Appendices 169 Appendix J: Photography Setup (1) (Fig. A-4) Camera: 35-mm SLR (single light reflex camera) with 105-mm macro lens Lighting: dual electronic flash units; overhead kicker light adds a backlighting effect that improves picture quality and softens or eliminates background shadows Background: Nassau blue no. 25 Film: Kodak Ektachrome ASA 100 STANDARD RHINOPLASTY VIEWS 1:7, frontal, base, lateral, oblique 1:5 and 1:3, close-up, base view Background ~ Overhead Kicker Light / I \ \ 8 Light Source Light Source Camera Figure 4. Schematic photography setup. REFERENCE I. Tardy ME. Brown R. Principles of photography infacial plastic surgery. New York: Thieme Publishers. 1992. ~ =~ ij: 1 . ~ ift: j~ 170 RHINOPLASTY DISSECTION MANUAL Appendix K: Indications For External Rhinoplasty Approach (1,2) Asy mmetric nasal tip Crooked-nose deformity (lower two thirds of nose) Sadd le-nose deformity Cleft- lip nasal deformity Secondary rhinoplasty requiring complex structural grafting Septal -perforation repair REF ERE NCES I. l ohnson CM 1r, Toriumi DM. Open structure rhinoplasty. Philadelphia: WB Saunders. 1990. 2. Toriumi DM, lohnson CM. Open structure rhinoplasty: featured technical points and long-term follow -up. Fa- cial Plast Surg Clin North Am 1993; I:1 -22 . Appendices 171 Appendix L: Suggested Surgical Instruments for Rhinoplasty 1. Needle holder 2. Bayonet forceps 3. Mallet 4. Takaha shi forceps 5. Siegel retractor 6. Converse retractor 7. Hemostat (curved) 8. Hemostat (straight) 9. Small nasal speculum 10. Large nasal speculum II. Small single skin hook 12. Small double skin hook 13. Small double skin hook 14. Medium double skin hook 15. Wide double skin hook 16. Freer/Cottle elevator 17. Joseph elevator 18. Converse scissors 19. Fomon scissors 20. Straight Stevens scissors 21. Curved Stevens scissors 22. Curved Iris scissors 23. Scalpel handle 24. Scalpel handle 25. Brown -Ad son forceps 26. Brown-Adson forceps 27. Bisho p- Harmon forceps 28. Bishop-Harmon forceps 29. 2.0-mm unguarded osteotome 30. 3.0-mrn straight unguarded osteotome 31. 3.0-mm straight guarded osteotome 32. 2.5-mm straight guarded osteotome 33. Medical grade sharpening stone 34. Dorsal (Rubin) osteotomes: small, medium, large 35. Rasps with tungsten-carbide inserts: 1/2, 3/4, 5/6 36. Aiache cartilage crusher 37. No. 10 Frazier tip suction . -II. -=?i: =- -4- U1 I • -" 172 RHINOPLASTY DISSECTION MANUAL Appendix M: List of Selected Companies with Address/Phone Numbers RHINOPLASTY INSTRUMENT SETS Anthony Products, Inc., Indianapolis, IN 800 428-1610 Ellis Instruments, Inc., Madison, NJ 800 218-9082 Instruments Unlimited, Quakertown, PA 800 818-0094 Invotec, Jacksonville, FL 800 998-8580 Lorenz Surgical, Jacksonville, FL 800 874-7711 MicroFrance, St. Aubin, France 800-874-5797 Smith-Nephew-Richards, Madison, WI 888 395-8060 Snowden Pencer, Tucker, GA 800 843-8600 Storz Instruments, St. Louis, MO 800 325-9500 Xomed Surgical Products, Jacksonville, FL 800 874-5797 ALLOPLASTIC CHIN IMPLANTS Allied Biomedical, Paso Robles, CA 800 276-1322 Hanson Medical, Inc., Kingston, WA 800771- 2215 Invotec, Jacksonville, FL 800 998-8580 Porex