Global Practice Patterns of Dorsal Preservation Rhinoplasty

Abstract

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.

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

“…PR hasincreasingly become the subject of a vast number of publications over the last few years [4][5][6][7]31 .…”

“…PR has increasingly become the subject of a vast number of publications over the last few years. [4][5][6][7]31 The merit of this enormous interest resides in the obvious advantage of avoiding reconstruction of the delicate keystone area following its resection in conventional hump reduction procedures. Preserving a natural dorsum is thus the attractive mainstay principle from which many recent technical modifications progressively derived.…”

“…A plethora of publications have increasingly addressed the topic of Preservation Rhinoplasty (PR) over the last few years. Since the first landmark papers that essentially gave rebirth, based on new anatomy and techniques,to a concept which had been described initially many years previously, many variations followed on the theme, as summarized in recent reviews [1][2][3][4][5][6] . Common to all of those, whether founded on surface or foundation techniques 7 and applying, symmetrically or not, a pushdown or letdown mobilization of the nasal pyramid on circumferential impaction osteotomies, is the key concept of preserving the whole nasal dorsum intact.…”

“…Since the first landmark papers that essentially gave rebirth, based on new anatomy and techniques, to a concept which had been described initially many years previously, many variations followed on the theme, as summarized in recent reviews. [1][2][3][4][5][6] Common to all of those, whether founded on surface or foundation techniques 7 and applying, symmetrically or not, a pushdown or letdown mobilization of the nasal pyramid on circumferential impaction osteotomies, is the key concept of preserving the whole nasal dorsum intact. A notable exception was that of a pushdown limited to the cartilaginous dorsum or extended to the bony cap, combined with conventional osteotomies of the bony vault, as described by Ishida et al [8][9][10][11] Although PR was described under a closed approach, it was also performed open by many, with the benefit of full visualization, precise piezo osteotomies, and piezo or burr osteoplasty, 12,13 together with the advantage of possibly combining with a structural approach to the tip.…”

Using the Autospreaders as a Cutting Guide for Component Hump Reduction in Rhinoplasty

“…However, the pitfall of these techniques is the higher rate of dorsal hump recurrence of up to 15%. [3][4][5] We present the use of the upper lateral cartilages (ULCs) as a turn-in flap and as a cutting guide during classic dorsal hump takedown. The cutting guide provides the optimal dorsal angulation and dictates the amount of resection needed.…”