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Proc Inst Mech Eng H 2021 Apr 23:9544119211011824. Epub 2021 Apr 23.

CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil Cedex, France.

Osteotomies are common surgical procedures used for instance in rhinoplasty and usually performed using an osteotome impacted by a mallet. Visual control being difficult, osteotomies are often based on the surgeon proprioception to determine the number and energy of each impact. The aim of this study is to determine whether a hammer instrumented with a piezoelectric force sensor can be used to (i) follow the displacement of the osteotome and (ii) determine when the tip of the osteotome arrives in frontal bone, which corresponds to the end of the osteotomy pathway. Read More

J Craniofac Surg 2021 Apr 15. Epub 2021 Apr 15.

Department of Otorhinolaryngology and Head and Neck Surgery; Health Sciences University Bozyaka Training and Research Hospital Department of Plastic, Reconstructive and Aesthetic Surgery; Izmir Bakircay University Cigli Training and Research Hospital Department of Otorhinolaryngology and Head and Neck Surgery, Izmir Bakircay University Cigli Training and Research Hospital, Izmir, Turke.

Abstract: Achieving aesthetic and functional results in rhinoplasty requires meticulous techniques, and postoperative edema, ecchymosis, and pain can deteriorate the desired outcomes. Different osteotomy techniques are defined to have optimal outcomes while reducing edema, ecchymosis, and pain. In this study, the authors compared conventional and power-assisted surgical burr osteotomy techniques in terms of early postoperative complications. Read More

J Oral Maxillofac Surg 2021 Feb 23. Epub 2021 Feb 23.

Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey.

Purpose: The aim of this study was to investigate the effects of traditional thermoplastic splints vs a 3D-printed custom external nasal splint designed to apply pressure to the lateral osteotomy lines and neighboring periorbital region on edema and ecchymosis after rhinoplasty.

Patients And Methods: Forty patients undergoing open rhinoplasty were included in this prospective randomized controlled study. The patients were divided into 2 groups. Read More

Ann Plast Surg 2021 04;86(4):376-380

Department of Radiology, University of Illinois at Chicago, Chicago, IL.

Background: Although casts or external splint materials are commonly applied on the external nose after rhinoplasty, their beneficial effects have not been previously demonstrated in controlled studies.

Methods: A total of 40 adult patients who underwent primary rhinoplasty were included in this prospective study. The patients were randomized into 2 groups to use an external splint or not after surgery. Read More

Facial Plast Surg 2021 Feb 14;37(1):45-52. Epub 2021 Mar 14.

Curso de Medicina, UniCesumar Curso de Medicina, Maringa, Paraná, Brazil.

Nasal dorsal preservation surgery was described more than 100 years ago, but recently has gained prominence. Our objective is to show the surgical technique, the main indications and counterindications, and the complications. It is a technique that does not cause the detachment of the upper lateral cartilage (ULC) from the nasal septum, and has the main following sequence: preparation of the septum and its resection can be at different levels (high or low, i. Read More

Facial Plast Surg 2021 Mar 11. Epub 2021 Mar 11.

Facial Plastic Surgery, Private Practice, Barcelona, Spain.

This report describes a technique to reduce nasal dorsum excess simultaneously to orthognathic surgery (OS) through a Le Fort I osteotomy. It avoids the need to change from endonasal intubation to intraoral intubation. It also eliminates the need to open the dorsum, preserving the integrity of the triangular cartilages at the nasal dorsum keystone area, avoiding iatrogenic nasal dorsum deformities. Read More

J Craniofac Surg 2021 Mar-Apr 01;32(2):609-611

Hacettepe University Department Otorhinolaryngology, Ankara, Turkey.

Objectives: The purpose of this study was to investigate the advantages of endoscopic lateral osteotomy, to evaluate the effects of the periosteal elevation on ecchymosis and to search the reasons for the ecchymosis and the intranasal mucosal tears.

Methods: On a randomly chosen side a subperiosteal tunnel was elevated, on the other side a subperiosteal tunnel was not elevated. Bilateral lateral osteotomies were performed. Read More

Aesthetic Plast Surg 2021 Mar 8. Epub 2021 Mar 8.

