Rhinoplasty Dissection Manual - part 10 potx

A reasoned approach to nasal base surgery.. The incomp etent external nasal valve: patbophysiology and treatment in primary and secondary rhinoplasty.. Surgery of the incompetent nasal v

Appendices 169

Photography Setup (1)

(Fig A-4)

Came ra : 5-mm SLR (single light reflex camera) with 105-mm macro lens

Lighting: dual elect ronic flash units; overhead kick er light adds a backlighting effect that

improves picture quality and sof tens or eliminates background shadows

Background: Nassau blue no 25

Film : Kodak Ekta chrome ASA 100

STANDARD RHINOPLASTY VIEWS

1:7, front al, base, lateral, oblique

1:5 and 1:3, close-up, base view

Background

/ I \ \

8

Camera

Figure 4 Schematic photography setup

REFERENCE

I Tardy ME.Brown R Principles ofp hotog raphy in f acia l p lastic s u rge ry New York: Thieme Publishers 992

~ -.=~

ij:

170 RHINOPLASTY DISSECTION MANUAL

Appendix K: Indications For External Rhinoplasty Approach

(1,2)

Asy mmetric n a s al tip Croo ked-no se deformity (lower t wo t hirds of n ose) Sadd le-nose deformity

C left- lip nasal deformity

Se condary rhin opla sty requ iring comple x s tr u ctural g rafting Septal -perforation repair

I loh nson CM 1r, Toriumi DM O pen st ructure rh inopla s ty Philadelphia: WB Saunders 1990

2 ToriumiDM, o hnson CM.Ope nstructure rhinoplasty:featured technicalpoint s and long-term follow -up Fa­

c ial P la st Surg Clin North Am 1993;I:1-22

Appendices 171

Appendix L:

Suggested Surgical

Instruments for

Rhinoplasty

1 Needle ho lder

2 Bay onet force ps

3 Ma llet

4 Takaha shi forceps

5 Siege l retrac tor

6 Co nverse retr actor

7 He most a t (curved)

8 He mo stat (straig ht)

9 S mall n asal s peculum

10 Large nasal s peculum

I S mall si ngle ski n h ook

1 2 Sma ll do uble skin h ook

13 Sm all doub le skin hook

14 Med ium do uble ski n hook

15 Wi de do uble skin hook

1 Fr eer/Cottle e levat or

1 Jose ph e levator

1 Co nver se scissors

1 Fo mon sciss ors

2 Stra ight Steve ns scissors

21 C urved Stevens scissors

22 Curved Iris sc issor s

2 Sc alpel h andle

24 Sca lpel h andle

25 Brow n -Adso n forceps

26 B rown-Adson fo rceps

2 Bis hop-Harmon forceps

28 Bis hop-Harmon forceps

2 2 0-mm ung uarded os teotome

30 3 0-mrn stra ight u nguarded os t eo tome

3 3.0- mm s tr a i g ht guarded os teotome

32 2 5-mm straig ht g uarded os teotome

3 Medical gra de sh arpening st one

3 Dors al ( Ru b i n) osteotomes : sma ll, m edium , arge

35 Ras ps with tun gsten-carbide i nserts: 1/ 2, 3/4, 5/6

36 Aia che carti lage crushe r

37 No 10 Frazier ti p suc tion

-II

-=?i:

-4- U1

172 RHINOPLASTY DISSECTION MANUAL

Appendix M: List of Selected Companies with Address/Phone Numbers

RHINOPLASTY INSTRUMENT SETS

Anthony Produ cts , Inc., Indianapolis, IN 800 428-16 10 Ell is Instruments, Inc , Madison, NJ 800 218-9082 Instruments Unlimited, Quakertown, PA 800 818-0094 Inv otec , Jacksonv ille, FL 800 998-8580

