Mediterranean Rhinoplasty

Description

The book offers a thorough description of rhinoplasty techniques for patients from the Mediterranean area. Noses come in different shapes and colors, depending on the various biotypes of the different geographic regions. This represents a topical issue for rhinoplasty surgeons, since different nasal morphologies imply different anatomic conditions. Moreover, beauty ideal varies from one region to the other, and those differences need to be taken into consideration. Based on these premises, the ethnic rhinoplasty is becoming more and more important among facial plastic surgeons. In order to broaden the understanding of anatomo-functional and cultural or cosmetic aspects specific to the Mediterranean nasal biotype, the book collects and discusses the experiences of surgeons operating on patients from the various regions of the Mediterranean area. Mediterranean Rhinoplasty represents a valuable resource not only for surgeons who are already experts in facial plastic surgery, but also for young otorhinolaryngologists, plastic surgeons and maxillofacial surgeons. Foreword Preface Contents 1: Shape and Function of the Nose 1.1 Anatomy and Function of the Nose 1.1.1 External Nose 1.1.2 Internal Nose 1.1.3 Nasal Valves 1.1.4 Nasal Innervation and Blood Supply 1.2 The Concept of Race and Ethnicity and Its Limits 1.3 If “Beauty Is in the Eye of the Beholder”, Can It also Be Objective? 1.4 Mainstream Beauty and Globalization 1.5 Patient’s Expectations in the Mediterranean Area 1.6 Conclusions References 2: Nasal Biotypes in the Mediterranean Area 2.1 Introduction 2.2 Historical Overview 2.3 The Mediterranean Nose 2.4 Ethnic Remarks in Rhinoplasty 2.5 Mediterranean Rhinoplasty References 3: Mediterranean Noses: The Tension Nose Deformity and Preservation Rhinoplasty 3.1 Introduction 3.2 Anatomical Findings in Tension Nose Deformity and TND Biomechanical Anatomy 3.3 Preoperative Considerations and Patient’s Assessment: The Decision-Making Process in TND 3.3.1 What Are the Critical Questions a Rhinoplasty Surgeon Should Ask to himself While Assessing a Patient Seeking Primary Rhinoplasty? (Table 3.1) 3.3.1.1 Question 1: Can I Preserve the Dorsum Lines? 3.3.1.2 Question 2: Is the Tip Difficult? 3.3.1.3 Question 3: Is the Septum Stable? 3.3.1.4 Question 4: Is the Pyriform Aperture Narrow? 3.3.1.5 Question 5: How Is the Facial Global Harmony? 3.3.2 What Are the most Common Primary Rhinoplasty Procedures Preserving the Natural Dorsum Aesthetic Lines as the First-Choice Procedures According to the Patient’s Anatomy and to the Best Benefit-Risk Ratio, in 2021? [8] 3.4 Surgical Management and Procedures in Tension Nose Deformity 3.4.1 The Dorsum: Type 2 Preservation Rhinoplasty with K-Area Resurfacing [24] 3.4.1.1 Discussion 3.4.2 The Tip and the Concept of “Structure-Preservation Rhinoplasty” 3.4.3 Miscellaneous Maneuvers 3.5 Clinical Case 3.6 Conclusion References 4: Morphological and Diagnostic Tools in Rhinoseptoplasty: Italian Experience 4.1 Introduction 4.2 Preoperative Evaluation: Imaging Techniques 4.3 Clinical Cases 4.4 Conclusions References 5: Functional Diagnostic Tools in Rhinoplasty: Italian Experience 5.1 Introduction 5.2 Assessment of Nasal Airflow 5.2.1 Objective Methods 5.2.2 Subjective Methods 5.3 Our Experience 5.4 Conclusions References 6: Northern Mediterranean Nose Correction: Italian Experience—Closed Approach 6.1 History of the Procedure 6.2 Endonasal Rhinoplasty 6.2.1 Indications 6.2.2 Endonasal Techniques 6.2.3 Saddle Nose and Valve Collapse 6.3 Conclusion References 7: Northern Mediterranean Nose Correction: Italian Experience—Open Approach 7.1 Introduction 7.2 Rhinoplasty: Open Approach 7.3 Clinical Evaluation 7.4 Most Frequent Surgical Techniques 7.5 Discussion 7.6 Conclusions References 8: Northern Mediterranean Nose Correction: Italian Experience: Preservation Approach 8.1 Introduction 8.2 Relevant Surgical Anatomy 8.2.1 The Key Stone Area 8.2.2 The Subdorsal Septum 8.2.3 Lateral Bony Nasal Walls 8.3 Hump Analysis/Classification 8.3.1 Nasal Dorsum Variability and Surgical Approach 8.4 Preoperative Analysis 8.5 Decision-Making Algorithm 8.6 Clinical Cases 8.7 Conclusions References 9: Northern Mediterranean Nose Correction: The Italian Experience: Tip Surgery 9.1 Introduction 9.2 Nasal Tip Assessment and Classification 9.3 Deviation of the Nasal Tip: How to Correct It 9.4 Tip Rotation and Support 9.5 Modification of Nasal Tip Projection 9.6 Modification of Nasal Tip Volume and Its Definition 9.7 Malposition or Malformation of the Lateral Crura 9.8 Skin Thickness and Intra- and Postoperative Skin Management 9.9 Conclusions References 10: Western Mediterranean Rhinoplasty 10.1 Introduction 10.2 Casuistic Analysis 10.3 Tension Nose 10.3.1 Preservation 10.3.1.1 Lateral Wall 10.3.1.2 Middle Wall Surface Technique 10.3.2 Resection 10.4 Nasal Tip Surgery 10.4.1 Tip Dynamics and Support Mechanism 10.4.2 Lateral Crura Control 10.4.2.1 7X Lateral Crura Suture 10.4.3 Midline Structuring 10.4.3.1 ANSA Banner 10.4.3.2 Columellar Strut and Medial Crura Overlap 10.4.3.3 Tip Medial SMAS and Vertical Scroll Ligament Repositioning 10.5 Conclusion 10.6 Clinical Cases References 11: Southern Mediterranean Nose Correction 11.1 Preoperative Work-Up 11.2 Surgical Considerations 11.2.1 Skin Quality 11.2.2 Nasal Tip 11.2.3 Dorsal Humps 11.3 Conclusions References 12: Eastern Mediterranean Nose Correction 12.1 Introduction 12.2 Preoperative Stage 12.3 Surgery 12.3.1 Approach 12.3.2 Bony Skeleton 12.3.3 Middle Vault 12.3.4 Spreader Flaps 12.3.5 Spreader Grafts 12.4 Dorsum Preservation 12.4.1 Tip 12.5 Sutures 12.5.1 Grafts 12.5.2 Nasal Septum 12.6 Segmental Septal Reconstruction 12.6.1 Revision Rhinoplasty References Further Readings