Essentials of Septorhinoplasty

Transcription

1 Essentials of Septorhinoplasty von Hans Behrbohm, Eugene Tardy 1. Auflage Essentials of Septorhinoplasty Behrbohm / Tardy schnell und portofrei erhältlich bei beck-shop.de DIE FACHBUCHHANDLUNG Thematische Gliederung: Plastische, Rekonstruktive & Kosmetische Chirurgie Thieme 2003 Verlag C.H. Beck im Internet: ISBN

2 VIII Contents 1 The Dual Character of Nasal Surgery... 1 Introduction... 2 Historical Review... 3 Origins of Plastic Nasal Surgery... 3 The Development of Plastic Surgery in Berlin and at the Charité Hospital from the 18th to 20th Centuries. 3 History of Surgery of the Internal Nose... 5 Phylogenesis... 7 The Nose as a Respiratory Organ... 7 The Nose as a Sensory Organ... 8 The Olfactory Sense... 8 The Vomeronasal Organ... 9 Prerequisites for the Concept of Functional Esthetic Nasal Surgery... 9 Septal Surgery with Functional and Esthetic Goals... 9 Principles of Submucous Septoplasty The Pediatric Nasal Septum The Nasal Valve Physiological Limits of Nasal Breathing Atraumatic, Structure-Conserving Techniques of Septorhinoplasty Functional Aspects of Septorhinoplasty Olfactory Disturbances Recurrent and Chronic Sinusitis Adjunctive Intranasal Measures Tympanic Ventilation Problems Rhinogenic Headache Nasal Surgery and Sleep-Disordered Breathing W. Pirsig Rhinophonia W. Seidner Esthetic Aspects of Septorhinoplasty Selecting an Approach for Septorhinoplasty Endonasal Approaches Open Approach References Contemporary Rhinoplasty: Principles and Philosophy M. E. Tardy, Jr. Introduction and Philosophy Indications Contraindications Alternative Techniques Preoperative Considerations Special Surgical Requirements Preoperative Analysis Surgical Techniques Surgery of the Nasal Tip Profile Alignment Bony Pyramid Narrowing and Alignment Alar Base Reduction Dressings and Bandages Key Technical Points Postoperative Care Complications Summary References Facial Proportions and Esthetic Ideals I. D. Papel, R. B. Capone Introduction Facial Proportions Standard of Reference Golden Proportion The Facial Angles The Face Analysis of Patients with a Nasal Deformity General Considerations Nasal Deformity Ethnic Variations The Caucasian Nose The African Nose The Asian Nose Summary References Physiology and Pathophysiology of Nasal Breathing G. Mlynski Introduction Preconditions for the Respiratory Function of the Nose. 76 The Correlation between Shape and Function of the Nose Inspiration Expiration General Remarks The Problem of Septal Deviation with Compensatory Turbinate Hyperplasia in Terms of Flow Dynamics Inspiratory Nasal Wing Collapse... 80

3 Contents IX Rhinological Functional Diagnostics Rhinomanometry Rhinoresistometry Acoustic Rhinometry Long-Term Rhinoflowmetry Combination of Rhinoresistometry, Acoustic Rhinometry, and Long-Term Rhinoflowmetry Concluding Remarks References Preoperative Management Evaluation of the Face and External Nose The First Impression The Preoperative Consultation Conducting the Consultation Analysis, Clinical Geometry Proportions and Symmetry The Face from the Front Skin and Connective-Tissue Type Profile Analysis Dentition and Profile The Nasal Base Palpation Manual Examination Techniques Nasal Endoscopy Principles of Nasal Endoscopy Technique Photographic Documentation D. Jaeger and Lighting Focal Length of the Lens Image Scale Framing the Image Background Film Material Informed Consent Personal Recommendations Psychological Issues in Rhinoplasty Potential Problem Patients Preoperative Workup Rhinological History Esthetic History Evaluation of the External Nose Endoscopic Examination Diagnostic Imaging Function Testing Laboratory Tests Photographic Documentation Informed Consent Planning the Operation Immediate Preoperative Preparations Positioning Local Anesthesia Marking the Operative Site Anesthetic Management in Rhinoplastic Operations M. Goldstein References Principles of Modern Septoplasty T. Hildebrandt Introduction Indications Contraindications Preoperative Considerations Preoperative Analysis Clinical Examination Function Studies Imaging Studies Structural Principles of the Nasal Skeleton and their Surgical Significance Surgical Technique References Open Structure Rhinoplasty D. W. Kim and D. M. Toriumi Introduction Indications Contraindications Alternative Techniques Preoperative Considerations Special Surgical Requirements Preoperative Analysis Surgical Technique Incisions Nuances and Technique Middle Vault Tip Base Stabilization Secondary Rhinoplasty Closure Key Technical Points Postoperative Care Complications References Suggested Reading

