Page 1
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 2
The nose is the central & most prominent feature of the face; & on its shape, size, & appearance, to a greater degree, depends the relative facial beauty of the person
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 3
A skillful dissembler may disguise, in a degree, the expression of the mouth; the hat may be slouched over the eyes; the chin may be hidden in an impenetrable thicket of beard; but the nose will stand out and `make its sign’ inspite of all precautions
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 4
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 5
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 6
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 7
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 8
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 9
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 10
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 11
Functions of the nose◦ Regulation of nasal airflow
◦ Filtration
◦ Defense against infection
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 12
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 13
aesthetics
Nasal landmarks
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 14
aesthetics
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 15
aestheticsTip define
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 16
aestheticsNaso-facial
angle
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 17
Esthetics
Naso-labial (columellar-labial) angle
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 18
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 19
L.A◦ I.V. Sedation
◦ Topical & Infiltrative Anesthesia
G.A. with endotracheal intubation
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 20
Topical & Infiltrative Anesthesia
Volume (1%lidocaine + 1:1ooooo epinephrine)
Vestibule,aperture – 2mlDorsum – 1ml
Lateral walls – 2mlTip, columella – 2mlDistal septum – 2ml
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 21
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 22
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 23
Closed Technique
An order of procedure: six stages
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 24
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 25
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 26
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 27
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 28
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 29
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 30
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 31
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 32
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 33
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 34
Two main objectives◦ To resect the excess cartilage & thus reduce the
size of the nasal tip & permit its reshaping
◦ To weaken the cartilage between the lateral & medial crura in order that the lateral crus may lie down assume a position in harmony with the new profile of the nose
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 35
Three precautions in performing surgical modifications of the shape of the alar cartilages◦ Avoid raw areas resulting from the removal of
vestibular lining
◦ Avoid excessive removal of the cartilage to avoid a pinched deformity
◦ Avoid sharp angles & protuberances
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 36
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 37
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 38
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 39
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 40
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 41
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 42
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 43
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 44
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 45
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 46
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 47
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 48
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 49
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 50
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 51
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 52
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 53
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 54
Open techniqueBasic differences
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 55
Indications◦ Sculpting the tip cartilages
◦ Proper placement of grafts
◦ Difficult septum
◦ Straighten a crooked nose
Contraindications◦ Who have not stopped smoking 7-10 days prior to
surgery
◦ External nasal scar
◦ Thick skinned noses requiring reduction
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 56
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 57
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 58
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 59
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 60
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 61
Dorsal humps are managed acc. to their size ◦ < 5mm – rasp
◦ > 5mm – osteotome
Nasal tip surgery◦ Columellar struts(intercrural)
◦ Suture techniques
◦ Tip grafts
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 62
Five basic types of tip sutures◦ Transdomal suture
◦ Interdomal suture
◦ Lateral crural mattress suture
◦ Intercrural suture &
◦ Columellar-septal suture
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 63
Transdomal sutureFirst suture
Domal creation suture of Daniel
Dome spanning suture of Tebbetts
Dome suture
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 64
Interdomal sutureDomal equalization suture of Daniel
Medial fixation suture of tebetts
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 65
Intercrural suture
Flare control suture
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 66
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 67
Columellar-septal sutureOrthopedic suture
Projection control suture
Tip rotation suture
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 68
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 69
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 70
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 71
OsteotomiesMedial oblique osteotomy
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 72
Indications◦ The secondary rhinoplasty deformity with loss of
alar cartilage◦ The secondary `polly tip’ deformity with loss of
definition of the profile line◦ The hypo plastic tip◦ The tethered lip◦ Congenital deformities `cleft lip nasal deformity’◦ The plunging tip with caudal angulations of alar
cartilage◦ the thick skinned tip with loss of anatomic
definition
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 73
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 74
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 75
Adjunctive techniques
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 76
Indications◦ To reduce the size of the nostrils
◦ To aid in recessing the tip &
◦ To reduce the flaring
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 77
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 78
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 79
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 80
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 81
It is designed to safe guard the integrity & preserve the physiologic mechanism of the nasal valve
It also provides an excellent exposure of the septal framework when correction of a septal deviation is required during the rhinoplasty
Contraindicated in very large nose because of the excess of mucous membrane that remains after the reduction of the nose
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 82
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 83
Tip exposure techniqueHockey stick incision
Popularized by Brown & McDowell (1951)
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 84
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 85
Tip exposure Retrograde technique
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 86
Tip exposureEversion technique
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 87
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 88
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 89
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 90
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 91
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 92
Projecting tip◦ Excessively projecting tip, `the Pinocchio nose’
require shortening & recession
◦ Whether tip is projecting or is the dorsum recessed
◦ If dorsum is recessed , the dorsal profile elevated by the cartilagenous graft with minimal tip surgery
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 93
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 94
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 95
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 96
Condition that become more accentuated with the aging
Anatomic basis of this deformity can vary◦ The septum is long, invading the lip & the
ligamentus attachments of the alar cartilages to the septal angle are adequate or
◦ 2nd type shows, on digital distraction, a lack of continuity between the tip of the nose & the septal angle
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 97
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 98
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 99
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 100
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 101
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 102
Extensive submucus resection rarely required
Conservative measures◦ Resection of bony spur /obstructive portion of
septum
◦ By incising the base of the septum, replacing it into the vomer groove
◦ Shaving areas of thickened septal cartilage
◦ Straightening a curved dorsal border of septum
◦ Straightening the dislocated caudal portion of septum
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 103
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 104
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 105
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 106
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 107
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 108
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 109
Saddle noseDepression of the dorsum of the nose
may occur in the bony or cartilagenous portion; when both are
affected termed saddle nose
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 110
Hemorrhage Infection Mucus cyst Necrosis Functional Iatrogenic◦ Tip ptosis◦ Alar retraction◦ Pollybeak◦ Nasofrontal angle◦ Saddle nose
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 111
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 112
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 113
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 114
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 115
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 116
AUGMENTATION OF THE LABIOCOLUMELLAR ANGLE
CORRECTION OF AN ACUTE NASOLABIAL ANGLE- TECHNIQUE BY AUFRICHT
NASAL SPINE
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 117
F 9.2 rees
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 118
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 119
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 120
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 121
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 122
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 123
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 124
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 125
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 126
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 127
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 128
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 129
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 130
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 131
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 132
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 133
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 134
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 135
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 136
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 137
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 138
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 139
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 140
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 141
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 142
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 143
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 144
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 145
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 146
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 147
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 148
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 149
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 150
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 151
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
Page 152
dr sumer yadav, mch plastic and reconstructive surgery,
[email protected]
