This document discusses techniques for de-projecting the nasal tip. It begins by describing the difference between nasal tip projection and rotation. It then discusses the mechanisms that provide stability to the nasal tip and what can happen when these supports fail. Anatomical features that cause over-projection are described as well as surgical techniques to achieve de-projection, including complete transfixion, reducing the anterior nasal spine or nasal septum, and modifying the lower lateral cartilages through techniques like lateral crural overlay. The document emphasizes that de-projection often requires a multi-step procedure tailored to the individual case.
Grafts in Nasal Surgery - Advanced Rhinoplastyjwmenger
The document is a lecture on the use of various nasal cartilage grafts in rhinoplasty surgery. It discusses different types of grafts including columellar struts, shield grafts, spreader grafts, dorsal onlay grafts, septal replacement grafts, alar rim grafts, and sidewall grafts. For each graft, it provides details on preferred materials, placement in the nose, and pre-operative and post-operative images showing examples of patients who received the grafts. The purpose of the grafts is to improve nasal function and breathing, achieve a desired nasal shape, and camouflage asymmetries.
Total maxillectomy is a surgical procedure to remove the entire maxilla bone. It was first described in the 1820s and approaches have been refined over time. It is indicated for malignant tumors involving the maxilla, extensive benign tumors, or fungal/granulomatous infections. Contraindications include poor general health, bilateral orbital involvement, or skull base extension. Potential complications include bleeding, infection, epiphora, skin graft breakdown, numbness, and atrophic rhinitis. Careful surgical planning and follow up are required due to significant reconstruction and rehabilitation needs.
Rhinoplasty or nose job is a surgery to make the nose better by changing the shape of nose. This lecture gives a broad idea on principles of rhinoplasty .
A rhinoplasty surgeon has to be quite careful while choosing the right candidate for rhinoplasty.
The document discusses various types of facial and neck trauma. Facial injuries are commonly caused by motor vehicle collisions, assaults, and child abuse. Evaluation involves imaging like CT scans to diagnose fractures. Treatment depends on the type and severity of the injury but may include closed reduction, open reduction, and reconstruction. Neck injuries are serious due to vulnerability of structures like the airway. Proper management of neck trauma aims to rapidly secure the airway and control bleeding.
This document discusses the anatomy, embryology, surgical techniques, and reconstructive options for microtia. It provides detailed descriptions of the Brent and Nagata autogenous cartilage reconstruction techniques, which are multi-staged procedures using costal cartilage grafts. Alternative options discussed include single-stage reconstruction, tissue expanders, osseointegrated prostheses, silicone prostheses, and alloplastic reconstruction with porous polyethylene implants. Complications of each approach are also reviewed.
This document discusses external rhinoplasty techniques presented by Dr. Abhineet. It covers indications for external rhinoplasty including reduction/augmentation and trauma/deformities. Pre-op assessment involves standardized photographs. Key anatomical points are defined. Ideal measurements and angles are provided. Techniques for hump reduction, tip work, grafts, and modifications to narrow the base are outlined. Potential complications like hemorrhage, infection and deformities are reviewed. The presentation compares open vs closed approaches and emphasizes achieving symmetry and natural appearance tailored to each patient.
This document discusses avoiding complications during endoscopic sinus surgery (ESS). It outlines common complications like injury to the orbit, optic nerve, great vessels, and nasolacrimal duct. Factors that help avoid complications include using nasal endoscopes, precise instruments, imaging guidance, and thorough knowledge of anatomy. Complications are more common during revision surgery, surgery for polyps, and in patients with complex anatomy. Careful attention to anatomical landmarks can help reduce risks.
This document discusses various incisions and techniques used in rhinoplasty surgery. It describes the main incisions used including caudal septal, intercartilaginous, vestibular, infracartilaginous, and transcolumellar incisions. It then discusses techniques for accessing and mobilizing the bony nasal pyramid including different types of osteotomies. Other topics covered include hump removal, saddle nose correction, tip surgery, and correcting various tip abnormalities.
Grafts in Nasal Surgery - Advanced Rhinoplastyjwmenger
The document is a lecture on the use of various nasal cartilage grafts in rhinoplasty surgery. It discusses different types of grafts including columellar struts, shield grafts, spreader grafts, dorsal onlay grafts, septal replacement grafts, alar rim grafts, and sidewall grafts. For each graft, it provides details on preferred materials, placement in the nose, and pre-operative and post-operative images showing examples of patients who received the grafts. The purpose of the grafts is to improve nasal function and breathing, achieve a desired nasal shape, and camouflage asymmetries.
Total maxillectomy is a surgical procedure to remove the entire maxilla bone. It was first described in the 1820s and approaches have been refined over time. It is indicated for malignant tumors involving the maxilla, extensive benign tumors, or fungal/granulomatous infections. Contraindications include poor general health, bilateral orbital involvement, or skull base extension. Potential complications include bleeding, infection, epiphora, skin graft breakdown, numbness, and atrophic rhinitis. Careful surgical planning and follow up are required due to significant reconstruction and rehabilitation needs.
Rhinoplasty or nose job is a surgery to make the nose better by changing the shape of nose. This lecture gives a broad idea on principles of rhinoplasty .
A rhinoplasty surgeon has to be quite careful while choosing the right candidate for rhinoplasty.
