1. Open Rhinoplasty Surgery
Advantages are as follows:
- Binocular visualization
- Evaluation of complete deformity without distortion
- Precise diagnosis and correction of deformities
- Allows use of both hands
- More options with original tissues and cartilage grafts
- Direct control of bleeding with electrocautery
- Suture stabilization of grafts (invisible and visible).
Potential Disadvantages are as follows:
- External nasal incision (transcolumellar scar)
- Prolonged operative time
- Protracted nasal tip edema
- Columellar incision separation
- Delayed wound healing.
2. Closed Rhinoplasty Surgery
The Advantages of Endo nasal Approach Are as Follows:
- no external scar
- Limited dissection process
- Permits the creation of precise pocket so graft material fits exactly without need for fixation
- Allows percutaneous fixation when large pockets are made
- faster healing by maintaining the vascular bridge
- Encourages accurate preoperative diagnosis and planning
- Produces minimal post-surgical swelling
- Reduces operating time
- Results in faster recovery
- Creates intact tip graft pocket.
Disadvantages:
- Requires experience and great reliance on accurate preoperative diagnosis
- Prohibits simultaneous visualization of the surgical field by a teaching surgeon and students
- Does not allow direct visualization of nasal anatomy Makes dissection of Alar
3. Preservation Rhinoplasty Surgery
Preservation rhinoplasty is popularised in recent years. Where nasal support tissue dissection is minimum to give natural looking result and faster recovery
Preservation rhinoplasty is composed of following 3 principles
- Elevation of the skin sleeve in subperochondrial-sub periosteal plane
- Preserving osseocartilagenous dorsum
- Maintaining alar cartilage with minimal excision while achieving desired shape with sutures
4. Structural Rhinoplasty Surgery.
Nasal frame work is created or supported by strong cartilage support to maintain the shape after rhinoplasty
5. Piezo Tome: The Precision Rhinoplasty surgery
Synonymes
ultrasonic rhinoplasty. Ultrasonic Rhino sculpture, Diamond rhinoplasty
How does Piezo rhinoplasty work?
A piezo tome is a specialized instrument which generate ultrasonic energy and apply to the bone without spreading to surrounding soft tissue.
Piezoelectric inserts (PEI) act selectively on bones and/or hard cartilage, without injuring soft tissues: skin, mucosa and flimsy cartilages such as the upper lateral cartilages and lower lateral cartilages. More so, the fracture lines created by PEIs are very accurate and eliminate the risk of radiating fracture lines encountered with traditional rhinoplasty instruments.
The piezo tome device comes with various attachments of sculpting tools which are used to reshape the bone precisely.
As there is no collateral damage to soft tissue. Reduced swelling and bruising and pain. Rresult in speedy recovery, less internal scaring and more precise nasal shape. Which reduces revision rhinoplasty need
There is faster recovery and less scar formation and increase patient satisfaction
Video link: https://www.youtube.com/watch?v=xHBamrlr2x4
What are the Benefit of Piezo Rhinoplasty
- Greater precision for bone shaping
- No splinting or inadvertent fracture of bone.
- Minimal bleeding
- Less swelling and bruising.
- Speedy recovery
- It also allows for sculpting of the bone.
- It is essential tool for preservation rhinoplasty
- In some cases, breaking of the nasal bones can even be avoided
- Can be used for preservation of the nasal bridge.
Reference link: Piezotome Rhinoplasty
Am I suitable for a Piezo rhinoplasty?
The instrumentation is designed for nasal bone sculpting. Therefore practically all patient of rhinoplasty benefit from piezo tome. More benefit to the patient with bony hump , bony deviations or bone irregularities and wide bony mid vault.
a piezo rhinoplasty needs to be performed using an open approach. However, the advantages of using the piezo tome for the rhinoplasty outweigh the presence of a minimal scar which is imperceptible.
Why are not all surgeons using Piezo rhinoplasty techniques?
- Many surgeons may not be familiar with this advanced technique
- Need to adapt and modify their standard rhinoplasty
- Piezo tome equipment is considerably more expensive.
In closed rhinoplasty, the surgeon performs every procedural incision endonasally (exclusively within the nose), and does not cut the columella. In open rhinoplasty, the surgeon makes an additional small, irregular incision to the columella.
The open approach continues to gain in popularity over the end nasal approach or closed approach for both primary and secondary rhinoplasty. There are advantages and disadvantages of both the techniques, but the correct approach determined by the patient’s anatomic deformity and the surgeon’s experience. Clearly, what is performed to alter the underlying anatomy is far more important than the type of incision used.
