Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 507 - файл
.pdf
38 Part IV: Clinical Case 8 223
https://t.me/medicina_free
Preoperative
Postoperative
Frontal
Frontal
Smiling
Frontal
Middle Third
Preoperative
Postoperative
Direct Dorsal
Direct Dorsal
Smiling
Overhead
Overhead
Smiling
224 38 Part IV: Clinical Case 8
https://t.me/medicina_free
Preoperative
Postoperative
Steeper
Backward Tilting Backward Tilting
Right Nasal
Aperture
Basal
Left Nasal
Aperture
Basal
Smiling
Preoperative
Postoperative
38 Part IV: Clinical Case 8 225
https://t.me/medicina_free
Preoperative
Postoperative
Right Oblique
Mid Cheek
Full Face
Left Oblique
Mid Cheek
Full Face
Right Oblique
Mid Cheek
Middle Third
Left Oblique
Mid Cheek
Middle Third
Preoperative
Postoperative
Right Oblique
Cheek Margin
Full Face
Left Oblique Right Oblique
Cheek Margin Cheek Margin
Full Face Middle Third
Left Oblique
Cheek Margin
Middle Third
226 38 Part IV: Clinical Case 8
https://t.me/medicina_free
Preoperative
Postoperative
Right Lateral
Left Lateral
Right Lateral
Smiling
Left Lateral
Smiling
Preoperative
Postoperative
Right Lateral
Middle Third
Left Lateral
Middle Third
Part IV: Clinical Case 9
https://t.me/medicina_free
39
Preoperative Assessment
1. Frontolateral walls
a. Large bulky tip, that is deviated to the left side.
(Frontal, Direct Dorsal and Backward Tilting Views).
b. The alae nasi are overshadowed by the large bulbous
tip. The left ala nasi is larger than the right (Frontal
and Direct Dorsal Views).
c. Asymmetrical smile. The right cheek is larger and the
left ala nasi was at a higher level on smiling.
2. Medial Wall
Right caudal septal deviation (Right Nasal Aperture
Views).
3. Bony pyramid
a. Small osteocartilaginous hump which was mainly
oblique and slightly deviated to the right side due
to bilateral maxillary asymmetry (Backward Tilting,
Oblique and Lateral Views). The right cheek is wide
and low while the left cheek is narrow and high
(Backward Tilting Views).
b. Wide base of the bony pyramid (Frontal, Direct
Dorsal, Overhead and Backward Tilting Views).
4. Alar base
a. Wide nasal apertures. The left nasal opening is nat-
urally wider than the right. (Backward Tilting and
Basal view).
b. Asymmetrical smile partly due to asymmetrical alae
nasi. The left nasolabial fold and the left cheek ball
were different from the right (preoperative Frontal
Smiling View).
Aims of Surgery
1. Reduce the size and bulk of the frontolateral walls.
2. Excision of the osteocatilagenous hump.
3. Reduction of the size of the bony pyramids and centralise
its deviation.
4. Reduction of the sizes of nasal apertures and equalising
both sides.
Surgical Plan
1. Frontolateral walls
a. DDD excluding the weak triangle. The area of the
weak triangle is rich in fat. Any attempt of defat ting
this area will lead to supratip depression.
2. Medial Wall
Septoplasty to correct the caudal septal deviation.
3. Bony pyramid
a. Excision of the osteocartilaginous hump.
b. Osteotomies, Kassanjian maneuver to the left i.e.
cross fracture of the bony pyramid after osteotomies
(see Surgery of the Bony Pyramid in the Text).
4. Alar base
a. Bilateral excision of the inferior segments of the
rim-still folds to reduce the size of the nasal openings.
More to be resected from the left side as the segment
is longer on this side.
b. Bilateral resection of the posterior segments of the
rim-sill folds to reduce the bulk of the alar base.
Surgical Procedure
1. As the surgical plan.
2. There was a supratip depression despite preserving the
weak triangular fat. Cephalic trimmings of the lateral
crurae were used as a supra-tip graft.
Post-Operative Analysis
1. Frontolateral Wall
a. Tip definition: the nasal tip is smaller with thinner
and smoother overlying skin. The tip is more
prominent and well identified from the alae nasi on
both sides. The alae nasi come into view to become
clearly visible and share in nasal aesthetics (Frontal,
Direct Dorsal, Overhead, Backward Tilt ing and Basal
Views).