The document discusses various types of facial and neck trauma. Facial injuries are commonly caused by motor vehicle collisions, assaults, and child abuse. Evaluation involves imaging like CT scans to diagnose fractures. Treatment depends on the type and severity of the injury but may include closed reduction, open reduction, and reconstruction. Neck injuries are serious due to vulnerability of structures like the airway. Proper management of neck trauma aims to rapidly secure the airway and control bleeding.
This document discusses the anatomy, embryology, surgical techniques, and reconstructive options for microtia. It provides detailed descriptions of the Brent and Nagata autogenous cartilage reconstruction techniques, which are multi-staged procedures using costal cartilage grafts. Alternative options discussed include single-stage reconstruction, tissue expanders, osseointegrated prostheses, silicone prostheses, and alloplastic reconstruction with porous polyethylene implants. Complications of each approach are also reviewed.
This document discusses external rhinoplasty techniques presented by Dr. Abhineet. It covers indications for external rhinoplasty including reduction/augmentation and trauma/deformities. Pre-op assessment involves standardized photographs. Key anatomical points are defined. Ideal measurements and angles are provided. Techniques for hump reduction, tip work, grafts, and modifications to narrow the base are outlined. Potential complications like hemorrhage, infection and deformities are reviewed. The presentation compares open vs closed approaches and emphasizes achieving symmetry and natural appearance tailored to each patient.
This document discusses avoiding complications during endoscopic sinus surgery (ESS). It outlines common complications like injury to the orbit, optic nerve, great vessels, and nasolacrimal duct. Factors that help avoid complications include using nasal endoscopes, precise instruments, imaging guidance, and thorough knowledge of anatomy. Complications are more common during revision surgery, surgery for polyps, and in patients with complex anatomy. Careful attention to anatomical landmarks can help reduce risks.
This document discusses various incisions and techniques used in rhinoplasty surgery. It describes the main incisions used including caudal septal, intercartilaginous, vestibular, infracartilaginous, and transcolumellar incisions. It then discusses techniques for accessing and mobilizing the bony nasal pyramid including different types of osteotomies. Other topics covered include hump removal, saddle nose correction, tip surgery, and correcting various tip abnormalities.
1. Flaps are used in reconstructive surgery to repair structural defects following procedures like cancer surgery. They involve transferring tissue from one part of the body to another while maintaining or reconnecting its blood supply.
2. There are many types of flaps classified by their blood supply, tissue type, and location. Common flaps used in head and neck reconstruction include local flaps like nasolabial and advancement flaps as well as regional and distant flaps like pectoralis major and radial forearm flaps.
3. Proper flap selection and design is important to replace tissue "like with like" and adhere to anatomical borders and units for optimal cosmetic and functional outcomes.
This document discusses the use of nasal grafts in rhinoplasty surgery. It describes various types of cartilage grafts including columellar struts, shield grafts, spreader grafts, dorsal onlay grafts, and grafts to augment the fronto-nasal angle. These grafts are often needed in revision cases to improve nasal function and breathing or achieve a desired nasal shape. The lecture contains images from surgery to illustrate how the grafts are used and their effects. Common graft materials include septal, auricular and costal cartilage.
This document provides an overview of rhinoplasty procedures. It discusses the history and anatomy of rhinoplasty. It describes techniques for open and closed rhinoplasty approaches. It covers tip work including tip suturing and grafts. It also discusses nasal augmentation including graft materials and saddle nose repair. Deformities like deviated nose and underprojected tip are reviewed along with surgical correction methods. Key anatomical structures and surgical principles are emphasized.
This document discusses potential complications from functional endoscopic sinus surgery (FESS) and their management. Some common complications include orbital injuries such as damage to the lamina papyracea or periorbita, periorbital emphysema, intraorbital hematoma, damage to nerves or muscles. Risk factors include dehiscence of the lamina papyracea, revision surgery, extensive disease, and distorted anatomy. Management depends on the specific complication but may include observation, antibiotics, steroids, repair, decompression, or intervention from an ophthalmologist. Preventing complications requires careful preoperative planning including CT scans, optimal surgical field preparation, identifying landmarks properly, and being meticulous during surgery
The document discusses a presentation on penetrating neck injuries (PNI). It provides background on the history of PNI management, anatomy of the neck zones, epidemiology of PNI, types of morbidity and injuries, diagnosis, management approaches, and clinical cases. Key points covered include the shift from mandatory neck exploration to more selective management based on clinical exam and adjunctive tests; common structures injured in PNI; and accurate diagnosis of injuries through clinical exam, imaging such as CT angiography, and endoscopy.
This document discusses the anatomy, development, classification and diagnosis of microtia, as well as approaches to total auricular reconstruction for microtia. It covers the nerve supply and embryological development of normal ears. It also describes classifications of microtia, associated deformities, timing of surgery, and factors to consider in patient assessment for ear reconstruction, including facial symmetry, skin envelope, vestige skin and hair.
The document discusses rhinoplasty techniques including:
- Anatomy and landmarks of the nose that determine facial beauty.
- Techniques for nasal tip surgery like sutures and grafts to reshape the tip.
- Osteotomies and cartilage modification techniques to reduce humps and change nasal shape.
- Adjunctive procedures like alar base resection to reduce flare and nostril size.