Lorenz Surgical , Jacksonville, FL 800 874-7711 MicroFrance , St Aub in, Fran ce 800-874-5797 Smith-Nephew-Richards, Madi son , WI 888 395- 8060 Snowden Pencer, Tucker, GA 800 843-8600

Storz Instrument s, St Louis, MO 800 325- 9500

Xo med Surgical Produ cts, Jack sonville, FL 800 874-5797

ALLOPLASTIC CHIN IMPLANTS

Allied Biomedical, Paso Roble s, CA 800 276-1322 Hanson Medical, Inc , Kingston, WA 800771-2215 Invotec , J ack sonville , FL 800 998-85 80

Porex Surgical, Inc , College Park , GA 800521-8145

W L Gore & Associ ates, Inc., Flagstaff, AZ 800 528-8763 Xom ed Surgical Products, Jacksonville, FL 800 874-5797

ALLODERM

Life Cell Corporation , The Woodlands, TX 800367-5737

DERMABOND (OCTYL-2-CYANOACRYLATE)

Ethicon, Somerville, NJ 800 888-9234

RHINOPLASTY POWER INSTRUMENTATION

Lin vatecIHall Surgical Products Group , Largo , FL 800 925-4255 United Ame rican Medical, McMinnville, TN 800 521-5002 Xom ed Surgical Products, Jacks onv ille , FL 800 874-5797

NASAL SPLINTS

Invotec, Jacksonv ille, FL 800 998-85 80 Shippert Medical Technologies (Denver Splints), Englewood , CO 800 888-8663

Appendices

Vision Medical (Thermo plast), Peoria, AZ 800 87

Xomed Surgical Products, Jacksonville, FL 800 8

INTRANASAL PACKS

Invotec, Jacksonville, FL 800 998

Xomed Surgical Products, Jacksonville, FL 800 8

: ~ -t-:

' ~,

174 RHINOPLASTY DISSECTION MANUAL

Appendix N: Selected Recommended

Literature

Adamson PA Open rhinopla sty In: Papel lD, Nachlas NE, eds Fa cial p lastic & reco nstructive s urgery St

Louis: Mosby Year Book , 1 992 : 295-304

Anderson JR A reasoned approach to nasal base surgery A rch Oto laryn gol He ad Ne ck Su rg 1984;110:349- 358

Becker DG,Tori umiDM, GrossCW,Tard yME Powered instrumentatio n fordorsalnasalreduction F acial P last

Su rg 1 997;13:29 1-297

Becker DG, Weinber ger MS, Greene BA, Tardy ME Clinical study of alar anatomy and surgery of the alar base

Arc h tolaryngo l H ead Ne ck Surg 1997 ;123:789-795 '

Beeson WHoThe nasal septum Otola ryng ol Clin N orth A m 1987;20:743-767

ByrdHS, AndochickS, CopitS,Walton KG Septa lextens iongrafts:a methodof controlling tipproject ion shape

P last R econstr Su rg J998;I00:999-1 0 IO

Byrd HS, Hobar Pc Rhinoplasty: a practical guide for surgic al planning P last R econstr S urg 1993;9 I:642-654,

discussion 655-656

CheneyML,GlicklichRE.Theuseofcalvarial bonein nasal reconstru ction Arch Otola ryng ol H ead Neck S urg

1995; 12 1:643-648

Constantian ME The incomp etent external nasal valve: patbophysiology and treatment in primary and secondary rhinoplasty Plast Rec onstr S urg 1994;9 3:919-93 3

Constantian MB,Clard y RB Therelative importance ofseptaland nasaJ valvularsurgeryincorrectingairwayob­

struction in primary and secondary rhinoplasty Plast Re cons tr S urg 199 6 ;98 : 38-54

Crumley RL, Lanser M Quantitative analysis of nasal tip projection La ryngoscope 1 998;98:202-208

• Dan iel RK Rhinoplasty and rib grafts: evolving a flexible operative tech nique P last Recons tr S urg 199 2;94 :

