Radiofrequency Thermotherapy vs Bone-Anchored Suspension for Treatment of Lateral Nasal Wall Insufficiency A Randomized Clinical Trial
|
|
- Griselda Patrick
- 5 years ago
- Views:
Transcription
1 Research Original Investigation Radiofrequency Thermotherapy vs Bone-Anchored Suspension for Treatment of Lateral Nasal Wall Insufficiency A Randomized Clinical Trial Joshua D. Weissman, MD; Sam P. Most, MD IMPORTANCE Lateral nasal wall insufficiency is a common problem with little consensus on optimal treatment. OBJECTIVE To assess the efficacy of radiofrequency () thermotherapy for the treatment of lateral nasal wall collapse. DESIGN, SETTING, AND PARTICIPANTS A prospective randomized trial comparing thermotherapy with bone-anchored suspension technique () for lateral nasal wall collapse in 13 patients was conducted, with recruitment occurring between March 1, 2010, and February 28, 2012, and follow-up of 1 year. The setting was a tertiary care facial plastic and reconstructive surgery clinic at an academic hospital. Eligible patients had lateral nasal wall insufficiency and met study inclusion criteria. Editorial page 80 Journal Club Slides and Supplemental content at jamafacialplasticsurgery.com CME Quiz at jamanetworkcme.com and CME Questions page 160 INTERVENTIONS Participants were randomized to receive either of the lateral nasal wall or thermotherapy to the lateral nasal wall. MAIN OUTCOMES AND MEASURES Outcomes were assessed 1, 3, 6, and 12 months after surgery using 2 subjective patient outcomes surveys (the Nasal Obstructive Symptom Evaluation and a visual analog scale) and a physician-derived assessment of lateral wall collapse. RESULTS Significant improvements in symptom scores were seen postoperatively for both treatment arms, though more consistently in the radiofrequency group. One month postoperatively, the mean (SD) drop in NOSE scores was 52.5 ± 22.2 and 51.7 ± 26 (P =.96) for the and groups, respectively. Similar results were noted at 6 and 12 months postoperatively (56.7 ± 38.2 vs 50 ± 14.7 [P =.76] and 53.3 ± 20.2 vs 56.7 ± 18.9 [P =.84] at 6 and 12 months, respectively). No statistical difference in change in NOSE scores occurred between the 2 groups at 1, 6, or 12 months postoperatively. Likewise, the drop in VAS scores between the 2 treatment groups was similar at each time point. One month postoperatively, the mean (SD) drop in VAS scores was 5.1 ± 2.8 and 4.8 ± 2.6 (P =.90). Similar results were noted at 6 and 12 months postoperatively (5.8 ± 3.4vs4.9± 3.1 [P =.72] and 5.5 ± 3.1vs5.4± 1.3 [P =.96] at 6 and 12 months, respectively). Using a physician-derived score, significant improvement was seen in patients in the group at 1 month (P =.005), 6 months (P =.002), and 12 months (P =.03). For the group, significant improvement was noted only at the 1-month postoperative visit (P =.007). Comparison of vs revealed significant improvement in the group over the group at 12 months (P =.04). The other periods revealed no significant differences between the two. CONCLUSIONS AND RELEVANCE Radiofrequency thermotherapy is a viable alternative option for lateral nasal wall collapse, both in terms of improvements in symptoms and physical examination, with suggested evidence for efficacy at least as good as that for bone-anchored suspension. LEVEL OF EVIDENCE 1. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN JAMA Facial Plast Surg. 2015;17(2): doi: /jamafacial Published online January 29, Author Affiliations: Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California (Weissman, Most); associate editor, JAMA Facial Plastic Surgery (Most). Corresponding Author: Sam P. Most, MD, Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA (smost@ohns.stanford.edu). 84 (Reprinted) jamafacialplasticsurgery.com
2 Thermotherapy vs Bone-Anchored Suspension Original Investigation Research Nasal obstruction due to lateral wall insufficiency (LWI) is a common finding in patients evaluated in otolaryngology and facial plastic surgery clinics, and treatment has been a challenge to the facial plastic surgeon. Many techniques have been described 1-6 to address this type of nasal obstruction, but none has emerged as a clear favorite. More recently, a small case series 7 described the use of radiofrequency () energy as a treatment for LWI. In theory, the scar and tissue retraction induced by low-energy delivery would decrease the tendency toward dynamic collapse of the lateral nasal wall and perhaps also contribute to a more patent static angle of the internal nasal valve. Although a novel use of the technology, the study was limited in that it was a case series, and LWI was not measured using a validated scale. We sought to more critically evaluate the usefulness of this technique compared with one of our preferred methods of treatment of lateral nasal wall collapse: bone-anchored suspension technique (). To accomplish this evaluation, we designed a single-center randomized clinical trial using both validated clinical measures of LWI and a disease-specific, validated outcome scale. Figure 1. CONSORT Flow Diagram 25 Patients assessed for eligibility 13 Randomized 12 Excluded (all refused to participate) 6 Randomized to 7 Randomized to 1 Lost to 1-mo follow-up 3 Lost to 6-mo follow-up 4 Lost to 12-mo follow-up (reasons varied) 5 Included in 1-mo follow-up 3 Included in 6-mo follow-up 2 Included in 12-mo follow-up 0 Excluded from analysis 1 Lost to 1-mo follow-up 3 Lost to 6-mo follow-up 4 Lost to 12-mo follow-up (reasons varied) 6 Included in 1-mo follow-up 4 Included in 6-mo follow-up 3 Included in 12-mo follow-up 0 Excluded from analysis indicates bone-anchored suspension technique;, radiofrequency. Methods Study Design Institutional review board approval was obtained from Stanford University School of Medicine for the study protocol, and all patients provided written informed consent. No financial compensation was provided. The project was approved through the institutional review board process in 2010, and the Stanford Institutional Review Board did not require registration at that time. At the request of the journal, the trial has been registered. The full study protocol can be found in the trial protocol in the Supplement. This study was a prospective randomized trial comparing thermotherapy with for lateral nasal wall collapse. Physician review of the videos for grading of the lateral nasal wall collapse was done in a blinded, nonsequential manner. Recruitment was done through a tertiary facial plastic surgery clinic, with all participants enrolled between March 1, 2010, and February 28, All eligible patients were offered the opportunity for enrollment in the trial with the caveat that the method of treatment for LWI would be determined in randomized fashion once they agreed to participate. Patients Eligible patients were adults with nasal obstruction for at least 1 year due to LWI as seen on examination, with or without septal deviation, turbinate hypertrophy, or