primary rhinoplasty

1. dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

2. The nose is the central & most prominent feature of the face; & on its shape, size, & appearance, to a greater degree, depends the relative facial beauty of the person dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

3. A skillful dissembler may disguise, in a degree, the expression of the mouth; the hat may be slouched over the eyes; the chin may be hidden in an impenetrable thicket of beard; but the nose will stand out and `make its sign’ inspite of all precautions dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

11.  Functions of the nose ◦ Regulation of nasal airflow ◦ Filtration ◦ Defense against infection dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

13. aesthetics Nasal landmarks dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

14. aesthetics dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

15. aesthetics Tip define dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

16. aesthetics Naso-facial angle dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

17. Esthetics Naso-labial (columellar-labial) angle dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

19.  L.A ◦ I.V. Sedation ◦ Topical & Infiltrative Anesthesia  G.A. with endotracheal intubation dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

20. Topical & Infiltrative Anesthesia Volume (1%lidocaine + 1:1ooooo epinephrine) Vestibule,aperture – 2ml Dorsum – 1ml Lateral walls – 2ml Tip, columella – 2ml dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

23. Closed Technique An order of procedure: six stages dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

34.  Two main objectives ◦ To resect the excess cartilage & thus reduce the size of the nasal tip & permit its reshaping ◦ To weaken the cartilage between the lateral & medial crura in order that the lateral crus may lie down assume a position in harmony with the new profile of the nose dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

35.  Three precautions in performing surgical modifications of the shape of the alar cartilages ◦ Avoid raw areas resulting from the removal of vestibular lining ◦ Avoid excessive removal of the cartilage to avoid a pinched deformity ◦ Avoid sharp angles & protuberances dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

54. Open technique Basic differences dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

55.  Indications ◦ Sculpting the tip cartilages ◦ Proper placement of grafts ◦ Difficult septum ◦ Straighten a crooked nose  Contraindications ◦ Who have not stopped smoking 7-10 days prior to surgery ◦ External nasal scar ◦ Thick skinned noses requiring reduction dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

61.  Dorsal humps are managed acc. to their size ◦ < 5mm – rasp ◦ > 5mm – osteotome  Nasal tip surgery ◦ Columellar struts(intercrural) ◦ Suture techniques ◦ Tip grafts dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

62.  Five basic types of tip sutures ◦ Transdomal suture ◦ Interdomal suture ◦ Lateral crural mattress suture ◦ Intercrural suture & ◦ Columellar-septal suture dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

63. Transdomal suture First suture Domal creation suture of Daniel Dome spanning suture of Tebbetts Dome suture dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

64. Interdomal suture Domal equalization suture of Daniel Medial fixation suture of tebetts dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

65. Intercrural suture  Flare control suture dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

67. Columellar-septal suture Orthopedic suture Projection control suture Tip rotation suture dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

71. Osteotomies Medial oblique osteotomy dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

72.  Indications ◦ The secondary rhinoplasty deformity with loss of alar cartilage ◦ The secondary `polly tip’ deformity with loss of definition of the profile line ◦ The hypo plastic tip ◦ The tethered lip ◦ Congenital deformities `cleft lip nasal deformity’ ◦ The plunging tip with caudal angulations of alar cartilage ◦ the thick skinned tip with loss of anatomic definition dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

75. Adjunctive techniques dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

76.  Indications ◦ To reduce the size of the nostrils ◦ To aid in recessing the tip & ◦ To reduce the flaring dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

81.  It is designed to safe guard the integrity & preserve the physiologic mechanism of the nasal valve  It also provides an excellent exposure of the septal framework when correction of a septal deviation is required during the rhinoplasty  Contraindicated in very large nose because of the excess of mucous membrane that remains after the reduction of the nose dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

83. Tip exposure technique Hockey stick incision Popularized by Brown & McDowell (1951) dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

85. Tip exposure Retrograde technique dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

86. Tip exposure Eversion technique dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

92.  Projecting tip ◦ Excessively projecting tip, `the Pinocchio nose’ require shortening & recession ◦ Whether tip is projecting or is the dorsum recessed ◦ If dorsum is recessed , the dorsal profile elevated by the cartilagenous graft with minimal tip surgery dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

96.  Condition that become more accentuated with the aging  Anatomic basis of this deformity can vary ◦ The septum is long, invading the lip & the ligamentus attachments of the alar cartilages to the septal angle are adequate or ◦ 2nd type shows, on digital distraction, a lack of continuity between the tip of the nose & the septal angle dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

102.  Extensive submucus resection rarely required  Conservative measures ◦ Resection of bony spur /obstructive portion of septum ◦ By incising the base of the septum, replacing it into the vomer groove ◦ Shaving areas of thickened septal cartilage ◦ Straightening a curved dorsal border of septum ◦ Straightening the dislocated caudal portion of septum dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

109. Saddle nose Depression of the dorsum of the nose may occur in the bony or cartilagenous portion; when both are affected termed saddle nose dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

110.  Hemorrhage  Infection  Mucus cyst  Necrosis  Functional  Iatrogenic ◦ Tip ptosis ◦ Alar retraction ◦ Pollybeak ◦ Nasofrontal angle ◦ Saddle nose dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

116.  AUGMENTATION OF THE LABIOCOLUMELLAR ANGLE  CORRECTION OF AN ACUTE NASOLABIAL ANGLE- TECHNIQUE BY AUFRICHT  NASAL SPINE dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

117.  F 9.2 rees dr sumer yadav, mch plastic and reconstructive surgery, smeryadav2004@gmail.com

primary rhinoplasty

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