597-61 I

Farrio r RT The osteotomy in rhinoplasty Laryngos cope 1978;88: 1449

Goode RL Surgery of the incompetent nasal valve La ryngoscope 19 85;95 : 546-555

Gunter JP The merits of the open approach in rhinoplasty Pl ast R econstr S urg 1997 ;99: 863~867

Gunter JP, Clark CP, Friedm an RM Internal stabilization of autogenous rib carti lage grafts in rhinoplasty: a bar­

rier to cartilage warpin g Pl ast Re cons tr Sur g 1998;I00:161-1 69

Gunter JP, Clark CP, Friedm an RM Internal stabilization of autoge nous rib cartilage grafts in rhinopla sty: a bar­

rierto cartilage warping Pla st R econstr S urg 1997; J00: J6 1-169 Gunter JP, Friedman RM Lateral crural strut graft: technique and clinical applications in rhinoplasty Plast R e­

co nstr S urg 1 997;99:943-955

Gunter JP, Rohri ch RJ.Managementofthe deviatednose:theimportance of septal reconstruct ion C lin Plast Sur g

1988;15:43-55

GunterJP, Rohrich RJ.Augmentati on rhinopla sty:dorsal onlay grafting using shaped autogenous septalcartilage

Gunter JP, Rohrich RJ, Friedman RM Classification and correction of alar-co lumellar discrepancies in rhino­

plasty P last R econstr S urg 1996;97:643-648

Johns on CM Jr, Godin MS The tensi on nose: open structure rhinoplasty approach P last R e onstr Su rg 1 995 ; 95:

43- 51

Johnson CM Jr, Godin MS The tensi on nose [Letter, comment] Plast Re cons tr Su rg 1 996;97:246

Johnson CM Jr,Toriumi DM Op en s truc ture r hinop lasty Philadelphi a: WB Saunders, 1990

Kamer FM, Pieper PG Revision rhinoplasty In: Bailey B, ed H ead a nd ne ck sur ge ry o tolary ngo logy Philadel­

phia:Lippincott, 1998:26 63-2676

Kasperbauer JL, acer GW, Kern EB Reconstructi ve surgery of the nasal sep tum In: apal ID, Nachlas NE, eds

Fa cial plast i c a nd re const ruct ive surg ery Philadelphia: Mosby Year Book , 1992:337-343

Konior RJ, Kridel RWH Controlled nasal tip position ing via the open rhinoplasty approac h F acial Pla st C Un

Kridel RWH, Konior RJ Contro lled nasal tip rotation via the lateral crural overlay techn ique A rch Ot ol H ead

Ne ck Su rg / 991;117 :411 41 5

Larra bee WF Jr, Open rhinopl asty and the upper third of the nose Fa cial Pl ast S urg C lin Nonti Am 1993;1 :23-38

Metzin ger SE, Boyce RG, Rigby PL, Joseph Jl , Anderson JR Ethmoid bone sandwich grafting for cauda l septal

McCollou gh EG Surgery of the nasal tip O tolaryng ol C lin Nor th Am 1987;20 :769-784

McCollou gh EG, Mang at D System atic approac h to correction of the nasal tip in rhinoplasty A rch Oto la ryngo l

1981;J07: 12- 16

Murakami CS, Cook TA, Guida RA Nasal recon struction with articulated irradiated rib cartilage A rch Ot o­

Murakami CS, Larrabee WF Comparison of osteot omy techniquesin thetreatme ntof nasal fracture s Facial Pl ast

Rohri chRJ,HollierLH.Rhinoplasty withadvanc ingage:characteristics and management Clin Plast Sur g 19 96 ;

Appendices 175

Schwartz MS, Tardy ME tandardized photodocumentation in facial plas tic surgery F acial Plast Sur g 1990;7:

1-1 2

Sheen JH preader graft: a method of reconstructing the roof of the middle nasal vault follo wing rhinoplasty