internal nasal valve narrowing. The patients must have not responded to medical management with topical corticosteroids and have had no nasal trauma or surgery within the past year. Excluded were all individuals with an active smoking history, immunocompromise, previous rhinoplasty, history of radiotherapy to the head and neck, septal perforation, and granulomatous disease (Figure 1). Many patients with LWI have concomitant issues with the septum and turbinates. Consequently, participants with septal deviation, inferior turbinate hypertrophy, and chronic rhinosinusitis were included in the study, reasoning that their treating surgical procedures would be randomly distributed between the 2 treatment arms. Interventions Bone-anchored suspension technique was performed in the manner described by Roofe and Most 8 on patients who were randomized into this treatment group. Radiofrequency thermotherapy of the lateral nasal wall was performed using a bipolar -induced thermotherapy device (Celon ProBreath; Olympus) in a manner similar to that described by Seren. 7 For application, a mucosal packet was created heading from the intermediate crus toward the piriform aperture (Figure 2). The probe was placed in the dissection plane, and 3 separate deliveries of 12 W were applied in 3 adjacent foci separated by approximately 2 mm. The tip of the probe was placed atop the piriform aperture to avoid infraorbital nerve damage. At these settings, the elliptical area of energy delivery extends from the tip of the probe back 11 mm, with a radius of 2.1 mm. Outcomes Three sets of outcome measures were assessed at the initial preoperative visit and as well at postoperative follow-up times of 1, 3, 6, and 12 months after treatment. For reporting purposes, time points with fewer than 3 patients were excluded. Developed in 2004, 9 the Nasal Obstructive Symptom Evaluation (NOSE) scale, a validated quality-of-life symptom survey, is more applicable to the realm of functional rhinoplasty with its assessment of nasal congestion. The NOSE scale has been used as a quality-of-life measure in studies on jamafacialplasticsurgery.com (Reprinted) JAMA Facial Plastic Surgery March/April 2015 Volume 17, Number 2 85
3 Research Original Investigation Thermotherapy vs Bone-Anchored Suspension Figure 2. Radiofrequency Device Application Sites septoplasty, 10 nasal valve correction, 11 functional rhinoplasty, 12 thermotherapy treatment of turbinates, 13 and lateral nasal suspension. 8 The scale is composed of 5 questions that are assigned 4 points each. The score is multiplied by 5 to convert it to a 100-point scale, with higher scores representing more significant symptoms. A visual analog scale (VAS) was used to assess overall nasal congestion. The scale is a 10-cm horizontal line anchored by word descriptors. It is scored by measuring the distance in millimeters from the left of where the patient s mark was placed. A higher number indicates more severe symptoms. Endoscopic evaluation of lateral nasal wall collapse was performed using a system 14 that grades the degree of lateral nasal wall movement with inspiration. The endoscopic examinations performed preoperatively and postoperatively were recorded, digitally reviewed, and measured in a randomized nonsequential manner at the conclusion of the study by the senior author (S.P.M.) to gauge response in a blinded fashion. In contrast to the previous 2 outcome assessments, endoscopic evaluation of lateral nasal wall collapse allowed for a somewhat less subjective, physician-derived assessment of the degree of lateral wall collapse. This measure has been validated regarding interrater and intrarater reliability. 15 Statistical Analysis Statistical analysis was conducted by performing paired and unpaired 2-tailed t tests comparing NOSE, VAS, and endoscopic evaluation scores within and between the 2 treatment arms. Each side of the nose was independently evaluated for the LWI score; thus, each ala/sidewall was counted individually. Results Entry point End point Green dots indicate the intranasal entry point for device; red dots approximate the end point of the device. Seven of the participants who were initially enrolled and randomized to the thermotherapy treatment group underwent this surgery. Six individuals were enrolled and underwent surgery to include the. Data collection postoperatively was highest at earlier times in the study, with most patients returning for their 1-month postoperative visit and then fewer for subsequent visits. Data were collected on all patients at their follow-up visits using the NOSE and VAS surveys along with a videographic recording of their nasal endoscopy examination. One patient in the group did not complete the VAS survey properly at his 6-month postoperative visit. In addition to the stated experimental intervention, 5 of the 6 patients (83%) and 6 of the 7 thermotherapy patients (86%) also underwent septoplasty, and 5 of the 6 recipients (83%) and all 7 thermotherapy recipients (100%) received inferior turbinate reduction. One patient in each group underwent concomitant endoscopic sinus surgery. All patients in the group underwent an external rhinoplasty approach, whereas 3 of the patients receiving thermotherapy (43%) had external rhinoplasty approaches performed, 1 of which was for cosmetic tip work and the other 2 for septal reconstruction. An unpaired t test was performed comparing preoperative NOSE scores and VAS scores. This evaluation revealed a significant baseline asymmetry in the mean (SD) preoperative NOSE scores for the and thermotherapy groups (P =.04). Differences in the VAS scores for the and thermotherapy groups were also significant (P =.046) (Table 1). Thus, to compare the efficacy of the 2 treatments, the changes in NOSE and VAS scores were calculated for each participant at each postoperative visit. In all cases, the NOSE and VAS scores decreased postoperatively. In addition, the decrease in the NOSE scores between the 2 treatment groups was similar at each time point (Table 2). One month postoperatively, the mean drop in NOSE scores was 52.5 (22.2) and 51.7 (26.0). Similar results were noted at 6 and 12 months postoperatively (56.7 [38.2] vs 50.0 [14.7] and 53.3 [20.2] vs 56.7 [18.9], respectively) (Table 2). No statistically significant change in NOSE scores occurred between the 2 groups at 1, 6, or 12 months postoperatively. Likewise, the drop in VAS scores between the 2 treatment groups was similar at each time point (Table 2). One month postoperatively, the mean drop in VAS scores was 5.1 (3.8) and 4.8 (2.6), respectively, for the and groups. Similar results were noted at 6 and 12 months postoperatively (5.8 [3.4] vs 4.9 [3.1] and 5.5 [3.1] vs 5.4 [1.3] at 6 and 12 months, respectively [Table 2]). No statistically significant difference in change in NOSE scores occurred between the 2 groups at 1, 6, or 12 months postoperatively. Comparing the preoperative physician-derived lateral nasal wall grading scores using an unpaired t test, no significant differences were noted between the preoperative mean thermotherapy and scores (2.1 vs 1.7; P =.23); thus, direct comparisons between the groups were made with this outcome assessment. For the thermotherapy group, paired t test comparison of the baseline scores to each postoperative assessment yielded significant improvement at 1 month (P =.005), 6 months (P =.002), and 12 months (P =.03), as reported in Table 3. For the group, the same comparisons 86 JAMA Facial Plastic Surgery March/April 2015 Volume 17, Number 2 (Reprinted) jamafacialplasticsurgery.com