- Considerations for open versus closed rhinoplasty approaches.
This document summarizes the surgical anatomy of the nose relevant for rhinoplasty procedures. It describes the three sections of the external nose, key areas like the keystone and nasal tip, blood supply, and different incision types used. The nasal septum and lateral nasal walls are also outlined. Diagrams are included to illustrate nasal anatomy terms and incision locations.
This document discusses microtia and abnormalities of the external ear. It begins with an introduction defining microtia and abnormal ear development. It then describes the anatomy of the external ear and some common developmental anomalies like preauricular sinuses and appendages. The document discusses indications for surgery for these anomalies. It also discusses grading of microtia, clinical assessment, audiological assessment, and management options for significant microtia including autologous ear reconstruction and bone-anchored auricular prostheses.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
Microtia is a congenital deformity where the external ear is underdeveloped, ranging from small ears to complete absence of the auricular tissues. Treatment options include autologous costal cartilage grafts and prosthetic reconstruction. The Tanzer, Brent, and Nagata techniques use harvested rib cartilage to construct an ear framework, with differences in staging and sculpting of features. Complications can include chest wall deformities, skin necrosis, infection, and resorption of the cartilage graft over time.
This document discusses principles of conservative surgery for head and neck cancers. It covers selective and comprehensive neck dissection techniques for managing cervical lymph nodes. It describes various open and endoscopic surgical procedures to preserve structure and function for cancers of the larynx and hypopharynx, including vertical partial laryngectomy, supracricoid laryngectomy, and transoral laser resection. Complications and oncologic outcomes of these organ preservation techniques are also discussed.
This document discusses various laryngeal surgeries including:
1. Endoscopic resections, vertical partial laryngectomies, and total laryngectomy are discussed as options for glottic cancer treatment. Complications can include bleeding, airway obstruction, and laryngeal stenosis.
2. Supraglottic laryngectomy and supracricoid partial laryngectomy are options for supraglottic cancers while preserving the larynx. Patient selection is important due to risk of aspiration.
3. Voice rehabilitation options after total laryngectomy include electrolarynx, esophageal voice, or tracheoesophageal voice via a puncture and fistula between the trachea and es
This document discusses various techniques for reconstructing skin and soft tissue defects in the head and neck region. It describes different types of grafts, local flaps, regional flaps, and free flaps that can be used including split thickness grafts, full thickness grafts, axial pattern flaps, transposition flaps, pedicled flaps like pectoralis major and latissimus dorsi flaps. Careful preoperative planning is important when using local flaps for head and neck reconstruction.
This document discusses the anatomy, etiology, evaluation, and management of iatrogenic facial nerve injury. It describes the segments of the facial nerve and provides surgical landmarks. Common causes of facial nerve palsy include Bell's palsy, trauma, infection, tumors, and iatrogenic injury during procedures like mastoidectomy or parotid surgery. Evaluation involves tests like ENoG and EMG to determine the severity of injury. Management depends on the timing and location of injury, and may involve supportive care, steroids, nerve decompression, repair, grafting, or muscle transposition procedures. The goal is to restore facial muscle function through reinnervation of the nerve.
This document discusses the management of laryngeal cancer. It covers treatment options for different stages of glottic and supraglottic cancers including endoscopic resection, radiation therapy, and open partial laryngectomies like vertical partial laryngectomy and supracricoid partial laryngectomy. It describes the surgical techniques and principles of various open partial laryngectomy procedures and their indications. Post-operative care and expected outcomes are also summarized.
The document discusses the history and surgical management of otosclerosis. It begins with an overview of the historical understanding and treatment of otosclerosis dating back to the 18th century. It then covers the evolution of stapes surgery techniques from early attempts in the late 19th century to modern laser and prosthesis approaches. Key aspects of stapedectomy and stapedotomy procedures are described, including indications, contraindications, outcomes, complications, and problems that can occur intraoperatively. Post-operative care and potential issues are also summarized.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
1. The document discusses techniques for de-projecting the nasal tip, which is important to assess along with tip rotation.
2. It describes the major and minor tip support mechanisms and what can happen when they are disrupted.
3. Various surgical techniques are presented for addressing over-projection, including reducing the nasal spine, lowering the nasal septum, and modifying the lateral and medial crura using techniques like lateral crural overlay. Multi-step procedures are often needed to achieve the desired result. Cases are shown to illustrate different techniques.
1. Flaps are used in reconstructive surgery to repair structural defects following procedures like cancer surgery. They involve transferring tissue from one part of the body to another while maintaining or reconnecting its blood supply.
2. There are many types of flaps classified by their blood supply, tissue type, and location. Common flaps used in head and neck reconstruction include local flaps like nasolabial and advancement flaps as well as regional and distant flaps like pectoralis major and radial forearm flaps.
3. Proper flap selection and design is important to replace tissue "like with like" and adhere to anatomical borders and units for optimal cosmetic and functional outcomes.
This document discusses the use of nasal grafts in rhinoplasty surgery. It describes various types of cartilage grafts including columellar struts, shield grafts, spreader grafts, dorsal onlay grafts, and grafts to augment the fronto-nasal angle. These grafts are often needed in revision cases to improve nasal function and breathing or achieve a desired nasal shape. The lecture contains images from surgery to illustrate how the grafts are used and their effects. Common graft materials include septal, auricular and costal cartilage.
