Учебники / Rhinoplasty Dissection Manual Toriumi 1999
.pdfMedial crura short bilatera lly
Lateral crura short bilaterally, caudally displaced
Tip-defining points poorly defined and widely separated
Columella:
Short, with a wide base
Nostri ls:
Horizontal orientation bilaterally
Alar base :
Laterally, inferiorly, and posteriorly disp laced bilatera lly
Nasa l floor:
Usually abse nt bilaterally
REFERENCE
J.Sykes 1M, Senders CW, Wang T D. Cook TA . Use of the open approach for repair of secondary cle defo rmity . Facial Plast Surg ChI! North Am 1993 ;1: 111126.
Appendix J:
Photography Setup (1)
(Fig. A-4)
Came ra: 35-mm SLR (single light reflex camera) with 105-mm macro lens
Lighting: dual elect ronic flash units; overhead kick er light adds a backlighting effect that improves picture quality and sof tens or elim inates background shadows
Background: Nassau blue no. 25 Film : Kodak Ekta chrome ASA 100
STANDARD RHINOPLASTY VIEWS
1:7, front al, base, lateral, oblique 1:5 and 1:3, close-up, base view
Background
~Overhead Kicker Light
/I \ \
8
Light Source |
Light Source |
Camera
Figure 4. Schematic photography setup.
REFERENCE
I . Tardy ME . Brown R. Principles ofphotog raphy in f acia l plastic surgery. New Yor k: Th ieme Publishers. 1992.
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Appendix
Indications For Extern
Rhinoplasty Approa
(1,
Asy mmetric nasal tip
Croo ked-nose deformity (lower two thirds of nose)
Sadd le-nose deformity
Cleftlip nasal deformity
Secondary rhinopla sty requ iring complex structural grafting
Septal -perforation repair
REFERENCES
I. l oh nson CM 1r, Toriumi DM . Open structure rhinoplasty. Ph iladelphia: WB Saunders. 1990 .
2.T oriumi DM , l ohnson CM . Open struc ture rhi nopla sty: featured technical point s and long-term follow cial Plast Surg Clin North Am 1993; I: 1-22 .
Appendix L:
Suggested Surgical
Instruments for
Rhinoplasty
1.Needle holder
2.Bayonet forceps
3.Mallet
4. Takaha shi forceps
5. Siegel retractor
6. Converse retractor
7. Hemostat (curved)
8. Hemostat (straight)
9. Small nasal speculum
10.Large nasal speculum I I . Small single skin hook
12.Small double skin hook
13.Small double skin hook
14.Medium double skin hook
15.Wide double skin hook
16.Freer/Cottle elevator
17.Joseph elevator
18.Converse scissors
19.Fomon scissors
20.Straight Stevens scissors
21.Curved Stevens scissors
22.Curved Iris scissors
23.Scalpel handle
24.Scalpel handle
25.Brow n-Adson forceps
26.Brown-Adson forceps
27. Bishop-Harmon forceps
28. Bishop-Harmon forceps
29. 2.0-mm unguarded osteotome
30.3.0-mrn straight unguarded osteotome
31.3.0-mm straight guarded osteotome
32.2.5-mm straight guarded osteotome
33.Medical grade sharpening stone
34.Dorsal (Rubin) osteotomes : small, medium, large
35.Rasps with tungsten-carbide inserts: 1/2, 3/4, 5/6
36.Aiache cartilage crusher
37.No. 10 Frazier tip suction
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Appendix
List of Select
Companies w
Address/Phone Numb
RHINOPLASTY INSTRUMENT SETS
Anthony Produ cts , Inc., Indianapolis, IN 800 428-1610
Ell is Instruments, Inc., Madison, NJ 800 218-9082
Instruments Unlimited, Quakertown, PA 800 818-0094
Inv otec, Jacksonv ille, FL 800 998-8580
Lorenz Sur gical , Jacksonville, FL 800 874-7711
MicroFrance, St. Aub in, Fran ce 800- 874-5797
Smith-Nephew-Richards, Madi son, WI 888 3958060
Snowden Pencer, Tucker, GA 800 843-8600
Stor z Instrument s, St. Louis, MO 800 3259500
Xo med Surgical Produ cts, Jack sonville, FL 800 874-5797
ALLOPLASTIC CHIN IMPLANTS
Allied Biomedical, Paso Roble s, CA 800 276-1322
Hanson Medi cal, Inc ., Kingston, WA 800771-2215
Invotec , Jacksonville , FL 800 998-8580