Sheen JH Tip graft: a 20 year retrospect ive Plast R econ str Surg 1993;91 :48- 63

Simons RL Vertical dome division in rhinoplasty Ot olaryngol Clin N orth Am 1987 ;20 : 785-796

Sykes JM,Senders CW, WangTD,CookTA.Useof theopen approach forrepair of econdary cleftlip nasalde­

formity F acial Pl ast S urg C lin Nor th Am 1993;1:111-126

Tardy ME Rhinoplasty inmidlife Ot olaryngol Clin N orth Am 1980 ;1:289-303

Tardy ME.Ethics andintegrity in facialplastic surgery:imperatives forthe 21st century, Facial Pla st S urg 1 995 ;

11:111-1 15

Tardy ME, Becker DG, Weinberger MS Illusions in rhinoplasty Fa cial Pl ast Sur g 1995;11:117-13 8

Tardy ME, Broadw ayD.Graphic record-keep ing in rhino plasty: a valuable self-learningdevice F ac ial Pla st Su rg

Tardy ME, Brown R Surgic al anatom y o f the nose New York: Raven Press, 1990

Tardy ME, Brown R, Pr inciples o f ph otography in fa c ial plastic sur g e/ Yo New York:Thieme Publishers, 1992

Tardy ME,Cheng E.Transdomal suture refinementof the nasal tip F acial Plast Sur g 1 987 ;4:317- 32 6

797-823

Tardy ME, Denneny J, ritsch MH The versatile cartilage autograft in reconstruction of the nose and face Laryn­

g os c op e 1 9 85 ;95 :52 3- 53 2

Tardy ME,Genack SH, MurrellGL.Aesthet ic correction ofalar-columellar disproportion Facial Pl ast S urg Cl in

Nor th Am 1 995 ;3 : 395-406

Tardy ME, Kron TK, Younger RY, Key M The cartilaginous pollybeak: etiology , prevention, and treatment Fa ­

c ial Pl ast Surg 1989;6:113-120

S urg 19 89 ;9 : 27 5-284

Tardy ME, Patt BS, Walter MA Alar reduct ion and sculpture: anatomic concepts F acial Pla st Su rg 199 3 ;9 :

Tardy ME, Schwartz M, Parras G Saddle nose deformity: autogenous graft repair F acial Plast S urg 1989;6:

TardyME,ToriumiDM.Alar retraction:compositegraft correction F acial Pla st S urg 1 989 ;6:101-107

TardyME, Toriumi DM.Philosoph y and principlesofrhinoplasty.In:CummingsCW, FredricksonJM, Harker

LA, et al., eds Ot olaryngology-head & neck surgery 2nd ed St Louis: Mosby Year Book, 1993:278-294

Tardy ME, Toriumi DM, Walter MA, Patt BS The difficult nasal tip In: Gates G., cd Current t herapy in oto ­

Thomas JR Steps for a safer method of osteotomies in rhinoplasty Lary ng oscope 1 9 87 ;97:746-747

ThomasJR,Griner NR,Remml erDJ.Stepsfora safer method of osteotomiesin rhinoplasty Lar yn g sc op e 1 9 87 ;

Thomas JR, Tardy ME Uniform photographic documentation in facial plastic surgery Otolaryn gol C lin North

Am 19 80;13:367-3 81

Toriumi DM Management of the midd le nasal vault: perative techniques in plastic & reconstructive surgery

1995;2:16-30

Torium i DM Surgical correction of the aging nose F a ci al Plast Su r g 1996; 12:205-214

Pl a st Su rg Clin No rth Am 1993;1:1-2 2

Toriumi DM, Johnson CM Management of the lowe r third of the nose open structure rhinopla sty technique In:

Toriumi DM, Josen J, Weinberger MS, Tardy ME Use of alar batten grafts for correction of nasal valve collapse

Toriu mi DM, Ries WR Innovative surgical management of the crooked nose F acial Pla st Sur g CUn N orth Am

1993; I:63- 78

Toriumi DM, Sykes JM, Johnson CM Open structure rhinoplasty for managem ent of the non-caucasian nose

Toriumi DM, Josen J, Weinberger M, Tardy ME Use of alar batten grafts for correction of nasal valve collapse

Wang TD Aestheti c structural nasal augmentation Op e r T ech Ot olar yngol Head N ec k S urg 1990

- ~-~ r.

