Kỹ Thuật Phẫu Thuật Nâng Mũi Đỉnh Cao (Mastering Rhinoplasty)

Subject Index
445
diced cartilage, 229
dorsal grafts, designer dorsum
advantages and disadvantages,
256–257
diced cartilage in fascia (DC-F), 252,
254–255
osseocartilaginous grafts (OC) and
fascia (F), 252–253
extended columellar strut, 244–245
fascia harvest
perichondrium, 238
technique, 238–239
fillers advantages and disadvantages, 227
harvesting, 328
lateral crural strut graft (LCSG), 230
and alar transposition, 260–261
extended lateral crural strut, 260
locations, 260–261
technique and problems, 260
lateral wall grafts, 264–265
open structure tip
analysis, 148
operative technique, 148–149
operative sequence, 228
operative technique and analysis,
230–231
osseocartilaginous rib grafts, 86–87
preparation, 34
principles, 34
problems, 228–229, 244–245
radix and radix/dorsal graft, 239
radix augmentation, F and DC, 74–75
radix grafts
area graft and fascia, 250–251
problems, 250
upper dorsum, 250–251
rib cartilage, 229
rib harvest
chondrosynschium, 240–241
inframmary approach, 240–243
osseocartilaginous, 242–243
problems, 242
subcostal approach, 240–241
septal harvest
problem, 232
secondary rhinoplasty, 232–233
technique, 232
septocolumellar strut, 244–245
spreader grafts, 34–35
application and problems, 248
functional and aesthetic necessity,
248–249
technique, 248
standard columellar strut, 244–245
technique, ARG and ARS, 258–259
transfixion approach, 233
Guiding principles, 10
H
Harder nose, 54–55
Hispanic rhinoplasty
analysis, 322–323
classification, 320–321
operative techniques, 322
Hyaluronic acid (HA), 242, 343
I
Implants: alloplasts
Analysis 426
case study 428–429
overview 226
surgical techniques 426–427
Implant disasters
early and immediate reconstruction,
426–427
staged reconstruction, 426
Infected implant
analysis, 428–429
operative technique, 428
Inframmary approach, harvesting costal
cartilage, 240–243
Interdomal suture, 122–123
Internal valve collapse and narrowing, 204
Intrinsic tip deficiency, 144–145
Isolated tip graft, 374, 375
L
Lasso technique, 222
Lateral crural deformities, 372
Lateral crural mattress suture (LCMS),
126–127
Lateral crural strut graft (LCSG), 230
and alar transposition, 260–261
extended lateral crural strut, 260
locations, 260–261
technique and problems, 260
Lateral wall grafts, 264–265
LCSG. See Lateral crural strut graft
Level of difficulty. See Classification
M
Marking principles, 16
Mestizo noses, 320, 321
Mexican–American noses, 320, 321
Middle Eastern rhinoplasty
alar rim grafts (ARG), 324
analysis and commentary, 326–327
operative techniques, 326
Mucosal tears, technical misadventures,
222–223
N
Nasal base
aesthetics/analysis
alar flare, 160–161
alar rim–nostril–columellar complex
(ARNC), 160, 166–167
columellar labial angle, 160–161
alar retraction
analysis, 180–181
operative technique, 180
alar rim elevation, 166

446
Subject Index
alar wedge excision, 156, 162–163, 172
anatomy
anatomical components, 158–159
extrinsic influences, 158
anterior nasal spine, 156, 164–165
base collapse
analysis, 176
operative technique, 176–177
columella, 164–165
combined sill
base excision, 162–163
wedge excisions, 162–163, 173
cymba concha, 166–167
lateral crural strut graft, 178–179
nostril
analysis, 171
intrinsic nostril shape change,
168–169
retainer splints, 178–179
sill excision, 156
size changing and tip disproportion,
168–169
nostril sill excision, 162–163
operative plan etiology and design,
156–157
principles
decision making level 1, 170
decision making level 2, 174–175
decision making level 3, 178
Q sign, 162
secondary surgery, 403
surgical technique, 334
Nasal fillers. See Restalyne
Nasal history and exam, 210
Nasal tip contouring, 345
Nasal valves, 186–187
Nostril, 160–161
analysis, 166–167, 171
inclination, ARNC, 166–167
intrinsic nostril shape change,
168–169
retainer splints, 178–179
sill excision, 156, 162–163
size changing, 168–169
tip disproportion, 168–169
valve, 200–201
O
Open approach and septal exposure
advantages, 360
septal consideration, 360–361
Open tip suture technique
analysis, 112–113
crural convexities
principles, 126
technique, 126–127
exposure, 112–113
factors and sutures, 115
incisions, 112–113
nostril rim shape
principles, 132
procedure, 134–137
technique, 132–133
projection
principles, 118
technique, 118–119
refinement
principles, 130
technique, 130–131
rotation and projection
principles, 128
technique, 128–129
symmetry improvement
principles, 124
technique, 124–125
tip definition
principles, 120
technique, 120–121
volume reduction
principles, 116
technique, 116–117
width adjustment
principles, 122
technique, 122–123
Operation method
alar base modification
principles, 42
surgical techniques, 42–43
anesthesia
local anesthesia, 19
principles and precautions, 18
caudal septum and anterior nasal spine
principles, 28
resection and relocation, 28–29
closure, cast, and post-op management
dressing and postoperative taping,
44–45
principles, 44
complications
incidence and hemorrhage, 64
infection, 64–65
nasal obstruction and septal
problems, 65
concerns and solutions, 46–47
consultation
analysis, 14
base and tip analysis, 15
nasal deformity and patient factors, 14
radix and dorsum, 15
decision making
ball tip, 60–61
common variations, 49
difficult nose, level 3, 58–59
harder nose, 54–55
operative sequence, 49
photographic analysis, 50
plan, 48
plunging tip, 56–57
dorsal modification
incremental dorsal reduction,
26–27
principles, 26