Department of Plastic Surgery, Malatya Education and Research Hospital, Malatya Turgut Özal University, Malatya, Turkey.

Background: In rhinoplasty, many techniques are used to increase the permanence of the planned final shape of the nose. Cartilage grafts can be diced and applied directly to the nasal dorsum, or by wrapping with a material. We aim to show that mixing and using diced cartilage grafts with fat grafts can contribute to the viability of cartilage grafts by comparing our early postoperative and long-term results. Read More

Ann R Coll Surg Engl 2021 Apr 8;103(4):272-277. Epub 2021 Mar 8.

Guy's and St Thomas' Hospital, London, UK.

Introduction: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. Read More

Ann Otol Rhinol Laryngol 2021 Mar 1:3489421996846. Epub 2021 Mar 1.

University of Washington School of Medicine, Seattle, WA, USA.

Objective: To describe the surgical technique of navigation-guided nasal osteotomies and assess feasibility of this technique for treating complex nasal bone deformities in reconstructive rhinoplasty.

Methods: A retrospective chart review was performed in order to identify patients who underwent computer-aided rhinoplasty from August 2014 to February 2017. Inclusion criteria were nasal bone deformities on computed-tomography (CT) that correlated with specific nasal complaints. Read More

Aesthetic Plast Surg 2021 Feb 17. Epub 2021 Feb 17.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: Reduction rhinoplasties, regardless of the methods used (structural or preservation), can cause a reduction in the internal nasal volume, which may lead to breathing problems. In 1977, Webster proposed preserving a little triangle in the beginning of the lower lateral osteotomy line to prevent breathing problem. However, its importance is still controversial. Read More

Plast Reconstr Surg 2021 Feb;147(2):364-369

From the Maxillofacial Plastic Surgery Unit, Policlinico G.B. Rossi University of Verona; private practice; and the Department of Neurosciences, Biomedicine, and Movement Sciences, Anatomy and Histology Section; and Dental Clinic and Maxillofacial Department, University of Verona.

Background: Rhinoplasty is the cosmetic procedure that is most difficult to master. Anatomical preservation should represent the main goal of rhinoplasty. One emerging tool appears to be erbium:yttrium-aluminum-garnet laser bone and cartilage reshaping. Read More

J Laryngol Otol 2020 Dec;134(12):1094-1095

Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey.

Objective: This study was performed on fresh frozen cadavers to investigate the role of angular artery damage.

Methods: Lateral osteotomies ('high-low-high' method) were carried out bilaterally, with a 4 mm guarded lateral osteotome, after the creation of a subperiosteal tunnel. Following completion of the lateral osteotomy, a skin incision was made in the midline dorsum. Read More

AJR Am J Roentgenol 2020 Dec 30. Epub 2020 Dec 30.

University of California San Francisco Department of Radiology and Biomedical Imaging, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-2573.

Facial feminization surgery (FFS) is an increasingly performed component of gender affirmation surgery for transgender women. Preoperative facial CT is performed to plan the adjustment of the patient's masculine characteristics to feminine, and to plan operative navigation around specific readily identifiable anatomic structures. In the upper face, surgery is performed to reduce the prominence of the brow and increase the nasofrontal angle; the radiology report should indicate the frontal sinus and supraorbital foramen anatomy. Read More

AJR Am J Roentgenol 2020 Dec 30. Epub 2020 Dec 30.

University of California San Francisco Department of Radiology and Biomedical Imaging, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-2573.

Facial feminization surgery (FFS) is an increasingly performed component of gender affirmation surgery for transgender women. Preoperative facial CT is performed to plan the adjustment of the patient's masculine characteristics to feminine, and to plan operative navigation around specific readily identifiable anatomic structures. In the upper face, surgery is performed to reduce the prominence of the brow and increase the nasofrontal angle; the radiology report should indicate the frontal sinus and supraorbital foramen anatomy. Read More

Plast Reconstr Surg 2021 01;147(1):65-67

From the Fondation Saint Jean de Dieu; the Department of Otolaryngology-Head and Neck Surgery, Adolphe-Rotschild Fondation; the Department of Otolaryngology-Head and Neck Surgery, Kremlin-Bicêtre AP-HP University Hospital; the Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, McGill University; and the Department of Head and Neck Oncology, Gustave Roussy Institut.

