Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to regional academies/ societies representing rhinoplasty surgeons worldwide. Respondent exposure to and use of DPR were assessed based on geographic location. Results: Eight hundred thirty-six responses were received. Despite early publications on DPR originating largely from Western Europe and the United States, Turkey and Mexico have the greatest use of DPR techniques currently. The familiarity across many regions with preservation techniques appear to be secondary to courses and conferences rather than incorporation into training. Mexico demonstrates the greatest exposure to DPR during training. One hundred twenty-five respondents had previously used but abandoned dorsal preservation techniques. Poor results, less predictability, and complications (largely hump recurrence) are cited as common reasons for this.
Conclusion:There is variability in the global practice of DPR across regions and this will likely continue to evolve.
Diced cartilage grafts are used to increase and refine the nasal contour, providing easy molding and versatility when compared with block grafts. However, all grafts present the possibility of visibility, distortion, and absorption. The aim of this study is to evaluate, through a systematic review, the outcome of the use of the free diced graft cartilage in rhinoplasty. A systematic search of the literature was performed in the databases (PubMed, Lilacs, Scielo, Cochrane) with the terms “diced cartilage” and “rhinoplasty.” Studies were selected according to the inclusion and exclusion criteria and data extracted and grouped for analysis. Six eligible studies were included. In total, 4,044 patients underwent rhinoplasty with free diced cartilage graft, with 61 (1.51%) of them requiring reoperation. The main reasons were overcorrection and irregularities of the nasal dorsum. The infection rate was reported in three studies, with 2 (0.06%) of 3,252 patients presenting infection at the graft site. Two cases of displacement were treated with external molding, without reoperation. The graft resorption was reported in four articles, which described 22 (0.67%) cases of partial resorption in 3,288 patients. Therefore, the available evidence suggests that resorption of the graft and unfavorable outcomes are rare.
Background
Patient satisfaction is an essential outcome measure after a rhinoplasty. Yet differences of opinions between rhinoplasty patients and surgeons on nasal aesthetic appearance are unknown.
Objectives
To determine the differences between patients and surgeons in the perception of nasal aesthetic appearance.
Methods
A retrospective cohort of 300 patients seen in consultation for cosmetic, functional, or combined cosmetic and functional rhinoplasty at a single tertiary care center from June 2017 to June 2020 were studied. Based on preoperative patient images, six surgeons with varying levels of expertise assessed nasal aesthetics utilizing a modified Standardized Cosmesis and Health Nasal Outcomes Survey for nasal cosmesis (SCHNOS-C). These scores were then compared to the patient reported SCHNOS-C scores.
Results
The cosmetic, functional, and combined subgroups consisted of 100 patients each. The mean age (SD) was 35.4 (13.7) years and 64% were women. The modified SCHNOS-C scores were well-correlated among the six surgeons but showed only weak correlations of 0.07 to 0.20 between patient reported scores and scores assessed by the surgeons. Compared to the surgeon’s scores, patients in the cosmetic subgroup perceived their nasal aesthetic problems to be more severe whereas the those in the functional subgroup perceived their nasal aesthetic problems to be milder compared to the surgeons.’
Conclusions
Our findings suggest that patients and surgeons perceive nasal cosmesis differently. This difference should be considered carefully when planning rhinoplasty or assessing its outcome.
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