Anatomically Based Optimization of Outcomes in Middle Eastern Rhinoplasy

Ghareeb, Fouad Mohammed; Nassar, Ahmed Tharwat; Talaab, Ahmed Abdelaziz; Alkashty, Sherief

doi:10.1097/gox.0000000000001862

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…It is however worthy to notice that the term "ligament" refers to "a band or sheet of brous tissue connecting two or more bones, cartilages or other structures", leading to a broad de nition [12,16]. To date, the description of the "cartilaginous nose" was based only on anatomical dissections [6,8,9,12,17,18], inducing a risk of fragile soft tissue distortion. Moreover, even during anatomical dissections, some tissues are di cult to precisely characterize, and it is therefore unclear if the described inter-domal ligaments truly correspond to ligaments, or brous or aponeurotic tissue.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of the nasal latero-lateral cartilage articulation: a micro-MRI study in human specimens

Haddad

Dodin²,

Hossu³

et al. 2022

Surg Radiol Anat

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Purpose: To study the anatomy of the latero-lateral joint (LLJ) between the upper lateral (ULC) and lower lateral (LLC) crus of the nasal cartilages, usually described as a scroll articulation.Methodology: Six nasal pyramids were taken in monobloc from fresh cadavers and imaged on micro-MRI with 0.4 mm slice thickness. Images were jointly interpreted by two head and neck radiologists and one surgeon. The junction between the ULC and LLC, the presence of ligaments and of sesamoid or accessory cartilages were assessed.Results: Eight LLJs could be analyzed, with 4 types of junctions: hook-shaped cephalic border of the LLC turned towards the nasal fossa and linear caudal border of the ULC (n=3), hook-shaped caudal border of the ULC and linear cephalic border of the LLC lateral crus (n=1), hook-shaped border of both cartilaginous edges with clinging (n=1) (scroll articulation) or without clinging (n=3). No ligament or sesamoid cartilage was found, but posterior accessory cartilages were seen in 75% of the cases. Conclusion:The classical scroll articulation of the LLJ has been observed in only 1/8 cases on micro-MRI images. The anatomy of the LLJ couldexplain the surgical di culty in raising the tip of the nose in some patients and not in others.

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Section: Discussionmentioning

confidence: 99%

Anatomy of the nasal latero-lateral cartilage articulation: a micro-MRI study in human specimens

Haddad

Dodin²,

Hossu³

et al. 2022

Surg Radiol Anat

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“…Figure (4) depicts how Van Gogh frequently changed the shape of his nose in his self portraits, perhaps to emphasize the impact of the nose on the shape of the whole face, and on the social impression and even the character of the person. A pleasant face is important for social interaction, employment, and overall functioning of the human being.…”

Section: Introductionmentioning

confidence: 99%

Critical Choices in Rhinoplasty: A 20-Year Single-Surgeon Retrospective Review of 1000 Cases

Farouk

2022

The Egyptian Journal of Plastic and Reconstructive Surgery

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Objectives: Highlighting certain convictions, techniques and tactics that can be crucial to surgical outcome of rhinoplasty, as an attempt to define clearer indications for what's termed "aesthetic" rhinoplasty.Methods: A 20-year single-surgeon review of 1000+ diverse rhinoplasties.Results: Surgical outcome was satisfactory in 90-97% of post-traumatic rhinoplasties, and in 82-90% of aesthetic rhinoplasties. Complications were minimal. Differences of satisfactory results between post-traumatic and aesthetic cases were found to be statistically significant, and there was disparity in assessment of results between the author and the other surgeons' panel.Conclusions: Like fingerprints and iris pattern, each human being has a unique shape of nose, related to (and inseparable from) the other facial features, and any attempt to impose geometric dimensions or mathematical beauty measures in such case is like squaring the circle; simply impossible. Each nose has a limit for change, and successful rhinoplasty is not only in imagining this particular limit; let alone achieving it, but successful rhinoplasty is when our imagination meets the patient's expectations, which is not more than a mere probability. The dilemma in figuring out a suitable "new look" for the nose, whether it is driven by an exact science or by the passion of plastic surgeons, can blur the thin red line between a justifiable rhinoplasty and a medical malpractice. Therefore, the most critical choice in rhinoplasty is the decision to do a rhinoplasty in the first place. The nose is undoubtedly the most significant facial feature. It characterizes shape and shapes character of the human being. So rhinoplasty is a Psychosurgery and the worst pitfall in practice of rhinoplasty is failing to realize that success and failure will always have equal chances.

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“…Regarding cephalic trimming, as noted in the article, 1 was done for all cases, in middle eastern nose, 4 reduction of the broad lateral crus of the LLCs by cephalic resection; this is performed to decrease the size of the lateral crus in comparison to white rhinoplasty where the lateral crus cephalic resection is necessary to narrow and rotate the tip cephalically.…”

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confidence: 99%

Invited Commentary from the author of: Zeina AM. True and Average Internal Nasal Valve Area in Septorhinoplasty: Radiological and Clinical Outcomes

Zeina

2020

Ann Plast Surg

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cartilage. Based on the results of the study, there was a significant improvement in all evaluation parameters in the postoperative period compared with the preoperative period in both groups in terms of AVA, whereas there was no significant difference between the 2 techniques in the postoperative period.Based on our experience with rhinoplasty, we have the following comments on some aspects of the study:1) As the authors noted in their article, the study was conducted on a limited number of patients (20 patients). In studies conducted to determine the effectiveness, a high number of patients are required to statistically compare 2 different techniques. A higher number of patients included in the study will provide more data and ensure an accurate and robust interpretation of statistical results.2) The mean follow-up period of patients is 10.2 months. How was the interval of follow-up times for patients (minimum and maximum follow-up periods)? We currentlyConflict of interest and sources of funding: none declared.

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Anatomically Based Optimization of Outcomes in Middle Eastern Rhinoplasy

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 10 publications

Anatomy of the nasal latero-lateral cartilage articulation: a micro-MRI study in human specimens

Anatomy of the nasal latero-lateral cartilage articulation: a micro-MRI study in human specimens

Critical Choices in Rhinoplasty: A 20-Year Single-Surgeon Retrospective Review of 1000 Cases

Invited Commentary from the author of: Zeina AM. True and Average Internal Nasal Valve Area in Septorhinoplasty: Radiological and Clinical Outcomes

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