Deviated Nose: Partial Lateral Osteotomies in a New Preservation Rhinoplasty Concept

Background: A deviated nose continues to be a problem to solve in Rhinoplasty. Various techniques were presented as a possible solution of this aesthetic and functional nasal deformation. In the light of current trend of preservation of structures and function, a modification of osteotomies was presented. Goals: The goal of this paper is to present partial lateral osteotomies surgical technique performed with piezo-electric instruments. Methods and Results: Partial and incomplete osteotomies were introduced as method to avoid disinsertion of nasal pyramid of glabellar area and to avoid bony step in areas of osteotomy cut. Rhinosculpture in its extended mode was promoted for modulation of bony structure with obtaining immediate aesthetic and structural results, minoring a surgical trauma. Conclusion: An incomplete oblique transverse, lateral and intermediate osteotomies, facilitates the "slide-down" positioning of the bone edges, without the need of bone dessinsertion in glabellar region.info:eu-repo/semantics/publishedVersio

Extended Dorsal Preservation in a New Concept of Preservational Rhinoplasty

Background: A dorsal preservation rhinoplasty concept was discussed and the benefits vs. contraindications and limitations were presented. In specific cases of severe nasal septal deformations associated with necessity of major septoplasty, focused on perpendicular plate, a New Concept of Extended Dorsal Preservation Rhinoplasty is presented (New Extended PR-D). PR-D is based on septoplasty, rhinosculpture and partial osteotomies. Goals: The objective of this paper is to present a new approach in some cases of rhinoplasty named as extended dorsal preservation rhinoplasty. Methods and Results: Partial and incomplete osteotomies were introduced as method to avoid disinsertion of nasal pyramid of glabellar area and to avoid bony step in areas off osteotomy cut. Rhinosculpture in its extended mode was promoted for modulation of bony structure with obtaining immediate aesthetic and structural results, minoring a surgical trauma. Conclusion: The principles of Preservation Concept were respected in this New Extended PR-D Concept.info:eu-repo/semantics/publishedVersio

Transepithelial accelerated versus conventional corneal collagen crosslinking in patients with keratoconus: a comparative study

Carolina Madeira,1 Ana Vasques,2 João Beato,1 Gonçalo Godinho,1 Luís Torrão,1 Manuel Falcão,1,3 Fernando Falcão-Reis,1,3 João Pinheiro-Costa1,4 1Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal; 3Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; 4Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal Purpose: To systematically compare the efficacy of transepithelial accelerated corneal collagen crosslinking (TE-ACXL) with conventional corneal collagen crosslinking (C-CXL) in patients with progressive keratoconus. Methods: Eyes of patients with progressive keratoconus who were treated with C-CXL (3 mW/cm2 for 30 minutes) were compared with those who underwent TE-ACXL (6 mW/cm2 for 15 minutes). Best-corrected visual acuity (BCVA), keratometry values, corneal thickness, and topometric indexes were compared before CXL, and at 2 months, 6 months, and 12 months postoperatively. Results: The study enrolled 26 eyes of which 16 had TE-ACXL and 10 had C-CXL. Both groups were comparable at baseline and 12 months in terms of BCVA (P=0.16 and P=0.57), Kmax (maximum keratometry) (P=0.31 and P=0.73), pachymetry (P=0.75 and P=0.37), index of surface variance (ISV) (P=0.45 and P=0.86), index of vertical asymmetry (IVA) (P=0.26 and P=0.61), and index of height decentration (IHD) (P=0.27 and P=0.86, respectively). We did not observe significant differences between preoperative and 12-month postoperative readings in within-group analysis: ΔKmax (TE-ACXL, -2.13±5.41, P=0.25 vs C-CXL, 0.78±1.65, P=0.17), Δpachymetry (TE-ACXL, 4.10±14.83, P=0.41 vs C-CXL, -8.90±22.09, P=0.24), ΔISV (TE-ACXL, -8.50±21.26, P=0.24 vs C-CXL, 3.80±12.43, P=0.36), ΔIVA (TE-ACXL, -0.12±0.31, P=0.26 vs C-CXL, 0.03±0.18, P=0.61), and ΔIHD (TE-ACXL, -0.03±0.07, P=0.18 vs C-CXL, -0.01±0.03, P=0.88). Conclusion: Both TE-ACXL and C-CXL were similarly effective. Further follow-up is required to determine whether these techniques are comparable in the long-term. Keywords: cornea, keratoconus, crosslinking, transepithelial, riboflavin, ultraviolet radiation, keratometr