artículos

Nasal hump reduction with powered micro saw osteotomy
BACKGROUND: Hump reduction with manual osteotomy is an invasive procedure in aesthetic rhinoplasty. OBJECTIVE: We describe powered micro saw osteotomy as an effective alternative to manual hump removal. METHODS: Powered micro saw osteotomy was performed to reduce the bony hump layer by layer to reach the intended level. The edges of the open roof were softened with a powered reciprocating rasp. Shielded burrs were used to remove minimal bony prominences as needed. RESULTS: Between April 2005 and February 2007, the author performed 332 primary rhinoplasty and septorhinoplasty procedures. Hump reduction with powered micro saw osteotomy was performed in 259 cases, including 127 with moderate humps (3 to 4 mm), 112 with large humps (5 to 6 mm), and 20 with very large humps (7 to 8 mm). Satisfactory results were maintained in all cases, with minimal revision in 10 cases and no complications. CONCLUSIONS: Powered micro saw osteotomy provides a less invasive approach to bony hump reduction and prevents the multiple complications associated with manual osteotomies.


The pain of nasal tampon removal after nasal surgery: a randomized control trial.
OBJECTIVE: The purpose of this study was to compare the pain and discomfort associated with the removal of two commercially available nasal tampons after nasal surgery. STUDY DESIGN: Prospective, paired, randomized clinical trial. SUBJECTS: Consecutive, consenting, adult patients undergoing nasal surgery. INTERVENTIONS: The nose was packed with a Rapid Rhino tampon (Applied Therapeutics, Tampa, FL) on one side and a Rhino Rocket tampon (Shippert Medical Technologies Corporation, Centennial, CO) on the other. OUTCOMES: The pain of packing removal was assessed with a validated 100-mm visual analog scale. Patient satisfaction was measured on a Likert scale from 1 to 5. RESULTS: In all 13 patients, the pain of removal was greater with the Rhino Rocket Tampon (82.7 +/- 20.9 mm) than with the Rapid Rhino tampon (12.0 +/- 11.9 mm); the mean difference was 70.7 mm (95% confidence interval [CI], 47.1-78.2 mm; P < 0.0001). Patient satisfaction was significantly higher with the Rapid Rhino nasal tampon (4.6 +/- 1.1 vs 1.5 +/- 0.7; mean difference 3.1 [95% CI, 2.6-3.6]; P < 0.001). CONCLUSIONS: Removal of the Rapid Rhino nasal tampon was significantly less painful and was associated with higher patient satisfaction than the removal of the Rhino Rocket nasal tampon.


Triological thesis: concurrent endoscopic sinus surgery and cosmetic rhinoplasty: rationale, risks, rewards, and reality.
OBJECTIVES/HYPOTHESIS: To examine the effect of concurrent endoscopic sinus surgery (ESS) on the postoperative course of cosmetic rhinoplasty (CR), identify any specific contraindications, and to develop more useful treatment regimen in patients undergoing concurrent ESS and CR. STUDY DESIGN: Retrospective case-control study. METHODS: Consecutive patients undergoing CR (performed by the principal investigator (PI) in a tertiary care academic practice) at the same operative setting as ESS from June 2004-June 2007 were identified. Additionally, patients undergoing CR (also by the PI) without ESS over the same time period (matched for gender, age, and rhinoplasty approach and techniques) were identified and used as control subjects. The office and hospital charts of these patients were reviewed for details of pre-, intra-, peri-, and postoperative care, preoperative CT scans as well as for patient and physician observations. Specifically noted were details regarding the type of cosmetic changes sought, course of symptoms of chronic sinusitis, prior treatment, surgical techniques used for both ESS and CR, and postoperative treatment with antibiotics and corticosteroids. Additionally, a literature review of articles describing concurrent CR and ESS was performed. RESULTS: Thirteen patients were identified who underwent ESS at the same time as CR. There were no cases of cerebrospinal fluid leak, epistaxis, orbital complications, septal perforation, cellulitis or saddle nose deformity. No correlation was found between sinus surgery performed and need for revision surgery (CR or ESS) or postoperative infections. However, the time to patient reported resolution of postoperative nasal swelling was significantly higher in patients undergoing concurrent ESS/CR compared to CR only (dorsal swelling: 9.62 +/- 6.18 (ESS/CR) vs. 5.85 +/- 1.95 (CR) weeks, P = .0469; nasal tip swelling: 19.31 +/- 13.02 (ESS/CR) vs. 10.38 +/- 2.96 (CR) weeks, P = .0240, unpaired t test). The same relation held true for doctor noted postoperative edema (nasal dorsal edema: 10.62 +/- 7.32 (ESS/CR) vs. 6.31 +/- 2.72 (CR) weeks, P = .0582; nasal tip edema: 21.46 +/- 15.66 (ESS/CR) vs. 12.23 +/- 4.10 (CR) weeks, P = .0508, unpaired t test). Among patients who underwent concurrent ESS and CR, this time was highly correlated with the severity of sinus disease on preoperative CT scanning (r(2) = 0.8573, P < .0001). A greater need for postoperative corticosteroid injections in the ESS/CR group was suggestive but not statistically significant (30.8% vs. 0%, P = .0957). CONCLUSIONS: While our data supports concurrent ESS and CR as safe, our findings suggest that the presence and treatment of concurrent sinonasal disease prolongs the patients' recovery from CR. This may be due to the effects of sinus pathology and manipulation of sinonasal venous and lymphatic drainage patterns or could be due to subclinical infectious soiling of rhinoplasty tissue planes. We recommend a two-team approach to promote excellent surgical technique, avoid surgeon fatigue, and enhance patient care. We recommend adequate medical management of chronic sinusitis prior to surgery, pre, intra and postoperative antibiotic coverage, appropriate postoperative sinus toilet beginning 1 week after surgery and careful and close patient follow-up to optimize results. Most importantly, we advocate close coordination of sinonasal and rhinoplastic care in a two-team approach to maximize care.

Se puede denotar los riesgos existentes en una cirugía plástica, ya sea funcional o estética. Por ejemplo, la rinoplastía representa uno de los procedimientos más comunes dentro del campo. El paciente al realizarse este procedimiento deberá tener en cuenta los riesgos, como infección, gratificaciones, seguridad en sí mismo (psicológico), la realidad de la cirugía y tanto así como sus expectativas estéticas.