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Functional Rhinoplasty & its Cosmetic implications

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LEFT : Pre-operative Frontal view
Complaints of severe nasal blockage & Snoring
DISTRESS VOR SCORE    2/10 where 10 is perfect breathing.
No help with decongestants
No Cosmetic Concerns
Attractive 35 year old lady with a very thin skin over the nose.

Investigations : Rhinomanometry and Acoustic Rhinometry with Waterford Splint Protocol.
Diagnosis : Left>Right Internal Nasal Valve Compromise. Dorsal Septal Deviation.
Management plan External Approach Septoplasty & Spreader grafts

Digital morphing technology used to explain the possible cosmetic implications of a Functional Rhinoplasty.

RIGHT: Post-operative Frontal view after 3 months
Columellar incision for External approach
Pleasant Tip and Dorsal appearance. No Tip bifidity.
Degree of swelling around the nasal tip expected to go down over 12 months.
DISTRESS VOR SCORE 9.5/10 ! Excellent breathing and reduced snoring. The effect on snoring is at times a short-term benefit.
Not concerned with the cosmesis but still happier with the appearance after surgery.

The appearance at 12 months will be interesting as the slight swelling dissipates.

Functional Rhinoplasty & its Cosmetic implications Functional Rhinoplasty & its Cosmetic implications

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3 Dimensional reconstruction of a person with facial injury showing a depressed left sided fractured nasal bone. The septum has dislocated off the maxillary crest and has blocked the left nasal cavity.
CT scan is not required in most mild nasal injuries but when a scan is available the 3D reconstruction can be a valuable tool.

Nose injury in a child

www.ncbi.nlm.nih.gov/pubmed/21197394
Int J Otolaryngol. 2010;2010:752974. Epub 2010 Dec 19.

Nasal birth trauma: a review of appropriate treatment.

Cashman EC, Farrell T, Shandilya M.
Department of Otolaryngology, Waterford Regional Hospital, Waterford, Ireland.

Abstract

The aetiology of nasal deformity has frequently included birth trauma. There is no consensus in the literature as to whether nasal surgery, in the form of closed reduction, is indicated in neonates. The majority of studies in the literature that advocate intervention have inadequate followup periods and there is a paucity of evidence for the adverse effects of conservative management. This case highlights the therapeutic dilemma posed by such nasal injuries in the neonate and, to the best of the authors’ knowledge, at the time of writing, represents the earliest reported case in the literature of nasal deformity in the neonate. The term nasal deformity is used to denote deformity of the nasal pyramid, soft tissue, and septum. Three main aspects of neonatal nasal deformity are addressed including, firstly, if nasal deformity at birth needs to be addressed, secondly, if left unaltered, what the long-term effects are and, finally, if intervention alters the normal course of midfacial development.
Nose injury in a child Nose injury in a child

Rhinoplasty information from the American Academy of Facial Plastic & Reconstructive Surgery

www.aafprs.org/patient/procedures/rhinoplasty.html

A very well thought out information source. AAFPRS is a body that standardized provision of Facial Plastic Surgery in the USA.

Facial Plastic Surgery is very well organized in the US with strict criteria for certification of surgeons and health providers.dscn8880_3

Munish Shandilya with the President of AAFPRS Robert L. Simons, Toronto 2006,
10 years after attending the Goldman’s tip Seminar at the Mount Sinai Hospital in Manhattan with him and getting hooked to the art of rhinoplasty.

His passion and enthusiasm were infectious …

Rhinoplasty information from the American Academy of Facial Plastic & Reconstructive Surgery Rhinoplasty information from the American Academy of Facial Plastic & Reconstructive Surgery

NOSE FRACTURE IN SPORTS : WHEN CAN I GO BACK TO TRAINING ?

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There are approximately 190 youngsters in my large prospective series of nasal fractures (472 and growing … ) who suffered nose injuries while playing sports.


All invariably ask “how soon can I return to active sports” ?


In my opinion the nose will take nearly 8 weeks to return to its pre-injury strength … maybe even longer …
I have on occasion successfully manipulated nasal fractures as late as 5 weeks after injury. This has led me to recommend a 8-12 week period of protection.


This however is an advice based on observation rather than concrete evidence and the sportsperson is allowed to make their own decision  in my clinics. I believe that ironclad recommendations against training … sometimes dissuade keen sportspersons from seeking timely and appropriate intervention …


Educating and informing patients with clear computer graphics is invaluable.


BTW 6 sportspersons broke their nose despite wearing helmets during a hurling match ! … those sliotars are slippery  customers …


There are several protective face devices that may be used during sports other than hurling …
for 8-12 weeks after nose surgery.
NOSE FRACTURE IN SPORTS : WHEN CAN I GO BACK TO TRAINING ? NOSE FRACTURE IN SPORTS : WHEN CAN I GO BACK TO TRAINING ?