Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips. Rollin K. Daniel

Transcription

1 Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips Rollin K. Daniel

2 Rollin K. Daniel Mastering Rhinoplasty A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips 2nd Edition With 259 Color Figures in 1408 Parts and 146 Integrated Intraoperative DVD Clips Jaye Schlesinger, Medical Illustrator Chuck Cox, Videographer 123

3 Rollin K. Daniel, MD 1441 Avocado Ave., Suite 308 Newport Beach, CA 92660, USA and Clinical Professor of Surgery Department of Plastic Surgery University of California, Irvine Irvine, CA, USA Medical Illustrator: Jaye Schlesinger, MFA School of Art and Design University of Michigan 906 Miner St. Ann Arbor, MI 48103, USA Videographer: Chuck Cox, WBV SD Biomedical Communications 4127 Pallon Court San Diego, CA, USA chuckcoxepacbell.net Additional material to this book can be downloaded from ISBN eisbn DOI / Springer Heidelberg Dordrecht London New York Library of Congress Control Number: , 2010 Springer-Verlag Berlin Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is per mitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: estudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (

4 Dedication To Beatrix Tirkanits, MD, FRCS (C) Diplomat, American Board of Plastic Surgery Both personal and professional partner whose sacrifice and support made this book possible. To Andrew Nicholas Daniel, PhD Son, scholar and fellow adventurer.

5 Contents 1 Simplifying Rhinoplasty A Basic Rhinoplasty Operation Radix and Dorsum Tip Techniques Nasal Base Functional Factors Grafts Primary Rhinoplasty: Decision Making Advanced Primary Rhinoplasty Secondary Rhinoplasty: Surgical Techniques Secondary Rhinoplasty: Decision Making Aesthetic Reconstructive Rhinoplasty Subject Index

6 Table of Dvd Clips 1 Rhinoplasty Simplified None 2 Basic Rhinoplasty Operation 2.1 a Analysis 2.1 b OperativePlanning 2.2 Anesthesia 2.3 a d Open Approach 2.3 e, f Dissection: Columellar to Tip 2.3 g, h Dissection: Bidirectional 2.4 a, b Septal Exposure: Transfixion 2.4 c, d Septal Exposure: Tip Split 2.4 e Extramucosal Tunnels 2.5 a c Tip Analysis 2.5 d f Symmetrical Rim Strips 2.6 Bony Hump Reduction 2.7 a f Cartilage Hump Reduction 2.8 a d Caudal Septal Resection 2.9 a c Caudal Septal Relocation 2.10 Septal Harvest 2.11 a, b Osteotomies: Low to High 2.11 c, d Osteotomies: Low to Low 2.12 Spreader Grafts 2.13 Columellar Strut & Suture 2.14 Domal Creation Suture 2.15 Interdomal Suture 2.16 Tip Position Suture 2.16 d f Tip Refinement Graft (TRG) 2.17 a, b Nostril Sill Excision 2.17 c, d Alar Wedge Excision 2.17 e, f Combined Sill & Wedge Excision 2.18 Cast & Post-Op Photos 3 Radix and Dorsum 3.6 Analysis 3.7 Fascia (F) Graft 3.8 (DC + F) Graft 3.13 Bony Vault Reduction 3.14 Split Cartilage Reduction 3.15 a, b Osteotomies: Low to High 3.15 c, d Osteotomies: Low to Low 3.15 j l Spreader Grafts 3.19 Fascia (F) Graft to Dorsum 3.20 (DC F) Graft 3.22 Decision Making 4 Tip Techniques 4.1 Tip: Operative Planning 4.5 Tip: Anatomy & Aesthetics 4.8 Tip: Analysis DVD 1

