Management of Common Complications in Rhinoplasty and Medical Rhinoplasty [chapter]

Sebastian Torres, Tito Marianetti
2016 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 3  
Rhinoplasty is considered among the most challenging aesthetic operations because many variables have to be taken into consideration to achieve an optimal aesthetic and functional result. This implies that complications are always waiting around the corner. It is of prime importance to know the main minor and major complications related to the procedure to be able to prevent and treat them promptly when required. Septorhinoplasty is a delicate and difficult procedure, which requires accurate
more » ... tomical knowledge and important clinical experience. Nevertheless, complications can affect both inexperienced and expert surgeons. Thus, the most frequent complications of rhinoplasty should be known and adequately prevented when possible. During septorhinoplasty, whatever approach is used, two fundamental rules must be kept in mind: 1. Respect the Cottle K area, which is anatomically defined as the intersection of the nasal bones, septum and triangular cartilages. 2. Preserve an adequate dorsal-caudal L structure for support. Damage to these structures causes an inadequate support of the nasal pyramid and with time causes nasal dorsum collapse and dorsum sill deformity spontaneously or after minor trauma. An adequate dorsal-caudal L structure of at least 1 cm is necessary for structural support to prevent this type of complication. The K area should be addressed with extreme care upon dorsal hump removal. Precise subperiosteal dissection is done above the nasal bones with a Joseph dissector. Incremental dorsal hump reduction with a rasp or osteotomes allows for maneuver control and removes the hard tissue while avoiding damage to the triangular cartilages or nasal bones. Treatment of L-structure fractures of the septum includes the use of robust reconstructive spreader grafts on the dorsal segment and columellar strut grafts on the caudal segment. Septal cartilage grafts are preferred when available; otherwise, conchae or costal cartilage grafts are necessary. Repair of K-area damage and triangular cartilage detachment from the nasal bones is more complex. If a small residue of cephalic cartilage remains, reattachment of the triangular cartilages is possible with non-resorbable sutures. Otherwise, holes are drilled in the nasal bone to anchor stitches of the triangular cartilages. Permanent surgical sutures (Nylon 4.0) are preferred over Kirchner metal wire, as proposed by other authors, given the fact that the skin is extremely thin in this area and a greater incidence of infection, irregularities and transcutaneous translucency can be expected with the latter technique. Dental trauma Hypoanesthesia of the superior central incisors and palatal premaxilla is frequently noted in the post-operative period after septorhinoplasty. This is due to the fact that the incisive nerve, before exiting in the oral cavity through the homonymous canal, lies on the maxillary crest at the base of the nasal septum. This complication frequently arises when septal dislocations close to the anterior nasal spine, nasal septum cartilage resections or anterior nasal spine remodeling procedures are done. Spontaneous resolution of the hypoesthesia is expected for the majority, and sensitivity is reestablished in a variable period between 1 week and 6 months. In the case of abnormal vascular support of superior anterior incisors or long teeth roots, a direct damage to the superior central incisors is possible; this can cause pulpitis or abnormal pigmentation. Prompt dental evaluation and endodontic therapy are advised, if necessary, before intrinsic pigmentation occurs or more complex and expensive prosthetic therapies are needed. Management of Common Complications in Rhinoplasty and Medical Rhinoplasty http://dx.
doi:10.5772/63130 fatcat:stzolv424bhdbmp66gy7a2kbpu