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Contemporary Review | Journal Club

Contemporary Review of Rhinoplasty

Patrick C. Angelos, MD; Mark J. Been, MD; Dean M. Toriumi, MD
Arch Facial Plast Surg. 2012;14(4):238-247. doi:10.1001/archfacial.2012.577.
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We conducted a contemporary review covering advances and trends in primary and functional rhinoplasty as published during the past decade. Specifically, we reviewed studies supporting the evidence for functional rhinoplasty, nasal valve surgery, and septal reconstruction. In addition, key articles discussing cephalic malpositioning of the lower lateral cartilages and tip contouring are reviewed. We also report studies involving lateral osteotomy techniques, computer imaging, and the use of homologous, alloplastic, and absorbable implants. When appropriate, we review outcomes data from key studies because these data are becoming increasingly important for evidence-based medicine, physician grading, and procedure reimbursement. Using evidence-based approaches whenever possible will help to ensure predictable patient outcomes.

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Figure 1. Diagram of the autospreader technique. A, The upper lateral cartilage is scored after hump takedown, parallel to the nasal bone. B, The upper lateral cartilage is turned in and sutured in mattress fashion to the septum. Reprinted from Yoo and Most.18

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Figure 2. Malposition of the alar cartilages. A, Anteroposterior (frontal) view with the lateral crura in orthotopic position. B, Anteroposterior (frontal) view with the lateral crura in cephalic position. The green lines indicate the vector of the right lateral crus; blue lines, the vector of the left lateral crus; black lines, the vertical midsagittal line; and angle, the angle between the lateral crural vector and the midsagittal line. Reprinted from Sepehr et al.12

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Figure 3. A favorable nasal tip contour has a horizontal orientation with a shadow in the supratip area that continues into the supra-alar regions. A, There is a smooth transition from the tip lobule to the alar lobule without a line of demarcation. The tip-defining points are seen as a horizontally oriented highlight with shadows above and below. B, The base view shows a triangular shape with no notching between the tip lobule and the alar lobule. The horizontal component of the nasal tip with a defined width is set by the position of the domes. Reprinted from Toriumi.4

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Figure 4. Correction of cephalically positioned lateral crura. A, Cephalically positioned lateral crura create excess vertical supratip tip fullness. Before manipulation, the caudal margin of the lateral crura lies below the cephalic margin. B, The lateral crura are dissected from the underlying vestibular skin. C, Lateral crural strut grafts are sutured to the undersurface of the lateral crura. D, A more caudally positioned pocket is created to accommodate the lateral crus. E, After lateral crural strut grafts are sutured to the undersurface of the lateral crura, the lateral crura are repositioned into the new, caudally positioned pockets to correct the cephalic positioning. After graft placement and repositioning, the lateral crura are now oriented close to 45° off midline instead of the preoperative cephalic orientation. Reprinted from Toriumi.4

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Figure 5. The alar rim graft (in green) is placed directly along the alar margin to effect contour changes and provide resilience. A, Basal view. B, Front view. C, Profile view. Reprinted from Boahene and Hilger.9

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Figure 6. Polydioxanone (PDS) plate surgical technique. A, Cartilage fragments are sutured to the PDS plate. B, The finished graft. C, The graft is reimplanted into the nose. Reprinted from Boenisch and Nolst Trenité.14

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