Daniel G. Becker

Septoplasty and Turbinate Surgery

When a patient requesting rhinoplasty also complains of nasal obstruction, it is critical to accurately diagnose the cause. The author reviews diagnostic procedures, including anterior rhinoscopy, nasal endoscopy, and coronal-sinus computed tomography scan. He discusses technical aspects of septoplasty and turbinate surgery, which address common causes of nasal obstruction, emphasizing traditional and endoscopic septoplasty, septoplasty techniques to address the caudal septum, and a graduated stepwise approach to the inferior turbinates.

Surgical treatment of nasal obstruction in rhinoplasty.

Often, rhinoplasty patients present not just for aesthetic correction, but for improvement of their nasal breathing due to functional abnormalities or problems. Because the aesthetic and functional problems must be addressed together, an understanding of both the internal and external anatomy is essential. In this article, the authors review the differential diagnosis of nasal obstruction and the important components of a thorough examination. In this article, medical treatment options are not discussed, but just as an exacting aesthetic analysis leads to an appropriate cosmetic rhinoplasty plan, a thorough functional analysis will dictate the appropriate medical or surgical treatment.

Revision Rhinoplasty: Panel Discussion, Controversies, and Techniques

UNLABELLEDnWhat is the single most difficult challenge in revision rhinoplasty and how do you address it? During revision rhinoplasty, when dorsal augmentation is necessary and septal and ear cartilage is not available, what is the best substance for correcting the problem? If rib cartilage is used for dorsal augmentation during revision rhinoplasty, what is the technique to prevent warping of the graft? Alloplast in the nose--when, where, and for what purpose? Does the 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 reductive rhinoplasty?nnnANALYSISnOver the past 5 years, how has your technique evolved or what have you observed and learned in performing revision rhinoplasty?

POWERED INSTRUMENTATION FOR RHINOPLASTY AND SEPTOPLASTY

Advances in surgical instrumentation are generally intended to allow the performance of a surgical maneuver more efficiently and accurately. Powered instrumentation may allow improved precision and ease in certain aspects of rhinoplasty and septoplasty. Through improved precision, tissue trauma can be minimized.

Analysis in otoplasty.

The normal auricle has a well-recognized shape, and significant deviation from normal is immediately evident. In particular, prominent ears are readily apparent and are a relatively frequent cause of patient concern. Correction of the outstanding ear requires a careful understanding of the discrete elements that compose the normal ear. Careful anatomic analysis to determine the precise cause allows appropriate preoperative planning for the correction of a protruding ear.

A Patient Seeking Aesthetic Revision Rhinoplasty and Correction of Nasal Obstruction

Thorough evaluation of a patient presenting with nasal obstruction, including nasal endoscopy and a CT scan when indicated, is recommended to guide proper diagnosis and treatment. The rhinoplasty surgeon should be aware of the differential diagnosis of nasal obstruction and should proceed with thorough evaluation or refer the patient for appropriate complete evaluation.

Anatomy, Physiology, and General Concepts in Nasal Reconstruction

Nasal reconstruction provides a challenging task for any facial plastic surgeon. In performing reconstructive surgery on the nose, one must balance both the functional aspects of the nasal airway with the aesthetic responsibilities of being the central fixture of the face. Before performing surgery, the surgeon must grasp the importance of the anatomic nasal relationships and subunits, the physiology of the skin, the flaps or grafts used to reconstruct these areas, and the basic steps in wound healing. Accurate preoperative planning and analysis of the nasal defect are also vital to producing both an aesthetic and functional nose.

An Internet otolaryngology referral center: a preliminary report.

Background The aim of this study was to review our early experience with the UPenn Otolaryngology Referral Center Website, ENTConsult.org. Methods ENTConsult.org is an interactive website that allows a referring physician to select a University of Pennsylvania Health System otolaryngologist and share clinical information, including uploaded pictures, radiographs, and other images via the Internet. Traditional methods of long-distance consultation involve mailing clinical information, which often is slow and unwieldy, thus discouraging consultation. ENTConsult.org seeks to take advantage of Internet functionality to facilitate efficient and timely consultation regardless of any of the participants’ locations. Results In this report we reviewed our initial experience with ENTConsult.org, including an overview of the website functionality and a detailed review of critical logistical considerations. Conclusion The UPenn Otolaryngology Referral Center Website ENTConsult.org offers considerable promise as an avenue for long-distance referral and consultation.

Postoperative Opioid Use in Sinonasal Surgery

Objective To survey patients following sinonasal surgery regarding postoperative pain and opioid use. Study Design Patients were surveyed for 4 days following sinus and/or nasal surgery regarding their pain level and use of prescribed opioids. Setting Four academic medical centers and 1 private practice institution. Subjects Consecutive adult patients undergoing sinonasal surgery. Results A total of 219 subjects met criteria and were included for analysis; 134 patients (61%) took 5 or fewer combination oxycodone (5-mg) and acetaminophen (325-mg) tablets in the first 3 postoperative days, and 196 patients (89.5%) took fewer than 15. Fifty-one patients (23%) consumed no opioid pain medication. Opioid consumption was positively correlated with postoperative pain (R2 = 0.2, P < .01) but was not correlated with the use of acetaminophen (R2 = 0.002, P = .48). No significant difference in postoperative pain or opioid consumption was seen with respect to age, sex, specific procedures performed, postoperative steroids, or smoking history. Current smokers reported higher average pain than nonsmokers (P < .001) and also required more postoperative opioids (P = .02). Conclusions An evidence-based approach to postoperative pain control following sinonasal surgery that reduces the number of unused and potentially diverted opioids is needed. The current study suggests that 15 combination oxycodone (5-mg) and acetaminophen (325-mg) tablets provide sufficient pain control for 90% of patients in the immediate postoperative period following sinonasal surgery, irrespective of the specific procedures performed, use of acetaminophen, or use of systemic steroids. Smoking status may help surgeons predict which patients will require larger opioid prescriptions.

Preoperative and postoperative care in cosmetic laser resurfacing

Advances in laser technology have allowed the application of lasers to cosmetic facial skin resurfacing. While this application has been extremely advantageous to patients, the development of pre- and postoperative therapeutic regimens was necessary to mitigate potential complications associated with laser resurfacing. Potential complications of laser resurfacing include prolonged postoperative erythema, hyperpigmentation, hypopigmentation, herpetic, bacterial or candidal infection, and other concerns including scarring and abnormal wound healing. In this report we review the state of the art of preoperative and postoperative care for cosmetic laser resurfacing.