Expanding indications for no dorsal dissection technique for hump treatment: the SPQR V2

Dr Finocchi developed a dorsal impaction Technique which achieved both dorsal reduction and profile straightening without the need for dorsal soft tissue envelope dissection

An Italian Online Survey Regarding the Use of Hyaluronidase in Previously Hyaluronic Acid-Injected Noses Looking for Surgical Rhinoplasty

Background: Nonsurgical nasal reshaping (nSNR) with hyaluronic acid (HA) filler is a well-established procedure performed to ameliorate nasal appearance and is considered a valid alternative to surgical rhinoplasty in selected patients. Objectives: The aim of our study is to evaluate the decision-making process and management of patients undergoing rhinoplasty, with previous HA filler injection, and evaluate if consensus could be achieved to recommend guidelines. Methods: Between April and May 2021, an online survey was sent to 402 Italian surgeons of different specialties. The survey collected information regarding the types of treatment of patients who have previously undergone nSNR, who should undergo surgical rhinoplasty. For those surgeons using hyaluronidase, an additional information was collected. Results: In a range of time of 2 months (April and May 2021), a total of 72 surgeons replied and completed the survey: out of the 402 questionnaires sent, the response rate was approximately 18%. The majority of respondents (61.5%) replied to inject hyaluronidase (HYAL) in patients who had to undergo a rhinoplasty but reported previous nSNR. Of the surgeons who use HYAL, 70% performed rhinoplasty after a waiting time of 3 to 4 weeks. Conclusions: Either direct surgical approach or hyaluronidase injection first seems to be a viable options. The use of HYAL before surgery is the choice with the broadest consensus in our survey. However, a larger case-control study with long follow-ups is necessary to understand if in patient seeking surgical rhinoplasty who already received nSNR, the injection of hyaluronidase before surgery is mandatory, recommended, or not

Combinazione Tower Pisa Concept—settoplastica Swinging Door nella correzione della deviazione del complesso setto-dorsale

Attraverso l’informazione e la descrizione obiettiva basata su casi clinici corredati da immagini e video, raggruppati per simili indicazioni chirurgiche e in un’ottica di assoluta obiettività, gli autori rappresentano non solo gli aspetti positivi ma anche quelli negativi e i punti deboli di ogni tecnica chirurgica descritta

Northern Mediterranean nose correction: Italian experience: preservation approach

Severe septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework it is mandatory its correction. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid. In certain cases, the association of a correct septoplasty and dorsal preservation allow the treatment of the crooked nose and at the same time gives natural results with rapid post-operative recovery. The aim of this chapter is to underline the versatility of the dorsal preservation technique for the correction of severe septal deviation

Pisa Tower Concept and swinging door septoplasty: a winning combination in the most complex dorso-septal deviation

The crooked nose – that is, the deviation of the nasal pyramid from the median line of the frontal plane – is a constant challenge for rhinosurgeons. The types of dorsal deviation can be many and often also involve the nasal tip. There are multiple causes of the deviation of the nasal pyramid and include, in the first instance, traumas, followed by iatrogenic or congenital factors. All faces present an asymmetry but most people do not notice this if it is less than 3-4 mm. However, it is very important to show the patient their facial asymmetry before performing the operation since the level of attention to each little detail will in- crease the post-operative period. A careful analysis becomes essential for planning the operation. Each of the ana- tomical components (upper lateral cartilages and alars, the septum, the osseous vault, the nasal spine, the soft tissues and the ligament must be assessed since each can contribute to creating this deformity. Even though, in structured rhinoplasty, various nasal osteotomy techniques have been described for the correction of osseous nasal deformities, so far surgical strategies have not been described that would be compatible with the dorsal pres- ervation philosophy. The three main pillars of the dorsum are made up of the nasal bones (in conjunc- tion with the upright branch of the maxillary bone) and the nasal septum. There- fore, the correction of a crooked pyramid must involve the evaluation and, where necessary, management of one or more pillars

A 3-level impaction technique for dorsal reshaping and reduction without dorsal soft tissue envelope dissection

Background: Preservation Rhinoplasty (PR) techniques are continuously evolving in the last two years. Many variations of old-fashioned techniques have been proposed since Daniel coined this term in 2018. Objectives: Authors want to describe indications for a new "three level impactions" technique allowing, in selected cases, a complete profile correction and dorsal reduction without the dorsal soft tissue envelope (STE) dissection. Methods: Three hundred fifty primary closed rhinoplasty cases were retrospectively studied from January 2018 and October 2019. Age, sex, race and technical details, surgical time and complications have been registered. Ninety-five dorsums were reduced and shaped without dissecting the dorsal soft tissue envelope, combining a 1) swinging door septoplasty with low septal strip resection, 2) endonasal bony cap mosaic osteotomies, and 3) Let down or Push down operation (LDO/PDO). Results: All patients showed a dramatic change in profile height and shape without neither dorsal STE dissection nor bony cartilage dorsal tissue resection. The average follow-up time was 14 months (range, 12-16 months). Conclusions: In selected patients, dorsum can be preserved without soft tissue envelope dissection. By combining multiple endonasal maneuvers is possible to obtain a dramatic change without dissecting the soft tissue envelope and at the same time avoiding any dorsal tissue resection: mosaic osteotomies for DKA conversion from S to V shaped dorsum, LDO and low septal strip resection for impaction and quadrangular cartilage flap rotation for profile setting. It is a versatile technique in selected patients, which leads to fast recovery and natural results

Anterograde and retrograde flow anastomoses to the internal mammary vessels in the third intercostal space

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Different degrees of NADPH oxidase 2 regulation and in vivo platelet activation: lesson from chronic granulomatous disease

In vitro study showed that NADPH oxidase (NOx), the most important enzyme producing reactive oxygen species (ROS), plays a role in the process of platelet activation. However, it is unclear if changes in its activity affect platelet activation in vivo