Aesthetic comparison of the ideal nasal radix height in brazilians

The harmony of the facial profile is widely influenced by the height and form of the nasal dorsum. A few millimeters can make the lateral view aesthetically more or less pleasing and adequate in a subject's face. Professionals working with facial aesthetics should focus not only on the surgical techniques for proposed outcomes, but also with the subtleties and subjectivity that characterize aesthetic concepts and judgment.Material and MethodsA prospective survey to evaluate the preferences of a group of healthcare professionals working with facial aesthetics, a group of fine artists, and lay people about the best nasal radix height; the survey involved comparing 3 different nasal radix heights using computer-altered photographs of women with measurements close to the Caucasian standard.Results and conclusionThe lowest position of the nasal radix - close to the height of the pupil - was preferred (53%), followed by the middle position (superior crease of the eye). The highest position, resembling classic Greek statues, was considered the worst. The authors aos evaluated the effect of age, gender, and educational level on the choice of the best and worst female profiles.     

Normal values for the Rhinoplasty Outcome Evaluation (ROE) questionnaire

Rhinoplasty Outcome Evaluation (ROE) is an easy-to-use questionnaire that allows comprehensive assessment of rhinoplasty-related patient satisfaction. However, normal values for this questionnaire are not known.Objective: To translate and cross-culture adapt the Rhinoplasty Outcome Evaluation questionnaire to Brazilian Portuguese and to establish normality parameters.Materials and Methods: Cross-sectional study with ROE administration to 62 patients waiting for rhinoplasty or septorhinoplasty (Cases) and 100 volunteer subjects without desire or need for nasal surgery (Controls). Assessment of possible sensitivity and specificity cutoffs.Results: The cases' mean score was 6.6 or 27.5% (SD 3.18; min 0; max 15) and controls' mean score was 17.94 or 74.75% (SD 3.91; min 7; max 24). The best cutoff was 12 or 50%, with 95.16% sensitivity and 95% specificity.Conclusion: At the zero-to-24 score of the Brazilian Portuguese ROE, we found 12 as the best cutoff, with 95.16% of sensitivity and 95% of specificity.     

Lipotransfer as an adjunct in head and neck reconstruction

OBJECTIVES: To present our technique of lipotransfer and to evaluate a single center's experience in the use of lipotransfer as an adjunct to head and neck reconstruction. STUDY DESIGN: A retrospective review of all patients undergoing lipotransfer over a 5-year period by the senior author was undertaken. A total of 23 patients with a minimum follow-up of 1 year were available for analysis. METHODS: Patient records were retrospectively reviewed to assess functional (in the case of palate augmentation) and esthetic outcomes. RESULTS: Twenty-three patients undergoing lipotransfer as part of their reconstructive effort included (1) eight patients undergoing temporal fossa augmentation following temporalis muscle flap reconstruction for extirpative skull base surgery, (2) six patients undergoing facial defect augmentation following traumatic atrophy, (3) three patients undergoing palatal augmentation for correction of velopharyngeal insufficiency, and (4) six patients undergoing soft tissue augmentation following flap reconstruction of the face. Twenty of the 23 patients had excellent maintenance of graft volume. An adequately vascularized recipient bed appears to be an important factor in determining ultimate graft survival using our technique. CONCLUSIONS: Lipotransfer of the head and neck represents a simple, effective adjunctive technique providing for large amounts of readily available, well-tolerated soft tissue filler material. Patient selection is important, specifically in regard to determining that there is adequate vascularity of the recipient bed.     

Using ERG inquiry to evoluate otoplasty satisfaction in an otorhinolaryngology medical residency training hospital

The ear deformity surgery intervention impact on psychological and self-esteem aspects, in adults and children, is well documented. Recently, the studys are focused on patient satisfaction, funcional result and impact on quality of life. Any modification on patient's quality of life has been a challenge. The use of valid and established questionnairies, like Glasgow Benefit Inventory (GBI), assists on data analyse, turning it consistent.AimThe aim of this study is to evaluate the impact on patients quality of life after otoplasty, through the GBI questionnaire.MethodsRetrospective study including patients underwent otoplasty, within july of 2009 to july of 2010. The data were collected through questionnaire applied by medical resident on 90 post-surgical return.Results36 patients answered the questionnaire. There was increase on patients quality of life demonstrated by positive mediana obtained through out questinnaire. There were no significantly differences between age and sex.ConclusionThe patients are satisfied with post-surgical results. There was increase on patients quality of life conform positive results obtained. The use of GBI showed easy and elucidative.     

The role of computer imaging in facial plastic surgery consultation: a clinical study

The influence of using computerized visual communication on preoperative communication between the surgeon and the patient was analysed. This was a retrospective study based on a questionnaire completed by 50 patients who had undergone various facial plastic surgical procedures. Prediction tracings and postoperative slides were compared by the surgeon. The role of computer imaging in communication between doctor and patient, as well as the patient–doctor relationship and trust in the judgement of the doctor was considered to be positive by most of the patients. The vast majority of patients thought computer imaging should be a routine part of preoperative evaluation. Both the surgeon and the patients agreed that the representative value of prediction tracing was about 80%. In view of the possible positive influences on communication and relationship in the preoperative phase, computer imaging may help to provide a clear and realistic preoperative informed consent.     