Surgical, Inc., College Park, GA 8 00521- 8145 W. L. Gore & Associates, Inc., Flagstaff, AZ 800 528-8763 Xomed Surgical Products, Jacksonville, FL 800 874-5797 ALLODERM LifeCell Corporation, The Woodlands, TX 800367-5737 DERMABOND (OCTYL-2-CYANOACRYLATE) Ethicon, Somerville, NJ 800 888-9234 RHINOPLASTY POWER INSTRUMENTATION LinvatecIHall Surgical Products Group, Largo, FL 800 925-4255 United American Medical, McMinnville, TN 800 521-5002 Xomed Surgical Products, Jacksonville, FL 800 874-5797 NASAL SPLINTS Invotec, Jacksonville, FL 800 998-85 80 Shippert Medical Technologies (Denver Splints), Englewood, CO 800 888-8663 Appendices 173 Vision Medical (Thermoplast), Peoria, AZ 800 874-5797 Xomed Surgical Products, Jacksonville, FL 800 874-5797 INTRANASAL PACKS Invotec, Jacksonville, FL 800 998-8580 Xomed Surgical Products, Jacksonville, FL 800 874-5797 - - - _J~ . :. ~ -t-: . '. ~, 174 RHINOPLASTY DISSECTION MANUAL Appendix N: Selected Recommended Literature Adamson PA. Open rhinoplasty. In: Papel lD, Nachlas NE, eds. Facial plastic & reconstructive surgery. St. Louis: Mosby Year Book , 1992:29 5- 304. Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol Head Neck Surg 1984;110:349- 358. Becker DG,Toriumi DM, Gross CW, Tardy ME. Powered instrumentatio n for dorsal nasal reduction. Facial Plast Surg 1997;13:291 -2 97. Becker DG, Weinberger MS, Greene BA, Tardy ME. Clinical study of alar anatomy and surgery of the alar base. Arch Otolaryngol Head Neck Surg 1997;123:7 89-7 95. ' Beeson WHoThe nasal septum. Otolaryngol Clin North Am 1987;20:74 3- 767. Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg J998;I00:999-1 0IO. Byrd HS, Hobar Pc. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;9 I:6 42-6 54, discussion 655 -6 56. Cheney ML, Glicklich RE. The use of calvarial bone in nasal reconstruction. Ar ch Otola ryngol Head Neck Surg 1995; 121: 643- 648. Constantian ME. The incompetent external nasal valve: patbophysiology and treatment in primary and secondary rhinoplasty. Plast Rec onstr Surg 1994;9 3:91 9-93 3. Constantian MB, Clardy RB. The relative importance of septal and nasaJ valvular surgery in correcting airway ob- struction in primary and secondary rhinoplasty. Plast Reconstr Surg 1996;98: 38- 54. Crumley RL, Lanser M. Quantitative analysis of nasal tip projection. Laryngoscope 1998;98:202 -20 8. • Daniel RK. Rhinoplasty and rib grafts: evolving a flexible operative technique. Plast Reconstr Surg 1992;94: 597- 61 I. Farrior RT. The osteotomy in rhinoplasty. Laryngoscope 1978;88: 1449. Goode RL. Surgery of the incompetent nasal valve. Laryngoscope 1985;95:546-555 . Gunter JP. The merits of the open approach in rhinoplasty . Plast Reconstr Surg 1997 ;99: 8 63 ~ 867 . Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a bar- rier to cartilage warping. Plast Recons tr Surg 1998;I00:161-1 69. Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a bar- ri ert o cartilage warping. Plast Reconstr Surg 1997; J00: J6 1-169. Gunter JP, Friedman RM. Lateral crural strut graft: techniqu e and clinical applications in rhinoplasty. Plast Re- constr Surg 1997;99:94 3-9 55. Gunter JP, Rohrich RJ. Management of the deviated nose: the importance of septal reconstruct ion. Clin Plast Surg 1988;15: 43-5 5. Gunter JP, Rohrich RJ. Augmentation rhinoplasty:dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg 1990;86:39 45. Gunter JP, Rohrich RJ, Friedman RM. Classification and correc tion of alar-columellar discrepancies in rhino- plasty. Plast Reconstr Surg 1996;97:64 3-64 8. Johnson CM Jr, Godin MS. The tension nose: open structure rhinoplasty approach. Plast Reconstr Surg 1995;95: 43- 51. Johnson CM Jr, Godin MS. The tension nose [Letter, comment] . Plast Recons tr Surg 1996;97:246. Johnson CM Jr, Toriumi DM. Open structure rhinoplasty. Philadelphia: WB Saunders, 1990. Kamer FM, Pieper PG. Revision rhinoplasty. In: Bailey B, ed. Head and neck surgery otolaryngo logy . Philadel- phia: Lippin cott, 1998:266 3- 2676. Kasperbauer JL, Facer GW, Kern EB. Reconstructive surgery of the nasal septum In: Papal ID, Nachlas NE, eds. Facial plastic and reconst ructive surg ery. Philadelphia: Mosby Year Book, 1992:337 -34 3. Konior RJ, Kridel RWH. Controlled nasal tip positioning via the open rhinoplasty approach. Facial Plast CUn Nort h Am 1993;1:53 -6 2. Kridel RWH, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otol Head Neck Surg /991;117:411 41 5. Larrabee WF Jr, Open rhinoplasty and the upper third of the nose. Facial Plast Surg Clin Nonti Am 1993;1:23 -38 . Metzinger SE, Boyce RG, Rigby PL, Joseph Jl , Anderson JR. Ethmoid bone sandwich grafting for caudal septal defects. Ar ch Otol Head Neck Surg 1994;120:1/21- 1125. McCollough EG. Surgery of the nasal tip. Otolaryngol Clin Nor th Am 1987;20 :769 -784 . McCollough EG, Mangat D. Systematic approach to correction of the nasal tip in rhinoplasty. Arch Otolaryngol 1981;J07:12- 16. Murakami CS, Cook TA, Guida RA. Nasal reconstruction with articulated irradiated rib cartilage. Arch Oto- laryngol Head Neck 5 11 rg 1991;117:3 27- 330. Murakami CS, Larrabee WF. Comparison of osteotomy techniqu es in the treatment of nasal fractures. Facial Plast Surg 1992;8:209-21 9. Rohrich RJ, Hollier LH. Rhinoplasty with advancing age: characteristics and management. Clin Plast Surg 1996; 23: 281- 296. Appendices 175 Schwartz MS, Tardy ME. Standardized photodocumentation in facial plastic surgery. Facial Plast Sur g 1990;7: 1-1 2. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Rec onstr Surg 1984;73:230 237 . Sheen JH. Tip graft: a 20 year retrosp ective. Plast Recon str Surg 1993;91:48- 63. Simons RL. Vertical dome division in rhinoplasty. Ot olaryngol Clin N orth Am 1987 ;20: 785-796. Simons RL, Gallo JF. Rhinoplasty complications. F aci al Plast Sur g Clin N orth Am 1994; 2:521-52 9. Sykes JM, Senders CW, Wang TD, Cook TA. Use of the open approach for repair of secondary cleft lip nasal de- formity F aci al Plast Surg Clin Nor th Am 1993;1:111-126. Tardy ME. Rhinopla sty in midlife. Otol aryngol Clin North Am 1980;13: 289-30 3. Tardy ME. Ethics and integrity in facial plastic surgery : imperatives for the 21st century, Facial Pla st Surg 1995; 11:111-1 15. Tardy ME. Rhinopla sty: the art and the science. Philadelphia: WB Saunders, 1997. Tardy ME, Becker DG, Weinberger MS. Illusions in