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Vocal Fold Injection via Microlaryngoscopy

Introduction The term vocal fold injection (VFI) typically refers to global vocal fold augmentation for purposes of addressing glottic insufficiency, although superficial injection into the lamina propria is performed occasionally (e.g., steroids, as for the treatment of vocal fold scar). In situations where the impact of global augmentation on symptoms is unpredictable, a trial VFI with a temporary material may also be beneficial. Many options for…

Recurrent Respiratory Papillomatosis

Introduction Recurrent respiratory papillomatosis (RRP) is a rare viral-induced disease of the upper aerodigestive tract characterized by epithelial lesions. Caused by human papillomavirus (HPV), this disease presents in both children and adults. RRP is considered a benign neoplastic process; however, the disease can lead to significant morbidity and fatal complications, and there is a risk for RRP to transform into an epithelial malignancy ( Fig. 3.1…

Phonomicrosurgery for Benign Vocal Fold Lesions

Introduction Patients complaining of hoarseness, vocal fatigue, diminished vocal range, strain, or other vocal issues require a complete laryngeal examination. Based on the findings of this examination, several treatments may be indicated, including surgery. Phonomicrosurgery (PMS) encompasses a variety of elective operations whose primary goal is to improve the quality of the voice. These procedures focus on precision microsurgical techniques to remove benign vocal fold lesions,…

Office-Based Laryngeal Procedures

Introduction Office-based laryngeal procedures are quickly gaining popularity. These procedures are cost effective and provide an important alternative for patients who are not good candidates for operative direct laryngoscopy. Included are those patients with contraindications to general anesthesia or who have anatomic variations that result in poor exposure when direct laryngoscopy is attempted. Advantages of procedures performed on an awake patient in the office include the…

Repair of Acute Nasal Fracture

The nasal bones are the most commonly fractured bones in the face. Acute nasal fractures may result in both nasal deformity and nasal airway obstruction. However, some controversy still surrounds the management of acute nasal fractures, in that a review of the literature demonstrates a lack of consensus with respect to the timing of repair of the acute nasal fracture, the anesthesia used during repair, and…

Nasal Septal Perforation Repair

The nasal septum plays a critical role in both the function, as well as the aesthetics, of the human nose. Structurally, the septum forms the foundation of the nasal pyramid and acts as the central support element of the nose, providing support for the cartilaginous and soft-tissue components of the nose and nasal cavity. Functionally, the nasal septum, and its relation with the upper lateral cartilages, forms a critical portion…

Nasal Reconstruction

The nose occupies a central position both anatomically and aesthetically in determining the overall appearance of the face. Surgery for reconstruction of the nose has a long history, dating back at least to 2000 bc . In India, nasal reconstruction has been performed by specialized castes for millennia. This grew out of necessity as a common punishment for adulterers, thieves, and prisoners was amputation of the…

Nasal Airway Obstruction

The nasal airway is of paramount importance to the astute rhinoplasty surgeon. Often, great aesthetic results are combined with poor functional outcomes, leading to dissatisfaction and the need for further intervention. This problem is curtailed by careful consideration and analysis of the function of the nose as well as its aesthetic value. Even well-experienced surgeons face this problem in a significant number of patients. In the…

Cleft Lip Rhinoplasty

The cleft lip nasal deformity is a complex, three-dimensional problem that challenges any rhinoplasty surgeon. The extent of the nasal deformity is related to the severity of the original cleft malformation and ranges from mild to severe. The secondary cleft nasal deformity is related to several factors: (1) the original deformity, (2) any interim surgery performed on the nose, lip, and alveolus, and (3) growth pattern…

Rhinoplasty in the Aging Patient

Aesthetic and reconstructive rhinoplasty is commonly acknowledged as the most demanding and difficult of the plastic surgical procedures. Although many technical advances have occurred throughout the past century, its fundamental philosophy remains constant. This philosophy involves significant planning and conservative surgical changes to achieve a natural-appearing result. Initially, the operation generally involved a tissue reduction procedure with excision of various nasal anatomic components. More recently, rhinoplasty…