This document provides an overview of rhinoplasty procedures. It discusses the history and anatomy of rhinoplasty. It describes techniques for open and closed rhinoplasty approaches. It covers tip work including tip suturing and grafts. It also discusses nasal augmentation including graft materials and saddle nose repair. Deformities like deviated nose and underprojected tip are reviewed along with surgical correction methods. Key anatomical structures and surgical principles are emphasized.
This document discusses potential complications from functional endoscopic sinus surgery (FESS) and their management. Some common complications include orbital injuries such as damage to the lamina papyracea or periorbita, periorbital emphysema, intraorbital hematoma, damage to nerves or muscles. Risk factors include dehiscence of the lamina papyracea, revision surgery, extensive disease, and distorted anatomy. Management depends on the specific complication but may include observation, antibiotics, steroids, repair, decompression, or intervention from an ophthalmologist. Preventing complications requires careful preoperative planning including CT scans, optimal surgical field preparation, identifying landmarks properly, and being meticulous during surgery
The document discusses a presentation on penetrating neck injuries (PNI). It provides background on the history of PNI management, anatomy of the neck zones, epidemiology of PNI, types of morbidity and injuries, diagnosis, management approaches, and clinical cases. Key points covered include the shift from mandatory neck exploration to more selective management based on clinical exam and adjunctive tests; common structures injured in PNI; and accurate diagnosis of injuries through clinical exam, imaging such as CT angiography, and endoscopy.
This document discusses the anatomy, development, classification and diagnosis of microtia, as well as approaches to total auricular reconstruction for microtia. It covers the nerve supply and embryological development of normal ears. It also describes classifications of microtia, associated deformities, timing of surgery, and factors to consider in patient assessment for ear reconstruction, including facial symmetry, skin envelope, vestige skin and hair.
The document discusses rhinoplasty techniques including:
- Anatomy and landmarks of the nose that determine facial beauty.
- Techniques for nasal tip surgery like sutures and grafts to reshape the tip.
- Osteotomies and cartilage modification techniques to reduce humps and change nasal shape.
- Adjunctive procedures like alar base resection to reduce flare and nostril size.
- Considerations for open versus closed rhinoplasty approaches.
This document summarizes the surgical anatomy of the nose relevant for rhinoplasty procedures. It describes the three sections of the external nose, key areas like the keystone and nasal tip, blood supply, and different incision types used. The nasal septum and lateral nasal walls are also outlined. Diagrams are included to illustrate nasal anatomy terms and incision locations.
This document discusses microtia and abnormalities of the external ear. It begins with an introduction defining microtia and abnormal ear development. It then describes the anatomy of the external ear and some common developmental anomalies like preauricular sinuses and appendages. The document discusses indications for surgery for these anomalies. It also discusses grading of microtia, clinical assessment, audiological assessment, and management options for significant microtia including autologous ear reconstruction and bone-anchored auricular prostheses.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
Microtia is a congenital deformity where the external ear is underdeveloped, ranging from small ears to complete absence of the auricular tissues. Treatment options include autologous costal cartilage grafts and prosthetic reconstruction. The Tanzer, Brent, and Nagata techniques use harvested rib cartilage to construct an ear framework, with differences in staging and sculpting of features. Complications can include chest wall deformities, skin necrosis, infection, and resorption of the cartilage graft over time.
This document discusses principles of conservative surgery for head and neck cancers. It covers selective and comprehensive neck dissection techniques for managing cervical lymph nodes. It describes various open and endoscopic surgical procedures to preserve structure and function for cancers of the larynx and hypopharynx, including vertical partial laryngectomy, supracricoid laryngectomy, and transoral laser resection. Complications and oncologic outcomes of these organ preservation techniques are also discussed.
This document discusses various laryngeal surgeries including:
1. Endoscopic resections, vertical partial laryngectomies, and total laryngectomy are discussed as options for glottic cancer treatment. Complications can include bleeding, airway obstruction, and laryngeal stenosis.
2. Supraglottic laryngectomy and supracricoid partial laryngectomy are options for supraglottic cancers while preserving the larynx. Patient selection is important due to risk of aspiration.
3. Voice rehabilitation options after total laryngectomy include electrolarynx, esophageal voice, or tracheoesophageal voice via a puncture and fistula between the trachea and es
This document discusses various techniques for reconstructing skin and soft tissue defects in the head and neck region. It describes different types of grafts, local flaps, regional flaps, and free flaps that can be used including split thickness grafts, full thickness grafts, axial pattern flaps, transposition flaps, pedicled flaps like pectoralis major and latissimus dorsi flaps. Careful preoperative planning is important when using local flaps for head and neck reconstruction.
This document discusses the anatomy, etiology, evaluation, and management of iatrogenic facial nerve injury. It describes the segments of the facial nerve and provides surgical landmarks. Common causes of facial nerve palsy include Bell's palsy, trauma, infection, tumors, and iatrogenic injury during procedures like mastoidectomy or parotid surgery. Evaluation involves tests like ENoG and EMG to determine the severity of injury. Management depends on the timing and location of injury, and may involve supportive care, steroids, nerve decompression, repair, grafting, or muscle transposition procedures. The goal is to restore facial muscle function through reinnervation of the nerve.