4 Thermotherapy vs Bone-Anchored Suspension Original Investigation Research Table 1. NOSE and VAS Scores for Patients Undergoing and to the Lateral Nasal Wall Postoperative, mo Treatment Preoperative NOSE Scores Mean (SD) [P value] a 85.8 (10.7) 33.8 (25.0) [.002] 26.7 (28.9) [.002] 30.0 (18.0) [<.001] No Mean (SD) [P value] a 69.3 (14.0) 18.3 (15.4) [<.001] 22.5 (11.9) [<.001] 16.7 (7.6) [<.001] No P value VAS Scores Mean (SD) [P value] a 8.6 (1.0) 4.2 (3.6) [.02] 3.4 (3.9) [.01] 3.7 (3.8) [.02] No Mean (SD) [P value] a 7.0 (1.4) 2.1 (2.1) [<.001] 2.6 (2.6) [.005] 2.2 (0.8) [<.001] No P value Abbreviations:, bone-anchored suspension technique; NOSE, Nasal Obstructive Symptom Evaluation;, radiofrequency; VAS, visual analog scale. a Row P values represent comparison with the preoperative score. Table 2. Comparison of Decrease in NOSE and VAS Scores With and Decrease in Postoperative Score, mo Treatment Group NOSE Scores Mean (SD) 52.5 (22.2) 56.7 (38.2) 53.3 (20.2) No Mean (SD) 51.7 (26.0) 50.0 (14.7) 56.7 (18.9) No P value VAS Scores Mean (SD) 5.1 (3.8) 5.8 (3.4) 5.5 (3.1) No Mean (SD) 4.8 (2.6) 4.9 (3.1) 5.4 (1.3) No P value Abbreviations:, bone-anchored suspension technique; NOSE, Nasal Obstructive Symptom Evaluation;, radiofrequency; VAS, visual analog scale. Table 3. Comparison of Preoperative and Postoperative LWI Scores With and Postoperative Treatment Group Preoperative 1 mo 6 mo 12 mo Mean (SD) [P value] a 1.7 (0.8) 0.8 (0.5) [.007] 0.8 (1.0) [.24] 1 (0) [.09] No.of alae Mean (SD) [P value] a 2.1 (0.9) 0.8 (1.1) [.005] 0.8 (0.7) [.002] 0.3 (0.5) [.03] No. of alae P value.84 > Abbreviations:, bone-anchored suspension technique; LWI, lateral wall insufficiency;, radiofrequency. a Row P values represent comparison with the preoperative score. yielded significant improvement only at the 1-month postoperative visit (P =.007), whereas the remainder of the follow-up data points were not significant. Because there were no significant baseline differences using this measure, evaluating each temporal postoperative visit of one group against the other revealed significant improvement in the thermo- jamafacialplasticsurgery.com (Reprinted) JAMA Facial Plastic Surgery March/April 2015 Volume 17, Number 2 87
5 Research Original Investigation Thermotherapy vs Bone-Anchored Suspension therapy group over the group at 12 months (P =.04). The other time periods revealed no significant differences between the groups (Table 3). One patient in the group experienced a small, selfresolving hematoma over the nasal sidewall within 24 hours after the operation. One patient in the thermotherapy group, who also underwent unilateral left endoscopic maxillary antrostomy with anterior ethmoidectomy, developed left-sided infraorbital nerve hypoesthesias involving the anterior and middle superior alveolar nerve distributions. This complication resolved within 6 months. All patients also developed mild edema over the sidewall where the energy had been delivered, although this always resolved within 1 to 2 weeks. There was no blanching or skin necrosis. Discussion The passage of air through the nasal airway involves a complex interaction among multiple potential fixed, anatomic components, such as septal deviation, along with reversible factors, such as mucosal edema or the nasal cycle. In addition to fixed obstructions, dynamic collapse of the nasal wall has been described by several authors. 1-3,7,14,15 The Bernoulli principle explains the fundamentals of the dynamic collapse seen with inspired air and subsequent negative intranasal pressure. The pressure decrease results in folding of weaker, more susceptible structures. The internal nasal valve is best described as the point of maximal narrowing in the anterior nasal airway between the septum, upper lateral cartilage, and anterior inferior turbinate. Lateral wall insufficiency can be thought of as occurring in 2 distinct regions: zones 1 and Zone 1 LWI occurs more cephalad as the upper lateral cartilage complex moves inward during inspiration with subsequently more significant collapse of the upper lateral wall. Externally, this may be seen as medial collapse in the supra-alar region, although it is possible that it can only been seen intranasally. Zone 2 LWI more approximates the classically described external nasal valve collapse because its location is more caudal, primarily involves the ala, and can reliably be seen externally. 14,16 The causes of LWI vary by site. Zone 1 LWI is more frequently idiopathic and is seen in the aging population; other causes include trauma, genetics, or prior surgery. 14 Zone 2 LWI also may be a consequence of surgical alterations in anatomic support, postfacial paralysis, or aging or may occur in patients with variant anatomy that predisposes such abnormality, including narrow nostrils, projected tip, and thin alae. 1,14 The causes of LWI may be related to weakening of softtissue attachments from the upper lateral cartilage to the piriform aperture. Dense fascial attachment was described 17 extending from the periosteum of the piriform aperture to lateral cartilages. Just as supports this ligamentous attachment, thermotherapy may also strengthen it. Means of treatment of LWI have varied and evolved alongside the field of facial plastic surgery, and treatment has centered on either structurally supporting the lateral nasal wall or repositioning the upper lateral cartilages. Alar batten grafts, lateral crural struts, flaring sutures, and suture suspension are a few of the techniques used to address lateral nasal wall collapse. 