rhinoplasty. Fa cial Plast Sur g 1995;11:117 -13 8. Tardy ME, Broadway D. Graphic record-keeping in rhinoplasty: a valuable self-learning device. Facial Plast Su rg 1989;6:108-112. Tardy ME, Brown R. Surgical anatom y of the nose. New York: Raven Press, 1990. Tardy ME, Brown R,. Prin ciples of ph oto graphy in fa cial plastic sur ge/ Yo New York: Thieme Publishers, 1992. Tardy ME, Cheng E. Transdomal suture refinement of the nasal tip. Fa cial Plast Sur g 1987 ;4:317- 326. Tardy ME, Cheng EY, Jernstrom V. Misadventures in nasal tip surgery. Otolaryngol Clin No rth Am 1987 ;20 : 797 -8 23. Tardy ME, Denneny J, Fritsch MH. The versatile cartilage autograft in reconstruction of the nose and face. Laryn- goscope 1985;95:523- 532. Tardy ME, Genack SH, Murrell GL. Aesthetic correcti on of alar-columellar disprop ortion. Facial Plast Surg Clin Nor th Am 1995;3:3 95-406. Tardy ME, Heinrich JA, Linbeck EO. Refinement of the nasal tip. Facial Plast Surg Clin North Am 1994 ;2: 45 9-476 . Tardy ME, Kron TK, Younger RY, Key M. The cartilaginous pollybeak: etiology , prevention, and treatment. Fa - cial Plast Surg 1989;6:113-120. Tardy ME, Patt BS, Waller MA. Transdomal suture refinement of the nasal tip: long-term outcomes. Facial Pla st Surg 1989 ;9:275 -2 84. Tardy ME, Patt BS, Walter MA. Alar reduct ion and sculpture: anatomic concepts. Fa cial Pla st Surg 1993;9: 295- 305. Tardy ME, Schwartz M, Parras G. Saddle nose deformity: autogenous graft repair. F acial Plast Surg 1989;6: 121- 134. Tardy ME, Thomas JR. Fa cial aesthetic surge ry. Philadelphi a: Mosby, 1995. Tardy ME, Toriumi DM. Alar retraction: composite graft correction. Facial Plast Surg 1 989 ;6 :101-107 . Tardy ME, Toriumi DM. Philosoph y and princip les of rhinoplas ty. In: Cummings CW, Fredrickson JM, Harker LA, et al., eds. Otol aryngology-he ad & neck surg ery. 2nd ed. St Louis: Mosby Year Book, 1993:278 -294. Tardy ME, Toriumi DM, Walter MA, Patt BS. The difficult nasal tip. In: Gates G., cd. Current therapy in oto - laryngology-h ead & neck surgery. 1993:1 70- 182. Tardy ME, Walter MA, Patt BS. The overprojecting nose: anatomic component analysis and repair. Fac ial Pla st Sur g 1993;9:30 6- 316 . Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new systematic approach. Pla st Rec onstrSurg 1994 ;94 :61-77. Thomas JR. Steps for a safer method of osteotomies in rhinoplasty. Lary ngoscope 1987; 97:746-747 . Thomas JR. External rhinoplasty: intact columellar approac h. Lar yngoscope 1990;I00(2 Pt 1 ):206- 208. Thomas JR, Griner NR, Remmler DJ. Steps for a safer method of osteotomies in rhinoplasty. Lar yngoscop e 1987 ; 97:74 6-747 . Thom as JR, Tardy ME. Uniform photographic documentation in facia l plastic surgery. Otolaryn gol Clin North Am 1980;13:367 -3 81. Toriumi DM. Subtotal reconstruct ion of the nasal septum: a prelimin ary report. Lary ngoscope 1994; I04:906-13. Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Oper Tech Otolaryngol H ead Neck Surg 1995;6:3 11- 3 18. Toriumi DM. Management of the middle nasal vault: operative techniques in plastic & reconstructive surgery 1995;2:16-30. Torium i DM. Surgical correction of the aging nose. Facial Plast Surg 1996; 12:205-214. Toriumi DM, Johnson CM. Open structure rhinoplasty featured technical points and long-term follow-up. Faci al Plast Surg Clin North Am 1993;1:1-2 2. Toriumi DM, Johnson CM. Mana gement of the lower third of the nose open structure rhinoplasty technique. In: Papel 10, Nachlas NE, eds. Facial plast ic & reconstructive sur gery. 1992:305- 313. Toriumi DM, Josen J, Weinberger MS, Tardy ME. Use of alar batten grafts for correction of nasal valve collapse. Ar ch Otol Head Neck Surg J997;123:802 -80 8. Toriumi DM. Mueller RA, Grosch T, Bhauacharyya TK, Larrabee WF. Vascular anatomy of the nose and the ex- ternal rhinoplasty approach. Ar ch Otol H ead Neck Sur g 1996;122:2 4- 34. Toriu mi DM, Ries WR. Innovative surgical management of the crooked nose. Facial Plast Sur g CUn N orth Am 1993; I:63- 78. Torium i DM, Sykes JM, Johnson CM. Open structure rhinoplas ty for management of the non-caucasian nose. Oper Tech Otola ryngol H ead Neck Surg 1990;1:225- 233. Toriumi DM, Tardy ME. Cartilage suturing techniques for correction of nasal tip deformities. Oper Tech Oto- lar yn gol H ead Ne ck Surg 1995;6:26 5-2 73. Toriumi DM, Josen J, Weinberger M, Tardy ME. Use of alar batten grafts for correction of nasal valve collapse. Ar ch Otol Head Neck Surg 1997;123: 802-808. Wang TD. Aesthetic structural nasal augmentation. Op er Tech Otolar yn gol Head Neck Surg 1990 . . - r. ~-~ III ' :- ~lIjl ~ ~ _ ' I , .' __ - - - - Subject Index 1'" ,11,,1 _U-' { , ~ .' '" Subject Index A page number followed by f indicates a figure. A Aesthetic analysis, I I, 157 Aesthetic/cosmetic issues alar base reduction, 113 closure of midco lumellar incision, 149, 150 f- 15 1f Aesthetic triangle, 16, 20 Airway obstruction. See Nasal obstruction Ala, rhinoplasty analysis, 20 Alar base cleft lip-nasal deformity bilateral, 168 unilateral, 167 resection, 113 -11 5 alar wedge excision, 114, I ISf internal excisions, 115 internal nostril floor reduction, 113, 114f pearls, l iS sliding alar flap, 114, 115f wedge excision of nostri l floor and sill, 114, 114f rhinoplasty analysis, 18 Alar batten graft, 105, 106 f-I09f Alar-columella relationship, 20, 21f Alar-facial groove (junction), 2f, 3f Alar flare internal nostril floor reduction, 113, 114f wedge excision of nostril floor and sill, 114, 114f Alar lobule, 3f, 5, 20 Alar nasalis muscle, 4f Alar sidewall, 2f Anatomy of nose, 1- 7 musculature, 4f nasal relationships, S, 7f nasal valve area, 6 pearls, 5-6 scroll region, 6 septum, 4f soft tissue layer, 6 surface anatomy, 2 f- 3f basal view, 2f frontal view, 2f lateral view, 2f oblique view, 3f surgical anatomy, 3f-5 f basal view, 3f lateral view, 3f oblique view, 3f vasculature, 4f- 5f Anesthesia, infiltrative injecti on technique, 2 5-29 columella injection, 25, 26f , 28 intercartilaginous, transcartilaginous, or delivery approach, 27, 28f lateral wall of nose, 27, 29f multiple injections along marginal incision area, 25, 26f for osteotomy, 27, 28 pearls, 27 -28 soft-tissue, domal region, 25, 26f Anomalous nasi, 4f Anterior septal angle, 3f Aquaplast cast, application and removal, 153 Artery(ies), nasal, 4f -5f Auricular