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
M. H. A. Shafy, Atlas of Clinical Cases in Rhinoplasty,
https://doi.org/10.1007/978-3-031-07504-9_39
227
228 39 Part IV: Clinical Case 9
https://t.me/medicina_free
b. Tip projection: The nasal tip at the same level of the
nasal dorsum with good aesthetic angle. This is
coupled with good aesthetic nasolabial angle (lateral
and oblique views).
c. Tip light reflex is seen as one spot off the nasal
tip. (Frontal and Backward Tilting Views).
2. Medial Wall
a. The right caudal septal deviation is corrected.
b. Mobile tip is abolished.
3. Bony Pyramid
a. Bony pyramid aesthetics improved: the nasal dorsum
is straight in the midline and the sidewalls are smooth
and narrow (all views except the Basal Views).
b. Dorsal light reflex is seen as an uninterrupted line off
the nasal dorsum (Direct Dorsal Views).
4. Alar Base
a. Superior alar groove aesthetics improved. They are
longer, deeper and better seen.
b. Posterior alar groove aesthetics improved by defatting
as well as excising the posterior segments of the
rim-sill folds. The flat tire appearance is no longer
present. (Backward Tilting, Basal and Nasal Aperture
Views).
c. Alae nasi aesthetics improved. They are pulled
medially become better seen, smaller and share in
nasal aesthetics. (Nasal Aperture, Oblique and Lateral
Views).
d. Nasal aperture aesthetics improved after defatting and
excision of the rim-sill folds :
i. The sizes became equal and smaller.
ii. The shapes became more elegantly oval in shape.
e. Marginal light reflexes are clearly seen at:
i. Inferior alar margins (Nasal Aperture Views).
ii. Nasal sill bands (Oblique Views).
iii. Lateral crural prominences (Lateral Views).
Commentary
a. The height of the nasal dorsum was carefully chosen to
be slightly lower than she would have liked as an Arab in
general. This height seemed to suit her face and overall
small body. The relatively large size of the lower third,
even after being reduced by defatting, provided a good
tip projection with the sloping medium height nasal
dorsum.
b. After resection of the Inferior segments of rim-sill folds,
predominantly more on the left side, the patient now has
better symmetrical smile than before the surgery.
c. It was not sufficient just to correct the crookedness of the
nose. An overall care of the four areas of the nose was
necessary to produce an attractive nose.
d. All goals of the surgery were achieved so that:
i. The frontolateral walls were reduced in bulk and
size.
ii. Crookedness of the nose was straightened.
iii. The size of the body pyramid was reduced.
iv. The sizes of the nasal apertures were reduced and
equalized.
v. She has a postoperative symmetrical smile.
vi. The overall result is an attractive small nose that
suits her small body.
39 Part IV: Clinical Case 9 229
https://t.me/medicina_free
Frontal
Frontal
Smiling
Frontal
Middle Third
Direct Dorsal
Direct Dorsal
Smiling
Overhead
Overhead
Smiling
230 39 Part IV: Clinical Case 9
https://t.me/medicina_free
Preoperative
Postoperative
Steeper
Backward Tilting Backward Tilting
Right Nasal
Right Nasal
Aperture
Aperture
Rim Sill Test
Basal
Left Nasal
Aperture
Rim Sill Test
Basal
Smiling
Left Nasal
Aperture
Preoperative
Postoperative
39 Part IV: Clinical Case 9 231
https://t.me/medicina_free
Preoperative
Postoperative
Right Oblique
Mid Cheek
Full Face
Left Oblique
Mid Cheek
Full Face
Right Oblique
Mid Cheek
Middle Third
Left Oblique
Mid Cheek
Middle Third
Preoperative
Postoperative
Right Oblique
Cheek Margin
Full Face
Left Oblique Right Oblique
Cheek Margin Cheek Margin
Full Face Middle Third
Left Oblique
Cheek Margin
Middle Third
232 39 Part IV: Clinical Case 9
https://t.me/medicina_free
Preoperative
Postoperative
Right Lateral
Left Lateral
Right Lateral
Smiling
Left Lateral
Smiling
Preoperative
Postoperative
Right Lateral
Middle Third
Left Lateral
Middle Third
Соседние файлы в папке @xirurgi_2025