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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4525_Библиотеки_им_академика_М_И_Перельмана
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13 Part II: Clinical Case 11 77
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Preoperative
Postoperative
Direct Dorsal
Direct Dorsal
Smiling
Overhead
Overhead
Smiling
Preoperative
Poftoperative
Backward Tilting
Steeper
Backward Tilting
Basal
Basal
Smiling
78 13 Part II: Clinical Case 11
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Preoperative
Poftoperative
Right Nasal
Aperture
Right Nasal
Aperture
Rim Sill Test
Left Nasal
Aperture
Rim Sill Test
Left Nasal
Aperture
Preoperative
Poftoperative
Right Oblique
Mid Cheek
Full Face
Left Oblique
Mid Cheek
Full Face
Right Oblique
Mid Cheek
Middle Third
Left Oblique
Mid Cheek
Middle Third
13 Part II: Clinical Case 11 79
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Preoperative
Poftoperative
Right Oblique
Cheek Margin
Full Face
Left Oblique Right Oblique
Cheek Margin Cheek Margin
Full Face Middle Third
Left Oblique
Cheek Margin
Middle Third
Preoperative
Poftoperative
Right Lateral
Left Lateral
Right Lateral
Smiling
Left Lateral
Smiling
80 13 Part II: Clinical Case 11
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Preoperative
Postoperative
Right Lateral
Middle Third
Left Lateral
Middle Third
Part II: Clinical Case 12
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14
Preoperative Assessment
1. Frontolateral walls
a. Large and bulky nasal tip which was completely
overshadowing the alae nasi (Frontal, Direct Dorsal and Backward Tilting Vi ews).
b. The nasal tip is deviated to the right side as a com-
pensatory mechanism to the left deviation of the
osteocartilaginous pyramid (Frontal Direct Dorsal and Backward Tilting Views).
2. Medial Wall
Nil of note.
3. Bony pyramid
a. Osteocartilaginous hump that is oblique and deviated
to the left side due to bilateral maxillary symmetry.
The left cheek is wide and low while the right cheek
is narrow and high (Frontal, Direct Dorsal, and
Backward Tilting Views). The nasal tip is counter
deviated to the right.
b. Wide base of bony pyramid (Frontal, Direct Dorsal
and Backward Tilting Views).
4. Alar base
Wide nasal openings due to long inferior segments of the
rim sill folds.
Aims of Surgery
1. Reduce the size and the bulk of the frontolateral walls.
2. To centralize and reduce the size of the bony pyramid.
3. Excision of the nasal hump.
4. Reduction of the size of nasal openings.
Surgical Plan
1. Frontolateral walls
a. DDD including the weak triangle to reduce the size
and bulk of the nasal tip.
b. Cephalic trim of the lateral crurae to reduce the size of
the frontolateral walls.
2. Medial Wall
Nil of note.
3. Bony Pyramid
a. Excision of the osteocartilaginous hump down to
the level of the anterior septal angle.
b. Osteotomies and Kassanjean maneuver to the right
i.e. cross fracture of the bony pyramid after osteotomies (see Surgery of the Bony Pyramid in Text).
c. Alar Base
Excision of the inferior segments of the rim sill folds.
Surgical Procedure
As per Surgical Plan.
Post-Operative Analysis
1. Frontolateral Walls
a. Tip definition improved: the tip is slimmer and
prominently well identified. The alae nasi come into
view to share in nasal aesth etics (Frontal, Direct
Dorsal, Overhead, Backward Tilting and Basal
Views).
b. Tip projection: the nasal tip is 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 Walls
Nil of Note.
3. Bony Pyramid
a. Bony pyramid aesthetics improved: the nasal dorsum
is straight and the sidewalls are smooth and narrow
(all views except the 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_14
81
82 14 Part II: Clinical Case 12
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b. Dorsal light reflex is seen as a regular one line off the
nasal dorsum (Direct Dorsal View).
4. Alar Base
a. Superior and posterior alar groove aesthetics
improved by defatting. The superior grooves become
longer and deeper (Oblique, Lateral and Direct Dorsal
grooves). Angles of the posterior alar grooves
become wider.
b. Nasal aperture aesthetics improved by defatting and
excision of the inferior segments of the rim sill folds.
The nasal openings became smaller oval in shape.
Frontal
Preoperative
c. 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. This patient maintained her exact features post-operatively
as she wished. The nose print is the same.
b. The smaller nose matches the sizes of the eyes, lips and
chin.
Frontal
Smiling
Frontal
Middle Third
Poftoperative
14 Part II: Clinical Case 12 83
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Direct Dorsal
Preoperative
Poftoperative
Preoperative
Poftoperative
Steeper
Backward Tilting Backward Tilting
84 14 Part II: Clinical Case 12
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Preoperative
Poftoperative
Right Nasal
Aperture
Right Nasal
Aperture
Rim Sill Test
Left Nasal
Aperture
Rim Sill Test
Left Nasal
Aperture
Preoperative
Postoperative
Right Oblique
Mid Cheek
Full Face
Left Oblique
Mid Cheek
Full Face
14 Part II: Clinical Case 12 85
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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
Preoperative
Postoperative
Right Lateral
Left Lateral
Right Lateral
Smiling
Left Lateral
Smiling
86 14 Part II: Clinical Case 12
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Preoperative
Postoperative
Right Lateral
Middle Third
Left Lateral
Middle Third
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