Dorsal Preservation Rhinoplasty: Core Beam Computed Tomography Analysis of the Nasal Vault, Septum, and Skull Base—Its Role in Surgical Planning

Sadri, Amir; East, Charles; Badia, Lydia; Saban, Yves

doi:10.1055/s-0040-1712538

Cited by 21 publications

(10 citation statements)

References 5 publications

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“…According to their results, junction points were located caudal to the dorsal osteotomy lines in only 5 adult patients. 27 In our study, in 31 patients, the junction point was located caudal to or in the same axis as the dorsal osteotomy line. In their study distance between transverse osteotomy line and junction point was 7.25 mm.…”

Section: Discussionmentioning

confidence: 65%

Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography

Demirel

Atesci

2021

Journal of Craniofacial Surgery

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Background: Nasal dorsum reconstruction is a crucial step of the rhinoplasty. For avoiding complications, techniques that preserve natural dorsal anatomy becomes popular recently. In preservation techniques, ethmoidal bone surgery may take part in the vast majority of defined techniques. Therefore, detailed anatomical knowledge is essential to avoid severe complications, especially cerebrospinal fluid leakage. Based on these, this study aimed to investigate anatomical safe boundaries of preservation techniques based on the measurements on computed tomography. Methods: A total of 100 patients who underwent paranasal computed tomography were enrolled in this retrospective study. Five groups were selected based on the age distribution. The distance of the dorsal osteotomy line to cranial base, amount of cartilaginous/bony septum overlaps under nasal bones, cartilaginous/bony septum length anterior and posterior to the nasal hump starting point, and anteroposterior distance of perpendicular plate was measured. Results: The mean distance between the starting point of the nasal hump and the cribriform plate was 29.5 mm. The amount of bony overlap above the cartilaginous septum was 10.9 mm in females and 10.5 mm in males. The length of septal cartilage posterior to nasal hump was 0 mm in 39 of 100 patients (39%) and the mean value was 2.38 mm in all populations. The mean distance from the starting point of the perpendicular plate to the cribriform plate was 28.17 mm. Conclusions: Perpendicular plate may take part in the constitution of the nasal hump. Therefore, delicate surgery with appropriate tools needed for avoiding the risk of skull base injury.

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Section: Discussionmentioning

confidence: 65%

Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography

Demirel

Atesci

2021

Journal of Craniofacial Surgery

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“…In all these phases, 3D modeling can help to better manage the patient, allowing to simulate each branch of the possible decision tree and to actively recognize anatomical landmarks as transverse radix osteotomy point (TROP) to avoid surgical complications. 4 For instance, it is important to identify any part of the perpendicular plate of the ethmoid before surgery, to avoid dangerous maneuvers and fracture to the cribriform plate, with consequent cerebrospinal fluid leakage.…”

Section: Discussionmentioning

confidence: 99%

“…3 Indeed, most limiting conditions to rhinoplasty originate in the low diagnostic imaging capacity to characterize this region in the pre-surgical phase. 4 More frequently, the nose's structures are studied using computed tomography. 5 Such technology allows the high spatial resolution analysis of most parts of the nose, especially the bone components.…”

Section: Introductionmentioning

confidence: 99%

Rhinoplasty Pre-Surgery Models by Using Low-Dose Computed Tomography, Magnetic Resonance Imaging, and 3D Printing

et al. 2021

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Rhinoplasty and surgical reconstruction of cartilaginous structures still remain a great challenge today. This study aims to identify an imaging strategy in order to merge the information from CT scans and magnetic resonance imaging (MRI) acquisitions and build a 3D printed model true to the patient’s anatomy, for better surgical planning. Using MRI, information can be obtained about the cartilage structures of which the nose is composed. Ten rhinoplasty candidate patients underwent both a low-dose protocol CT scan and a specific MRI for characterization of nasal structures. Bone and soft tissue segmentations were performed in CT, while cartilage segmentations were extrapolated from MRI and validated by both an expert radiologist and surgeon. Subsequently, a 3D model was produced in materials and colors reproducing the density of the three main structures (bone, soft tissue, and cartilage), useful for pre-surgical evaluation. This study has highlighted that the optimization of a CT and MR dedicated protocol has allowed to reduce the CT radiation dose up to 60% compared to standard acquisitions with the same machine, and MR acquisition time of about 20%. Patient-tailored 3D models and pre-surgical planning have reduced the mean operative time by 20 minutes.

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“…One-year follow-up is adequate for an article, but inadequate in terms of long-term longevity of dorsal preservation in particular. The reader interested in larger studies with long-term follow-up is referred to articles by Saban et al 17,28,29 . Finally, no formal airway obstruction measurement tool was used although none of the patients in this series subjectively complained of airway obstruction and no anatomical nasal obstruction was noted on postoperative examination.…”

Section: Patient Selectionmentioning

confidence: 99%

A 3-Level Impaction Technique for Dorsal Reshaping and Reduction Without Dorsal Soft Tissue Envelope Dissection

Finocchi¹,

Vellone

Mattioli

et al. 2021

Aesthetic Surgery Journal

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Background Preservation Rhinoplasty (PR) techniques are continuously evolving in the last two years. Many variations of old-fashioned techniques have been proposed since Daniel coined this term in 2018. Objectives Authors want to describe indications for a new “three level impactions” technique allowing, in selected cases, a complete profile correction and dorsal reduction without the dorsal soft tissue envelope (STE) dissection. Methods Three hundred fifty primary closed rhinoplasty cases were retrospectively studied from January 2018 and October 2019. Age, sex, race and technical details, surgical time and complications have been registered. Ninety-five dorsums were reduced and shaped without dissecting the dorsal soft tissue envelope, combining a 1) swinging door septoplasty with low septal strip resection, 2) endonasal bony cap mosaic osteotomies, and 3) Let down or Push down operation (LDO/PDO). Results All patients showed a dramatic change in profile height and shape without neither dorsal STE dissection nor bony cartilage dorsal tissue resection. The average follow-up time was 14 months (range, 12-16 months). Conclusions In selected patients, dorsum can be preserved without soft tissue envelope dissection. By combining multiple endonasal maneuvers is possible to obtain a dramatic change without dissecting the soft tissue envelope and at the same time avoiding any dorsal tissue resection: mosaic osteotomies for DKA conversion from S to V shaped dorsum, LDO and low septal strip resection for impaction and quadrangular cartilage flap rotation for profile setting. It is a versatile technique in selected patients, which leads to fast recovery and natural results.

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Dorsal Preservation Rhinoplasty: Core Beam Computed Tomography Analysis of the Nasal Vault, Septum, and Skull Base—Its Role in Surgical Planning

Cited by 21 publications

References 5 publications

Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography

Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography

Rhinoplasty Pre-Surgery Models by Using Low-Dose Computed Tomography, Magnetic Resonance Imaging, and 3D Printing

A 3-Level Impaction Technique for Dorsal Reshaping and Reduction Without Dorsal Soft Tissue Envelope Dissection

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