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Highlights of Archives of Facial Plastic Surgery
May/Jun 2008

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2008;10(3):151. doi:10.1001/archfaci.10.3.151
The Caudal Septum Replacement Graft

Hossam M.T. Foda, MD, discusses a retrospective series of 120 patients who presented for rhinoplasty to correct the aesthetic and functional problems resulting from loss of the caudal septal and premaxillary support. In most cases, the caudal septal deficiencies followed previous surgical excisions. An external rhinoplasty approach was used in all cases. The lost nasal tip support was reconstructed using a cartilaginous caudal septum replacement graft that was combined with premaxillary augmentation using a roll of Mersilene mesh, which improved the support and stability of the graft. The technique used provided excellent support to the nasal tip, allowing it to maintain its position over the long-term follow-up (1-12 years). No cases of infection, displacement, or extrusion were encountered. The surgical technique is described in detail, and the impressive operative results are well illustrated.

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Outcome Measures in Facial Plastic Surgery: Patient-Reported and Clinical Efficacy Measures

Evaluation of outcomes in facial plastic surgery is a difficult task owing to the subjective nature of this field. There has been a surge in literature with validated instruments for both patient-reported as well as clinically measured outcomes. John S. Rhee, MD, MPH, and Brian T. McMullin, MD, conducted a thorough review of existing outcome measures in facial plastic surgery literature. They evaluate the validity and reliability of the measures, make recommendations on how to integrate existing measures into future studies, and highlight the challenges in this evolving field.

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Intranasal Z-plasty for Internal Nasal Valve Collapse

Various surgical procedures are available for correction of nasal valve collapse. Intranasal Z-plasty has been used in treatment of nasal valve stenosis and cleft nasal deformities. Jay M. Dutton, MD, and Marci J. Neidich, MD, performed a retrospective medical chart review of 12 patients who underwent intranasal Z-plasty for internal valve collapse. The mean duration of follow-up was 16.8 months. Ten patients underwent bilateral surgery, and 2 patients underwent unilateral surgery. Each patient's nasal obstruction was rated on a subjective scale of 0 to 10 (10 indicating total nasal obstruction). The mean preoperative (postoperative) score was 7.17 (3.25). Mean improvement score was 3.29 (P < .001). The authors conclude that intranasal Z-plasty is a safe and minimally invasive technique that does not require open rhinoplasty and requires local anesthesia with or without sedation. It is, however, technically challenging, and there is a learning curve involved.

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The Tripod Theory of Nasal Tip Support Revisited: The Cantilevered Spring Model

Anderson's tripod theory has been a dominant theory of nasal tip dynamics in rhinoplasty for the past 4 decades. Recent trends in nasal ideals and appreciation for ethnic variations have challenged the traditional thinking about the tripod concept. Richard W. Westreich, MD, and William Lawson, MD, DDS, expand on previous knowledge of the traditional tripod model while incorporating the cartilage’s intrinsic and external forces as an integral part of nasal tip position. They argue that the lower lateral cartilages act as a cantilevered spring tripod that has a single point of rigid fixation: the caudal septum. A discussion of balance of the intrinsic and extrinsic forces that ultimately determine the final nasal tip position and demonstrative cases are provided.

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Margaret of Austria by Jean Hey (also known as the Master of Moulins) (active fourth quarter of the 15th century).

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This issue's Highlights were written by Joseph Shvidler, MD.