The Merits of the External Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0041-1732480 ◽

2021 ◽

Author(s):

Andres Gantous ◽

Hedyeh Ziai

Keyword(s):

Open Approach ◽

Endonasal Approach ◽

External Rhinoplasty ◽

Nasal Function

AbstractThe authors present their views on the merits of external rhinoplasty in the context of a renewed awareness of the endonasal approach. Why do we continue to perform rhinoplasty via an open approach? The benefits of this technique such as its unparalleled exposure, the opportunity for technical precision, and the ability to better preserve nasal function are thoroughly explored. The criticisms of this technique are presented and discussed. The authors thoughts on rhinoplasty as a whole are examined.

Download Full-text

Management of the Crooked Nose

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1283 ◽

2016 ◽

Vol 7 (3) ◽

pp. 168-172

Author(s):

Jessica W Scordino ◽

Frederick J Stucker

Keyword(s):

Surgical Techniques ◽

Successful Outcome ◽

Open Approach ◽

Form And Function ◽

Crooked Nose ◽

Self Image ◽

Level Of Satisfaction ◽

High Level ◽

And Function ◽

Nasal Function

ABSTRACT Aim: To describe an approach for the diagnosis and management of patients presenting with crooked nose. Background Patients with crooked nose suffer from functional ailments, most significant nasal obstruction, as well as esthetic concerns which may impact their self-image as well as others’ perception of them. As such, management of the crooked nose is an especially challenging task in that it demands careful attention to both nasal function and appearance. There are a plethora of surgical techniques which may be utilized, and the surgeon's approach must be tailored to each individual patient's presentation. Technique Accurate diagnosis is imperative for a successful outcome and relies on a thorough history and careful physical examination. Surgical intervention may be addressed by either an endonasal or open approach based on the location and severity of the deformity. It is helpful to break down the nose in vertical thirds when planning your surgical approach. Different techniques are used to address the upper third comprising the nasal bones, middle third composed of the upper lateral cartilages and septum, and the lower third composed of the lower lateral cartilages and caudal septum. Conclusion Management of the crooked nose is a technically challenging endeavor that highlights the need to address both form and function for a successful outcome. Effective treatment can significantly improve a patient's quality of life leading to a high level of satisfaction for both the patient and the surgeon. How to cite this article Scordino JW, Stucker FJ. Management of the Crooked Nose. Int J Head Neck Surg 2016;7(3):168-172.

Download Full-text

Grafts in Endonasal Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0041-1729633 ◽

2021 ◽

Author(s):

Daniel D. Lee ◽

Ziad Katrib ◽

Edwin F. Williams

Keyword(s):

Plastic Surgeon ◽

Endonasal Approach ◽

Facial Plastic ◽

Nasal Function

AbstractRhinoplasty is arguably one of the most challenging but rewarding procedures for the facial plastic surgeon. To adequately improve facial aesthetic parameters and preserve nasal function, the appropriate utilization of grafts is of utmost importance. While there is no best method, I found that in my hands, the endonasal approach allowed me to achieve greater control over my results by limiting dissection, utilizing less cartilage, and minimizing variables. In this manuscript, I outline the surgical pearls I have developed throughout my career that have helped me execute these grafts efficiently and effectively.

Download Full-text

Endoscopic Endonasal Approach to Foramen Magnum Meningioma—Technical Note and Case Example

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1673428 ◽

2018 ◽

Vol 37 (04) ◽

pp. 362-366

Author(s):

Flavio Romero ◽

Rodolfo Vieira ◽

Bruno Ancheschi

Keyword(s):

Cranial Nerves ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Technical Note ◽

Open Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Midline Approach ◽

Lower Cranial Nerves

AbstractForamen magnum (FM) tumors represent one of the most complex cases for the neurosurgeon, due to their location in a very anatomically complex region surrounded by the brainstem and the lower cranial nerves, by bony elements of the craniocervical junction, and by the vertebrobasilar vessels. Currently, the open approach of choice is a lateral extension of the posterior midline approach including far lateral, and extreme lateral routes. However, the transoraltranspharyngeal approach remains the treatment of choice in cases of diseases affecting the craniocervical junction. For very selective cases, the endoscopic endonasal route to this region is another option. We present a case of a ventral FM meningioma treated exclusively with the endoscopic endonasal approach.