This document discusses the management of laryngeal cancer. It covers treatment options for different stages of glottic and supraglottic cancers including endoscopic resection, radiation therapy, and open partial laryngectomies like vertical partial laryngectomy and supracricoid partial laryngectomy. It describes the surgical techniques and principles of various open partial laryngectomy procedures and their indications. Post-operative care and expected outcomes are also summarized.
The document discusses the history and surgical management of otosclerosis. It begins with an overview of the historical understanding and treatment of otosclerosis dating back to the 18th century. It then covers the evolution of stapes surgery techniques from early attempts in the late 19th century to modern laser and prosthesis approaches. Key aspects of stapedectomy and stapedotomy procedures are described, including indications, contraindications, outcomes, complications, and problems that can occur intraoperatively. Post-operative care and potential issues are also summarized.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
1. The document discusses techniques for de-projecting the nasal tip, which is important to assess along with tip rotation.
2. It describes the major and minor tip support mechanisms and what can happen when they are disrupted.
3. Various surgical techniques are presented for addressing over-projection, including reducing the nasal spine, lowering the nasal septum, and modifying the lateral and medial crura using techniques like lateral crural overlay. Multi-step procedures are often needed to achieve the desired result. Cases are shown to illustrate different techniques.
[Dr. Suh's thesis in International journal SCI]
“A Novel technique for short nose correction”
The nominated thesis is about A Novel technique for short nose correction; Hybrid septal extension graft that have acquired the favorable reputation internationally based on the advanced clinical experiences.
This document discusses the anatomy and surgical techniques related to rhinoplasty of the nasal tip. It begins with the anatomy of the nasal tip and supporting structures. It then covers surgical approaches like external rhinoplasty and tip delivery. Tip modification techniques are outlined such as suture contouring, cartilage resection, and grafting. Both overprojected and underprojected tip deformities are addressed along with techniques to adjust tip projection and rotation.
The external rhinoplasty approach provides extensive exposure of the nasal skeleton for complex revision surgeries and deformities. It involves an incision connecting the mid-columella to bilateral marginal incisions, allowing visualization of the nasal bones, vault, septum, and tip cartilages while preserving the soft tissue envelope. Some disadvantages are disruption of minor tip support mechanisms and potential for tip ptosis. Precise grafting techniques can then be used to correct dorsal abnormalities, strengthen the nasal valve, alter tip projection and rotation, and address septal deviations.
A Novel Technique of Asian Tip Plasty by Dr. Man Koon, Suh from JW Plastic Su...JW Plastic Surgery
Background
The columellar strut graft is one of the most commonly used invisible grafts in tip plasty techniques for nasal tip projection. However, the columellar strut graft induces cephalic rotation of the dome with nasal tip projection. This is an effective change in Western people with a long nose; however, this change should be avoided in Asians who have a relatively short nose and visible nostrils. We designed a more convenient and effective technique using a rein-shaped columellar strut graft that can prevent cephalic rotation of the dome.
Methods
A total of 32 patients underwent surgery with a rein-shaped columellar strut graft with a septal cartilage. The projection and location of the nasal tip, nasal length, and nasolabial angle were measured after taking a photograph of the lateral view, and the preoperative and postoperative results were compared.
Results
There were statistically significant differences between the preoperative and postoperative values of the nasal tip projection ratio and nasal tip location ratio. There were no revision surgeries and no direct complications associated with the use of the columellar strut graft.
Conclusion
We performed tip plasty with a modified columellar strut graft—the rein-shaped columellar strut graft. In most cases of using this method, the tip projection was increased and the cephalic rotation of the tip was prevented. This surgical procedure can also be used for lengthening (rotating caudally) of the nose in some cases, as well as for the purpose of preventing the cephalic rotation of the tip.
Surgical orthodontics ii /certified fixed orthodontic courses by Indian den...Indian dental academy
This document discusses surgical procedures for correcting various maxillary deficiencies. It describes LeFort I, II, and III osteotomies for advancing or repositioning the maxilla. Specific deficiencies discussed in detail include maxillary anteroposterior deficiency, excess, vertical deficiency, and combinations thereof. For each, the document outlines characteristic facial and dental features, differential diagnosis, presurgical orthodontics, surgical technique including grafting and fixation considerations, and postsurgical orthodontic treatment. Risk factors for relapse after LeFort I advancement are also examined based on a retrospective study. The document provides an in-depth overview of surgical orthodontic treatment approaches for correcting various maxillary skeletal discrepancies.
biomechanics of open bite closure by incisor extrusionMaher Fouda
This document discusses various techniques for treating anterior open bites in orthodontics. It begins by noting that while deep bites are commonly treated using intrusion mechanics, open bites have received less attention despite being a common problem. Techniques discussed include incisor extrusion using vertical elastics, extractions to allow incisor eruption/retroclination, and appliances like tongue cribs. Challenges with reliability and patient compliance with vertical elastic use are also addressed. The document provides details on biomechanics, appliances, and cases.
This document outlines surgical assessments for various rhinoplasty patients. It describes pre-operative conditions such as hump deformities, nasal tip issues, and septal deviations. For each patient, it provides a brief surgical plan in 3 sentences or less, including procedures like hump removal, osteotomies, tip work, and grafting. It aims to demonstrate the importance of thorough surgical assessment and planning in rhinoplasty. Pre- and post-operative photos support each assessment. The document is intended for colleagues as part of an advanced rhinoplasty course.
