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Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty

Frants, Anna; Varelas, Antonios N; Franco, Alexa M; White, W Matthew; Constantinides, Minas S; Miller, Philip J; Lee, Judy W
PURPOSE/OBJECTIVE:Rhinoplasty is amongst the most challenging surgeries to perfect and can take decades. This process begins during residency; however, residents often have limited exposure to rhinoplasty during their training and lack a standardized method for systematically analyzing and formulating a surgical plan. The DESS (Deformity, Etiology, Solution, Sequence) is a novel educational format for residents that serves to increase their pre-operative comfort with the surgical evaluation and intraoperative planning for a rhinoplasty. MATERIALS AND METHODS/METHODS:A qualitative study performed at a tertiary academic institution with an otolaryngology residency program evaluating three consecutive residency classes comprised of four residents per class. A 9-item questionnaire was distributed to measure change in resident comfort after utilizing the DESS during their facial plastics rotation. Questionnaire responses highlighted resident comfort with facial nasal analysis, identifying deformities, suggesting surgical maneuvers, and synthesizing a comprehensive surgical plan. RESULTS:Ten of the twelve residents surveyed responded. Of those that responded, comfort in facial nasal analysis, identification of common nasal deformities, surgical planning, and development of an overall surgical plan were significantly improved after completion of the facial plastic rotation. These residents largely attributed their success to the systematic educational format, with an average score of 4.8/5.0 (SD 0.42). CONCLUSION/CONCLUSIONS:While rhinoplasty is a challenging artform to master, systematic approaches to analysis and operative planning are vital for teaching and guiding residents. Through this novel methodology, residents display significant improvement in their comfort with facial nasal analysis and overall surgical preparation.
PMID: 37952257
ISSN: 1532-818x
CID: 5610802

Evidence-Based Performance Measures for Rhinoplasty: A Multi-Disciplinary Performance Measure Set

Manahan, Michele A; Fedok, Fred; Davidson, Caryn; Ahmad, Jamil; Constantinides, Minas; Davis, Richard; Friedman, Oren; Gilman, Robert; Ishii, Lisa; Keyes, Geoffrey; Lin, Samuel J; Marcus, Benjamin; Matarasso, Alan; Most, Sam P; Quereshy, Faisal; Sinno, Sammy; Steinbacher, Derek; Tollefson, Travis; Rohrich, Rod
The American Society of Plastic Surgeons (ASPS), American Academy of Otolaryngology-Heand and Neck Surgery (AAO-HNS), and the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) commissioned the multi-disciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty. 1 outcome measures and 3 process measures were identified. The outcome looked at patient satisfaction with patient satisfaction with rhinoplasty procedures. The process measures look at motivations and expectations of the procedure, airway assessment, and non-narcotic shared decision-making strategies for pain management. All measures in this report were approved by the ASPS Quality and Performance Measures Work Group and Executive Committee, as well as the AAO-HNS Foundation, the AAFPRS, the Rhinoplasty Society, and the American Association of Oral and Maxillofacial Surgeons. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
PMID: 33235037
ISSN: 1529-4242
CID: 4680602

Rhinoplasty: panel discussion

Adamson, Peter A; Constantinides, Minas; Kim, Alyn J; Pearlman, Steven
Should one use an open or closed rhinoplasty approach? How appropriate is the endonasal approach in modern-day rhinoplasty? Should the tip lobule be divided or preserved? Are alloplastic implants inferior to autologous implants? Does release and reduction of the upper lateral cartilages from the nasal dorsal septum always require spreader graft placement to prevent mid one-third nasal pinching in reduction rhinoplasty? Over past 5 years, how have rhinoplasty techniques and approaches evolved?
PMID: 24290994
ISSN: 1064-7406
CID: 688102

Alar retraction: etiology, treatment, and prevention

Alexander, Ashlin J; Shah, Anil R; Constantinides, Minas S
IMPORTANCE: The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated. OBJECTIVE: To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers. DESIGN: Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage. SETTING: Tertiary care academic health center. PARTICIPANTS: Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction. MAIN OUTCOMES AND MEASURES: Intraoperative findings, postoperative results. RESULTS: Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values. CONCLUSIONS AND RELEVANCE: Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts-can improve alar retraction. LEVEL OF EVIDENCE: 4.
PMID: 23619765
ISSN: 2168-6076
CID: 896792

Aesthetic Subunits of Nose

Chapter by: Sheu, Mike C; Bloom, Jason D; Constantinides, Minas
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 110-112
ISBN: 3642234992
CID: 1808262

Alar Retraction

Chapter by: Paul, Benjamin C; Bloom, Jason D; Constantinides, Minas
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 113-117
ISBN: 3642234992
CID: 1808242

Inverted-V Deformity

Chapter by: Lee, Judy Washington; Constantinides, Minas
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 1378-1381
ISBN: 3642234992
CID: 1808222

Nasal Function (Rhinometry, Rhinomanometry), Evaluation

Chapter by: Sheu, Mike C; Bloom, Jason D; Constantinides, Minas
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 1746-1746
ISBN: 3642234992
CID: 1808232

Polly Beak Deformity

Chapter by: Gupta, Sachin; Constantinides, Minas
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 2168-2170
ISBN: 3642234992
CID: 1808252

Nonmelanoma skin cancer of the head and neck: molecular mechanisms

Cobanoglu, H Bengu; Constantinides, Minas; Ural, Ahmet
Histopathologic examination is the gold standard for the diagnosis of skin cancer. Because analysis of molecular parameters such as nucleic acids and DNA are also gaining importance in diagnosis, prognosis, and therapy, an understanding of the molecular mechanisms underlying the pathogenesis of nonmelanoma skin cancer of the head and neck is of growing importance for the diagnostician and surgeon alike. This article presents a description of the effect on cells and impact on DNA of ultraviolet radiation, with a discussion of squamous cell and basal cell carcinoma in terms of the effects of genetic pathways and apoptosis.
PMID: 23084296
ISSN: 1064-7406
CID: 205342