Subject Index
447
extramucosal tunnels, 22–23
graft
preparation, 34
principles, 34
spreader grafts, 34–35
marking principles, 16
open approach
columellar to tip and bidirectional
exposure, 20–21
principles, 20
operative plan and sequence, 16–17
osteotomies
principles, 32
types and techniques, 32–33
postoperative management
breathing and initial appearance, 63
ecchymosis and edema, 62–63
smiling and numbness, 63
septorhinoplasty
level 1, aesthetic purpose, 51–53
septal harvest, 30–31
septum
exposure, 22–23
harvest, 30–31
symmetrical rim strips, 24–25
tip
analysis, 24–25
surgery, 36–41
Osseocartilaginous rib
grafts, 86–87, 252–253
harvest, 243
Osteotomies
Asian rhinoplasty, 330
principles, 32
radix modification
low-to-high and low-to low, 80–81
specialized method, 82–83
types and techniques, 32–33
Over projecting nose
analysis, 284–285
levels, 282–283
operative techniques, 284
Over-resected nose
analysis, 416–417
operative technique, 416
Over-sutured nose modification,
152–153
P
Perfection attributes, 2
Photographic analysis, 355, 356
Plunging tip modification, 56–57
Postinjection management, 343
Postoperative management
breathing and initial appearance, 63
ecchymosis and edema, 62–63
smiling and numbness, 63
Posttraumatic nose
analysis, 314–315
classification, 312–313
operative techniques, 314
Primary rhinoplasty. See Decision
making
Profile correction, 90–91
R
Radix and radix/dorsal graft, 239
Radix modification
aesthetics, 72–73
anatomy, 70–71
augmentation
fascia graft (F) and diced cartilage (DC),
74–75
principles, 74
decision making
level 2, asymmetric bony vault, 92–95
level 1, profile correction, 88–91
level 3, radix reduction, 96–99
levels of difficulty, 68
osteotomies
low-to-high and low-to low, 80–81
specialized method, 82–83
reduction
principles, 76
soft tissue and bony reduction, 76–77
spreader grafts, 82–83
Resection/repositioning, 362
Reserve composite graft, 236–237
Restalyne
final thoughts, 347
indications, 344
injection technique, 344–345
patient satisfaction, 346
personal preference, 342–343
postinjection management, 343
posttreatment care and adverse effects,
346
specific areas, 345
Retracted nostril and nose, 376–377
Revision rhinoplasty
analysis and commentary
major, 341
minor, 339–340
classification, 338
Rib harvest
chondrosynschium, 240–241
inframmary approach, 240–242
osseocartilaginous, 242–243
problems, 242
subcostal approach, 240
Rim shape modification
principles, 132
procedure, 134–137
technique, 132–133
S
Scar tissue release, tip surgery, 370, 371
Seagull-in-flight concept, 160
Secondary osseocartilaginous vault surgery,
364, 365
Secondary rhinoplasty. See Decision
making; Surgical techniques

