Abstract

Surgical perforation’s repair is a great challenge for the rhinologist plastic reconstructive surgeon.

The procedure could be difficult both for the patient disconfort and for the invasive treatment; the success rate could vary due to the local situation and surgical level and experience of the operator .

The Author with more than 30 years of experience report  his results in a large series of patients operated on  with different personal tecniques , sometimes personal and innovative .

A diagnostic work – up is suggested to better manage the pathology and to know in advance the limits of the surgery to be planned .

In this report and in our experience endoscopic diagnostic imaging with high resolution optics , different angulation is very important and absolutely necessary. These images demonstrate the appearance of perforation and its margins as weel as the conditions of the surrounding mucosa and  of structures  surrounding the perforation  itself , residual bones and cartilage enclosed when present and the real size of residual mucosa that sometimes id very little or the presence of a double perforation in the same patient.

In addition to endoscopic images, a high-resolution CT scan is performed , with or without contrast to obtain the best visualization of the structures below the perfortion the precise evaluation of the sizes antero posterior and cranio-cephalic , the images are selected and subsequentely processed with different  visualization and colouring method in a post-processing work .

This methodologic approach  is useful to improve surgical planning and the results .

Many   type of surgical repair are described from the beginning of our experience in classic  closed rhinoplasty approach to a combination of open approach with endoscopic vision and surgical reconstructions . Many biologic tisssues and devices were been utilized during the procedure and in the time after to complete the full healing and safety of the new septum ; the dimensions of perforations in relationsheep with the residual septum is essential to obtain the best results .

A series of 84 patients  were evaluated with a size of the  perforation from 2mm to 43 mm who undurwent to one or two procedures  to obtain the best result both in the functional and in the aesthetic  morphological aspect. The percentage of not succesful results was of 15% of cases but in three cases the hole was realized many years after the operation due to many  factors ,but in some cases anyway the external aspect of the nose was better than before .

During surgery many options could be utilized with the employment  of grafts  from the same patient like auricolar cartilage , costal cartilage  and also bank omologous cartilage .

In many cases a reductive reconstructive Rhinoplasty was performed and the nasal skeleton reassembled to improve the possibility of closing completly the defect .

In conclusion a diagnostic work-up with CT is mandatory and could be useful to improve radiological imaging with elaboration of images  ; before the surgical procedure for a certain period of time, one or two months ,it is useful to utilize soft ointments or products to obtain the residual mucosa in a better state and in this way the surgical reconstruction and flaps are more effective ; the employment of graft with different tissues is imporant to obtain long lasting results .

BIBLIOGRAPHY:

1. MOCELLA, F. MUIA , P.G. GIACOMINI , D. BERTOSSI , E. RESIDORI, S. SGROI

“Innovative tecnique for large septal perforation repair and radiological evaluation”

Acta Otorinolaringoiatria Ital  . Giugno 2013;33(3):202–214.

Codice PMC: PMC3709522 Codice PMI: 23853417

2. “The nasal septum. A complete overview for the role of the septum in nasal “ Gabriele Molteni, Stelio Antonio Mocella, Dario Bertossi, Riccardo Nocini.

EDITOR PICCIN PADUA ITALY 2024

3. “THE PERFORATED NASAL SEPTUM: A PILLAR TO BE REBUILT “

S.A.MOCELLA AND R. NOCINI PAG 484-497

IN “ THE  WAYS OF RHINOPLASTY “  BY A. BOCCIERI, V.FINOCCHI AND T. MARIANETTI

ND  ACTA MEDICA GRIFFIN ED. 2023 ISBN 978-88-97438-64-9

4  .Mocella S.A , Biasiutti C: Nasal cavities and paranasal sinuses

Volumes  detected with high resolution CT  Data.

Official Meeting of the Scientific Venetian Society- PADUA SEPTEMBER 2007

5. Stelio Antonio Mocella ¹ , N. Bianchi ¹ , R. Cerini ² , A. Beltramello

Magnetic Resonance Imaging in primary and secondary rhinoseptoplasty

Facial Plastic Surgery  VOL 12 .4   1996

Abstract

Abdominoplasty is a very common procedure,
especially for patients with abdominal laxness, striaes, and
muscle rectus diastases. With the advent of liposuction
28 years ago, we can improve body contouring by treating
lipodystrophies in the epigastric, flank, trochanteric, and
buttocks areas. The procedure combining abdominoplasty
and liposuction is called lipoabdominoplasty. Many new
techniques have been proposed since these procedures were
introduced; we now revisit the superior pull-down
abdominal flap technique with several new modifications
and improvements.

Abstract

Non-surgical nasal rhinoplasty using hyaluronic acid (HA) is a technique that has been widely adopted due to its minimally invasive and reversible nature. Reshaping the nose with HA is becoming increasingly popular for its quick and safe outcomes, serving as an effective alternative for correcting minor nasal deformities. The proposed approach, named the Tip Up (TU) technique, focuses on strategic injection sites, specifically in the Nasal Tip region, Nasal Spine, and Columella, utilizing minimal amounts of the product to minimize risks and enhance the predictability of the results. Procedures are performed under anesthesia without vasoconstrictors to prevent ischemia, and careful selection of the product ensures subtle and precise corrections. This case series details all aspects of the TU technique, highlighting the satisfactory and predictable aesthetic results achieved through a safe and reliable procedure.

Abstract

Tummy tuck procedures continue to be one of the most popular aesthetic procedures for many patients after pregnancy or significant weight loss.  The standard abdominoplasty or lipoabdominoplasty procedures as are often performed tend to flatten the abdomen and alter the natural three-dimensional contour of the abdominal soft tissue by disturbing the discrete abdominal regions or forms.  Method: Since 2006, the author has been performing a modified abdominoplasty technique that he termed “High-Definition Tummy Tuck” since.  The underlying premise of this technique is a modified dissection approach that preserves the discrete abdominal forms inorder to retain definitions and manipulation of Scarpe’s fascia to enhance the three-dimensional contour of the abdomen, according to aesthetic principles.  Results: Since 2006, the author has performed over 1000 High-Definition tummy tuck procedures safely and consistently in non-bariatric and post-bariatric patients.  This presentation describes the principles, technique, results and fundamentals of this natural yet athletic abdominoplasty technique.  Conclusion:  High-Definition Tummy Tuck is a safe abdominoplasty technique that preserves definitions and contour of the abdomen to achieve an aesthetically pleasing three-dimensional abdominal contour without employing liposculpture or fat grafting.