Porex Surgical, Inc ., College Park, GA 800521-8145
W. L. Gore & Associ ates, Inc., Flagstaff, AZ 800 528-8763
Xom ed Surgical Products, Jacksonville, FL 800 874-5797
ALLODERM
LifeCell Corporation, The Woodlands, TX 800367-5737
DERMABOND (OCTYL-2-CYANOACRYLATE)
Ethicon, Somerville, NJ 800 888-9234
RHINOPLASTY POWER INSTRUMENTATION
Lin vatecIHall Surgical Products Group, Largo , FL 800 925-4255 United Ame rican Medical, McMinnville, TN 800 521-5002 Xom ed Surgical Products, Jacks onv ille, FL 800 874-5797
NASAL SPLINTS
Invotec, Jacksonv ille, FL 800 998-85 80
Shippert Medical Technologies (Denver Splints), Englewood , CO 800 888-8663
Vision Medical (Thermoplast), Peoria, AZ 800 874-5797
Xomed Surgical Products, Jacksonville, FL 800 874-5797
INTRANASAL PACKS
Invotec, Jacksonville, FL 800 998-8580
Xomed Surgical Products, Jacksonville, FL 800 874-5797
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Appendix
Selected Recommend
Literatu
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Becker DG, Weinber ger MS, Greene BA, Tardy ME. Clinical study of alar anatomy and surgery of the
Arc h Otolaryngo l Head Neck Surg 1997;123:789-795. '
Beeson WHoThe nasal septum. Otola ryng ol Clin North Am 1987;20:743-767.
Byrd HS, Andochick S, Copit S, Walton KG. Septal ex tension grafts: a method of controlling tip project i
Plast Reconstr Su rg J998 ; I00:999-1 0 IO.
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Cheney ML , Glicklich RE . The use of calvarial bone in nasal reconstru ction . Arch Otola ryng ol Head N 1995; 12 1:643-648.
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• D an iel RK. Rhinoplasty and rib grafts: e volving a flexible operative tech nique. Plast Reconstr Surg 597-61 I.
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Gunter JP, Roh rich RJ, Friedman RM . Classification and correc tion of alar-co lumellar discrepancies plasty. Plast Reconstr Surg 1996;97:643-648.
Johns on CM Jr, Godin MS. The tension nose: open structure rhinoplasty approach. Plast Reconstr Su rg 4351.
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Larra bee WF Jr, Open rhinopl asty and the upper third of the nose. Facial Plast Surg Clin Nonti Am 1993; Metzin ger SE, Boyce RG, Rigby PL, Joseph Jl , Anderson JR. Ethmoid bone sandwich grafting for caud
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McCollou gh EG. Surgery of the nasal tip. Otolaryng ol Clin North Am 1987;20 :769-784 .
McCollough EG, Mang at D. System atic approac h to correction of the nasal tip in rhinoplasty . A rch Oto 1981;J07: 1216.
Murakami CS, Cook TA, Guida RA. Nasal recon struction with articulated irradiated rib cartilage. A laryn gol Head Neck 511rg 1991;117:327-330.
Murak ami CS, Larr abee WF. Comparison of osteot omy techniqu es in the treatme nt of nasal fractures. Fa
Surg 1992;8:209-21 9.
Rohrich RJ, Hollier LH. Rhin oplasty with advancing age: characteristics and management. Clin Plast Su 23:281-296 .
Schwartz MS, Tardy ME . Standardized photodocumentation in facial plastic surgery . Facial Plast Surg 1990;7: 1-1 2.
Sheen JH . Spreader gra ft: a method of reconstructing the roof of the middle nasal vault follo wing rhinoplasty.
Pl ast Reconstr S urg 19 84 ;7 3:2 30--237 .
Sheen JH. Tip graft: a 20 year retrosp ect ive. Plast R econ str Surg 1993;91 :4863.
Simon s RL. Vertical dome division in rhinoplasty. Otolaryngol Clin North Am 1987 ;20 :785-796. Sim ons RL, Gallo JF . Rhinoplasty complications. Facial Pl ast Surg Cl in North Am 1994; 2:521-529.
Sykes JM , Senders CW, Wang TD , Cook TA . Use of the ope n approach for repair of secondary cleft lip nasal de formity.. Facial Plast S urg Clin North Am 1993;1:111-126.
