed in 4 patients (12%). Follow-up ranged from 12 months to 6 years (median, 4.2 years).

Conclusions

Precontoured positioning plates with or without pericranial flaps enable precise reconstruction of midfacial defects with precise incorporation of cranial bone grafts. In our series we routinely covered the bone grafts with well-vascularized tissues, leading to a low incidence of complications and excellent aesthetic results.

Author Affiliations

Department of Otolaryngology—Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, and the Division of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, Fort Worth, Tex.

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