COVID-19 is an emerging viral illness that has rapidly transmitted throughout the world. Its impact on society and the health care system has compelled hospitals to quickly adapt and innovate as new information about the disease is uncovered. During this pandemic, essential medical and surgical services must be carried out while minimizing the risk of disease transmission to health care workers. There is an elevated risk of COVID-19 viral transmission to health care workers during surgical procedures of the head and neck due to potential aerosolization of viral particles from the oral cavity/naso-oropharynx mucosa. Thus, patients with facial fractures pose unique challenges to the variety of injuries and special considerations, including triaging injuries and protective measures against infection. The proximity to the oral cavity/naso-oropharyngeal mucosa, and potential for aerosolization of secretions containing viral particles during surgical procedures make most patients undergoing operative interventions for facial fractures high risk for COVID-19 transmission. Our proposed algorithm aims to balance patient care with patient/medical personnel protection as well as judicious health care utilization. It stratifies facial trauma procedures by urgency and assigns a recommended level of personal protective equipment, extreme or enhanced, incorporating current best practices and existing data on viral transmission. As this pandemic continues to evolve and more information is obtained, the protocol can be further refined and individualized to each institution.
Structural deficiencies of the nasal dorsum most commonly derive from congenital, traumatic, and iatrogenic etiologies. Alternatively, dorsal deficiency may be a manifestation of a generally underprojected nose with otherwise appropriate relationships between the radix, dorsum, and tip. In analyzing dorsal deficiency, associated anatomic abnormalities leading to compromise of both aesthetic form and respiratory function must be recognized and incorporated into the reconstructive plan. The cornerstone of augmentation rhinoplasty employs either autologous graft or alloplastic implant material to restore dorsal height and structural support to the nasal skeleton. Many autologous and alloplastic materials are currently available to the rhinoplasty surgeon, each of which carries a characteristic profile of relative advantages and limitations. Although most rhinoplasty surgeons prefer autologous materials, the choice of material must be individualized to each patient. The reconstructive plan ultimately formulated emerges after thoughtful consideration of the extent of the dorsal deficiency, characteristics of the overlying skin-soft tissue envelope, history of prior surgery, associated structural abnormalities, preferences of the surgeon, and views of the patient. Regardless of the specific methods used to augment the nasal dorsum, optimizing the aesthetic profile and maximizing respiratory function in a sustainable manner with minimal patient risk and morbidity remain the primary objectives.
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