Mestizo Rhinoplasty

Most individuals have an interest in being perceived by others as attractive, regardless of their ethnic heritage, racial background, or country of origin. Over time, migratory movements have contributed to the ethnic and racial melting pot responsible for the diversity we have come to expect in major metropolitan areas. Industrialized countries in the world today constantly receive immigrants from developing countries seeking more freedom or better…

Middle Eastern Rhinoplasty

Aesthetic rhinoplasty in patients of Middle Eastern extraction poses a specific set of challenges for the rhinoplasty surgeon. As is true in other geoethnic groups, several unique anatomic features define the appearance of the “Middle Eastern nose” and require a tailored approach to achieve aesthetic refinement. Implicit in the surgical methodology for this group is the prevention of “Westernization rhinoplasty” and preservation of the native ethnic…

African American Rhinoplasty

Rhinoplasty in the African American population presents a unique set of challenges, including skin and soft tissue envelope thickness, alar base width, and inherent ethnic considerations. A delicate balance of patient satisfaction, achieving an aesthetically pleasing result, and maintaining a natural appearance are three goals to stay focused on during the surgical planning and execution phases of these procedures. Among these, meeting the patient's expectations can…

Asian Rhinoplasty

Cosmetic surgery for the Asian nose stands in marked contradistinction to that for the Western nose in that its objectives can be the opposite in many cases (i.e., augmentation rather than reductive rhinoplasty). However, an Occidental ideal for rhinoplasty has often been used for the Asian patient, leaving an individual with too high a nasal dorsum and too narrow a tip for his or her ethnicity.…

Short Nose

Lengthening the short nose is one of the most difficult challenges in rhinoplasty. Etiologies for the development of a short nose include congenital, traumatic, iatrogenic (previous surgery), infectious, and granulomatous factors. Regardless of the cause, short nose correction requires the surgeon to precisely identify anatomical abnormalities and deficiencies and to perform an array of technically precise and difficult operative techniques. The Short Nose Defined There is…

The Thick-Skinned Rhinoplasty Patient

When it comes to the subject of rhinoplasty, many authors trivialize or overlook the role of nasal skin in cosmetic nasal surgery. Instead, interest is directed at the nasal skeleton and the various methods of modifying the underlying skeletal framework. Although skeletal modification is fundamental to a successful rhinoplasty, the nasal skin and its associated soft tissue components, often called the skin–soft tissue envelope (SSTE), also…

Thin Skin Rhinoplasty: Aesthetic Considerations and Surgical Approach

Thin nasal skin readily reveals imperfections of the underlying osseocartilaginous framework and has profound implications for the surgical planning and execution of rhinoplasty. Thin skin may be a normal variant or the result of prior surgery, trauma, or disease. The relative inattention to this subject in the literature is striking, particularly when one considers the small tolerance for error that exists when working with thin skin.…

The Underprojected Nose and Ptotic Tip

Surgery of the lower third of the nose represents one of the most challenging aspects of rhinoplasty. The nasal tip is a three-dimensional structure described in terms of projection, rotation, length, and shape. Each of these components must be considered to achieve an aesthetically pleasing result, which depends upon symmetry and proportion in relation to the rest of the nose and surrounding facial features. The nasal…

The Large Nose

Reduction rhinoplasty has been the main objective for the majority of cosmetic rhinoplasties performed in Caucasians over many decades. Rhinoplasty experts today have a much better understanding of the intricate relationships between anatomic changes and rhinoplasty outcomes than previous generations of nasal surgeons. Although Aufricht's observation that rhinoplasty is “an easy operation to do, but it is hard to get good results” still holds true, the…

Saddle Nose Deformity

A saddle nose deformity derives its name from the appearance of the nose on lateral view as the dorsal curve resembles the depression in a horse's saddle. The gross deficiency that exists in the dorsum of the nose, no matter the etiology, creates an obvious and progressive scooped-out deformity. When viewed frontally, an illusory excessive width exists across the bridge. The first paper written on the…