7 x Table of Dvd Clips 4.9 Open Approach 4.10 Exposure: Columellar to Tip 4.11 Exposure: Bidirectional Table 4.2 Open Tip Suture Technique Step by Step 4.12 a, b Symmetrical Rim Strips 4.14 Columellar Strut & Suture 4.16 a, b Domal Creation Suture 4.19 a, b Interdomal Suture 4.21 Domal Equalization Suture 4.23 a, b Lateral Crural Mattress Suture 4.25 a, b Tip Position Suture 4.27 Tip Refinement Graft (TRG) 4.29 Alar Rim Graft, Alar Structure Graft 4.31 a, b Open Structure Tip Graft (OST) 4.31 c, d OST: Columellar Strut & Suture 4.31 e, f OST: Domal Suture 4.32 a, b OST: Dome Excision & Tip Graft 4.32 c OST: Integrated Tip Graft 4.32 d OST: Projected Tip Graft 4.39 OST: Operation with 4 year Result 5 Nasal Base 5.4 Analysis 5.5 Base Analysis 5.6 a, b Nostril Sill Excision 5.6 c, d Alar Wedge Excision 5.6 e, f Combined Sill & Wedge Excision 5.7 Excision: Caudal Septum & ANS 5.11 Composite Grafts 5.20 Nostril Splints 6 Functional Factors 6.1 a, b Septal & Valvular Obstruction 6.1 e, f Total Septal Deviation 6.2 Nasal Obstruction in a Cosmetic Case 6.3 a, b Septal Exposure: Transfixion Approach 6.3 c, d Septal Exposure: Dorsal/Tip Split 6.3 e, f Septal Exposure: Dorsal Split 6.3 g, h Septal Exposure: Tip Flip 6.4 a, b Septal Exposure 6.4 c, d Septal Resection 6.6 d Caudal Septal Relocation 6.9 Total Septoplasty 6.10 Nostril Valve 6.11 Vestibular Valve 6.12 Internal Valve 6.22 Repair of Mucosal Tear DVD 2 7 Grafts 7.3 Spetal Harvest 7.4 a Spetal Harvest: BiDirectional Approach 7.5 b e Conchal Cartilage Harvest 7.6 Composite Ear Graft: Harvest 7.8 a Fascia Harvest: Approach 7.8 b d Fascia Harvest: Endoscopic View 7.9 a, b Fascia: Radix Graft 7.9 c, d Fascia: Combined Radix Dorsal Graft 7.11 a, b Costal Rib: Supraperichondrial Harvest 7.11 c, d Costal Rib: Subperichondrial Harvest 7.12 Inframammary Rib: Full Thickness Resection 7.13 Oseeocartilaginous Rib Harvest 7.14 b Columellar Strut: Shaping & Insertion 7.14 c Extended Columellar Strut 7.14 d Septo Columellar Strut 7.15 Tip Refinement Grafts (TRG) 7.16 Structured Tip Graft: Integrated 7.17 Structured & Cap Tip Graft: Projected 7.18 Spreader Grafts 7.19 a c Radix Graft: Fascia 7.19 d f Combined Radix & Dorsal Graft: Fascia 7.19 g i Radix or Dorsal Graft: DC + F 7.20 Dorsal Graft: Osseocartilaginous Rib 7.21 Dorsal Graft: Double Layer Fascia 7.22 a DC F: Overview 7.22 b DC F: Dicing Cartilage 7.22 c DC F: Fascia Sleeve 7.22 d DC F: Filling Sleeve 7.22 e DC F: Graft Insertion 7.25 Alar Rim Grafts (ARG) 7.26 Alar Rim Structure Grafts (ARS) 7.27 Lateral Crural Strut Graft (LCSG) 7.28 Lateral Crural Strut Graft (LCSG) with Alar Transposition 7.30 e Dermis Graft: Harvest 7.30 f Dermis Graft: Insertion

8 Table of Dvd Clips xi 8 Primary Rhinoplasty: Decision Making 8.17 b Lateral Crural Strut Graft (LCSG) 8.17 c Lateral Crural Strut Graft (LCSG) with Alar Transposition 9 Advanced Primary Rhinopasty None 10 Secondary Rhinoplasty: Surgical Techniques 10.4 Analysis 10.5 Skin Defatting 10.6 Fascia Blanket 10.7 Secondary Septum 10.8 b Structured Tip Graft 10.9 Dorsum/Spreader Grafts a Caudal Septal Replacement b Micro Osteotomies e h Spreader Grafts a c Fascia Coverage d, f Add-on TRG Grafts g i Structured Tip Graft (OST) 11 Secondary Rhinoplasty: Decision Making 11.2 Fascia Blanket Case Study: Complex Secondary Rhinoplasty 12 Aesthetic Reconstructive Rhinoplasty 12.1 b Foundation Layer 12.1 c Spreader Graft 12.1 d Dicing Cartilage 12.1 e, f Fixation of Septal Strut to ANS 12.1 i, j Fixation of Septal Strut & Spreader Graft 12.1 k, l Insertion of Columellar Strut & Tip Graft 12.1 m, n Dorsal Graft: DC F 12.7 Dorsal Graft: Osseocartilaginous 12.8 Nostril Support: Major Rim Grafts Dermis Graft: Insertion