Arch Otolaryngol
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Comparative Study Clinical Trial
Vascular anatomy of the nose and the external rhinoplasty approach.
To characterize the venous, lymphatic, and arterial blood supply of the nose and determine the effect of the external rhinoplasty approach on this vasculature. We hypothesized that dissection in the areolar tissue plane below the musculoaponeurotic layer of the nose will preserve the nasal vasculature and minimize postoperative nasal tip edema. ⋯ The major arterial, venous, and lymphatic vasculature courses in or above the musculoaponeurotic layer of the nose. In the external rhinoplasty approach, dissection in the areolar tissue plane below the musculoaponeurotic layer will minimize tip edema and protect against skin necrosis by preserving the major vascular supply to the nasal tip.
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To determine if elective cosmetic septorhinoplasty impacts on nasal air flow resistance over the long-term. ⋯ (1) Patients with normal nasal resistance values may suffer long-term, asymptomatic increase in nasal resistance values after cosmetic open septorhinoplasty, often with no quantifiable change at the nasal valve. (2) Patients with elevated nasal resistance measurements generally improve with open septorhinoplasty. Patients with isolated septal deformities improve with septoplasty. Patients with upper lateral cartilage collapse improve with spreader grafts. The lasting objective improvement on the nasal valve using spreader grafts is reported herein for the first time. (3) Subjective estimations of nasal patency do not correlate well with objective measures of patency, namely nasal resistance measurements. (4) Cosmetic septorhinoplasty can alter nasal patency. Continued care must be exercised when manipulating the nasal framework for cosmetic purposes, as slight changes to the nasal valve may result in significant alterations in nasal air flow resistance.