Operating Room Footage - Deep Temporalis Fascia for Rhinoplasty

http://www.rhinoplastyspecialist.com

Another important detail is to ascertain if you have nasal obstruction. I will determine if the nasal obstruction was present preoperatively. If the obstruction is a result of the surgery, a number of questions need to be answered. Did you have reductive rhinoplasty surgery? I will have you point out where the obstruction is. Is it static or dynamic? Present with normal or deep inspiration? What alleviates and worsens the nasal obstruction? What are the characteristics of the nasal obstruction? Was septal surgery performed? With these important questions answered I am now ready to perform the physical examination.

For the physical exam, I use a detailed nasal analysis worksheet. I will perform a detailed visual and tactile evaluation of the nose. For the bony dorsum, I will examine the osteotomies, presence of open roof deformity or rocker deformity, and hump under- or over- resection. Then I will examine the middle part of your nose, called the middle vault. I will look for middle vault abnormalities such as a narrow middle vault, inverted V deformity or under-resection of the caudal cartilaginous dorsum (Polly beak deformity). For the tip, I will examine tip projection, rotation, support, alar and columellar retraction, over aggressive Weir incisions, and lower lateral crural characteristics such as over-resection, cephalically oriented or bossae formation. Over-resection of the lower lateral cartilage complex in patients with a heavy sebaceous skin-soft tissue envelope can cause tip ptosis and nasal obstruction. This problem often occurs in Hispanic, Asian, Middle Eastern and African-American patients. A deviated cartilaginous dorsum and tip can signify a deviated septum. This is only a partial list of anatomical problems that I need to identify in nasal analysis.

For patients with nasal obstruction, Ill observe you performing normal and deep inspiration on frontal and basal views. Often, the diagnosis is easily identifiable as supra-alar, alar and/or rim collapse or slit-like nostrils during static or dynamic states. External Valve Collapse (lower lateral cartilage pathology) can be evaluated with the soft end of a cotton swab while plugging the contra-lateral nostril. The cotton swab elevates the area of obstruction whether its the alar rim, lower lateral crura or supra-alar region. I will see if the nasal obstruction is alleviated by elevating the nasal tip in patients with ptosis of the nasal tip. I will perform the Cottle maneuver (pulling laterally on the cheek) to check for internal valve collapse. Although this test is generally non-specific, internal nasal valve pathology caused by supra-alar pinching or a narrowed angle between the upper lateral cartilage and septum can be diagnosed. On basal view, Ill examine the medial crura to identify if they are impinging into the nasal airway. Following a thorough external nasal evaluation, I will examine the inside of your nose. I will examine your nose with a nasal speculum and check the nasal septum for perforations, persistent deviation and for any remaining cartilaginous remnants to be used for grafting. Other causes of nasal obstruction to identify are: hypertrophic inferior turbinates, synechiae (scar bands) between the lateral nasal wall and septum, nasal masses and middle turbinate abnormalities (concha bullosa).

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[sporemedical]

If you want to know more about Rhinoplasty surgery, Dr. Nassif will answer your questions on his channel... YT username "drpaulnassif"

WE WANT TO HEAR FROM YOU! Tell us what you want to know about Facial Plastic & Reconstructive Surgery and Dr. Nassif will post a video on the subject.

[scarfllow]

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[billysue2]

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[scarfllow]

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