1-4 Paniello 6 introduced nasal valve suspension as a treatment for internal nasal valve collapse. This method allowed for passage of a retention suture from an endonasal approach to a fixation point on the inferior orbital rim as accessed through a transconjunctival incision. This approach was modified by Friedmanetal, 18,19 who used a 3-mm external incision in an infraorbital skin crease to access the rim along with burial of the suture beneath the nasal mucosa to avoid granuloma formation. Shortly after their original study, 18 Friedman et al 19 reported on a larger series of patients who had undergone treatment with the investigators modified with outcomes measured by the 20-Item Sino-Nasal Outcome Test (SNOT-20) 20 and acoustic rhinometry, with mean follow-up of just over 1 year. They noted significant quality-of-life improvement in more than 84% of patients who received treatment exclusively for valve correction, although the SNOT-20 was designed primarily for evaluation of rhinosinusitis. The follow-up ranged from 6 to 60 months. A series by Roofe and Most 8 reported no complications and significant improvement with as seen on the NOSE scale, with mean follow-up of approximately 4 to 5 months. Radiofrequency treatment of the lateral nasal wall was proposed by Seren 7 more recently. He theorized that the low-level energy delivered to the soft tissues of the lateral nasal wall would induce similar changes used in thermotherapy ablation of turbinates: controlled necrosis followed by development of scar and tissue retraction. In his study, a turbinate probe was used to treat the lateral nasal wall. Outcomes were judged as significantly improved according to VAS scores during 16 weeks of follow-up. Our study was set up as a noninferiority assessment of thermotherapy to the lateral nasal wall compared with the older. Recruitment proceeded slower than expected, likely owing to the mandatory acceptance of a randomized treatment method. As such, the numbers were small, with 6 participants undergoing and 7 undergoing thermotherapy. The small sample size probably led to significant baseline differences between the 2 patient-derived subjective outcomes measures (NOSE and VAS), with less-symptomatic baseline scores seen on both measures for the thermotherapy group. According to a new severity classification scheme based on NOSE scores, 21 the thermotherapy group would be categorized as severe and the group would be categorized as extreme. We were able to compare postoperative outcomes with baseline scores within each group, with more robust and consistent significant improvements seen for the thermotherapy group as measured by the NOSE and VAS and significant but fewer improvements seen in the arm. However, the baseline differences prevent direct comparison using these outcomes measures. The physician-derived grading of LWI, which was performed in a blinded nonsequential manner, revealed no baseline asymmetries and showed consistent significant improvement in the thermotherapy arm at all intervals. The group demonstrated significant improvement only at 1 month. 88 JAMA Facial Plastic Surgery March/April 2015 Volume 17, Number 2 (Reprinted) jamafacialplasticsurgery.com
6 Thermotherapy vs Bone-Anchored Suspension Original Investigation Research Although the subjective outcomes measures indicated the thermotherapy group to have overall fewer symptoms preoperatively, the physician-assessed measure indicated greater amounts of collapse in this group. Direct comparison of both groups revealed significant improvement of the thermotherapy group over the group at 12 months postoperatively. It may be argued that direct comparison between the groups should not be undertaken given the baseline asymmetries on the subjective scores; however, we think it merits reporting. Strengths of the study include the randomized design and the use of validated outcomes measurements for both LWI and subjective measures of nasal obstruction. Shortcomings of this study largely stem from the small sample size and loss of participants to follow-up. All patients underwent other nasal surgical interventions, such as septoplasty, in addition to the thermotherapy and interventions. Ideally, this study would have involved only the experimental and control interventions in isolation to allow for comparison; however, such a study is not feasible since most patients have causes of obstruction other than the lateral nasal wall that can be addressed during the same procedure. Conclusions Radiofrequency thermotherapy is a viable alternative for the treatment of LWI independently as well as an alternative to. Although the consequences of a small sample size limit our ability to make broad conclusions, the data support thermotherapy of the lateral nasal wall as an effective, lessinvasive means of treatment for LWI. Significant improvements were seen and continued at 1 year following surgery. Based on the physician-derived assessment of lateral nasal wall collapse, there is even a suggestion that thermotherapy may be better than at addressing physical evidence of lateral nasal wall collapse. Larger studies are necessary to confirm and validate the results of this study. ARTICLE INFORMATION Accepted for Publication: October 24, Published Online: January 29, doi: /jamafacial Author Contributions: Dr Weissman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: All authors. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: All authors. Obtained funding: Weissman. Administrative, technical, or material support: All authors. Study supervision: Most. Conflict of Interest Disclosures: After completion of the analysis but before submission of the manuscript for publication, Dr Most has become a consultant for Aerin Medical Corp. No other disclosures were reported. Disclaimer: Dr Most is an associate editor of JAMA Facial Plastic Surgery but was not involved in the editorial review or the decision to accept the manuscript for publication. REFERENCES 1. Toriumi DM, Josen J, Weinberger M, Tardy ME Jr. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg. 1997;123(8): Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. 1997;99(4): Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg. 1998;101(4): Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg. 1984;73 (2): Nyte CP. Hyaluronic acid spreader-graft injection for internal nasal valve collapse. Ear Nose Throat J. 2007;86(5): Paniello RC. Nasal valve suspension: an effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg. 1996;122(12): Seren E. A new surgical method of dynamic nasal valve collapse. Arch Otolaryngol Head Neck Surg. 2009;135(10): Roofe SB, Most SP. Placement of a lateral nasal suspension suture via an external rhinoplasty approach. Arch Facial Plast Surg. 2007;9(3): Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130(2): Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004; 130(3): Rhee JS, Poetker DM, Smith TL, Bustillo A, Burzynski M, Davis RE. Nasal valve surgery improves disease-specific quality of life. Laryngoscope. 2005;115(3): Most SP. Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument. Arch Facial Plast Surg. 2006;8(5): Harrill WC, Pillsbury HC III, McGuirt WF, Stewart MG. Radiofrequency turbinate reduction: a NOSE evaluation.laryngoscope. 2007;117(11): Most SP. Trends in functional rhinoplasty. Arch Facial Plast Surg. 2008;10(6): Tsao GJ, Fijalkowski N, Most SP. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence). 2013;4(2):e66-e68. doi: /ar Burstin PP. Functional valvular indrawing. Arch Facial Plast Surg. 2009;11(6): Rohrich RJ, Hoxworth RE, Thornton JF, Pessa JE. The pyriform ligament. Plast Reconstr Surg. 2008;121(1): Friedman M, Ibrahim H, Syed Z. Nasal valve suspension: an improved, simplified technique for nasal valve collapse. Laryngoscope. 2003;113(2): Friedman M, Ibrahim H, Lee G, Joseph NJ. A simplified technique for airway correction at the nasal valve area. Otolaryngol Head Neck Surg. 2004;131(4): Piccirillo JF, Merritt MG Jr, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg. 2002;126(1): Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg. 2013;15(5): jamafacialplasticsurgery.com (Reprinted) JAMA Facial Plastic Surgery March/April 2015 Volume 17, Number 2 89
