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Contemporary Review of Rhinoplasty

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.

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Contemporary Review of Rhinoplasty

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

  2. Introduction • Presentation of recent advances and trending topics in rhinoplasty.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

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

  10. Contact Information • 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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