Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Apr 1997
Comparative StudyThe lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach.
A precise and reproducible lateral osteotomy is a requirement for successful rhinoplasty. Two basic techniques have evolved: the external perforated method and the internal continuous method. The literature supporting the external perforated technique maintains that it contributes to a controlled, stable fracture and produces less nasal airway narrowing, hemorrhage, edema, and ecchymosis; however, the continuous internal method is used by many rhinoplasty surgeons. ⋯ In a blinded fashion, four different investigators used nasal endoscopy to detect mucosal perforations and bony irregularities. Eleven percent of the perforated osteotomies resulted in mucosal tearing as opposed to 74 percent of the continuous osteotomies (p < 0.001). This anatomic study confirms our clinical experience that the external perforated osteotomy results in a more controlled fracture with less intranasal trauma and can minimize the associated morbidity (hemorrhage, edema, and ecchymosis) in the rhinoplasty patient.
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Plast. Reconstr. Surg. · Apr 1997
The role of the cranial base in facial growth: experimental craniofacial synostosis in the rabbit.
Craniofacial synostosis designates premature fusion in sutures of the cranial vault (calvarium). When craniofacial synostosis is associated with a syndrome (e.g., Apert, Crouzon), premature fusion of the cranial base has been postulated to occur as well. This study was designed to determine whether the primary growth disturbance in craniofacial synostosis is located at the cranial base (i.e., spheno-occipital synchondrosis) or the calvarial vault (i.e., coronal and sagittal sutures) or both. ⋯ Analysis indicated that (1) craniofacial length was shortened most significantly by cranial base fusion, (2) cranial base fusion and cranial vault fusion had an additive effect on craniofacial length restriction, (3) the anterior cranial base was significantly shortened by cranial base and cranial vault fusion (p < 0.05), (4) the posterior cranial base was shortened by cranial base fusion only (p < 0.05), and (5) cranial base fusion alone significantly flattened the cranial base angle (p < 0.05), whereas cranial vault fusion alone did not. These results suggest that cranial base fusion alone may account for many dysmorphic features seen in craniofacial synostosis. This model is consistent with the findings of other investigators and confirms both a primary directive and translational role of the cranial base in craniofacial growth.