Surgical Treatment of Nasal Obstruction
Surgical Treatment of Nasal Obstruction P. Daniel Knott, MD FACS Director, Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology/Head and Neck Surgery UCSF Medical Center Nothing
More informationNasal Valve Obstruction
Nasal Valve Obstruction J RANDALL JORDAN, MD, FACS Facial Plastic Surgery Department of Otolaryngology and Communicative Disorders University of Mississippi Medical School Disclosures Financial- none Off-label-none
More informationAbsorbable Nasal Implant for Treatment of Nasal Valve Collapse
NOTE: This policy is not effective until March 1, 2019. Medical Policy Manual Surgery, Policy No. 209 Absorbable Nasal Implant for Treatment of Nasal Valve Collapse Next Review: November 2019 Last Review:
More informationEffect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length
Research Original Investigation Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Yan Ho, MD; Robert Deeb, MD; Richard Westreich, MD; William Lawson, MD, DDS IMPORTANCE Resection of
More informationNasal Soft-Tissue Triangle Deformities
339 Hossam M.T. Foda, MD 1 1 Division of Facial Plastic Surgery, Otolaryngology Department, Alexandria Medical School, Alexandria, Egypt Facial Plast Surg 2016;32:339 344. Address for correspondence Hossam
More informationNasal Evaluation & Non-surgical Nasal Therapy in SDB
Nasal Evaluation & Non-surgical Nasal Therapy in SDB Edward M. Weaver, MD, MPH Seattle VA Medical Center University of Washington Harborview Medical Center Acknowledgments This material is the result of
More informationScientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim
Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the lar Rim Richard Ellenbogen, MD; and Greg azell, MD ackground: lthough the alar rim has frequently been neglected in correction
More informationORIGINAL ARTICLE. Surgery for the Dysfunctional Nasal Valve
Surgery for the Dysfunctional Nasal Valve Cadaveric Analysis and Clinical Outcomes Rodney J. Schlosser, MD; Stephen S. Park, MD ORIGINAL ARTICLE Objectives: To quantify changes in the cross-sectional area
More informationCorrection of the Retracted Alar Base
218 William D. Losquadro, M.D. 1 Anthony Bared, M.D. 2 Dean M. Toriumi, M.D. 2 1 Mount Kisco Medical Group, Katonah, New York 2 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology
More informationRhinoplasty and the Nasal Valve January 2008
TITLE: Rhinoplasty and the Nasal Valve SOURCE: Grand Rounds Presentation, The University of Texas Medical Branch, Dept. of Otolaryngology DATE: January 16, 2008 RESIDENT PHYSICIAN: Jeffrey Buyten, MD FACULTY
More informationUse of tent-pole graft for setting columella-lip angle in rhinoplasty
Agrawal et al. Plast Aesthet Res 2018;5:13 DOI: 10.20517/2347-9264.2018.17 Plastic and Aesthetic Research Letter to Editor Open Access Use of tent-pole graft for setting columella-lip angle in rhinoplasty
More informationORIGINAL RESEARCH ARTICLE
Erickson et al. Journal of Otolaryngology - Head and Neck Surgery (2016) 45:2 DOI 10.1186/s40463-016-0115-9 ORIGINAL RESEARCH ARTICLE Open Access Acoustic rhinometry and video endoscopic scoring to evaluate
More informationMedical Policy. MP Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
Medical Policy MP 7.01.163 BCBSA Ref. Policy: 7.01.163 Last Review: 10/18/2018 Effective Date: 01/25/2019 Section: Surgery Related Policies 9.01.502 Experimental / Investigational Services DISCLAIMER Our
More informationMedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications:
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.038.MH Septoplasty-Rhinoplasty This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar CareFirst
More informationBony hump reduction is an integral part of classic
Rhinoplasty Nasal Hump Reduction With Powered Micro Saw Osteotomy INTERNATIONAL CONTRIBUTION Yakup Avşar, MD Background: Hump reduction with manual osteotomy is an invasive procedure in aesthetic rhinoplasty.
More informationFibular Bone Graft for Nasal Septal Reconstruction: A Case Report
220 Nasal septal reconstruction Case Report Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report Yakup Cil1* Diyarbakır Military Hospital, Department of Plastic Surgery 21000 Diyarbakır, Turkey
More informationComponent Rhinoplasty
18 Original Article Component Rhinoplasty Muhammad Humayun Mohmand*, Muhammad Ahmad Cosmetic Plastic Surgeon, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan ABSTRACT BACKGROUND According
More informationComparison of the Effects of Spreader Graft and Overlapping Lateral Crural Technique on Rhinoplasty by Rhinomanometry
Original Article 99 Comparison of the Effects of Spreader Graft and Overlapping Lateral Crural Technique on Rhinoplasty by Rhinomanometry Mahmoud Omranifard, Hosein Abdali, Mehdi Rasti Ardakani, Amiryousef
More informationSurgical Management of Nasal Airway Obstruction
Surgical Management of Nasal Airway Obstruction John F. Teichgraeber, MD a, Ronald P. Gruber, MD b, Neil Tanna, MD, MBA c, * KEYWORDS Nasal obstruction Nasal breathing Septal deviation Nasal valve narrowing
More informationUpdate on the Evidence for Functional Rhinoplasty Techniques
Update on the Evidence for Functional Rhinoplasty Techniques David Chan, MD 1 and Taha Z. Shipchandler, MD, FACS 1 1. Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology,,
More informationAssessment of Nasal Function After Tip Surgery With a Cephalic Hinged Flap of the Lateral Crura: A Randomized Clinical Trial
529647AESXXX10.1177/1090820X14529647Aesthetic Surgery JournalAmali et al research-article2014 INTERNATIONAL CONTRIBUTION Rhinoplasty Assessment of Nasal Function After Tip Surgery With a Cephalic Hinged
More informationAnalyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection
COSMETIC A Multivariate Analysis of Nasal Tip Deprojection Jacob G. Unger, M.D. Michael R. Lee, M.D. Robert K. Kwon, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background: Projection of the nasal tip is a
More informationAlar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse
Aesth Plast Surg (2009) 33:625 634 DOI 10.1007/s00266-009-9349-5 ORIGINAL ARTICLE Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse Valerio Cervelli Æ Diana Spallone
More informationSpreader Graft in Closed Rhinoplasty: The Rail Spreader
Original Article 515 Spreader Graft in Closed Rhinoplasty: The Rail Spreader Alberto Scattolin, MD 1 Niana Orlando, MD 1 Luca D Ascanio, MD 2 1 Department of Otolaryngology, Villa Donatello Clinic, Piazzale
