By ENT-Plastic Surgeon Dr.K.O.Paulose F.R.C.S(Fellow of the Royal College of Surgeons UK)
Consultant ENT Surgeon Jubilee Hospital, Trivandrum, Kerala, South India
The nose is located in the central part of the face and also the most prominent structure, so any small deformity is easily visible. Therefore it is not surprising that nasal surgery or rhinoplasty is performed so often. Nevertheless, rhinoplasty is a significantly satisfactory procedure that helps individuals achieves greater self- esteem and personal satisfaction.
Rhinoplasty is a type of cosmetic surgery that is performed in order to reshape the nose. Although rhinoplasty is most often sought for cosmetic reasons, it can also help correct structural defects that may cause breathing problems.
The indication for rhinoplasty is a particularly difficult problem, and the surgeon carries a huge responsibility for refusing or accepting the request. It is an easy operation to do, but it is hard to get good results.
There are two approaches for Septo rhinoplasty, the endonasal approach and the external approach, I prefer the later.
Who can do Rhinoplasty-ENT or Plastic surgeon?
With the modernization of society demand of cosmetic value has been increasing. In majority of centers rhinoplasty is done by plastic surgeons and general people have the concept that this is the work of plastic surgeons. But an ENT surgeon who had been trained to do plastic surgical procedures is the best person to carry out the Rhinoplasty. Moreover, only the ENT surgeon can solve the functional and structural aspects of the nasal deformities like the septum, turbinates etc.
Rhinoplasty may require the addition of material to augment the nose. Augmentation is necessary for both aesthetic and functional indications. Functional reasons for augmentation include providing structural support for areas deficient of material, such as the upper or lower lateral cartilages. Augmentation may also be required for aesthetic reasons. Typically, augmentation rhinoplasty is performed to increase the projection of the nasal dorsum on the profile view. The nasal tip may also be augmented. In addition, grafts may be placed to camouflage irregularities of the bony dorsum and of the upper or lower lateral cartilages.
A number of materials are available to the Rhinoplastic surgeon to augment the nose. These include
and Alloplasts (synthetic implants),
and Allogenous materials (obtained from cadavers), or
and Autologous implants (harvested from the patient’s own tissue).
Many surgeons prefer to use autologous tissue whenever possible, and some evidence suggests a lower incidence of infection when the patient’s own tissue is used. Autologous materials have the potential to be incorporated into the host tissue bed, offering stability, as well as resistance to infection and extrusion over time.
Autologous materials are also believed to have the unique ability to adapt to the host bed. Thus, a graft consisting of cartilage tends to fix well to cartilage, and bone tends to fix well to bone.
Autologous materials used include cartilage and bone; examples include septal, auricular, and costal cartilages as well as costal or calvarial bone.
Iliac crest as bone graft
Bone from the iliac crest, calvaria, rib, tibia, and ulna have been used. The advantages include the abundant bone available and its resistance to warping. Some believe that endochondral bone sources, such as the rib, iliac crest, and tibia, have greater resorption rates than those of membranous bone such as calvaria. Furthermore, the donor sites are typically outside the primary surgical field and are often associated with relatively greater morbidity. Compared with cartilage grafts, autologous bone grafts have a greater tendency to feel unnatural, with sharp edges occasionally showing through as the skin retracts over time. Use of bone for augmentation in the lower third of the nose appears particularly unnatural because of its rigidity.
As shown in the pictures below-
Please make sure to take the graft on the opposite side in which patients sleep. Start mobilizing as soon as possible. The sutures are removed on 10th post op day.
Graft material is available in plenty
Donor site is away from nasal site
Donor site â€“infection, haematoma, pain.
Feel hard on lower third of nasal pyramid
Preop saddle tip due to lack of septal support who underwent iliac crest graft.
Pre op-Extreme saddle tip -(Post op picture will be uploaded soon)
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