Copyright restrictions may apply Contemporary Review of Rhinoplasty Angelos PC, Been MJ, Toriumi DM....

Copyright restrictions may apply

Contemporary Review of Rhinoplasty

Angelos PC, Been MJ, Toriumi DM. Contemporary review of rhinoplasty. Arch Facial Plast Surg. 2012;14(4):238-247.


Introduction

• Presentation of recent advances and trending topics in rhinoplasty.


Purpose

• To review recent advances and trends in rhinoplasty surgery, including the following:

– Functional rhinoplasty

– Nasal valve surgery

– Septal reconstruction

– Nasal tip contouring

– Osteotomies

– Computer imaging

– Grafting

• To review outcomes studies for an evidence-based approach.


Relevance to Clinical Practice, Public Health, or Personal Health

• Rhinoplasty is one of the most common procedures in facial plastic surgery and all of plastic surgery.

• Rhinoplasty has functional and cosmetic implications for patients.


Description of Evidence

• A literature review was performed, citing mostly rhinoplasty articles since 2000 focusing on advances and highlighting those with outcomes data.

• Overall, rhinoplasty studies have a low level of evidence; more well-designed studies are needed for an evidence-based approach.

• See the article’s Table for a summary of studies reviewed.


Controversies and Consensus

• Various techniques for nasal valve surgery.

– Lack of widely used objective measures.

– Nasal Obstruction Symptom Evaluation (NOSE) instrument is a validated quality-of-life measure.

– Consensus: evidence supports functional rhinoplasty and nasal valve repair.

• Septal reconstruction techniques including caudal septal replacement grafts have also been shown to improve quality of life using the NOSE scale.

• Various aspects of tip contouring were reviewed, as were techniques for improving the nasal airway.

– Consensus: cephalic malpositioning of the lower lateral cartilages contributes to nasal tip deformities.


• Osteotomy techniques have been compared:

– Microperforating and continuous lateral osteotomies.

– Consensus: both seem to create similar changes in width.

• Irradiated homologous costal cartilage grafts:

– Historically thought to be less predictable than autologous tissue in their ability to resist resorption and warping.

– Long-term studies have shown absorption rates comparable to autogenous grafts with low overall complication rates.

• For alloplastic materials, silicone has higher implant removal rates than Gore-Tex or Medpor.

– New studies are showing safety and efficacy of polydioxanone plates in rhinoplasty.

• Computer imaging continues to evolve in rhinoplasty.

Controversies and Consensus


Discussion

• Evidence-based approaches will benefit patients as well as surgeons and help ensure predictable and lasting results in rhinoplasty.

• More outcomes studies and well-designed trials are needed to allow for more evidence-based approaches in rhinoplasty surgery.


Conclusions

• Rhinoplasty surgery including various techniques will continue to evolve and remain one of the most common procedures in plastic surgery.


• If you have questions, please contact the corresponding author:

– Dean M. Toriumi, MD, Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, 1855 W Taylor St, Third Floor, Chicago, IL 60612.

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