The Problem Dorsal contour irregularities You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
The Problem Nasal airway obstruction due to inferior turbinate hypertrophy. The Background When planning a facial cosmetic procedure such as a rhinoplasty, the ideal result should meet the aesthetic goals of both patient and physician without sacrificing function. This is especially important when considering the nose, since the aesthetic goal is often a reduction in size, which may lead to nasal airway narrowing. Many surgeons today…
The Problem Turbinate hypertrophy is a common cause of functional problems in patients undergoing aesthetic rhinoplasty. Failure to diagnose and treat the problem may cause the persistence of the obstructive symptoms in a large group of patients and even cause a flare up of symptoms in others. Even minor modifications in nasal airflow during different steps of rhinoplasty such as hump removal, tip surgery, lateral osteotomy,…
The Problem Turbinate hypertrophy is a relatively common nasal airway problem that needs to be considered before planning any aesthetic nose surgery. Based on the etiology of the hypertrophy, treatment may be done before the rhinoplasty, simultaneous with the surgery, or in postoperative periods. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a…
Summary The severe septal deformity is even today a challenging problem. Standard techniques often do not achieve a good long-term result in function or aesthetics. Therefore, we used the idea of removing a badly deformed septum, building up a straight and strong neo-construct, and replanting it back into the nose. During the last 39 years, we improved this technique continuously and have proven that it is…
The Problem Dorsal septal deflections The Background One of the most frequently performed surgeries in otorhinolaryngology is the correction of septal deviations. In cases where the L-strut is straight, septoplasty is relatively a straightforward operation. However, when the L-strut is deviated, it creates a challenge for the surgeon. In this chapter, we focus on the deflections of the dorsal septum. The Indications The deflections of the…
The Problem Nasal septal deviation is a common cause of nasal obstruction, a problem that can significantly impact an individual’s quality of life. Traditional septoplasty is adequate for treating the majority of septal deviations. However, deviation of the anterior septum poses unique anatomic challenges and renders traditional septoplasty insufficient. These challenges include high rates of associated internal nasal valve (INV) stenosis as well as aesthetic deformity…
The Problem Severely deviated nasal septum. The Background Nasal septal deviation is one of the leading causes of nasal obstruction. Literature demonstrated over 75% of 2000 cadaveric subjects to have some degree of septal deviation. Approximately 33% of patients who visit an otolaryngologist report nasal obstruction, with up to a quarter of these patents seeking surgical intervention. Septoplasty is one of the three most common otolaryngologic…
The Problem Currently, most surgeons performing rhinoplasty procedures utilize two-dimensional (2D) photography to evaluate new patients, to document results, and to plan a successful procedure. It is important to note that 2D photography lacks the ability to document the entire clinical picture. In today’s cosmetic medicine market it is more important than ever before to document results from various procedures such as rhinoplasty. Being able to…
Introduction Rhinoplasty is by far the most challenging and difficult operation on the face. It requires an organized approach to preoperative preparation: careful history taking, facial analysis, photography, imaging, and operative planning. The most critical thing is always to have standardized well-taken pictures on every patient. In this chapter, the fundamentals of photography for rhinoplasty will be presented. In rhinoplasty, photography is necessary for the following…
The Problem The initial examination is the most important step in the design and plan of a successful rhinoplasty surgery. During the initial visit, surgeons must obtain accurate data to determine if they can deliver a safe and successful outcome to the patient. The surgeon should obtain a thorough medical and surgical history to determine if any further medical clearances, consultations, or advanced diagnostics are required.…
More than 500 years ago, Leonardo Da Vinci illustrated the importance of facial proportions and beauty. In no area of the human body is that more important than the face. As an aesthetic surgeon it is imperative for one to understand the ideal facial proportions, and this is particularly important when considering the nose. Many say that rhinoplasty and nasal surgery is a procedure where mere…
Rhinoplasty has been considered one of the most technically challenging procedures of Aesthetic Surgery. Not only is it a surgery that has a functional component but it also vastly encompasses aesthetic aspects. Unlike many other procedures, the results of rhinoplasty are plainly visible to the general population and not just something that can be disguised or placed out of public view. Thus, the results of this…
Lymphedema Milestons and Globalization Lymphedema Milestones in Diagnosis and Treatment The surgical and microsurgical treatment of lymphedema is rapidly evolving with new techniques, improved outcome reporting, and descriptions of more effective treatment strategies. Moving forward within the specialty, a thorough understanding of previous developmental milestones related to anatomy, basic science research, diagnosis, variable techniques of lymphedema surgery, long-term outcomes, and multimodal treatment will aid in refining…
Key Points Surgical success can be defined as the downgrading of the patient’s lymphedema grades with improved symptoms, at least a 10% decrease in circumferential difference, a decrease in episodes of cellulitis, and improved quality of life. Surgical cure can be defined as a return to a normal limb circumference and the ability to wean off compressive therapy—in other words, not curing the lymphatic pathology, rather…
Key Points Complete decongestive therapy remains the only lymphedema treatment that is supported at the highest level of evidence. Health-related quality of life (QOL) is a multidimensional construct that encompasses physical, functional, emotional, and social well-being parameters. A variety of QOL instruments have been used to capture outcomes in lymphedema patients, but some of these instruments were not sensitive to lymphedema-specific outcomes. Lymphedema-specific symptom assessment tools…
Key Points If there is significant pitting (>8–10 mm in depth) of the lymphedematous limb, conservative treatment (combined physiotherapy) is indicated to remove the lymph and transfer the lymphedema to a non-pitting state, which indicates that any remaining excess volume consists of lymphedema-induced adipose tissue. Liposuction for lymphedema is indicated when pitting is absent or minimal. Tumescent solution (1–2 L) injected to subcutaneous tissue combined with…
Key Points Treatment of advanced lymphedema remains a challenge in reconstructive surgery. Surgical management with excisional procedures is indicated in select patients when conservative measures have failed. Based on an improved knowledge of vascular anatomy and understanding of perforator flap surgery, radical reduction of lymphedema with preservation of perforators applies an excisional approach and microsurgical techniques to the radical reduction of lymphedema. Chen-modified Charles procedure consists…
Key Points The Lymphatic Microsurgical Preventative Healing Approach, or immediate lymphatic reconstruction (ILR), is a surgical procedure for the prevention of lymphedema (LE). This procedure is performed by trained microsurgeons in patients at high risk for the development of LE (e.g., patients undergoing lymphadenectomy). In ILR, divided lymphatics are identified immediately after the completion of lymph node dissection and lymphovenous anastomoses are created between the extremity…
Key Points Lymphedema staging Surgical treatment of lymphedema & lymphatic microsurgery SS-MLVA/single site – multiple lymphatic-venous anastomoses MLVLA – multiple lymphatic-venous-lymphatic anastomoses (autologous interpositioned vein graft) CLyFT – complete lymphedema functional treatment FLLA-LVSP/fibro-lipo-lymph-aspiration by lymph vessel sparing procedure BPV test – blue patent violet lymphochromic test ICG test – indocyanine green (fluorescent) lymphography (ICGL) Superficial and deep lymphoscintigraphy with transport index LyMPHA – lymphatic microsurgical preventive…