448
Subject Index
Septal and valvular obstructions, 184–185
Septal disjunction, technical misadventures,
222–223
Septal harvest, 328, 329
Septal perforation, 392
Septal saddle nose
aesthetic tip and dorsum, 418
analysis, 420–421
diagnosis, 418–419
operative technique, 420
problem, 418
septal foundation, stabilizing, 418–419
test, 418–419
Septal support surgery, 218
Septal surgery
analysis, 394, 395
operative techniques, 394
Septocolumellar graft, 328, 330, 331
Septocolumellar strut, 244–245
Septorhinoplasty
level 1, aesthetic purpose, 51–53
septal harvest, 30–31
Sheen’s adage approach, 316
Skin envelope thinning, 316
Soft tissue defatting, 328, 329
Spreader grafts, 269, 368
application and problems, 248
definition and advantages, 34–35
functional and aesthetic necessity,
248–249
radix and dorsum modification, 82–83
technique, 248
Standard operative sequence, 3
Structured tip grafts, 372–374
Subcostal approach, harvesting costal
­cartilage, 240–241
Superficial muscular aponeurotic system
(SMAS), 70–71
Surgical cause and effect, 8–9
Surgical techniques
aesthetic reconstructive rhinoplasty, 350,
351
alar base/nostril sill, 376–377
analysis, 352–353
caudal septum, 366, 367
consultation, 354
dorsal modification, 364–365
dorsal septal deviation, 366, 367
open approach and septal exposure
advantages, 360
septal consideration, 360–361
operative planning, 355, 357
operative techniques, 352
osteotomies, 269, 368
photographic analysis, 355, 356
retracted nostril and nose, 376–377
skin envelope, 358–359
spreader grafts, 269, 368
tip analysis, 362–363
tip surgery
alar cartilages preparation, 370
bossas and bumps, 374
columellar strut, 370, 371
incisions, divisions, and bossa, 372
isolated tip graft, 374, 375
lateral crural deformities, 372
scar tissue release, 370, 371
structured tip grafts, 372–374
tip sutures plus add-on TRG grafts, 372,
373
total alar replacement, 374
total tip, 374, 375
vestibular valve, 366, 367
Symmetry improvement, tip
principles, 124
technique, 124–125
T
Tip definition
analysis, 272–273
levels, 270–271
operative techniques, 272
Tip grafts, 330, 331. See also
Tip refinement grafts (TRG)
Tip modification method
aesthetics
extrinsic factors, 110–111
intrinsic factors, 108–109
analysis, 24–25
anatomy, 106–107
decision making
level 2, intrinsic tip deficiency,
142–145
level 3, open structure tip graft,
146–149
level 1, unattractive tip, 138–141
open tip suture technique
add-on grafts, 130–131
alar rim grafts, 132–137
columellar strut and suture, 118–119
domal creation suture, 120–121
domal equalization suture, 124–125
exposure, 112–113
factors and sutures, 115
incisions, 112–113
interdomal suture, 122–123
lateral crural mattress suture (LCMS),
126–127
position suture, 128–129
symmetrical rim strips, 116–117
tip analysis, 112–113
surgery
add-on tip refinement grafts, 40–41
columellar strut and suture, 36–38
domal creation suture, 38–39
interdomal suture, 38–39
principles, 36
tip position suture, 38–41
suture technique, 104–105
technically demanding sutures and ­
over-sutured nose, 150–153
Tip refinement grafts (TRG)

Subject Index
449
overview 40–41
case study 144–145
surgical techniques 130–131
types 246–247
structured tip graft, 246–247
types, 246–247
Tip surgery
alar cartilages preparation, 370
bossas and bumps, 374
columellar strut, 370, 371
incisions, divisions, and bossa, 372
isolated tip graft, 374, 375
lateral crural deformities, 372
scar tissue release, 370, 371
structured tip grafts, 372–374
tip sutures plus add-on TRG grafts, 372,
373
total alar replacement, 374
total tip, 374, 375
Tip sutures plus add-on TRG grafts, 372,
373
Tip width, 274–275
Total septoplasty, 184–185
analysis, 216
exposure and excision, 198
operative technique, 198–199, 216–217
reinsertion and shaping graft, 198
Total tip replacement, 362, 363
Turbinates
anatomy, 208–209
indications, 208
problems, 208–209
technique, 208
U
Unattractive tip, 140–141
Underprojecting nose
analysis, 288–289
levels, 286–287
operative techniques, 288
Unilateral cleft lip nose
anatomical limitations, 430–431
nostril symmetry lack, 430
surgical technique, 430–431
Unilateral cleft nasal deformity
analysis, 432–433
operative technique, 432
Upper lateral cartilage (ULC), 264
Upward rotating short nose
analysis and commentary, 296–297
levels, 294–295
operative techniques, 296
V
Valvular surgery, 392
Vestibular valve, 202–203, 366, 367
W
Wide nose/wide tip
analysis, 276–277, 280–281
levels, 278–279
operative techniques, 276, 280