A Staging System for Revision Rhinoplasty

Rodman, Regina; Kridel, Russell W. H.

doi:10.1001/jamafacial.2016.0249

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…Five patients (3.5%), all of whom were stage IV according to the revision rhinoplasty grading system as described by the senior author (R.W.H.K. ), 15 presented with such severe nasal deformities before their surgery with us that the need for additional surgery was anticipated. The revision rhinoplasty grading system prognosticates the difficulty of a revision rhinoplasty depending on the presenting nasal deformities, the number and source of cartilaginous grafts required for nasal reconstruction, and the number of previous surgeries.…”

Section: Resultsmentioning

confidence: 99%

“…The nationally reported revision rates for primary rhinoplasty ranges from 5 to 15%, 15,[25][26][27][28][29][30][31] and is even higher for revision rhinoplasty. However, no article specifically discusses the revision rates for revision rhinoplasty; so, it is not possible to ascertain whether a minor or major revision was needed Fig.…”

Section: Discussionmentioning

confidence: 99%

“…in most instances. 15 Reasons for revision rhinoplasty range from the small deformities that can be corrected in the office to major cosmetic and functional deficits that require multiple procedures to address. A surgeon's true revision rate may also be confounded by the fact that patients usually return to their original surgeon for minor revisions, but will often seek a new surgeon for major revisions.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

Kridel

Delaney

2018

Facial plast Surg

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Septal perforation repair and septorhinoplasty (SRP) each present unique surgical challenges. However, in many instances, these procedures may be performed together successfully. In this study, the authors aim to determine the safety and effectiveness of combining primary or revision SRP and septal perforation repair via an open approach. A retrospective review was carried out of all consecutive patients who had SRP and septal perforation repair via an open approach between 1986 and 2017 in the senior author's practice. Perforation closure in surgery and at the patient's last follow-up, resolution of presenting symptoms, cosmetic results, and complications were analyzed. Records for 141 patients who had simultaneous septal perforation repair and SRP via an open approach, with a mean follow-up of 3.24 years, were reviewed. The mean anterior-posterior perforation dimension was 1.41 ± 0.89 cm, and the mean vertical perforation dimension was 1.16 ± 0.59 cm. The most common etiologies for septal perforation were previous SRP (35.4%) and septoplasty (24.1%). An overall 93.6%, perforation closure, 91.1% symptom relief, and 91.2% patient satisfaction with cosmetic results were achieved. Septal perforations under 1.5 cm in height were closed in 96.7% of patients as opposed to 71.4% of patients with perforations 1.5 cm or taller. Minor revision rhinoplasties were performed in 7.0% of patients. Postoperative infections were rare and noted in only two (1.4%) patients. In the largest study of its kind to date, the authors have shown that in experienced hands septal perforation repair may be performed simultaneously with primary or revision SRP via an open approach without compromising the perforation repair outcome. The vertical dimension of a septal perforation and presence of mucosa above and below a perforation are important considerations for the difficulty of a perforation closure, as septal mucosa is recruited from these locations in our technique of four-quadrant intranasal bipedicled mucosal advancement flap closure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

Kridel

Delaney

2018

Facial plast Surg

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“…Rhinoplasty is a technically challenging and complex surgical procedure with revision (failure) rates varying from 10–15% 2, 4, 19, 25 . To the general public it is often viewed dismissively as purely a cosmetic procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining or increasing nasal tip support after surgery is the most important element of both functional and cosmetic rhinoplasty and exceptionally important in order to achieve predictable steady-state outcomes. Rhinoplasty surgery is technically challenging and revision rates (failure) historically vary between 10–15% 2, 4, 19, 25 . Prior to performing surgery, one of the surgeon’s most informative physical examination maneuvers is nasal tip palpation.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Model and Validation of Nasal Tip Deformation

et al. 2016

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Nasal tip mechanical stability is important for functional and cosmetic nasal airway surgery. Palpation of the nasal tip provides information on tip strength to the surgeon, though it is a purely subjective assessment. Providing a means to simulate nasal tip deformation with a validated model can offer a more objective approach in understanding the mechanics and nuances of the nasal tip support and eventual nasal mechanics as a whole. Herein we present validation of a finite element (FE) model of the nose using physical measurements recorded using an ABS plastic-silicone nasal phantom. Three-dimensional photogrammetry was used to capture the geometry of the phantom at rest and while under steady state load. The silicone used to make the phantom was mechanically tested and characterized using a linear elastic constitutive model. Surface point clouds of the silicone and FE model were compared for both the loaded and unloaded state. The average Hausdorff distance between actual measurements and FE simulations across the nose were 0.39mm ± 1.04 mm and deviated up to 2mm at the outermost boundaries of the model. FE simulation and measurements were in near complete agreement in the immediate vicinity of the nasal tip with millimeter accuracy. We have demonstrated validation of a two-component nasal FE model, which could be used to model more complex modes of deformation where direct measurement may be challenging. This is the first step in developing a nasal model to simulate nasal mechanics and ultimately the interaction between geometry and airflow.

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Classifying Revision Rhinoplasy Complexity—The Impossible Dream?

Larrabee

2016

JAMA Facial Plast Surg

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A Staging System for Revision Rhinoplasty

Cited by 13 publications

References 8 publications

Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

Finite Element Model and Validation of Nasal Tip Deformation

Classifying Revision Rhinoplasy Complexity—The Impossible Dream?

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