cartilage alar batten graft, 105 harvesting, 139, 140f-1 42f, 14 6-14 7 B Beveling of skin edges, 45 Bifidity, nasal tip, 17 Bleeding, septoplasty, 33 Blood vessels, 4f -5 f Bone infarction, 6 Bones, nasal, 3f, 5 infracture during osteotomy, 67 -6 8 medialization, 68 postoperati ve margins, smoothing with rasps, 62, 63f postoperati ve shifting, digital exercises for, 153 Bossa formation, 22, 110, 163 Bro w- tip aesthetic lines, 17 Bulbosity, 17 Buttress graft, 102, 102f -10 5f Byrd's method, nasal projection, 16, 19, 159 C Calvarial bone, harvesting, 144, 144f-1 46f, 147 Cap graft, 102, 102f- I05f Cartilage harvesting. See Tissue harvesting lower lateral (LLC). See Lower lateral cartilage quadrangular, 4f - . ,:,_. ~-i 179 180 SUBJECT INDEX Cartilage tcontd.i sesa moid ,3 f upper lateral (ULC ). See Upper lateral cartilage Cartilage-splitting approac h, 37, 38f -3 9f Cephalic trim, 77,11 0 Cervi cal point, IOf, I I, 157 Chin alterations augmentation, 165f alloplastic imp lant manufacturers, 172 Legan facial-co nvexity angle, 15 Cleft lip-nasal def ormity, I 67f , 167- 168 bilateral, 167f, 168 unilateral, 167, 167f Columella, 2f cleft lip-nasal deform ity bilateral, 168 unilatera l, 167 hanging columella deformity, septoplasty, 31 infilt rative ane sthe tic injection technique, 25, 26f, 28 retracted, 17 caudal extension grafts, 118, 118 f-12lf plumpi ng graft, 1l7 , 117f rhino plasty analysis, fron tal view, l7 Columella-labial angle (junc tion), 2f Columellar artery, 4f Columellar flap, 47, 47f-4 9f elevation of, 47, 49f infiltrative anesthetic inject ion technique, 27f Columellar-labial confluence, 18 Co lume llar-lobular angle, 18 Columellar show normal value, 15, 20 rhinoplasty analysis, 15, 158 Columell ar strut cartilage graft, 56, 81 -8 4 dorsal onlay graft interdigitating with. See Saddle nose deformity placement, 81- 84 endonasal approach, 81, 83f -84f external rhinoplas ty approach, 81, 82f tripod con cept , 155 Complic ations, 163 Compressor muscles, 4f Com pressor narium minor, 4f Computed tomography (CT scan), concha bullosa, 78, 78f Concha bullosa, 78, 78f Conchal cartilage. See Auricu lar cartilage Converse scissors, nasal dissection, 5 Jf Corrugator muscle, 4f Crumley's method, nasal projection, 16, 159 Crus/crura, 3f. See also specific area Cyanoacrylate adhesive manufacturer, 172 skin closure, 113 D Delivery approach, 40-4 3 delivery of LLC, 41 -4 2, 42 f-43f intercarti laginous incision, 40, 40f marginal incision, 41, 4 lf Depressor muscles, 4f Depressor septi nasi, 4f Derma bond. See Octyl-2-cya noa cry late Digital exercises, postoperative, 153 Dilator muscles, 4f Dilator naris anterio r, 4f Dissection auricular cartilage harvesting, 139, 140 f-1 41f delivery of LLC, 41 -4 2, 42f -43f external rhinoplasty approach. See External rhinoplasty approac h, nasal dissecti on retrograde, 50 rib cartilage harvesting, 144 septoplasty, 31 , 32f, 33 Dome divided, tip graft in, 101, 10If divis ion. See Nasal tip, surgery identification , 84 Dorsal nasal artery, 4f Dorsu m of nose cartilagi nous, exposure and incision for hump removal, 59, 60f contour assessment, anes thetic injection and, 27 irregularities, pos toperative, 163 rhinoplasty analysis, 11 ,20 Double break , 18 -1 9 Dural tear, parietal bone harvesting, 144 E Edema, persistent postoperative supratip edema, 152-1 53 Elevator muscles, 4f Endonasal approach alar batten graft placement, 106f columellar strut cartilage graft placement, 8 1, 83f- 84f incision closure, 152, 152f nasal dissection, 56 spreader grafts, 71, 72f Ethmoid bone harvesting . 