Facial Plast Surg 2018; 34(03): 239-244
DOI: 10.1055/s-0038-1654677
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functional Compromise in the Middle Vault in the Management of Revision Rhinoplasty

Leo Wang
1   Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Oren Friedman
2   Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
01 June 2018 (online)

Abstract

As rhinoplasty procedures become more common, the need for revision surgeries increases as well. Unlike primary rhinoplasties, revision rhinoplasties can be more challenging because of anatomic differences from initial surgery, a lack of available cartilage, tissue remodeling responses, and other complications. As such, surgeons should be prepared to address revision rhinoplasty patients differently from primary rhinoplasty patients. Here, the authors describe a generalizable approach to revision functional rhinoplasty patients and detail some of the surgical techniques that can be employed to achieve optimal outcomes, with particular attention paid to procedures that can be used in the middle vault.

 
  • References

  • 1 Friedman O, Cekic E, Gunel C. Functional rhinoplasty. Facial Plast Surg Clin North Am 2017; 25 (02) 195-199
  • 2 Ghosh A, Friedman O. Surgical treatment of nasal obstruction in rhinoplasty. Clin Plast Surg 2016; 43 (01) 29-40
  • 3 Neaman KC, Boettcher AK, Do VH. , et al. Cosmetic rhinoplasty: revision rates revisited. Aesthet Surg J 2013; 33 (01) 31-37
  • 4 Spataro E, Piccirillo JF, Kallogjeri D, Branham GH, Desai SC. Revision rates and risk factors of 175 842 patients undergoing septorhinoplasty. JAMA Facial Plast Surg 2016; 18 (03) 212-219
  • 5 East C, Kwame I, Hannan SA. Revision rhinoplasty: what can we learn from error patterns? An analysis of revision surgery. Facial Plast Surg 2016; 32 (04) 409-415
  • 6 Kucur C, Kuduban O, Ozturk A. , et al. Psychological evaluation of patients seeking rhinoplasty. Eurasian J Med 2016; 48 (02) 102-106
  • 7 Naraghi M, Atari M. Comparison of patterns of psychopathology in aesthetic rhinoplasty patients versus functional rhinoplasty patients. Otolaryngol Head Neck Surg 2015; 152 (02) 244-249
  • 8 Naraghi M, Atari M. A comparison of depression scores between aesthetic and functional rhinoplasty patients. Asian J Psychiatr 2015; 14: 28-30
  • 9 Naraghi M, Atari M. Self-esteem and rhinoplasty: a case-control study. Plast Aesthetic Res 2016; 3 (04) 111
  • 10 Phillips KA. The presentation of body dysmorphic disorder in medical settings. Prim Psychiatry 2006; 13 (07) 51-59
  • 11 Constantian MB. What motivates secondary rhinoplasty? A study of 150 consecutive patients. Plast Reconstr Surg 2012; 130 (03) 667-678
  • 12 Chauhan N, Alexander AJ, Sepehr A, Adamson PA. Patient complaints with primary versus revision rhinoplasty: analysis and practice implications. Aesthet Surg J 2011; 31 (07) 775-780
  • 13 Lee M, Zwiebel S, Guyuron B. Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg 2013; 132 (04) 769-776
  • 14 Goudakos JK, Daskalakis D, Patel K. Revision rhinoplasty: retrospective chart review analysis of deformities and surgical maneuvers in patients with nasal airway obstruction-five years of experience. Facial Plast Surg 2017; 33 (03) 334-338
  • 15 Vuyk HD, Watts SJ, Vindayak B. Revision rhinoplasty: review of deformities, aetiology and treatment strategies. Clin Otolaryngol Allied Sci 2000; 25 (06) 476-481
  • 16 Spielmann PM, White PS, Hussain SSM. Surgical techniques for the treatment of nasal valve collapse: a systematic review. Laryngoscope 2009; 119 (07) 1281-1290
  • 17 Friedman O, Cook TA. Conchal cartilage butterfly graft in primary functional rhinoplasty. Laryngoscope 2009; 119 (02) 255-262