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Tardy ME . Ethics and integrity in facial plastic surgery : imperatives for the 21st cen tury, Facial Pla st S urg 1995 ; 11:111-1 15.
Tardy ME. Rhinoplasty: th e art and the s cience. Philadelphi a: WB Saunders, 1997 .
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Tard y ME, Broadw ay D. Graphic record-keeping in rhino plasty: a valuable self-learning device. Facial Pla st Su rg 1989;6:108-112.
Tardy ME, Brown R. Surgical anatomy of the nose. New York: Raven Press, 1990.
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Toriu mi DM, Ries WR . Innovative surgical management of the crooked nose. Facial Pla st Surg CUn North Am 1993; I:6378 .
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Op er Tech Otola ryngol Head Neck Surg 1990;1:225233.
Toriumi DM, Tardy ME . Cartilage suturing techn iques for correction of nasal tip deformitie s. Op er Tech Oto laryngol Head Ne ck Surg 1995 ;6 :26 5-273.
Toriumi DM, Josen J, Weinberger M, Tardy ME. Use of alar batten grafts for correction of nasal valve collapse.
Arch Oto l Head N eck Surg 1997;123 :802-808.
Wang TD . Aestheti c structural nasal augme ntation. Op er Tech Otolaryngol Head Neck S urg 1990 .
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Subject Index
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Subject Index
A page number followed by f indicates a figure.
A
Aesthetic analysis, I I, 157 Aesthetic/cosmetic issues alar base red uction, 113
closure of midco lumellar incision, 149, 150f15 1f Aesthetic triangle, 16, 20
Airway obstruction. See Nasal obstruction Ala, rhinoplasty analysis, 20
Alar base
cleft lip-nasal deformity bilateral, 168 unilateral, 167
resection, 113-11 5
alar wedge excision, 114, I ISf internal excis ions, 115
internal nostril floor reduction, 113, 114f pearls, l iS
sliding alar flap, 114, 115f
wedge excision of nostri l floor and sill, 114, 114f rhinoplasty analysis, 18
Alar batten graft, 105, 106f-I09f Alar-columella relationship, 20, 2 1f Alar-facial groo ve (junction), 2f, 3f Alar flare
internal nostril floor reduction, 113, 114f
wedge excision of nostril floor and sill, 114, 114f Alar lobule, 3f, 5, 20
Alar nasalis muscle, 4f Alar sidewa ll, 2f Anatomy of nose, 1- 7
musculature, 4f
nasal relationships, S, 7f nasal valve area , 6 pearls, 5-6
scroll region, 6 septum, 4f
soft tissue layer, 6 surface anatomy, 2f-3f
basal view, 2f frontal view, 2f lateral view, 2f oblique view , 3f
surgical anatomy, 3f-5f basal view, 3f
lateral view, 3f oblique view, 3f
vasculature, 4f5f
Anesthesia, infilt rative injecti on technique, 25-29 columella injection, 25, 26f, 28
intercartilaginous, transcartilaginous, or delivery approach, 27, 28f lateral wall of nose, 27, 29f
multiple injections along marginal incision area, 25, 26f for osteotomy, 27, 28
pearls, 27-28
soft -tissue, domal region, 25, 26f Anomalous nasi, 4f
Anterior septal angle, 3f
Aquaplast cast, application and removal, 153 Artery(ies), nasal, 4f-5f
Auricular carti lage alar batten graft, 105
harvesting, 139, 140f-1 42f, 146-147
B
Beveling of skin edges, 45 Bifidity, nasal tip, 17 Bleeding, septoplasty, 33 Blood vessels, 4f-5f Bone infarction, 6
Bones, nasal, 3f, 5
infracture du ring osteotomy, 67-68 medialization, 68
postoperati ve margins, smoo thing with rasps, 62, 63 f postoperati ve shifting, digital exe rcises for, 153
Bossa formation, 22, 110, 163 Brow-tip aesthetic lines, 17 Bulbosity, 17
Buttress graft, 102, 102f-105f
Byrd' s method, nasal projection, 16, 19, 159
C
Calvarial bone, harvesting, 144, 144f-1 46f, 147 Cap graft, 102, 102fI05f
Cartilage
harvesting. See Tissue harvesting
lower lateral (LLC). See Lower lateral cartilage quadrangular, 4f
179
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