This document provides information about maxillary orthognathic surgery. It discusses the history and types of maxillary osteotomies performed, including Lefort I, II, and III osteotomies. Lefort I osteotomy is described as the workhorse procedure used to correct functional and aesthetic maxillary issues. Complications, patient satisfaction rates, and surgical techniques for performing the various maxillary osteotomies are summarized.
Expansion appliances /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Rhinoplasty is a diverse group of surgical procedures that can be performed for cosmetic or functional purposes. The surgery involves techniques such as modifying the radix, nasal dorsum, nasal tip, nasal base, and lateral osteotomy. Rhinoplasty can also involve premaxillary augmentation or be performed in conjunction with septoplasty. The goals are to narrow or widen the nose, straighten deviations, and optimize esthetic balance.
1) Rhinoplasty, or nose surgery, is a cosmetic procedure used to reshape the nose. It involves altering the bone and cartilage structures to change the shape and appearance of the nose.
2) A thorough clinical examination is required to properly assess the nasal deformities and plan the surgical approach. Photographs are also taken to document the pre-operative appearance.
3) The surgery involves making incisions to access and alter the nasal structures. Common procedures include reducing a hump, narrowing the nasal tip, changing the angle between the nose and upper lip, and correcting breathing problems by modifying the nasal septum.
Basic principle of rhinoplasty. by venukumar.tvenukumar55
This document provides an overview of the basic principles of rhinoplasty surgery. It discusses nasal anatomy including landmarks like the radix, rhinion, septal angle, and lower lateral cartilages. It covers surgical techniques for both endonasal and external rhinoplasty approaches. Key steps for various nasal deformity corrections are outlined such as hump removal, dorsal augmentation, and tip work. The document also lists common instruments used in rhinoplasty surgery.
This document summarizes Dr. Ahcene Madjoudj's experience with reconstructive rhinoplasty surgery following trauma or deformity. It describes various surgical techniques used for different types of injuries and conditions, including saddles, burns, cancer resections, and cleft lip/palate. Across cases, the goals are to reconstruct the nasal structure and shape while balancing aesthetic and functional concerns. The document emphasizes the challenges of meeting patient expectations given limitations of reconstructive surgery.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
Histololgy of Female Reproductive System.pptxAyeshaZaid1
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1. De-projection of the Nasal Tip
D.J. Menger
International Course in Advanced Rhinoplasty Techniques
The Netherlands
www.AdvancedRhinoplasty.nl
2. Dear colleague,
This presentation illustrates the difference between nasal tip projection and tip rotation, it shows the
mechanisms that provide stability to the nasal tip and what happens if these support mechanisms fail.
Anatomical features that cause over-projection of the tip are discussed in addition to how de-projection
of the tip can be achieved; which surgical techniques are available, how and when should you use them
in order to reach the desired esthetical outcome.
CAUTION: This lecture contains pictures taken during surgery, which might be shocking. The lecture is
intended for colleagues and is part of the "International Course in Advanced Rhinoplasty Techniques".
Dirk Jan Menger, MD
Course Director
The Netherlands
www.AdvancedRhinoplasty.nl
3. In the assessment of the nasal tip there are two important factors to keep in mind:
1. The distance between the alar groove and the tip defining point, known as nasal tip projection. This
length should be in harmony with the length of the nose. On average the length of the nose should be 1,8
times longer than this nasal tip projection.
2. Nasal tip rotation or the nasolabial angle. In woman his angle should be between 90 and 120 degrees in
man 90 to 105 degrees.
Both rotation and projection should be in harmony with the rest of the face and with the height of the
nasal dorsum in particular.
www.AdvancedRhinoplasty.nl
4. There are a couple of mechanisms that keep the nasal tip in place and provide stability and support. These
mechanisms can be divided into major and minor tip support mechanisms. The major support mechanisms
include the size, shape and resilience of the lower cartilages (LL) , they play an important role.
•
Size, shape, and resilience of the lower lateral
cartilages
•
Fibrous attachment of:
– the medial crura to the nasal septum
– the lateral crura to the upper laterals
www.AdvancedRhinoplasty.nl
5. The fibrous attachments between the medial crura (MC) and the nasal septum and the attachments between
the lateral crura (LC) and the upper laterals (UL) are also part of the major support mechanisms.
•
Size, shape, and resilience of the lower lateral
cartilages
•
Fibrous attachment of:
– the medial crura to the nasal septum
– the lateral crura to the upper laterals
www.AdvancedRhinoplasty.nl
6. Minor Tip Support Mechanisms: these include:
the septal dorsum, the interdomal ligament, the membranous septum, the nasal spine, the minor alar cartilages
and the attachments of the lower laterals (LL) to the soft tissue envelope.
•
•
•
•
•
•
septal dorsum
interdomal ligament
membranous septum
nasal spine
minor alar cartilages of the LL
attachments of the LL to the soft tissue envelope
www.AdvancedRhinoplasty.nl
7. Loss of tip support mechanisms:
When one or more of the major or minor support mechanisms are disturbed due to rhinoplasty, trauma or
other causes: than the tip can drop downward causing de-projection and downward rotation.
www.AdvancedRhinoplasty.nl
8. Some patients are born with insufficient nasal tip projection, like in this patient. There was under-projection of
the tip, a fleshy bulbous columella and a relative high nasal dorsum.
www.AdvancedRhinoplasty.nl
9. Such a deformity of the nasal tip can easily be resorted and brought into better proportions with the use of
structural grafts to lengthen the tip, increasing its projection using a columellar strut graft, a shield-and tip onlay
grafts.