  • 18 Saleh AM, Younes A, Friedman O. Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscope 2012; 122 (02) 254-259
  • 19 Rosenberger ES, Toriumi DM. Controversies in revision rhinoplasty. Facial Plast Surg Clin North Am 2016; 24 (03) 337-345
  • 20 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73 (02) 230-239
  • 21 Clark JM, Cook TA. The ‘butterfly’ graft in functional secondary rhinoplasty. Laryngoscope 2002; 112 (11) 1917-1925
  • 22 Teymoortash A, Fasunla JA, Sazgar AA. The value of spreader grafts in rhinoplasty: a critical review. Eur Arch Otorhinolaryngol 2012; 269 (05) 1411-1416
  • 23 Thomas JR. Advanced Therapy in Facial Plastic and Reconstructive Surgery. PMPH-USA: Connecticut; 2010
  • 24 Gruber RP, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (06) 1903-1910
  • 25 Hussein WK, Elwany S, Montaser M. Modified autospreader flap for nasal valve support: utilizing the spring effect of the upper lateral cartilage. Eur Arch Otorhinolaryngol 2015; 272 (02) 497-504
  • 26 Saedi B, Amali A, Gharavis V, Yekta BG, Most SP. Spreader flaps do not change early functional outcomes in reduction rhinoplasty: a randomized control trial. Am J Rhinol Allergy 2014; 28 (01) 70-74
  • 27 Loyo M, Gerecci D, Mace JC, Barnes M, Liao S, Wang TD. Modifications to the butterfly graft used to treat nasal obstruction and assessment of visibility. JAMA Facial Plast Surg 2016; 18 (06) 436-440
  • 28 Boahene KDO, Hilger PA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg 2009; 11 (05) 285-289
  • 29 Rudy S, Moubayed SP, Most SP. Midvault reconstruction in primary rhinoplasty. Facial Plast Surg 2017; 33 (02) 133-138
  • 30 Seren E. A new surgical method of dynamic nasal valve collapse. Arch Otolaryngol Head Neck Surg 2009; 135 (10) 1010-1014
  • 31 Weissman JD, Most SP. Radiofrequency thermotherapy vs bone-anchored suspension for treatment of lateral nasal wall insufficiency: a randomized clinical trial. JAMA Facial Plast Surg 2015; 17 (02) 84-89
  • 32 Webster RC, Davidson TM, Smith RC. , et al. M-plasty techniques. J Dermatol Surg 1976; 2 (05) 393-396
  • 33 Sillers MJ, Cox III AJ, Kulbersh B. Revision septoplasty. Otolaryngol Clin North Am 2009; 42 (02) 261-278 , viii
  • 34 Chambers KJ, Horstkotte KA, Shanley K, Lindsay RW. Evaluation of improvement in nasal obstruction following nasal valve correction in patients with a history of failed septoplasty. JAMA Facial Plast Surg 2015; 17 (05) 347-350
  • 35 Gillman GS, Egloff AM, Rivera-Serrano CM. Revision septoplasty: a prospective disease-specific outcome study. Laryngoscope 2014; 124 (06) 1290-1295
  • 36 Friedman O, Koch CA, Smith WR. Functional support of the nasal tip. Facial Plast Surg 2012; 28 (02) 225-230
  • 37 Kamer FM, Churukian MM. Shield graft for the nasal tip. Arch Otolaryngol 1984; 110 (09) 608-610
  • 38 Jang YJ, Hong HR. Augmentation shield grafts. JAMA Facial Plast Surg 2015; 17 (04) 301-302
  • 39 Bussi M, Palonta F, Toma S. Grafting in revision rhinoplasty. Acta Otorhinolaryngol Ital 2013; 33 (03) 183-189
  • 40 Loyo M, Wang TD. Revision rhinoplasty. Clin Plast Surg 2016; 43 (01) 177-185
  • 41 Wang LL, Friedman O. Update on injectables in the nose. Curr Opin Otolaryngol Head Neck Surg 2017; 25 (04) 307-313
  • 42 Sowder JC, Thomas AJ, Ward PD. Essential anatomy and evaluation for functional rhinoplasty. Facial Plast Surg Clin North Am 2017; 25 (02) 141-160
  • 43 Gassner HG. Structural grafts and suture techniques in functional and aesthetic rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 2010; 9: Doc01 Doi: 10.3205/cto000065
  • 44 Bloching MB. Disorders of the nasal valve area. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc07