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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4420_Библиотеки_им_академика_М_И_Перельмана
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108 / Index
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Primary rhinoplasty (continued)
nondelivery approach, 12
osteotomies, 16–17
overall concept in, 7
profile-plasty, 14–15, 15f
refinement techniques, 28–29
specific tip-sculpting techniques, 17, 18f
Procerus muscle, function of, 1
Profile analysis, 3–4, 4f
Profile-plasty, 14–15, 15f, 45–55
bony profile reduction in, 50–53
instrumentation for, 50–52, 51f
complications of, 53–55
computer imaging analysis for, 47–49, 47f, 48f
dorsal, 14–16, 15f, 16f
preoperative consultations for, 45–47
procedures of, 49–53
Ptotic nose, revision rhinoplasty of, 71, 71f
Q
Quadrangular cartilage, anatomy of, 2
R
Radix, low, 53, 54f, 90, 92, 94, 94f
Radix grafts, 15, 53, 54f, 90
Rasps, 50
Refinement techniques, 28–29
Revision rhinoplasty, 65–88
for alar collapse and retraction, 80–82, 81f, 82f
consultations for, 67–68
for errors of commission correction, 75, 76f, 77, 77f
grafts used in, 77–80
for “hourglass” deformity correction, 85–86, 85f, 86f
for inadequate tip projection correction, 86
for incomplete primary nasal defects correction,
70–73, 71f, 72f, 73f, 74f, 75f
indications for, 69–70
of the lobule, 65
nasofacial relationships in, 89–90
need for, 65, 67
for overly-narrow nasal tip correction, 82–84, 83f, 84f
for overly-reductive nasal defects correction, 70,
75–77
for overly-rotated nasal tip correction, 86
in profile-plasty patients, 55
rates of, 67
for short nose correction, 86
timing of, 68
with total lobular reconstruction, 97–99, 98f, 99f
grafts for, 79–80, 79f, 80f
reasons for, 65, 67–69
tip-support construction in, 87
Rhinitis, allergic, 5
Rhinoplasty. See also Primary rhinoplasty; Secondary
rhinoplasty
reasons for, 45
as short nose cause, 95, 97–99, 98f, 99f, 100f
Rib costochondral dorsal onlay grafts, 91
Rim grafts. See also Alar rim grafts
for alar base maintenance, 27
for alar retraction correction, 80
large, 13
S
Saddle-nose deformity, 15–16, 15f, 78f
correction of, 54, 55f, 77
trauma-related, 58f
St. John’s wort, 5
Scars, postoperative, tip rhinoplasty-related, 43
Scroll area, 2
Secondary rhinoplasty. See Revision rhinoplasty
Septal angle, 47
anterior
preoperative analysis of, 8
in tip rotation techniques, 38
Septal cartilage, in nasal fractures, 58f
Septal cartilage grafts, 27
onlay grafts, 27, 93, 93f, 94f
Septoplasty, caudal or dorsal approach to, 11
Septorhinoplasty, immediate, 62
Septum, nasal
anatomy of, 2, 58f
caudal
overresection of, 99, 99f, 100f
in profile-plasty, 49
deficiency of
iatrogenic, 98–99, 99f
as nasal tip projection loss cause, 91
deviation of, 2
congenital, 57
preoperative evaluation of, 11
dorsal
cartilaginous, 33
incremental reduction of, 5
overresection of, 98–99, 99f
fractures of, 58–59, 58f, 62, 63–64, 63f
injury to, as short nose cause, 95, 96f
as nasal tip support structure, 67
overgrowth of, 8–9
Sesamoid complex, 33
Shield grafts, 87
columellar strut-tip, 100f
in combination with
cap grafts, 79, 79f, 92, 93, 93f
tip grafts, 93f
double-dome, 17
for nasal tip under-projection correction, 24, 24f
for short-nose lengthening, 92–93, 93f, 95, 97f
single-dome, 17
sutured columellar lobular, 79, 79f
tip columellar, 17f
in tip rhinoplasty, 36–37
Short nose
definition of, 89
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lengthening of, 89–101
with DARTT (dynamic adjustable rotation tip-
tensioning technique), 93–95, 94f, 95f, 96f
facial analysis for, 89–90
for hereditary short nose, 92–95, 92f, 93f, 94f,
95f
for iatrogenic short nose, 95, 97–99, 98f, 99f, 100f
literature review of, 90–91
with posterior caudal septal angle excision, 27
for predevelopmental/posttraumatic short nose,
95, 96f, 97f
revision surgery following, 70, 86
with spreader grafts, 27
with tip grafting, 27
as nasal surgery complication, 89
revision rhinoplasty of, 70, 86
“Shrink wrap” phenomenon, 67, 80
Silastic implants, 54
Simons relation, of nasal projection to upper lip
length, 34
Singe-dome tip-sculpting technique, 17, 18f
Single-dome suturing technique
in boxy nasal tip, 19–20, 22f
in infantile nasal tip, 23, 23f
in trapezoid nasal tip, 23f
Sinusitis, 5
Skeleton, facial. See also Bones, nasal
analysis of, 3
Skin, nasal
anatomy of, 1
preoperative evaluation of, 3, 5, 8, 11f, 34
thick, 34
thin, 11f, 34
“Ski slope” deformity, 54
Soft-tissue onlay grafts, 17
Soft-tissue overlay grafts, 80, 80f
Splints, nasal, 41, 43f
Aquaplast
®
, 61–62
for nasal bone fractures, 61–62
complications of, 63–64
in pediatric patients, 63
for primary rhinoplasty patients, 29, 30f
silicone, 43
Spreader grafts, 16, 16f
bilateral, 16f, 90
in cartilaginous dorsal profile reduction, 15
definition of, 86
for dorsal profile reduction, 16
extended
bilateral, 96f
for short nose lengthening, 95, 96f
for hourglass deformity prevention, 85
for mid-nasal vault support, 11–12, 51–52, 51f, 52f
for nasal vault width maintenance, 47
need for, 15, 15f
in patients with short nasal bones, 5, 90
placement and suturing of, 52, 52f, 86
sources of, 51–52
in tip rhinoplasty, 36
Steroids, intralesional, 43
Strut grafts
columellar, 37, 38, 87f, 94
in external columellar approach, 8, 13–14, 14f
L-shaped, 13, 98–99
for short nose lengthening, 95, 96f
in endonasal approach, 8
lateral crural, for iatrogenic short nose correction, 99,
100f
for lobule deficiency correction, 92
in primary rhinoplasty, 13
®
Surgicel
, 41, 43f
Sutures and suturing
of alar batten grafts, 28f
alar-spanning, 17, 19, 21f
double-dome unit, 17
T
Taping, postoperative, 41, 43f
Temporalis fascia grafts, 15f, 95, 97f
as camouflage grafts, 54–55
as overlay grafts, 28–29
“Tensegrity,” 67
“3-4-5 triangle,” of nasal tip projection, 3–4
Tip grafts, 90
applications of, 79
in bossae treatment, 75, 76f
in combination with shield grafts, 93f
double-layered, 98, 100f, 101
extended, 87f
in nose lengthening procedures, 91–92, 98, 100f, 101
sources of, 79
in tip rhinoplasty, 36–37, 36f, 37f
in total lobular reconstruction, 79–80, 79f, 80f
types of, 17, 79
Tip rhinoplasty, 33–44
complications of, 43
external, 41, 43
facial analysis for, 33
instrumentation and materials for, 35t
postoperative care for, 41, 43
preoperative considerations for, 33–34
special considerations in, 38, 40f
alar rim grafts, 38, 42f
cephalic malposition of lower lateral cartilage,
38, 40f
external valve collapse, 38, 41f
techniques of
to decrease tip rotation, 38
endonasal rhinoplasty, 34–35, 35t
external rhinoplasty, 35–36, 36t
to increase tip rotation, 38, 39f
tip grafts, 36–37, 36f, 37f
tip projection control, 37–38
tip-sculpting techniques, 35, 36
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Tip-sculpting techniques
in primary rhinoplasty, 17, 18f
double-dome, 17
single-dome, 17, 18f
in tip rhinoplasty, 35, 36
Tongue-and-groove technique, of short nose lengthening, 90
Total lobular reconstruction, 97–99, 98f, 99f
grafts for, 79–80, 79f, 80f
graft technique for, 87
reasons for, 65, 67–69
tip-support structure reconstruction in, 87
Trauma, nasal. See also Fractures, nasal
preoperative evaluation of, 5
as short nose cause, 95, 96f
Tripod theory, 2, 33
Turbinates
inferior
anatomy of, 2
hypertrophic, 5
hypertrophy of, 2
middle, anatomy of, 2
superior, anatomy of, 2
U
Unitip deformity, 82–84, 83f, 84f
Upper lateral cartilage spreader flaps. See Auto spreader
grafts
V
Vomeric groove, 58f
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