Pisa Tower Concept: A New Paradigm in Crooked Nose Treatment.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 Jul 2021
01 Jul 2021
Historique:
entrez:
28
6
2021
pubmed:
29
6
2021
medline:
16
9
2021
Statut:
ppublish
Résumé
The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the "Pisa Tower concept." From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up. The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery. The authors' opinion is that the association of "swinging door" septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising. Therapeutic, IV.
Sections du résumé
BACKGROUND
BACKGROUND
The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the "Pisa Tower concept."
METHODS
METHODS
From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up.
RESULTS
RESULTS
The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery.
CONCLUSIONS
CONCLUSIONS
The authors' opinion is that the association of "swinging door" septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising.
CLINICAL QUESTION/LEVEL OF EVIDENCE
METHODS
Therapeutic, IV.
Identifiants
pubmed: 34181604
doi: 10.1097/PRS.0000000000008064
pii: 00006534-202107000-00011
doi:
Types de publication
Journal Article
Observational Study
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
66-70Informations de copyright
Copyright © 2021 by the American Society of Plastic Surgeons.
Références
Özücer B, Çam OH. The effectiveness of asymmetric dorsal preservation for correction of I-shaped crooked nose deformity in comparison to conventional technique. Facial Plast Surg Aesthet Med. 2020;22:286–293.
Koçak I, Gökler O, Şentürk E. Is osteoplasty with unilateral osteotomy effective in the correction of the crooked nose? J Craniofac Surg. 2018;29:491–494.
Stepnick D, Guyuron B. Surgical treatment of the crooked nose. Clin Plast Surg. 2010;37:313–325.
Saban Y, Daniel RK, Polselli R, Trapasso M, Palhazi P. Dorsal preservation: The push down technique reassessed. Aesthet Surg J. 2018;38:117–131.
Manafi A, Rajaee A, Manafi A. Concomitant overlap steal tip-plasty: A versatile technique to simultaneously adjust the rotation, definition, projection, and symmetry of the nasal tip. Aesthet Surg J. 2016;36:147–155.
Wright WK. Principles of nasal septum reconstruction. Trans Am Acad Ophthalmol Otolaryngol. 1969;73:252–255.
Gunter JP, Rohrich RJ. Management of the deviated nose: The importance of septal reconstruction. Clin Plast Surg. 1988;15:43–55.
Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg. 2005;7:218–226.
Gubisch W. The extracorporeal septum plasty: A technique to correct difficult nasal deformities. Plast Reconstr Surg. 1995;95:672–682.
Gilbert SE. Overlay grafting for lateral nasal wall concavities. Otolaryngol Head Neck Surg. 1998;119:385–388.
André RF, Vuyk HD. Reconstruction of dorsal and/or caudal nasal septum deformities with septal battens or by septal replacement: An overview and comparison of techniques. Laryngoscope. 2006;116:1668–1673.
Demir UL. A novel approach to crooked nose in rhinoplasty: Asymmetric level osteotomy combined with unilateral spreader graft. J Craniofac Surg. 2019;30:1512–1515.
Koçak I, Senturk E. Osteoplasty in crooked nose deformity: A novel approach. Aesthetic Plast Surg. 2017;41:628–636.
Bloom JD, Immerman SB, Constantinides M. Osteotomies in the crooked nose. Facial Plast Surg. 2011;27:456–466.
Lothrop O. An operation for correcting the aquiline nasal deformity: The use of new instrument; report of a case. Bost Med Surg J. 1914170835–837.
Cottle MH, Loring RM. Corrective surgery of the external nasal pyramid and the nasal septum for restoration of normal physiology. Ill Med J. 1946;90:119–135.
Cottle MH. Nasal roof repair and hump removal. Arch Otolaryngol Head Neck Surg. 1954;60:408–414.
Gola R, Nerini A, Laurent-Fyon C, Waller PY. [Conservative rhinoplasty of the nasal canopy]. Ann Chir Plast Esthet. 1989;34:465–475.
Huizing EH. Push-down of the external nasal pyramid by resection of wedges. Rhinology. 1975;13:185–190.