Download Full-text

Endoscopic endonasal approach for clipping of a PICA aneurysm

Neurosurgical Focus: Video ◽

10.3171/2020.4.focusvid.19901 ◽

2020 ◽

Vol 2 (2) ◽

pp. V14

Author(s):

Ezequiel Goldschmidt ◽

Philippe Lavigne ◽

Carl Snyderman ◽

Paul A. Gardner

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Neurological Deficits ◽

Csf Leak ◽

Open Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Posthemorrhagic Hydrocephalus ◽

Cerebellar Artery ◽

Lower Cranial Nerves

This video depicts the case of a 59-year-old woman that presented to the emergency department with the worst headache of her life. CT showed subarachnoid hemorrhage and digital subtraction angiogram demonstrated a right-side posterior inferior cerebellar artery (PICA) aneurysm. Given the medial and ventral position of the aneurysm, deep to the lower cranial nerves, which obviated distal control from an open approach, and the absence of an endovascular option able to reliably preserve the PICA, an endonasal approach was offered. A far medial approach was performed, and the aneurysm was successfully clipped. The patient developed a postoperative CSF leak with persistent posthemorrhagic hydrocephalus treated with reexploration and an eventual ventriculoperitoneal shunt. The patient was discharged without neurological deficits.The video can be found here: https://youtu.be/_9hsM2CaMow.

Download Full-text

Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions

Neurosurgery ◽

10.1227/neu.0000000000000922 ◽

2015 ◽

Vol 77 (6) ◽

pp. 888-897 ◽

Cited By ~ 17

Author(s):

Ali Kooshkabadi ◽

Phillip A. Choi ◽

Maria Koutourousiou ◽

Carl H. Snyderman ◽

Eric W. Wang ◽

...

Keyword(s):

Foramen Magnum ◽

Open Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Combined Approach ◽

Endoscopic Endonasal ◽

Primary Bone Tumors ◽

Far Lateral Approach ◽

Lower Clivus ◽

Occipital Condyles

BACKGROUND: The endoscopic endonasal approach (EEA) for craniocervical lesions involving the lower clivus and occipital condyles carries an unclear risk of atlanto-occipital (AO) instability requiring arthrodesis. OBJECTIVE: Elucidate risk factors for AO instability following EEA for clival lesions. METHODS: We reviewed patients with clival tumors who underwent EEA at our institution between 2002 and 2012. Resection of the lower clivus, foramen magnum, AO joint, and occipital condyles were evaluated on fine-cut postoperative computed tomography. RESULTS: Two hundred twelve patients (mean age 47.9 years, 57.1% male) underwent transclival EEA for lower clival lesions. In addition to the lower clivus, resection involved the condyle in 14.2% of patients, the foramen magnum in 16.5%, and the AO joint in 1.4%. Quantification of condyle resection revealed complete resection in 3 cases, 75% resection in 8 cases, 50% resection in 6 cases, and 25% resection in 13 cases. Seven of these patients had EEA combined with an open, far-lateral approach. In total, 7 patients required arthrodesis following EEA (3.3%), 4 of them after a combined approach. All patients who underwent arthrodesis had primary bone tumors such as chordoma, chondrosarcoma, or osteosarcoma (P = .022). Degree of condyle resection was a significant factor predisposing to occipitocervical instability (P = .001 and P < .001 for 75% and 100% condyle resection, respectively). Use of a combined approach was significantly associated with arthrodesis (P < .001). CONCLUSION: EEA resection of the occipital condyles that results in greater than 75% condyle resection or EEA in combination with an open approach significantly increases the risk of AO instability and likely necessitates AO fixation.

Download Full-text

Open Rhinoplasty – Should It Be the Procedure of Choice?

Canadian Journal of Plastic Surgery ◽

10.1177/229255039300100405 ◽

1993 ◽

Vol 1 (4) ◽

pp. 166-176

Author(s):

Bernd R Neu

Keyword(s):

Surgical Technique ◽

Open Rhinoplasty ◽

Open Approach ◽

Nasal Dorsum ◽

Endonasal Approach ◽

External Appearance ◽

Cartilage Grafts ◽

Tip Rotation ◽

Post Traumatic ◽

New Perspective

BR Neu. Open rhinoplasty – Should it be the procedure of choice? Can J Plast Surg 1994;1(4):166-176. Open rhinoplasty is currently recognized for its usefulness in treating complex nasal deformities. This study examines and supports the routine use of the open approach for all cosmetic nasal operations. Forty consecutive open rhinoplasties were carried out. Included were primary, secondary and post-traumatic deformities. The surgical technique is described and the results are reviewed. Precision is enhanced with the open exposure. Alar cartilages are repositioned and contoured into shape with sutures. Tip rotation and elevation are more easily controlled. Cartilage grafts are used less often and, when required, are accurately sutured into place. A learning period is needed to understand the new perspective of the exposed cartilages and the effect on the external appearance. Asymmetries are easily created, and overcorrections must be avoided. The procedure takes longer. Nasal tip hypoesthesia and edema are more pronounced. The columellar scar is well accepted. The improved results with open rhinoplasty justify it becoming the procedure of choice in the author's practice. Minor modifications of the nasal dorsum or tip are still carried out through the endonasal approach.

Download Full-text