In this case also a bony- and cartilaginous hump reduction was performed in combination with spreader grafts and
micro-osteotomies
www.AdvancedRhinoplasty.nl
10. pre- and post operative lateral view
www.AdvancedRhinoplasty.nl
11. Iatrogenic de-projection/amputation:
Sometimes surgery itself causes de-projection or amputation of the nasal tip. This case illustrates a patient who
was referred due to multiple rhinoplasties in the past.
www.AdvancedRhinoplasty.nl
12. In this case I had to remove all the scar tissue and remnants of grafts that were brought into the nose
in previous surgeries elsewhere, only the soft tissue envelope could be preserved. The entire
cartilaginous skeleton was rebuild using rib grafts and auricular composite grafts.
www.AdvancedRhinoplasty.nl
13. This is an exceptional case, it shows that one should be careful when disrupting or manipulating major and minor
tip support mechanisms. During the surgical procedure they should always be restored in order to avoid
problems as outlined in this case.
pre- and postoperative frontal view.
www.AdvancedRhinoplasty.nl
15. Back to the over-projected nasal tip:
Over-projection of the nasal tip is often caused by a combination of three features:
1. a strong nasal spine
2. long medial- and lateral crura
3. a high nasal septum
In general: in most patients with over projection of the nasal tip the cause is multi factorial and
therefore the surgical techniques to lower the tip too are multistep procedures. In the next up coming
slides surgical techniques to de-project the nasal tip will be discussed.
2
3
1
www.AdvancedRhinoplasty.nl
16. Surgical Solutions:
complete transfixion
One of the easiest procedures is the complete transfixion incision. Due to this incision the attachment between
the medial crura and the septum is disturbed which causes de-projection of the tip.
www.AdvancedRhinoplasty.nl
17. Surgical Solutions:
reduction of the anterior nasal spine
Another solution might be the reduction of the anterior nasal spine. Especially in patients with a strong spine in
combination with a short upper lip, this can give just enough de-projection to bring the tip in better harmony
with the rest of the nose and face.
www.AdvancedRhinoplasty.nl
18. Surgical Solutions:
lowering the nasal septum
Some patients with too much tip projection have a very high nasal septum. By lowering the cartilaginous part of
the septum, the tip will de-projection as a result.
www.AdvancedRhinoplasty.nl
19. Surgical Solutions:
Tripod Theory
The LL can be altered too, this is the basis for the tripod concept. The middle leg of the tripod is the MC,
the LC are the other two legs. One can imagine what happens if one or more legs are shortened:
shortening the middle leg will cause de-projection and downward rotation of the tip.
When only the lateral legs are shortened: the tip will de-project and rotate upwards.
H. Tschopp
www.AdvancedRhinoplasty.nl
20. Surgical Solutions:
lateral crural overlay
Shortening of the lateral crura can be achieved using an interrupted strip, or a lateral crural overlay technique in
which the lateral crus is cut and sutured side to side.
www.AdvancedRhinoplasty.nl
21. Surgical Solutions:
lateral- and medial crural overlay
The medial crura, they too can be shortened and placed side-to-side, medial crural overlay, or the so-called
“Lipsett maneuver”. The effect is twofold; downward rotation and de-projection of the nasal tip. When both LC and MC-overlay is performed, the rotation of the tip will not change, only de-projection will be achieved.
www.AdvancedRhinoplasty.nl
22. Surgical Solutions
dome amputation with onlay tip graft
A more aggressive method to de-project the tip is to amputate the domes, suture them together and
camouflage the area with a small onlay graft.
www.AdvancedRhinoplasty.nl
23. De-projection of the nasal tip, a multistep procedure:
As mentioned before, in many patients a multi-step procedure is necessary to achieve the desired post-operative
result.
For example this male patient with breathing problems. In this case a complete transfixion incision was made,
the nasal spine was reduced and the lateral- and medial crura were shortened using the crural overlay
technique as described earlier.
www.AdvancedRhinoplasty.nl
24. The deviated and over-projected nose:
This patient had an over-projected tip and a strong deviation of the bony and cartilaginous dorsum to the right
due to nasal trauma.
External approach rhinoplasty: osteotomies, including intermediate on the left, septal
correction, spreader/splint on the left side, lateral- and medial crural overlay, reduction of the anterior nasal
spine.
www.AdvancedRhinoplasty.nl
27. The deviated tension nose
This patient had breathing problems on the right side due to collapse of the mid-nasal third, hence the concave
area just cephalic of the LC. The dorsum was deviated to the left side, bifidity of the domes, over-projection of
the bony- and cartilaginous dorsum and nasal tip.
www.AdvancedRhinoplasty.nl
28. The reason for this over-projection was threefold and caused by the combination of:
a strong nasal spine, relative long medial crura and
1
2
www.AdvancedRhinoplasty.nl
29. a high nasal dorsum.