III '

:- ~lIjl

,11,,1

_U-'

~

A

Aesthetic analysis, I I, 15

Aesthetic/cosmetic issu

ala r base red uction,

closure of midcolumellar incision, 149, 50

Aesthetic trian le, 16,

Airway obstruction See Nasal bstructio

A , rhinoplasty analysis, 2

Alar bas

cleft p-nasal deform it

bilateral, 1

uiateral,

resectio , 113-11

alar wedge excision, 1, I IS

internal excisio s, 1

intern al nostril floor reduction, 113 11

pearl s, l

sli ing alar flap, 114, 1

wedgeexcisionof nostrilfloorandsill, 114,11

rhinoplasty analysis, 1

Alar batten graft, 105, 0

Alar -columellarelationship, 20, 2

Alar-facialgroo ve (junction), f, 3

Alar fl

internal nostril floor reductio n, 113, 1f

wedge excision of nostril floor and sill 114 11

Alar lobule, f, ,

Alar nasalis mu

Alar sidewa ll,

Anatomy of nse,

-musculature,

nasal relationships, S,

nasal valve area,

pearls,

scroll region,

septu ,

soft tissue layer,

surface anatomy, 2

basal iew, 2

font al view, 2

lateral iew,

o lique view,

surgic l anatomy, 3f-5

basal view,

la ral view,

oblique vie ,

vasculature, 4f-Anesthesia, infiltrative injection te hnique , 2 columella injection, 5, 26f,

intercartilaginous, transcartilaginous, or delivery approach, 27,

lateral wall of nose, 27 multip le injections along marginal inc isio n area, 25, 26 for osteo tomy, 27,

pearls, 2 soft-tissue, omal region,2 ,26 Anomalous nasi,

Anterior septal angle, Aquaplast cas t, application and removal,

Artery(ies), asal, 4f Auricular cartilag alar batten graft,

harvesting, 139, 140f-1 42f, 146-14

B Beve ling of skin edges, Bifidity nasal ti , Bleeding, septoplas Blood vessels, 4f-5