More informationEssentials of Septorhinoplasty
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
More informationThe overprojected ( Pinocchio ) tip and the ptotic
Featured Operative Technique Management of the Overprojected Nose and Ptotic Nasal Tip William E. Silver, MD, FCS; and Giancarlo F. Zuliani, MD The overprojected ( Pinocchio ) tip and the ptotic tip are
More informationThere are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE
ORIGINAL ARTICLE Erdem Tezel, MD, and Ayhan Numanoğlu, MD Abstract: Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of
More informationPresenter: dr. Labeb Sailan Obad F1
Presenter: dr. Labeb Sailan Obad F1 the correlation between currently existing objective tests for nasal airway patency and the patient s symptoms remains controversial Different measurement tools for
More informationSpecially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery
Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery By GRAEME M. CLARK (Melbourne) IN nasal surgery, cartilage or bone transplants are required for support or correction of
More informationAlireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods
Plastic Surgery International Volume 0, Article ID 4578, 4 pages doi:0.55/0/4578 Clinical Study Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with
More informationAchieving a consistent functional and aesthetic
Special Topic Simplifying the Management of Caudal Septal Deviation in Rhinoplasty Fadi C. Constantine, M.D. Jamil Ahmad, M.D. Palmyra Geissler, M.D. Rod J. Rohrich, M.D. Dallas, Texas; and Mississauga,
More informationTime for Recovery of Symptoms after Septoplasty
American Journal of Medicine and Medical Sciences 2017, 7(10): 350-355 DOI: 10.5923/j.ajmms.20170710.02 Time for Recovery of Symptoms after Septoplasty Abdullah Alotaibi 1, Bassam Ahmed Almutlaq 2, Hussain
More informationA new classification system of nasal contractures
Original Article J Cosmet Med 2017;1(2):106-111 https://doi.org/10.25056/jcm.2017.1.2.106 pissn 2508-8831, eissn 2586-0585 A new classification system of nasal contractures Geunuck Chang 1, Donghak Jung
More informationNASAL AIRWAY OBSTRUCtion
ORIGINAL ARTICLE Role of Virtual Surgery in Preoperative Planning Assessing the Individual Components of Functional Nasal Airway Surgery John S. Rhee, MD, MPH; Daniel E. Cannon, MD; Dennis O. Frank, PhD;
More informationCHAPTER 17 FACIAL AESTHETIC SURGERY. Christopher C. Surek, DO and Mohammed S. Alghoul, MD. I. BROW LIFT (Figures 1 and 2)
CHAPTER 17 FACIAL AESTHETIC SURGERY Christopher C. Surek, DO and Mohammed S. Alghoul, MD I. BROW LIFT (Figures 1 and 2) A. Open Coronal Brow Lift Technique 1. Coronal incision is made in the hair-bearing
More informationSubciliary versus Subtarsal Approaches to Orbitozygomatic Fractures
CME Subciliary versus Subtarsal Approaches to Orbitozygomatic Fractures Rod J. Rohrich, M.D., Jeffrey E. Janis, M.D., and William P. Adams, Jr., M.D. Dallas, Texas Learning Objectives: After studying this
More informationSecondary rhinoplasty
Free full text on www.ijps.org Secondary rhinoplasty Gaith Shubailat American Board of Plastic Surgery Address for correspondence: Gaith Shubailat, P. O. Box 5180, Amman, Jordan 11183. E-mail: gaith@shubailat.com
More informationFundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty.
COSMETIC Classifying Deformities of the Columella Base in Rhinoplasty Michael R. Lee, M.D. Georges Tabbal, M.D. T. Jonathan Kurkjian, M.D. Jason Roostaeian, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background:
More informationWe conducted a contemporary review covering advances and trends in primary
JOURNAL CLUB CONTEMPORARY REVIEW Contemporary Review of Rhinoplasty Patrick C. Angelos, MD; Mark J. Been, MD; Dean M. Toriumi, MD We conducted a contemporary review covering advances and trends in primary
More informationORIGINAL ARTICLE. Reconstruction of the Nasal Columella. David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A.
ORIGINAL ARTICLE Reconstruction of the Nasal Columella David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A. Hilger, MD Objective: To report techniques successful for nasal columella
More informationSubjective Assessment of Outcomes of Septoplasty
aijoc Punnoose Philip et al Original Article 10.5005/jp-journals-10003-1261 1 Punnoose Philip, 2 Deepika Pratap, 3 Aroor Rajeshwary, 4 Vadisha Bhat ABSTRACT Septal deviation is the leading cause of chronic
More informationThe Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty
IJMS Vol 36, No 3, September 2011 Original Article The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty Behrooz Gandomi 1, Mohammad Hossein Arzaghi
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationORIGINAL ARTICLE. Quantitative Study of Nasal Tip Support and the Effect of Reconstructive Rhinoplasty. accomplish both an excellent
ORIGINAL ARTICLE Quantitative Study of and the Effect of Reconstructive Rhinoplasty Holger G. Gassner, MD; William J. Remington, MD; David A. Sherris, MD Objectives: To develop a method to quantify nasal
More informationReconstruction of Dorsal and/or Caudal Nasal Septum Deformities With Septal Battens or by Septal Replacement: An Overview and Comparison of Techniques
The Laryngoscope Lippincott Williams & Wilkins, Inc. 2006 The American Laryngological, Rhinological and Otological Society, Inc. Reconstruction of Dorsal and/or Caudal Nasal Septum Deformities With Septal
More informationNew Instruments for Submembranous Dissection in Rhinoplasty
Letter to the Editor New Instruments for Submembranous Dissection in Rhinoplasty Aesthetic Surgery Journal 2017, Vol 37(7) NP73 NP78 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints
More informationAugmentation Rhinoplasty with Rib Cartilage Graft
Elaine Marie A. Lagura, MD Eduardo C. Yap, MD Anna Victoria G. Garcia, MD Augmentation Rhinoplasty with Rib Cartilage Graft Department of Otolaryngology Head and Neck Surgery Ospital ng Makati ABSTRACT
More informationThe upper buccal sulcus approach, an alternative for post-trauma rhinoplasty
British Journal of Plastic Surgery (2003), 56, 218 223 q 2003 The British Association of Plastic Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/s0007-1226(03)00117-6 The
More informationDubai Standards of Care (Septoplasty)
Dubai Standards of Care 2017 (Septoplasty) Preface Ear, nose and throat disorders are the most common problem dealt with in daily practice. In Dubai, the management of ear, nose and throat disorders were
More informationLATERAL OSTEOTOMIES ARE
ORIGINL RTILE Quantitative omparison etween Microperforating Osteotomies and ontinuous Lateral Osteotomies in Rhinoplasty Richard. Zoumalan, M; nil R. Shah, M; Minas onstantinides, M Objective: To determine
More informationKnow Your Nose: Coding the Nose and Sinuses
Know Your Nose: Coding the Nose and Sinuses Presented by: Melissa Hainz, CPC Date: September 20, 2017 AOA-35 Know Your Nose: Coding the Nose and Sinuses Coding Basics Coding Conundrums Rhinoplasty/Sinus
More informationSnoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 6
Snoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 6 MINIMALLY INVASIVE TREATMENTS OF SNORING AND SLEEP APNEA OVERVIEW The past decade has seen the rise of effective,
More informationCharlin S Syndrome Following a Routine Septorhinoplasty
Kavyani et al. 103 Case Report Charlin S Syndrome Following a Routine Septorhinoplasty Ali Kavyani1*, Ali Manafi2 1. 2. Department of Plastic Surgery, School of Medicine, Shiraz University of Medical Sciences,
More informationRepair of Traumatic Nasal Septal Perforation Using Temporalis Fascia and Interpositional Auricular Cartilage Graft
Med. J. Cairo Univ., Vol. 83, No. 1, March: 181-185, 2015 www.medicaljournalofcairouniversity.net Repair of Traumatic Nasal Septal Perforation Using Temporalis Fascia and Interpositional Auricular Cartilage
More informationRHINOPLASTY (NOSE RE-SHAPING)
PROCEDURE FACT SHEET PLASTIC SURGERY RHINOPLASTY (NOSE RE-SHAPING) This is a guide for people who are considering having a nose re-shaping (Rhinoplasty) operation. We advise that you talk to a plastic
More informationThere is no uniform grading system for nasal dorsal deformities currently in general use
ORIGINAL ARTICLE A Grading System for Nasal Dorsal Deformities Matthew A. Kienstra, MD; Holger G. Gassner, MD; David A. Sherris, MD; Eugene B. Kern, MD There is no uniform grading system for nasal dorsal
More informationUNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1
Journal of Plastic, Reconstructive & Aesthetic Surgery (2006) -, -e- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47
More informationCompared with other ethnicities, Asians have
Original Article Correction of Asian Short Nose with Lower Lateral Cartilage Repositioning and Ear Cartilage Grafting Jin Suk Byun, MD, PhD* Kenneth K. Kim, MD, FACS, Background: Asians with short nose
More informationINFORMED CONSENT-RHINOPLASTY SURGERY
INFORMED CONSENT-RHINOPLASTY SURGERY 2000 American Society of Plastic Surgeons. Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and
More informationOPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY THE NASAL SEPTUM IN RHINOPLASTY: BASIC SEPTOPLASTY TECHNIQUES FWA Otten Introduction Septal corrections form an important step in rhinoplastic
More informationMastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips. Rollin K. Daniel
Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips Rollin K. Daniel Rollin K. Daniel Mastering Rhinoplasty A Comprehensive Atlas of Surgical Techniques with
More informationPatient profile, indications, complications and Evaluation of Septoplasty outcome in a Base Hospital in Sri Lanka
Patient profile, indications, complications and Evaluation of Septoplasty outcome in a Base Hospital in Sri Lanka Rubasinghe M.S., De Silva M.D.K., Wanasinghe W.M.S.C.L., De Livera R.J.K., Wimalaratna
More information19, 2006 RESIDENT PHYSICIAN:
TITLE: Rhinoplasty SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: April 19, 2006 RESIDENT PHYSICIAN: Alan L. Cowan, M.D. FACULTY ADVISOR: David C. Teller, M.D. SERIES EDITORS: Francis
More informationRhinology Products. Rhinology Products. Superior solutions for superior patient care.
Rhinology Products Superior solutions for superior patient care. The Doyle Open-Lumen Splint addresses the problem of potential closure of the airway lumen by a hypertrophied turbinate. We also offer the
More informationUCL Repair: Emphasis on Muscle Dissection and Reconstruction
UCL Repair: Emphasis on Muscle Dissection and Reconstruction Unilateral cleft lip repair is performed using rotation-advancement technique. Markings are made on columella base, redlines, Cupid s bow on
More informationThe Precision of Template Rhinoplasty
The Precision of Template Rhinoplasty Paul O Keeffe Sydney www.oknoses.com.au Disclosure of Relevant Financial Interests Nothing to disclose Objective To determine a new stable nose profile Calculate soft
More informationNasal obstruction is one of the most common complaints of patients
Augmenting the nasal airway: Beyond septoplasty Patrick Simon, M.D., and Douglas Sidle, M.D., F.A.C.S. ABSTRACT Background: Nasal airway obstruction is a common complaint of patients presenting to otolaryngology
More informationEvaluation With Acoustic Rhinometry of Patients Undergoing Sinonasal Surgery
ORIGINAL ARTICLE Evaluation With Acoustic Rhinometry of Patients Undergoing Sinonasal Surgery R L A Raja Ahmad, MS (ORL)*, B S Gendeh, MS (ORL)** Department of Otolaryngology-Head & Neck Surgery, Kulliyyah
More informationCorrection of Secondary Deformities of the Cleft Lip Nose
CME Correction of Secondary Deformities of the Cleft Lip Nose Samuel Stal, M.D., and Larry Hollier, M.D. Learning Objectives: After studying this article, the practitioner should be able to: 1. Describe
More informationSurgical treatment of non-melanoma skin cancer of the head and neck: expanding reconstructive options van der Eerden, P.A.
UvA-DARE (Digital Academic Repository) Surgical treatment of non-melanoma skin cancer of the head and neck: expanding reconstructive options van der Eerden, P.A. Link to publication Citation for published
More informationRhinoplasty - Tip Augmentation by Extended Columellar Strip
World Articles of Ear, Nose and Throat ---------------------Page 1 Rhinoplasty - Tip Augmentation by Extended Columellar Strip Authors: Vikas Sinha*, Viral A. Chhaya**, Dilavar A. Barot***, Keyur Mehta****,
More informationAllen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N.
CME Cleft Rhinoplasty Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N. Edina and Minneapolis, Minn. Learning Objectives: After studying this article, the participant should
More information1. BRIEF DESCRIPTION OF TRAINING
RHINOLOGY 1. BRIEF DESCRIPTION OF TRAINING Exposure to clinical rhinology is provided in each of the four ORL years over the course of several rotations in a graduated approach. MEE General Otolaryngology
More informationAssessing symptoms of empty nose syndrome in patients following sinonasal and anterior skull base resection
Research Article Page 1 of 5 Assessing symptoms of empty nose syndrome in patients following sinonasal and anterior skull base resection Joel Hardman 1,2, Julie Ahn 3, Arjuna Nirmalananda 2 1 University
More informationFRONTAL SINUPLASTY P R E P A R E D A N D P R E S E N T E D B Y : D R. Y A H Y A F A G E E H R 4 16/ 12/ 2013
FRONTAL SINUPLASTY P R E P A R E D A N D P R E S E N T E D B Y : D R. Y A H Y A F A G E E H R 4 16/ 12/ 2013 ANATOMY: FRONTAL SINUS Not present at birth Starts developing at 4 years Radiographically visualized
More informationThe goal of septorhinoplasty is the reconstruction of the
Otolaryngology Head and Neck Surgery (2007) 137, 862-867 ORIGINAL RESEARCH FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY The use of autogenous costal cartilage graft in septorhinoplasty Ali Moshaver, MSc,
More informationClosed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas.