In the assessment of the surgical steps to be taken in order to reduce the over-projection in this case, again
multiple surgical procedures will be necessary:
•
•
3
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
30. 1. Lowering the nasal dorsum (hump reduction) and the nasal septum.
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
31. 2. Oblique- and lateral osteotomies, for realignment and infraction of the nasal bones.
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
32. 3. A spreader graft only on the right side to camouflage the concavity in the mid nasal third.
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
33. 4. Reduction of the anterior nasal spine to reduce the "short and crowded upper-lip".
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
34. 5. De-projection of the nasal tip was performed using medial crural overlay, the medial crura are sutured side to
side. Between the MC's a columellar strut is placed to stabilize the columellar complex.
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
35. 6. Minimal cephalic resection of the LC followed by trans- and interdomal sutures to to camouflage the bifidity
of the nasal tip and to refine the tip defining region.
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
www.AdvancedRhinoplasty.nl
36. 7. Finally a small radix graft (diced cartilage) is placed in the fronto-nasal angle, augmentation of this area gives
the illusion that the nasal bridge is less prominent.
•
•
•
•
•
•
•
hump reduction / reduction of cartilaginous
septum
osteotomies
– lateral / oblique
spreader graft right side
reduction anterior nasal spine
medial crural overlay
tip refinement
– cephalic resection
– sutures trans- and interdomal
small radix graft
www.AdvancedRhinoplasty.nl
39. pre- and postoperative views.
A less crowded upper-lip, de-projection and “softening” of the nasal tip, a slightly lower nasal dorsum that fits
better in her profile and minimal augmentation of the nasofronatal angle.
www.AdvancedRhinoplasty.nl
40. This Patient had functional- and esthetic problems of the nose. Especially in the lateral view her nose was too
prominent. She had a short upper lip, too much projection of her nasal tip and a cartilaginous dorsum that was
relatively high.
www.AdvancedRhinoplasty.nl
41. Pre- and postoperative lateral view after an external approach rhinoplasty. Hump reduction, oblique- and lateral
osteotomies, thin spreader grafts, reduction of the anterior nasal spine and caudal septum, de-projection of the
tip using medial- and lateral crural overlay, columellar strut and tip sutures.
www.AdvancedRhinoplasty.nl
43. This patient had complaints of an irregular and over-projected nasal dorsum and tip. There was a concavity in
the mid nasal third on the right side and breathing problems due to a strong deviation of caudal nasal septum.
www.AdvancedRhinoplasty.nl
44. A multi step procedure was performed using an external approach rhinoplasty:
hump reduction, oblique- and lateral osteotomies, spreader graft on the right side, septal correction, deprojection of the tip using medial- and lateral crural overlay, columellar strut and tip sutures.
pre- and postoperative lateral view.
www.AdvancedRhinoplasty.nl
45. pre- and postoperative basal view.
The septal deviation was reconstructed using a caudal septal splint graft.
www.AdvancedRhinoplasty.nl
46. Caudal septal splint graft. This graft can be used to straighten severe septal deviations. The deviated area of the
nasal septum is first weakened by "scoring the cartilage" with a blade, than the graft is sutured to this area in
order to straighten and support the caudal septum.
www.AdvancedRhinoplasty.nl
49. A long over-projected nose
This patient had a nose that was too long. There was over-projection and downward rotation of the nasal tip
and too much columellar show. She had previous rhinoplasty performed elsewhere, a hump was removed
trough an endonasal approach. Hence the open roof deformity due to insufficient osteotomies and infraction of
the nasal bones. There was a deviation of the mid nasal third to the left side and a concavity on the right side.
There was also bifidity and asymmetry of the tip defining points.
www.AdvancedRhinoplasty.nl
50. Assessment:
Shortening of the nose by removing a strip of the caudal septum and upper laterals. A limited hump
removal, oblique- and lateral osteotomies to close the open roof. A spreader/splint graft on the right
side of the nasal septum to camouflage the concavity and to straighten the mid nasal third. Deprojected of the tip using a medial- and lateral crural overlay, a columellar strut graft, tip sutures to
smoothen her asymmetric tip.
www.AdvancedRhinoplasty.nl
51. Another goal of surgery was to improve the eyebrow esthetic line to the tip defining points.
www.AdvancedRhinoplasty.nl
52. pre- and postoperative oblique view.
A shorter nose, upward rotation of the nasal tip, de-projection of the tip and a smooth nasal dorsum.
www.AdvancedRhinoplasty.nl
55. Conclusions, over-projection of the nasal tip is often multi-factorial.
The anatomical structures that are involved are the anterior nasal spine, the nasal septum and the
lower lateral cartilages.
• Over-projection of the nasal tip is often multi-factorial:
– nasal spine
– nasal septum
– lower lateral cartilages
www.AdvancedRhinoplasty.nl
56. De-projection of the nasal tip requires a multistep procedure:
A rhinoplasty with detachment of tip support mechanisms and reduction of the anterior nasal spine,
the nasal septum and/or medial- and lateral crura. At the end of surgery the tip support mechanisms
should be restored in order to reach a balanced and stable long-term postoperative result.
• De-projection of the nasal tip requires a multistep procedure:
– detachment of tip support mechanisms
– reduction
• spine
• septum
• medial- and lateral crura
www.AdvancedRhinoplasty.nl