Bo e infarctio Bones, nasal, , infracture during osteotomy, 6 medializ

postoperati ve margins,smoothing with rasps, 62,63

pstoperati ve shifting,digitalexercises for, 1 Bossa for mati n, 22, 110, 1

Brow-tip aesthetic lines Bulbosity,

Buttress graft, 0 , 102f-10 Byrd' s method, nasal projection, 16, 1,

C

Calvarial bone, harve sting 144, 144f-1 46f, 1

Cap graft, 102, 102f Cartil

harvesting S ee Tissue harvestin

lower lateral (LLC) S ee Lower lateral cartil

q adrangul ,

- ,:,_- ~-i

179

180 SUBJECT INDEX

Cartilage t co ntd.i

sesa mo id,3f

upper lateral (ULC) S ee Upper lateral cartilage

Cartilage-spltting approach, 37, 38

Cephalic trim, 77,11

Cervi cal point, IOf, I I,

Chin alteratio

augmenta tion , 165

alloplas tic implant manufacturers,

Le an facial-convexity a gle, 1

Cleft lip- nasal deformity, I67f, 67- 1

bilateral , 167f,

unilateral, 67,

Colu mell a, 2f

cleft lip-nasal deform it

bilateral, 1

unilateral,

h ngin g columella d formity, septo plasty, 3

infiltrative anesthetic injection techniq ue, 5, 26f,

retr acte d, 1

c udal extension grafts, 118 118

plumpi ng graft , 1l7, 11

rhino p lasty analysis, frontal view, l7

Columella-labi ala gle (junction), 2f

Colu mell ar artery, f

Columellar flap, 47, 47f-49f

ele vation of, 47 49f

infiltrat ive anesthetic injection tec hniq ue,

Columell ar-labi al c nfluen e 1

Columellar -lob u lar ang le,

Columellar sh

normal value, 15,

rhinoplasty a aly sis, 15, 1

Columell ar strut cartilage graft, 56 81

dorsal onlay graft interd igitat g with S ee Sa dle n se deformit

placem e nt, 81-8

e donasal approac h, 81,8

e ternal rhin plas ty approach, 81,

tripod co cept, 1

Com plic ations, 1

Co mpressor muscl es, 4

Com pressor narium m or,

Compute d tomograph y (CT scan), concha bullosa , 78,

Concha bullosa, 78

Conchal cartilage S ee Auricu lar cartilag

Converse scissors, asal dissection 5 J

Corru gat or muscle,

Cru mley's method, nasal projection, 16,

Cyanoacrylate adhesiv

manufacturer,

skin closure, 11

D

D ivery approach 40-4

delivery ofL C ,41-42,4

intercarti lag inous inc ision , 40,

marginal incision, 41, 4

De pressor muscles,

De presso r septi nasi,

Derma bond S ee Octyl-2 -cya noa cry l

Digital exercises, postoperative , 1

Dilato r muscle s, 4

Dilator naris anterior, 4

Diss

a ricularcartilageharv esting 1 9,140 f-1

e ternal rhinop lasty approach Se e Externa l rhinop lasty a proac h, nasal

dissecti on

re

rib cartilag e h rvesting 1

septo lasty, 31, 32f,

D

divided, tip graft

divis ion Se e Nasal tip surg

identification , 8

Dorsal n sal artery , 4f

Dorsum of nose

c rtilagi nous, exposure and inc isio n for hump remo val, 59, 60f

c ntour assessment, anes thetic injection and,

irreg ularities, pos topera tive, 1

rhinoplasty analysis,

Dou ble break, 8

Dural tear, parietal bone harvesting,

E

Ede ma persiste nt postoperative sup ratip edema, 152-1 5

Elevator muscles,

Endonasal approach

alar batte n graft plac ment, 106f

c lumellar stru tca rtilage graft placeme nt,8 ,83f- 84f incision closure, 152, 152f

nasal dissectio ,

spreader grafts,71, 72f

Ethmoid bone

harve sting 14 , 14

perpe d ic ular plate, 4f

splinting (sand wich) grafts, 122, 123

External rhinoplasty ap proach, 4

anesthesia injectio n technique,2 -29,

26f-backgrou nd,

columella r strut carti lage graft plaem ent, 1 82

dissection, 4

in isions

indications for,

integrated dorsal graf t-co lumellar strut for saddle nose deformity, 3 marg inal incision, 43

colume llar extension, 45, 46f, 5

n sal di ection,

defining columellar flap, 47,4 f-49f

elevation of periosteum and expo sure of bony vault, 54-56, 55f excision of cephalic car

exposure ofc rtilaginousmid d le nasal vault, 54,54 f

flap elevation, 47 , 49f

incisio n marking, 43, 44f

lateral crus, 50, 1f

margina l incision, 43, 44f, 4

midcolumellar incision,43,44f,4 , 45f

midlin e d rsal dissection, 52, 52f- 53f

retrograde dissect ion ,

three-poi nt counter trac tion, 50 50f

pearls,

septoplasty, 3 , 34f

spreader graft placeme nt, 7 1, 72f-75 f

transcolumellar (midcolu mella r) incision,43 closure,

marking for, 43, 44f

F

Face

Frankfort plane, 1 , 3f,

horizontal faci al thirds, 1 , 12f,

surface measurem ent s, 22 23f