Photographic Atlas of Rhinoplasty: Problem-solving and Troubleshooting

770 Pages·2021·202.471 MB·English

by  Süreyya Şeneldir

Süreyya Şeneldir
https://t.me/mebooksfree
Photographic Atlas
of Rhinoplasty
Problem-solving and Troubleshooting
123
Photographic Atlas of Rhinoplasty

Süreyya  eneldir
Ş
Photographic Atlas
of Rhinoplasty
Problem-solving and Troubleshooting
Süreyya Şeneldir
Rhinoplasty School
Istanbul, Turkey
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ISBN 978-3-030-44324-5 ISBN 978-3-030-44325-2 (eBook)
https://doi.org/10.1007/978-3-030-44325-2
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For my father who was always there for me and who will continue to be…
Preface
I often look back on my life, remember what I passed through, and think of where I am right
now. Just like it was yesterday, I remember what I wanted to learn and where I started.
Currently, books are not the initial choice for learning, perhaps because tablets, phones, and
computers are more convenient and faster. Videos attract more attention because they are
dynamic. Everyone has a history that they want respected. Writing this book is proof of my
respect for the belief that books are the best teachers and friends.
I learned everything from books. When I started my career, few people were well trained in
rhinoplasty and it was difficult to contact other professionals. Therefore, I took advantage of
the books I read and meetings I attended. I spent much time experimenting with what I learned,
keeping up with new techniques, and identifying key points. Sometimes it took me years to
answer the questions in my head. Now, it is much simpler to obtain the information that we
need. However, with this excess “infollution,” we have trouble determining which information
to use or where to use it.
I asked myself “What type of book should I write?” I decided that it should be like an atlas
and include everything about rhinoplasty. The language should flow and be organized and
readable. It should be a guide for my colleagues, conveying everything that I show them when
practicing with them face to face. In addition, every example should be real, not hypothetical.
That is why this Atlas includes extensive pictures and drawings that are in order and follow
each other sequentially. The pictures and drawings took 2 years to complete. The videos of the
examples of the described subjects were prepared for colleagues using an augmented reality
technique. I am aware of what I needed to learn when I was at the beginning of my career, and
my current colleagues have the same requirements.
Jacob Riis said “When nothing seems to help, I go look at a stonecutter hammering away at
his rock perhaps a hundred times without as much as a crack showing in it. Yet at the hundred
and first blow it will split in two, and I know it was not that blow that did it, but all that had
gone before.” This book reflects not just my most recent work but the first hundred that went
into that work.
In the Photographic Atlas of Rhinoplasty, each chapter is supported by related examples.
However, these examples do not simply show techniques. Each pre-, intra-, and postoperative
example is real and refers to specific subjects. Therefore, there are no hypothetical examples
in this book.
I went to the effort of supporting every detail with real examples and interpreting them
clearly and accurately. It was very important that I make them understandable for everyone, at
any level of training. As I always highlighted in my “Rhinoplasty School” meetings and other
meetings at which I spoke, there is no such thing as a miracle rhinoplasty technique. Therefore,
considering many techniques is always more helpful because one technique may lead to differ-
ent conclusions in different cases. That is why every step and detail in rhinoplasty should be
explained.
I did my best to convey my experiences and knowledge in my book. Rhinoplasty improves
with sharing, and sharing my own experiences in this book brought me great satisfaction. I
hope that it will be as helpful and as satisfying for my colleagues, and I hope they can obtain
the information that they need.
vii
viii Preface
Thank you to everyone who has helped me through my journey in rhinoplasty. I am grateful
for everyone who contributed material aid and spiritual support. Special thanks to Omer Faruk
Guven, who was with me in this from the beginning to the end and who gave meaning to the
book with his original drawings.
Istanbul, Turkey Süreyya Şeneldir
Contents
Part I Radix
1 Radix: Definition and Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 One: The Vertical Position of the Radix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Two: The Projection (Height) of the Radix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2 High Radix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.2 Treatment Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.3 What Is the Radix Saw? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.4 Clinical Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.4.1 Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.4.2 Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.4.3 Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.4.4 Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.4.5 Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3 Low Radix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.2 Treatment Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.3 Clinical Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.3.1 Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.3.2 Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.3.3 Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.3.4 Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.3.5 Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.3.6 Case 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3.7 Case 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3.8 Case 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Part II Dorsum
4 Dorsum: Definition and Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
5 Dorsum: Dorsal Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.2 Treatment Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
ix
x Contents
5.2.1 En Bloc Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.2.2 Segmental Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.3 Clinical Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5.3.1 Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5.3.2 Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
5.3.3 Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.3.4 Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.3.5 Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6 Middle Vault Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
6.2 Treatment Strategy and Clinical Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
6.2.1 Spreader Graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
6.2.2 Spreader Grafts Are Used to Avoid a Narrow Middle Vault . . . . . . . . . . 68
6.2.3 Correction of Dorsal Septal Deviations
Can Also Be Performed with Spreader Grafts . . . . . . . . . . . . . . . . . . . . . 70
6.2.4 Asymmetric Spreader Graft to Reconstruct the Middle Vault . . . . . . . . . 84
6.2.5 Collapsed Lateral Nasal Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6.2.6 Straightening of the Dorsal Septum and the Caudal Septum . . . . . . . . . . 89
6.2.7 Autospreader Graft (Autospreader Flap) . . . . . . . . . . . . . . . . . . . . . . . . . 93
6.2.8 Unique Situations in Middle Vault Reconstruction . . . . . . . . . . . . . . . . . 99
6.2.9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
7 Dorsum: Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
7.2 Treatment Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
7.2.1 Transverse Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
7.2.2 Lateral Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
7.3 How Can We Use Osteotomy in Cases? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
7.3.1 Wide Nasal Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
7.3.2 Wide Base and Uncomplicated Dorsum . . . . . . . . . . . . . . . . . . . . . . . . .132
7.3.3 Wide Base and Narrow Dorsum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
7.3.4 Wide Base and Wide Dorsum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
7.3.5 Asymmetric Bone Pyramid (Deviated Nasal Bone Pyramid) . . . . . . . . .135
7.3.6 Double Saw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
7.3.7 Short Nasal Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
7.3.8 Narrow Nasal Base. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
7.3.9 Narrow Nasal Root . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
7.3.10 Unique Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
7.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
8 Dorsum: Final Touch the Dorsum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
8.2 Treatment Strategy and Clinical Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
8.2.1 Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
8.2.2 Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
8.2.3 Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
8.3 Excessive Septal Cartilage in the Dorsum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
8.3.1 Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
8.3.2 Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180