Open Rhinoplasty

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery. Key words: open rhinoplasty, nasal anatomy, nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques This review contains 23 figures, 2 tables, and 43 references.

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Narrowing the Wide Tip via Endonasal Approach

Facial Plastic Surgery ◽

10.1055/s-0041-1735561 ◽

2021 ◽

Author(s):

Omotara Sulyman ◽

Steven Dayan

Keyword(s):

Healing Time ◽

Open Rhinoplasty ◽

Endonasal Approach ◽

Nasal Tip ◽

Nasal Anatomy ◽

Facial Plastic ◽

The Aesthetic ◽

Contractile Forces ◽

Tip Rhinoplasty ◽

Gain Access

AbstractRhinoplasty is arguably the most complex and intricate surgery performed by facial plastic surgeons. Nasal tip refinement of a broad nasal tip has remained the most challenging part of rhinoplasty as sophisticated techniques are critical to achieve aesthetically pleasing and structurally sound nasal tips that can withstand the contractile forces of healing. Successful tip refinement relies on an in-depth preoperative and intraoperative understanding of the patient's nasal anatomy, well developed arsenal of techniques, the experience of the surgeon, and the aesthetic desires of the patient. Although the approach to gain access to the nasal tip so as to successfully reshape the tip has been a topic of debate over many years, the aim of this article is to outline and demonstrate how the broad nasal tip can be successfully recontoured through an endonasal approach using nondestructive techniques that have been effectively used in open rhinoplasty. We believe that there continues to be a place for endonasal tip rhinoplasty especially in this era in which patients desire less invasive procedures with shorter healing time.

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Aortic valve replacement with a pulmonary autograft: case studies of the Ross procedure

American Journal of Critical Care ◽

10.4037/ajcc1997.6.6.418 ◽

1997 ◽

Vol 6 (6) ◽

pp. 418-422 ◽

Cited By ~ 1

Author(s):

C Scott ◽

M Schactman ◽

LM Graver

Keyword(s):

Aortic Valve ◽

Preoperative Evaluation ◽

Surgical Techniques ◽

Spare Part ◽

Postoperative Management ◽

Term Treatment ◽

Ross Procedure ◽

Long Term Treatment ◽

Attractive Option

The Ross procedure is an old surgical technique that is gaining popularity some 30 years after its introduction. The patient's own pulmonary valve is essentially used as a "spare part" to replace the diseased aortic valve. The Ross procedure has become an accepted and attractive option for patients with a life expectancy of more than 20 years and for patients in whom long-term treatment with anticoagulants is undesirable or problematic. Careful preoperative evaluation and postoperative management, as well as proficient surgical techniques, are all necessary to achieve good outcomes.

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An Update on Airway Management

10.2174/97898114323851200301 ◽

2020 ◽

Keyword(s):

Airway Management ◽

Surgical Techniques ◽

Daily Practice ◽

Postoperative Management ◽

Diagnostic Methods ◽

Emergency Rooms ◽

Specific Patient ◽

Medical Practitioners ◽

Preoperative Diagnostic ◽

Airway Devices

In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehensive updates presented in this volume make this a useful reference for anesthesiologists, surgeons and EMTs at all levels. Key topics reviewed in this reference include: New airway devices, clinical management techniques, pharmacology updates (ASA guidelines, DAS algorithms, Vortex approach, etc.), Induced and awake approaches in different settings Updates on diagnostic accuracy of perioperative radiology and ultrasonography Airway management in different settings (nonoperating room locations and emergency rooms) Airway management in specific patient groups (for example, patients suffering from morbid obesity, obstetric patients and critical patients) Algorithms and traditional surgical techniques that include emergency cricothyrotomy and tracheostomy in ‘Cannot Intubate, Cannot Ventilate’ scenarios. Learning techniques to manage airways correctly, focusing on the combination of knowledge, technical abilities, decision making, communication skills and leadership Special topics such as difficult airway management registry, organization, documentation, dissemination of critical information, big data and databases

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ESOPHAGEAL FISTULATION OF SHEEP FOR SHAM FEEDING STUDIES

Canadian Journal of Animal Science ◽

10.4141/cjas84-178 ◽

1984 ◽

Vol 64 (5) ◽

pp. 106-107 ◽

Cited By ~ 2

Author(s):

H. W. CHAPMAN ◽

W. L. GROVUM

Keyword(s):