Operative Techniques in Otolaryngology (2007) 18, 233-242 Closed rhinoplasty Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD From the Center for Aesthetic Surgery, Colleyville, Texas. KEYWORDS
More informationORIGINAL ARTICLE. patients with impaired nasalbreathingandaestheticdiscomfortduetostenosisofthenasalvestibule.
ORIGINAL ARTICLE Postoperative Management of Nasal Vestibular Stenosis The Custom-made Vestibular Device Dirk-Jan Menger, MD; Peter J. F. M. Lohuis, MD, PhD; Steven Kerssemakers, MD; Gilbert J. Nolst Trenité,
More informationColumella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair
Original Article Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Yoon Seok Lee 1, Dong Hyeok Shin 1, Hyun Gon Choi 1, Jee Nam Kim 1, Myung Chul
More informationChanging the Convexity and Concavity of Nasal Cartilages and Cartilage Grafts with Horizontal Mattress Sutures: Part I. Experimental Results
Cosmetic Changing the Convexity and Concavity of Nasal Cartilages and Cartilage Grafts with Horizontal Mattress Sutures: Part I. Experimental Results Ronald P. Gruber, M.D., Farzad Nahai, M.D., Michael
More informationThe Honrubia Technique of Balloon Sinuplasty for the Improvement of Symptoms in Chronic Sinusitis. Patients. Vincent Honrubia MD, FACS
The Honrubia Technique of Balloon Sinuplasty for the Improvement of Symptoms in Chronic Sinusitis Patients Vincent Honrubia MD, FACS Allyssa Cantu, PA-S Sharon Gelman, MEd, PA-S Rachel Tsai, BS Director,
More informationNASAL OBSTRUCTION. Andy Whyte PERTH RADIOLOGICAL CLINIC UNIVERSITY OF MELBOURNE UNIVERSITY OF WA
NASAL OBSTRUCTION Andy Whyte PERTH RADIOLOGICAL CLINIC UNIVERSITY OF MELBOURNE UNIVERSITY OF WA INTRODUCTION sinonasal imaging focuses on structural abnormalities of the POSTERIOR (BONY 3/4 ) of the nose
More informationCONSENT FOR RHINOPLASTY, SEPTOPLASTY AND TURBINATES
CONSENT FOR RHINOPLASTY, SEPTOPLASTY AND TURBINATES Surgery of the nose (rhinoplasty) is an operation frequently performed by plastic surgeons. This surgical procedure can produce changes in the appearance,
More informationNose Reshaping (Rhinoplasty)
Nose Reshaping (Rhinoplasty) Are you interested in improving the appearance of your nose? If so, you re not alone. Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed
More informationTriple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses
Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Ahmed Elshahat, MD Plastic Surgery Department, Faculty of Medicine, Ain Shams University; and Eldemerdash Hospital, Cairo, Egypt
More informationThe Crooked Nose and its Functional Surgical Correction
The Crooked Nose and its Functional Surgical Correction Armando González Romero Introduction The nose is a highly specialized organ of the respiratory system and is essential for homeostasis. The pathological
More informationAugmentation Rhinoplasty with Autologous Grafts
Aesth Plast Surg (2008) 32:136 142 DOI 10.1007/s00266-007-9052-3 REVIEW Augmentation Rhinoplasty with Autologous Grafts D. J. Bottini Æ P. Gentile Æ A. Donfrancesco Æ L. Fiumara Æ V. Cervelli Published
More informationThe question Which face lift technique is COSMETIC. A Comparison of Face Lift Techniques in Eight Consecutive Sets of Identical Twins
COSMETIC A Comparison of Face Lift Techniques in Eight Consecutive Sets of Identical Twins Darrick E. Antell, M.D., D.D.S. Michael J. Orseck, M.D. New York, N.Y. Background: Selecting the correct face
More informationCanine Fossa Puncture for Severe Maxillary Disease in Unilateral Chronic Sinusitis With Nasal Polyp
The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Canine Fossa Puncture for Severe Maxillary Disease in Unilateral Chronic Sinusitis With Nasal Polyp Jang
More informationEndoscopic septoplasty
Endoscopic septoplasty Claudiu Manea, MD, PhD University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Septal deviation is a common clinical finding in patients reporting nasal obstruction.
More informationPREOPERATIVE COMPUTER
ORIGINAL ARTICLE Accuracy of Preoperative Computer Imaging in Rhinoplasty Umang Mehta, MD; Kashif Mazhar, MD; Andrew S. Frankel, MD Objective: To quantitatively measure the accuracy of preoperative computer
More informationRod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D.
Techniques in Cosmetic Surgery Rhinoplasty with Advancing Age Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Houston and Dallas, Texas Rhinoplasty in the
More informationPerichondrium Graft: Harvesting and Indications in Nasal Surgery. Armando Boccieri, MD, and Tito M. Marianetti, MD
ORIGINAL ARTICLE Perichondrium Graft: Harvesting and Indications in Nasal Surgery Armando Boccieri, MD, and Tito M. Marianetti, MD Abstract: Irregularities in the nasal contour of patients who underwent
More informationResearch Article Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales
Plastic Surgery International Volume 2016, Article ID 6945297, 9 pages http://dx.doi.org/10.1155/2016/6945297 Research Article Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple
More informationNaso-Orbital Complex Reconstruction with Titanium Mesh and Canthopexy
Case Report imedpub Journals http://www.imedpub.com DOI: 10.4172/2472-1905.100011 Naso-Orbital Complex Reconstruction with Titanium Mesh and Canthopexy Abstract Context: We are introducing the reconstruction
More informationAnatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC
Anatomy of External NOSE By Dr Farooq Aman Ullah Khan PMC 24 th Nov. 2017 The External Nose Descriptions of the nose always begin with that part of it which is covered by the skin, i.e., the EXPOSED PART
More informationCorporate Medical Policy Septoplasty
Corporate Medical Policy Septoplasty File Name: Origination: Last CAP Review: Next CAP Review: Last Review: septoplasty 4/1999 8/2018 8/2019 8/2018 Description of Procedure or Service There are many potential
More informationShamouelian et al.: Rethinking Nasal Tip Support: A Finite Element Analysis
The Laryngoscope VC 2014 The American Laryngological, Rhinological and Otological Society, Inc. Rethinking Nasal Tip Support: A Finite Element Analysis David Shamouelian, MD; Ryan P. Leary, MD; Cyrus T.
More information