143, 147 perpendicular plate, 4f splinting (sand wich) grafts, 122, 123f External rhinoplasty approach, 43 -56 anesthesia injection techn ique, 25- 29, 26f- 29f background, 43 columellar strut cartilage graft placement, 8 1, 82f dissecti on, 43 incisions for, 43 indications for, 170 integrated dorsal graft-co lumellar strut for saddle nose deformity, 133f marg inal incision, 43, 44f columellar extension, 45, 46f, 56 nasal dissection, 4 3-4 7 defining columell ar flap, 47, 47 f-49f elev atio n of periosteum and exposure of bony vault, 54-56 , 55f exci sion of cephalic cartilage, 50 exposure of cartilag inous middle nasal vault, 54, 54f flap elevation, 47, 49f incision marking, 43, 44f lateral crus, 50, 51f marginal incision, 43, 44f, 47 midcolumellar incision, 43, 44f, 45, 45f midline dorsal dissection, 52, 52f- 53f retrograde dissection , 50 three-poi nt countertraction, 50, 50f pearls, 56 septoplasty, 33, 34f spreader graft placeme nt, 7 1, 72f -7 5f transc olum ellar (midcolu mellar) incision, 43 closure , 56 marking for, 43, 4 4f F Face F rankf ort plane, 12, 13f, 158 horizontal facial thirds, 12, 12f, 158 surface measurement s, 22, 23f Legan facial-conv exity angle, 14f, 15 [...]... grafts alar batten graft, 105 , 106 f- 109 f, J II cap or buttress graft, 102 , I02f-1 05f caudal extension grafts, 118, 118f-1 21f in divided domes, 101 , IOIf lateral crural grafts, 110, I I Of pearls, II I shield-shaped tip graft, 9 8- 101 narrowing, transdomal surgical techniques for, 86 projection, surgical goals and options for achieving, 16 1 See also specific procedures rhinoplasty analysis, I I... autogenous tissue, 13 9-1 47 calvarial bone, 14 4- 146 conchal (auric ular) car tilage, 13 9-1 42 ethm oid bone, 143 rib graft , 14 3-1 44 integrated dorsal graft -columellar strut for saddle nose defo rmity, 13 0- 137 lateral crural grafts, I 10, II Of nasal tip, 9 8- 10 1 onlay cartil age wafer grafts, 77 plumping grafts, 117, 1 l7f, 138 shield-shaped tip graft, 98 ··10I spreader grafts, 7 1-7 9 Greenstick frac... gra ft 56, 8 1- 84 majo r support mechanisms, 160 minor sup port mechanisms, 160 surgery, 8 1-1 11 See also specific procedu re accentuate tip, 8 6-9 5 alar batten graf t, 105 , 106 f-I 09f, II I cap or buttress graft, 102 , 102 f-J 05f caudal extension grafts, 118, 118f-1 21f columellar strut cartilage graft placement, 8 1-8 4 dome division with intact vestibular skin and suture reco nsti 95f, 9 5-9 6, 96f dome... fication, 84 lateral crura l gra fts, 110, 1JOf lateral crural overlay, 96, 96f-97f lateral crural steal, 94 f, 95 pearls, 11 0-1 11 reduction of crural volume and rigidity , 85, 85f refinement, 162 sculpting techniques , 160 shield-shaped tip graft, 9 8-1 0 I placeme nt, 98 , 99f preoperative and