Key Words ◽

Surgical Techniques ◽

Sham Feeding ◽

Feeding Techniques

Esophageal fistulae suitable for sham feeding studies were produced in 19 sheep. A new plug design, surgical techniques and maintenance procedures including a method for reducing the size of large fistulae are described. The technique was more successful with older sheep than with lambs. Key words: Sheep, esophageal fistulae, sham feeding, techniques

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Postoperative Management for the Obese Patient

10.2310/anes.18335 ◽

2021 ◽

Author(s):

Shiliang Alice Cao ◽

Maurice Frankie Joyce

Keyword(s):

Obese Patient ◽

Preoperative Evaluation ◽

Postoperative Management ◽

Impaired Wound Healing ◽

Obstructive Sleep ◽

Increased Risk ◽

Postoperative Cognitive Decline ◽

Complete Reversal ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

Obesity results in physiologic changes that effect nearly every organ system, including respiratory, cardiovascular, gastrointestinal, endocrine, genitourinary, and neuropsychiatric. These changes are associated with complications in the postoperative period that the anesthesia provider must take into account when planning the anesthetic of the obese patient. Obesity is associated with obstructive sleep apnea, obesity hypoventilation syndrome, and restrictive-type changes in lung volumes that decrease the obese patient’s ability to compensate for the changes that take place with anesthesia. The anesthetic provider should conduct a thorough preoperative evaluation, ensure complete reversal of neuromuscular blockade prior to extubation to prevent obstruction, ensure adequate pain control without compromising respiratory function, and consider use of Continuous positive airway pressure (CPAP) machines for patients on home CPAP. Obesity is also associated with an increased risk of perioperative arrhythmias, thrombotic events, impaired wound healing, decreased kidney function, and postoperative cognitive decline. Anesthetic providers should make every effort to take steps in order to prevent these complications and be knowledgeable about their management should they occur. This review contains 3 figures, 2 tables, 37 references

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Video-assisted thoracoscopic extended thymectomy in myasthenic children

Pediatric Reports ◽

10.4081/pr.2013.e4 ◽

2013 ◽

Vol 5 (1) ◽

pp. 4 ◽

Cited By ~ 1

Author(s):

Rita Sonzogni ◽

Lorenzo Novellino ◽

Alberto Benigni ◽

Ilaria Busi ◽

Magda Khotcholava ◽

...

Keyword(s):

Case Reports ◽

Preoperative Evaluation ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Ventilator Weaning ◽

New Drugs ◽

Extended Thymectomy ◽

Myasthenic Patient ◽

Surgical Department ◽

Video Assisted

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

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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.

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MANAGEMENT OF THE SURGICAL SOLUTIONS FOR FEEDING – A PREVENTION FACTOR FOR NUTRIENT BALANCE IMPAIRMENT

Romanian Medical Journal ◽

10.37897/rmj.2017.3.3 ◽

2017 ◽

Vol 64 (3) ◽

pp. 194-200

Author(s):

Corneliu Tudor ◽

◽

Costel Şavlovschi ◽

Cristian Brănescu ◽

Ahed El-Khatib ◽

...

Keyword(s):

Nutrient Balance ◽

Surgical Techniques ◽

Postoperative Management ◽

Postoperative Surveillance ◽

Feeding Tubes ◽

Term Evolution ◽

Long Run ◽

Nursing Services ◽

Limited Period

Aim. The paper aims, thanks to the long-standing practice, to synthesize the clinical experience gained during the surgery for feeding tubes management and highlight the details we had to deal with in order to overcome the local and general difficulties. Materials and method. A retrospective study was carried out over a period of 20 years (1996-2016), on the patients who underwent surgery for placing feeding tubes in our clinic. They were analyzed: the techniques used, the long-term evolution, the complications and the incidents and the way they were solved. Results. A total of 329 patients were enrolled in the study. The surgical techniques used were: classic surgical solutions (300 cases) and percutaneous endoscopic gatrostomy (PEG, 29 cases). For classical interventions, post-operative evolution was good in 219 patients (73%) and was complicated by various accidents and incidents in 81 cases (23%). The study presents the causes that may lead to these complications, the local and general, clinical and paraclinical consequences and the correct surgical attitude, as well as particular cases that required the adaptation of the surgical techniques to local anatomical and functional polymorphism. In the long run, the jejunostomy appears to be relatively inferior to gastrostomy, in terms of toland efficiency. PEG complications were minor and transient, but the reduced number of cases and the limited period of postoperative surveillance did not allow statistically significant conclusions to be drawn. Conclusions. The postoperative management of surgical feeding solutions requires permanent collaboration between surgeon, patient and outpatient nursing services at home and requires knowing and observing of a specific nursing protocol to avoid disturbing the nutrient balance of the patient.

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