4 X Contents 8 Endonasal Tip Approaches and Techniques S. Perkins Introduction Indications Contraindications Preoperative Considerations Preoperative Analysis Surgical Technique Case Studies Broad/Wide Tip Bulbous/Boxy Tip Bifid Tip Trapezoid Tip Asymmetrical Tip Postoperative Care Complications Bossa Formation Alar Retraction Tip Asymmetry Improper Projection Summary References Suggested Reading Alar Reduction and Sculpture R. Thomas and M. E. Tardy, Jr. Introduction Indications Contraindications Alternative Techniques Preoperative Considerations Special Surgical Requirements Preoperative Analysis Graduated Surgical Techniques Internal Nostril Floor Reduction Wedge Excision Nostril Floor and Sill Alar Wedge Excision Alar Flap Sliding Alar Flap Key Technical Points Postoperative Care Complications Conclusions References Suggested Reading The Deviated Nose S. S. Park Introduction Indications Contraindications Preoperative Considerations Age Preoperative Analysis and Diagnosis Normal Anatomy and Diagnosis Analysis of Aberrant Anatomy Surgical Correction Upper Third Deviations Middle Third Deviations Tip Deviations Functional Repair Principles of Postoperative Care Complications Conclusion Representative Cases Case 1: Mild Dorsal Deviation Case 2: Severe Dorsal Deviation Case 3: Fractured Dorsum and Twisted Tip Case 4: Functional Obstruction from Deviated Dorsum References The Functional Tension Nose, The Overprojected Nose Introduction Definition of Terms Measurement of Overprojection Indications Functional Indications Esthetic Indications Contraindications Functional Contraindications Esthetic Contraindications Preoperative Preparations and Prerequisites Inspection Palpation Function Studies Informed Consent Photographic Documentation and Computer Simulation

5 Contents XI Laboratory Tests Postoperative Measures Preoperative Analysis Principles of Surgery for the Overprojected Nose and Tension Nose Principal Causes of Overprojection Operative Strategy Central Role of the Septum Intranasal Septal Resection Principles of Profile Correction and Hump Removal Complications Infection Bleeding Dislocations References The Saddle Nose Causes and Pathogenesis, Approaches and Operative Techniques, Principles of Tissue Replacement in the Nose Introduction Indications Functional Indications Esthetic Indications Contraindications Preoperative Preparations and Prerequisites History Inspection Nasal Endoscopy Palpation Laboratory Tests Preoperative Analysis Type I Pathogenic Mechanism of Saddle Nose Type II Pathogenic Mechanism of Saddle Nose Type III Pathogenic Mechanism of Saddle Nose Surgical Strategy Reconstruction for Minor Saddling of the Cartilaginous Dorsum with a Circumscribed Defect in the Cartilaginous Septum and Normal Tip Support. 207 Reconstruction for Deep Saddling of the Cartilaginous Dorsum with Extensive Cartilage Losses or Septal Perforations and Adequate Tip Support Harvesting the Donor Cartilage Reconstruction of the Nasal Dorsum with Severe Loss of Tip Support Guidelines for Tissue Replacement in the Nose Graft Requirements Synthetic Implants Autologous Grafts Allografts Fibrin Glue Principles of Implantology in the Nose Harvesting Graft Material Preparing the Recipient Bed Postoperative Care Complications References Nasal Trauma O. Kaschke Introduction Trauma-Relevant Anatomy of the Nose Classification of Nasal Trauma Isolated Central Nasal Fractures Naso-orbito-ethmoid Fractures Diagnostics Inspection and Palpation Intranasal Diagnostics Imaging Diagnostics Management of Nasal Traumas Chronological Procedure Anesthesia Management of Isolated Central Nose Fractures Management of Naso-orbito-ethmoid Fractures Management of Soft-Tissue Injuries to the Nose Long-term Complications Following Nasal Traumas References Postoperative Care and Management O. Kaschke Introduction Intraoperative Management Internal Dressing External Dressing Postoperative Management First Postoperative Day Early Postoperative Period Late Postoperative Period References Index