postoperative views, 100 f-IOlf size of, 98, 98f, I II tip gra fts, 9 8- lOI tip-defining points, zr, 3f tripod conce... and meas uremen ts, 12· ·16, 15 8-1 59 vertical facial fifths, 12, 12f, 158 Facet ,2f Flap, co lumellar, 47, 47f-49f Frankfort plane, 12, 13f, 158 G Gla bella, 9, 10f, 157 Gnathion, 10f, 11, 157 Goo de 's method, nasal projec tion, 15f, 16, 18,159 Grafts/grafting alar batten graft, 105 , 106 f-l09f cap or buttress graft, 102 , I02f-1 05f caudal extension grafts, 118, 118f-1 21f, 138 colume llar strut cartilage... nose deformi ty, 132f sec on dary rhinoplasty pa tien t requiri ng alar batten graf ts, I08f trapezo ida l asym metric nasal tip, 90f Orbicularis or is muscle, 4f Osseo cart ilagino us j unction , 2f, 3f , 6 Osteotomy, 6 7-6 9 anestheti c injection , 27, 28 inter mediate, 68 lateral, 6 7-6 8, 68f high-to-lo w, 67, 68f high-to-low-to-h igh, 67 inf racture of nasal bone, 6 7-6 8 med ial, 67, 68f nasofron tal... 86f lateral crural overlay, 96, 96f-97f lateral crural steal, 94f, 95 single transdo mal suture technique, 86, 89f-93f tip grafts, 9 8-1 0 1 transdomal surgical techniques for, 8 6-9 5 trapezoidal asymmetric tip, 89f-93f trapezoida l tip and broad doma l angles, 87f-89f anterior protrusion See Rhinoplasty analysis, nasal projection asymm etry, 81, 83f bifidity, 17 cleft lip-nasal deform ity bilateral, 168... cephalic resection of lateral crura, 85, 85f L-strut integr ated dorsal graft-c olumellar strut , 13 0-1 37 in septoplasty , 33, 33f M Mattress sutur es closure of auricular cartil age harvest site, 139, 142f closure of midcolumell a incision , 149, 150f-15If spreader graft stabilization, 75, 75f Maxilla, ascendng process, 3f : :-. ::::c::"" -' r,-I r ; ' ~-~ ~ Maxillary crest, 4f Medial crura l footplate,... 15 2-1 53 d igital exercises, 153 per sisten t supratip edema, 15 2-1 53 suture rem ova l, 152 Po well-Humphries " aesthetic triangle," 16,20 Procerus mus cle , 4f Pseudohyperteloris m, 17, 22 Pyriform aperture , 3f in osteotomy, 67 Q Quadran gular cartilage, 4f R Radi x projection, 1 9- 20 Rasps, 62, 63 f Rhin ion , 2f, 3f, 9, 10f, 157 sellion vs., 6 Rhi noplasty analysis, 9-2 3 base view , 17f, 1 7-1 8... physica l examination and anatomic analysis, 1 6-2 1 Powell- Hum phries "aes the tic trian gle," 16 ski n qu alit y, 11, 15 6 surface angles , planes, and measurement s, defini tions, 1 2- 16, 15 8- 159 Rib carti lage (gra ft) harvesti ng, 143f, 14 3-1 44 , 147 pos tope rat ive pai n, 147 integrated dorsal graft-colume llar strut for sadd le nose deform ity, 13 0-1 37 Rocker deform ity, 6, 163 Rotation See . 37. No. 10 Frazier tip suction . -II. -= ?i: =- - 4- U1 I • -& quot; 172 RHINOPLASTY DISSECTION MANUAL Appendix M: List of Selected Companies with Address/Phone Numbers RHINOPLASTY. 800 87 4-7 711 MicroFrance, St. Aubin, France 80 0-8 7 4-5 797 Smith-Nephew-Richards, Madison, WI 888 39 5-8 060 Snowden Pencer, Tucker, GA 800 84 3-8 600 Storz Instruments, St. Louis, MO 800 32 5-9 500. 1997;123: 80 2-8 08. Wang TD. Aesthetic structural nasal augmentation. Op er Tech Otolar yn gol Head Neck Surg 1990 . . - r. ~-~ III ' :- ~lIjl ~ ~ _ ' I , .' __ - - - - Subject