Addressing the Upper Third of the Nose in Endonasal Rhinoplasty

Effective management of the upper nasal vault is based on a thorough preoperative analysis and detailed understanding of the requisite principles and techniques utilized to modify the anatomic structures in this region. The surgeon must equally consider form and function when performing manipulation of the upper nasal vault. Special considerations apply when managing this anatomic region via an endonasal or closed approach. A review of this topic is presented with a focus on techniques as they apply to the endonasal rhinoplasty patient.

Ectopic primary olfactory neuroesthesioblastoma originating from the anterior nasal septum

<div class="WordSection1"><p class="abstract">Olfactory neuroestesioblastoma (ONB) is a rare malignant neoplasm of the paranasal sinus. Ectopic growth of ONB outside the region of neuroepithelial cells are exceedingly rare and so far, it has only been reported to arise from the maxillary sinus, sphenoid sinus, posterior septum and the turbinates. None has been reported to originate from the anterior cartilaginous part of the septum. A 31-year-old lady, who was premorbidly well, presented with 2 episodes of spontaneous epistaxis from the left nostril in 1 year. The epistaxis worsened over the one week prior to her visit. Nasoendoscopy showed a vascularised round mass at the anterior part of the left septum. Initial biopsy was reported as possible ectopic squamous cell carcinoma of the salivary gland. A repeat biopsy then confirmed the diagnosis of ONB. Computed tomography scan of the paranasal sinus showed an isolated mass (18×18 mm) arising from the anterior part of the septum. Endoscopic resection of the tumour was done and histopathology report revealed as ONB. Post-operative radiotherapy was given with a total dose of 66. The rarity of ONB poses a challenge during diagnosis. The histological identification is difficult as these tumours may show little or no differentiation. A simple biopsy from the mass is often insufficient and may produce inaccurate results. Isolated growth without involvement of the upper nasal vault is extremely rare. A possible explanation would be the presence of ectopic neuroepithelial cells at the cartilaginous anterior septal area that has failed to degenerate during fetal development.</p></div>

Dorsal Preservation Rhinoplasty: Core Beam Computed Tomography Analysis of the Nasal Vault, Septum, and Skull Base—Its Role in Surgical Planning

Dorsal preservation rhinoplasty in cases of a convex or overprojected noses has significant advantages over resection and reconstruction of the dorsum. Analysis of the subdorsal septum in relation to the radix osteotomy to achieve a drop or hinge of the natural dorsum is important in avoiding possible complications involving the skull base, frontal sinus, and subsequent radix position. In the majority of patients, simple cut release of the perpendicular plate rather than resection superiorly may be necessary where the quadrangular cartilage junction with the perpendicular plate is caudal to the radix osteotomy. Computed tomography is helpful in delineating this position as well as providing information on the frontal sinus and position of the cribriform plate prerhinoplasty.

Objective Comparison Between Spreader Grafts and Flaps for Mid-Nasal Vault Reconstruction: A Randomized Controlled Trial

Objective: The goal of rhinoplasty is not exclusively aesthetic and the nasal function should always be considered. Several rhinoplasty techniques can participate in nasal valve dysfunction (eg, dorsal hump reductions). Therefore, mid-nasal vault reconstruction by spreader grafts or flaps is mandatory in these cases. To date, there is a literature gap in comparing both techniques objectively. This study shows an objective comparison between spreader grafts and flaps for mid-nasal vault reconstruction. Material and Methods: This study was a double-blind randomized controlled trial including 40 patients who were randomly divided into 2 groups. Group 1 (20 patients) underwent spreader grafts insertion, whereas group 2 (20 patients) underwent spreader flap placement technique. Pre-operative active anterior rhinomanometry measurements were compared to 6-month post-operative measurements. Data were summarized as mean (standard deviation) for the quantitative variables. Comparisons between the 2 groups were done using unpaired t test. Results: In both groups, a significant decrease in nasal resistance was noted in both the right and left sides 6 months post-operatively ( P < .001). However, the comparison between the 2 both groups showed no statistical significance. Conclusion: Both spreader grafts and flaps, which are used for the mid-nasal vault reconstruction, have comparable and effective results in reducing the nasal resistance as evidenced by active anterior rhinomanometry measurements.

The Use of Osteotomies in Nasal Profileplasty

In rhinoplasty, osteotomies are performed to manipulate the bony nasal vault to improve the function and/or the aesthetics of the nose. This article provides an overview of the instruments used for osteotomies, as well as the indications and techniques for osteotomies in nasal profileplasty.

Widened Dorsum: Bony and Cartilaginous Contributions

Creation of a pleasing dorsal nasal profile in the anterior and lateral views requires proper analysis and planning to determine the required series of steps to accomplish the desired outcome. The widened nasal dorsum is a common esthetic complaint of the patient seeking rhinoplasty. Often patients seek an unrealistic result that, if accomplished, would leave them with a restricted nasal vault and nasal airway compromise. Nasal function must be balanced with the patient and surgeon's desire to narrow the nasal dorsum. Various techniques are used to control the width of the upper third, or bony vault, and middle third, or cartilaginous vault.