A Complete Subperichondrial Dissection Technique for Rhinoplasty With Management of the Nasal Ligaments

Çakır, Barış; Öreroğlu, Ali Rıza; Doğan, Teoman; Akan, Mi̇that

doi:10.1177/1090820x12445471

Cited by 119 publications

(43 citation statements)

References 12 publications

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“…In addition, infiltration beneath septal mucoperichondrium is said to aid the elevation of the mucoperichondrial flap by ''hydrodissection''. Although the effect of hydrostatic infiltration for subperichondrial dissection is controversial [13], numerous textbooks and authors advocated hydrostatic subperichondrial dissection [1][2][3][4]. Hydrodissection is mechanical, which means that it is independent of adrenalin's pharmacological effect, and can be gained from any fluid infiltrated under the mucoperichondrium.…”

Section: Discussionmentioning

confidence: 99%

“…Hydrodissection is mechanical, which means that it is independent of adrenalin's pharmacological effect, and can be gained from any fluid infiltrated under the mucoperichondrium. In our study, we preferred to compare the agents used for subperichondrial infiltration instead of regional nerve blocks since numerous authors advocated hydrostatic subperichondrial dissection [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Vasoconstrictor agents combined with local anesthetics are often used in nasal surgery to reduce bleeding and maintain adequate exposure. This infiltration also targets subperichondrial plane to take advantage of hydrodissection [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure

Güngör

Baklacı

Kum

et al. 2015

Eur Arch Otorhinolaryngol

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The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure

Güngör

Baklacı

Kum

et al. 2015

Eur Arch Otorhinolaryngol

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“…2 Unless the midline SMAS/Pitanguy (Superficial Muscular Aponeurotic System) ligament is preserved, the extended closed delivery approach can also cause significant edema due to the extensive and inherent nature of the dissection. 17 Through limited incisions and dissection, and by keeping mucosal bridges and a broad base of central and lateral alar margin undisturbed, the modified closed-open approach may partially avoid this complication. The often-decreased operative time, compared with both open and closed delivery approaches, is an additional bonus.…”

Section: Discussionmentioning

confidence: 99%

A Modified Closed-Open Approach as Part of a Graduated and Integrative Approach to Rhinoplasty

Röjdmark

Agko

2019

Indian J Plast Surg

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Introduction Open versus closed approach in rhinoplasty is a frequently debated topic in aesthetic plastic surgery. Although good results can often be achieved with either technique, both have unique advantages and disadvantages. In this investigation, we present our experiences of a modified closed-open approach that has been applied on 482 complex primary and secondary rhinoplasties. Three representative cases are described in more detail. Materials and Methods The procedure begins as a closed approach through an intracartilaginous incision allowing cephalic trimming of the lateral crura, dorsal rasping, and/or excision. Patients requiring extensive nasal tip maneuvers are subjected to exposure of the alar cartilage framework through a transcolumellar/limited marginal incision. This provides not only adequate exposure of the alar cartilages but also easy access to the septum. Conclusion In our hands, this approach is easy and expeditious. It requires less tip dissection, and therefore may avoid the prolonged postoperative edema that is often a consequence of open or extended closed tip delivery approaches.

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“…3,4 Besides meticulous surgical technique with maximum soft tissue and blood vessel preservation, few techniques are available to prevent long-term skin damage and shrinkage. 5,6 Autologous fat grafting of the nose is not a common technique, although there are studies providing evidence for faster postoperative recovery from bruising and swelling. 7,8 To our knowledge, the long-term effects of fat grafting on nasal skin quality and the long-term survival of free fat transplants in the nose have not been investigated so far.…”

mentioning

confidence: 99%

Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

et al. 2021

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A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

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A Complete Subperichondrial Dissection Technique for Rhinoplasty With Management of the Nasal Ligaments

Abstract: Subperichondrial dissection of the nasal framework allows reshaping and redraping of the nasal tip and controlled manipulation and repair of ligaments without disturbing the overlying soft tissue.

Cited by 119 publications

References 12 publications

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure

A Modified Closed-Open Approach as Part of a Graduated and Integrative Approach to Rhinoplasty

Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

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