Rhinoplasty

7.14.1 Give us a diagram of the nerves and vessels of the nose.

7.14.2 What are the standard photodocumentation views for a rhinoplasty?

7.14.3 What surgical techniques can be used to increase projection of a nasal tip? Decrease projection?

7.14.4 Discuss nasal proportions and landmarks.

7.14.5 What surgical techniques can help get rid of a boxy tip?

7.14.6 How do you fix a crooked nose?

7.14.7 Major and minor tip support mechanisms. What is the “tripod” theory?

7.14.8 When and why should we use alar wedge excisions? Where do the incisions go?

7.14.9 I hate my nose and am going to be your first rhinoplasty patient. Analyze my nose (be kind) and tell me how you can make me pretty. Ask Dr. (your facial plastic surgeon) for help.

7.14.10 Internal and external nasal valves-what are they, how do you evaluate for collapse and how would you correct it?

7.14.11 Compare and contrast the endonasal vs. open approach.

7.14.12 Help us understand the anatomy of the nasal cartilages.

7.14.13 Discuss the management of saddle nose deformity. Etiologies?

7.14.14 Describe intranasal incisions.

7.14.15 How do you perform osteotomies? Describe the various incisions used to gain access to the lower lateral cartilage. What are the advantages and disadvantages of each?

7.14.16 Your rhinoplasty patient is very unhappy two weeks after surgery because her nose is not quite straight and the tip is still boxy. What should you do?

7.14.17 Describe the pollybeak deformity. How can you prevent it?

7.14.18 What are the advantages and disadvantages of open rhinoplasty?

Sheen JH. Closed versus open rhinoplasty--and the debate goes on. Plast Reconstr Surg. 1997 Mar;99(3):859-62. PMID:9047208

7.14.19 How can one narrow a wide nasal dorsum without altering its projection?

Harris MO, Baker SR. Management of the wide nasal dorsum. Arch Facial Plast Surg. 2004 Jan-Feb;6(1):41-8. PMID:14732644

7.14.20 Does insurance cover a rhinoplasty for an old fracture? What if the patient has a deviated septum but you are also doing cosmetic work on the tip? How would you code for this?

7.14.21 How do you fix a boxy tip?

7.14.22 Are patients happy with rhinoplasties? Read an outcomes study.

7.14.23 What are the various alloplastic implants that can be used in augmentation rhinoplasty? What are the advantages and disadvantages of each? When would you use cartilage rather than alloplast?

7.14.24 What are the various methods of infracturing? What different exposures can be used?

7.14.25 Should you always do medial, as well as lateral osteotomies?

Rohrich RJ, Minoli JJ, Adams WP, Hollier LH. The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg. 1997 Apr;99(5):1309-12; discussion 1313. PMID:9105357

Becker DG, McLaughlin RB Jr, Loevner LA, Mang A. The lateral osteotomy in rhinoplasty: clinical and radiographic rationale for osteotome selection. Plast Reconstr Surg. 2000 Apr;105(5):1806-16; discussion 1817-9. PMID:10809115

7.14.26 Evaluate the depressor septi of your co-residents. What problems does it cause in rhinoplasty and what should you do about it?

Rohrich RJ, Huynh B, Muzaffar AR, Adams WP Jr, Robinson JB Jr. Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg. 2000 Jan;105(1):376-83; discussion 384-8. PMID:10627007

7.14.27 Your first patient as a facial plastics fellow wants surgery to correct his asymmetric nostrils. Impress your new attending with your knowledge on this topic.

Truswell WH. Using permanent implant materials for cosmetic enhancement of the perioral region. Facial Plast Surg Clin North Am. 2007 Nov;15(4):433-44, vi. PMID:18005884

7.14.28 What are nasal tip bossae and why do they occur? Can this be corrected?

Kridel RW, Yoon PJ, Koch RJ. Prevention and correction of nasal tip bossae in rhinoplasty. Arch Facial Plast Surg. 2003 Sep-Oct;5(5):416-22. PMID:12975141