Summary: Reduction of a nasal hump and nasal base narrowing are very common steps during a primary rhinoplasty procedure. The greatest difficulty is to obtain stable fracture lines, a natural appearance, beautiful dorsal aesthetic lines, and the absence of palpable or visible irregularities, especially in the long term. The surgeon strives for a reproducible technique, which seems to be more feasible with mechanical osteotomies (powered or piezoelectric) than with traditional manual osteotomies. Read More

Facial Plast Surg 2020 Oct 24;36(5):499-504. Epub 2020 Dec 24.

Department of Otorhinolaryngology, Khoo Teck Puat Hospital, Singapore, Singapore.

Osteotomies in rhinoplasty are performed to correct deformities in nasal contour. The size of osteotome used is dictated by the thickness of the bony nasal pyramid along the osteotomy route. The aim of this study is to determine whether nasal bony dimensions differ between different ethnic groups in Singapore. Read More

Ann Plast Surg 2021 02;86(2S Suppl 1):S52-S57

From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

Background: The surgical management of hypertelorism is challenging for plastic surgeons, and limited long-term outcome data are available. The purpose of this long-term study was to report a single-surgeon experience with a staged reconstructive protocol for hypertelorism correction.

Methods: This retrospective study reviewed the records of patients with hypertelorism who were surgically managed by a single surgeon between 1978 and 2000. Read More

World J Plast Surg 2020 Sep;9(3):290-295

Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Several methods have been introduced to correct crooked nose during rhinoplasty. This study aimed to compare the final shape of nasal pyramid as well as patients' satisfaction of the outcomes in two different rhinoplasty techniques.

Methods: Participants in this study underwent rhinoplasty with two different techniques of double lateral osteotomy in comparison with asymmetric dorsal hump reduction using rasp. Read More

J Plast Reconstr Aesthet Surg 2021 05 6;74(5):1077-1086. Epub 2020 Nov 6.

Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea. Electronic address:

A rhinoplasty technique involving lower lateral cartilage (LLC) repositioning and grafting of ear cartilage allows for nasal lengthening and nasal tip mobility. For better esthetic outcomes in patients with cleft lip nasal deformity (CLND), we combined cosmetic nasal tip plasty with standard techniques. We performed open rhinoplasty combined with reverse-U incision and V-Y plasty in 62 patients with secondary unilateral CLND from October 2013 to June 2018. Read More

Cleft Palate Craniofac J 2020 Dec 3:1055665620977367. Epub 2020 Dec 3.

Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Objective: To evaluate evolving practice patterns in secondary cleft rhinoplasty.

Design: Retrospective review of data submitted during Maintenance of Certification (MOC).

Setting: Evaluation of MOC data from the American Board of Plastic Surgery. Read More

Int J Pediatr Otorhinolaryngol 2021 Jan 16;140:110502. Epub 2020 Nov 16.

Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.

Background: To review our experience with pediatric nasal dermoids, and discuss reconstructive options for the nasal dorsum after pediatric nasal dermoid removal.

Methods: Retrospective review of pediatric nasal dermoid cases from January 1 2005 through October 1 2016.

Results: Twenty-five cases (12 males, 13 females) were identified. Read More

Arch Plast Surg 2020 Nov 15;47(6):516-521. Epub 2020 Nov 15.

Human Plastic Surgery Clinic, Seoul, Korea.

In rhinoplasty, osteotomy is becoming more and more frequent as a way to achieve aesthetically pleasing and functional results, as well as patient satisfaction. In procedures to correct a deviated nose, osteotomy to correct the bone plays an essential role in addition to correction of the septum and cartilage, and osteotomy can reduce the wide nose bridge and give a slightly higher appearance in Asian rhinoplasty. However, osteotomy is relatively invasive, and the nasal bones of Asians are often low and thick, so bleeding or swelling during surgery can be somewhat more severe, and a stuffy nose can occur after surgery if osteotomy is performed incorrectly. Read More

Arch Plast Surg 2020 Nov 15;47(6):495-504. Epub 2020 Nov 15.