Restorative rhinoplasty in the aging patient

OBJECTIVE: The objective of this study is to review our favorable experience in performing rhinoplasty in aging patients. METHODS: All patients aged 65 years or greater who underwent rhinoplasty, either esthetic or functional, by the senior author (Y.D.) from August 1997 to July 2005 with a minimum follow up of 1 year were retrospectively reviewed. RESULTS: A total of 51 patients met the inclusion criteria and had complete records available for review. The average age was 69.5 years (range, 65-82 years) with 24 female and 27 male patients. All but two patients underwent open rhinoplasty. Eighteen procedures represented secondary rhinoplasties. Seven patients required auricular cartilage grafts, and 11 patients required costal cartilage grafts. One costal cartilage graft was aborted as a result of excessive calcification. All patients underwent columellar strut placement, 92% underwent internal valve grafts, and 80.4% underwent grafting of the external nasal valves. Nasal osteotomies were performed in only 23.5% of patients, all with the percutaneous technique. Revision surgery was necessary in only three (5.8%) patients, all of whom required grafting of the external valve (not performed primarily). In each of these cases, no significant external valve collapse was noted preoperatively. Premaxillary augmentation with diced or crushed cartilage grafts was performed in 81.8% (n = 18) of patients with an edentulous maxillary arch. CONCLUSIONS: Aging patients present unique technical challenges in rhinoplasty that warrant a comprehensive approach to restore internal and external valve competency and tip support. Consideration of prophylactic external valve grafts in addition to the routine use of internal valve grafts and columellar struts may help decrease the need for revision surgery in this patient population. Reasonable functional and esthetic outcomes can be expected in the aging patient.     

鼻内镜下鼻整形手术技术教学经验

鼻位于面部中央,位置显著而独立,是面部美学结构的关键,在整个面部美学形态和立体结构中都起着举足轻重的作用。鼻的整形再造手术可以追溯到公元前600年,早在古印度时期就有所记载。在当时的古印度,切除鼻子被当成是惩治人的一种常用手段,因此导致了这种手术的兴起。     

Viability of crushed and diced cartilage grafts wrapped in oxidized regenerated cellulose and esterified hyaluronic acid: an experimental study

OBJECTIVES: The objective of this study was to investigate the viability of diced/crushed cartilage grafts wrapped in esterified hyaluronic acid (HYAFF) and oxidized regenerated cellulose (Surgicel) with respect to macroscopic and microscopic parameters. STUDY DESIGN: Experimental study. METHODS: A total of 10 New Zealand rabbits were acquired for the study. Cartilage grafts were harvested from both ears, with the ventral and dorsal perichondrial layers dissected off. There were six comparison groups in this experimental study: 1) bare, diced cartilage, 2) diced cartilage wrapped in Surgicel, 3) diced cartilage wrapped in HYAFF, 4) bare, crushed cartilage, 5) crushed cartilage wrapped in Surgicel, 6) crushed cartilage wrapped in HYAFF. Six cartilage grafts were inserted into the six subcutaneous pockets of the same animal. All the rabbits were sacrificed at the end of 2 months, the samples were collected, and the total specimen was examined histopathologically. The sections were stained with hematoxylin-eosin and Masson trichrome stain and examined under light microscopy. RESULTS: There was a significant difference among the bare, diced cartilage, the Surgicel, and the HYAFF groups with respect to fibrosis, chronic inflammation, cartilage mass, and vascularization. A significant difference was observed among the bare, crushed cartilage, Surgicel, and HYAFF groups with respect to fibrosis, chronic inflammation, and cartilage mass. There was no significant difference among the three groups regarding vascularization. CONCLUSIONS: This study suggests that wrapping cartilage grafts with Surgicel grossly reduces cartilage viability and the regeneration potential of the chondrocytes, leading to fibrosis formation. On the other hand, hyaluronic acid promotes cartilage integrity and survival, thus increasing clinical predictability and avoiding the need for overcorrection.     

Evaluation of the Esthetic and Functional Outcomes of Extracorporeal Septoplasty for Rhinoplasty in Asian Patients

ObjectivesIn extracorporeal septoplasty (ECS), the entire septal cartilage is harvested, and a neo-L strut is built extracorporeally. Thus, ECS can simultaneously achieve septum straightening and tip projection. This study evaluated the functional and esthetic outcomes of the ECS technique for rhinoplasty in Asian patients.MethodsWe conducted a retrospective review of 64 patients who underwent rhinoplasty using ECS between January 2016 and March 2018. Subjective patient satisfaction was assessed and objective surgical outcomes were evaluated. Improvement in nasal obstruction was rated using a visual analog scale (VAS). Anthropometric changes were compared between preoperative and postoperative facial photographs. Complications and revisions were also analyzed.ResultsThe participants comprised 64 patients (48 males and 16 females, with a mean age of 29.3 years). The mean operative time was 89.3 minutes. In total, 61 patients were satisfied with the esthetic outcome, and the overall objective rhinoplasty outcome score was 3.45. Preoperative nasal obstruction symptoms (7.9±1.2 on VAS) improved postoperatively (3.1±1.3, P<0.001), and significant improvements were also observed in the nasofrontal angle (152.3° to 148.1°, P<0.001), nasolabial angle (88.8° to 92.0°, P<0.001), and nasal tip projection (0.62 to 0.66, P<0.033). Recurrent deviation of the nasal septum and external nose or tip deprojection did not occur in any patients, and there were no cases of revision during the mean follow-up period of 13.3 months.ConclusionECS might be an esthetically and functionally satisfactory alternative rhinoplasty technique for Asian patients with a shortage of septal cartilage.