JW Plastic Surgery Center, Seoul, Korea.

The primary procedural components of deviated nose correction are as follows: osteotomy to correct bony deviation, septal deviation correction, manipulation of the dorsal septum to correct upper lateral cartilage deviation, and correction of functional problems (manipulation for correction of internal valve collapse and hypertrophy of the inferior turbinate). The correction of tip and nostril asymmetry cannot be overemphasized, because if tip and nostril asymmetry is not corrected, patients are unlikely to provide favorable evaluations from an aesthetic standpoint. Tip asymmetry, deviated columella, and resulting nostril asymmetry are primarily caused by lower lateral cartilage problems, which include deviation of the medial crura, discrepancy in the height of the medial crura, and asymmetry or deformity of the lateral crura. Read More

Facial Plast Surg Clin North Am 2021 Feb;29(1):77-84

Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94304, USA.

Dorsal preservation rhinoplasty requires precise management of the osseocartilaginous vault. Ultrasonic piezo instruments offer several advantages compared with traditional tools such as hand saws, rasps, and osteotomes. As always, an understanding of the dynamics of manipulation of the vault, anatomy, and proper technique are paramount and are reviewed herein. Read More

Facial Plast Surg Clin North Am 2021 Feb;29(1):123-130

UCL, Rhinoplasty London, London SW1W 8TW, UK. Electronic address:

Crooked or deviated noses pose a specific challenge as many of the elements in a deviated nose are not symmetric and therefore not ideal for preservation techniques. Deviated noses are often where a hybridization between preservation and structural rhinoplasty is required. Careful preoperative evaluation of the soft tissue and bony anatomy of the patient is very important and congenital or post-traumatic asymmetry may involve more than the nasal pyramid. Read More

Facial Plast Surg Clin North Am 2021 Feb;29(1):101-111

Plastic Surgery, UC Irvine School of Medicine, 1441 Avocado Avenue, Suite 203, Newport Beach, CA 92660, USA. Electronic address:

For rhinoplasty surgeons, surgery of the dorsum has never been so dynamic or as easily learned. Reproducible techniques offer excellent results that can be difficult to achieve in certain patients using component reduction. An expanding repertoire of dorsal preservation (DP) techniques is evolving. Read More

JMIR Med Educ 2020 Nov 17;6(2):e19792. Epub 2020 Nov 17.

Health Design Lab, Thomas Jefferson University, Philadelphia, PA, United States.

Background: Nasal osteotomy is a commonly performed procedure during rhinoplasty for both functional and cosmetic reasons. Teaching and learning this procedure proves difficult due to the reliance on nuanced tactile feedback. For surgical simulation, trainees are traditionally limited to cadaveric bones, which can be costly and difficult to obtain. Read More

Oral Maxillofac Surg Clin North Am 2021 Feb 3;33(1):7-21. Epub 2020 Nov 3.

UNAM León, México Residence Program, León, Guanajuato, México.

By performing a preservation rhinoplasty, the surgeon can achieve natural and stable results by intraoperative replacement of resection with preservation and excision with manipulation of ligaments, cartilages, soft tissues, and the osseocartilaginous dorsum. In this article, the authors explain step by step the dorsal preservation rhinoplasty with low septal strip and a combination of nasal bones osteoplasty and osteotomies, the tip preservation rhinoplasty based on nose tip polygons, and the authors' technique for modify the nasal tip projection and rotation with a posterior strut or anterior septal strip. Read More

Oral Maxillofac Surg Clin North Am 2021 Feb 3;33(1):23-30. Epub 2020 Nov 3.

Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran; School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences.

Piezoelectric tools are the novel ultrasonic methods for effective and safe osteoplasty or osteotomy in comparison with traditional soft and hard tissue approaches using rotating instruments due to lack of microvibrations, ease of control and use, and safer cutting, mainly in complex anatomic areas. Piezoelectric indicates favorable and valuable outcomes based on the immediate postoperative morbidities, even though long-term results have not been investigated. It could be indicated that the piezosurgery in rhinoplasty can be considered as a reliable and safe method and should be taken into account as a part of the surgeon's repertoire for rhinoplasty. Read More