eMedicine Specialties > Plastic Surgery > Nose
Rhinoplasty, Maxillary Augmentation: Treatment
Updated: Apr 2, 2008
Treatment
Surgical Therapy
Two common surgical approaches are the intranasal and intraoral routes.
The intranasal approach uses an incision made in the lateral vestibule that is brought down to the level of the nasal spine. The vertically oriented incision is located in the membranous portion of the septum and is the primary site of subperiosteal elevation underlying the alar bases.
The surgical approach via the intraoral modality commences with an incision through the gingivobuccal mucosa. The dissection is carried out in the subperiosteal pocket, allowing for adequate exposure of the implant site.
Different materials have been used to correct both premaxillary and maxillary hypoplasia.
Materials such as silicone silastic, cartilage and/or bony autografts and/or homografts, hydroxyapatite granules, Gore-Tex, acellular dermis, porous polyethylene, and, in the past, Proplast have been used. The choice of implant material used should be based on availability, biocompatibility, rate of extrusion, familiarity with the material, and previous surgical outcomes.
Various custom-shaped implants are also available.
Preoperative Details
Appropriate assessment of the hypoplastic areas and the expected outcome must be reviewed thoroughly with the patient. The surgeon and patient then should decide on the desired degree of correction.
Intraoperative Details
In either approach, care must be taken to avoid the infraorbital neurovascular plexus. Usually, this does not pose a problem because the subperiosteal dissection is not extended into this area unless the implants used are those described by Hinderer.3
Postoperative Details
Postoperative antibiotics are administered routinely, and the patient is advised to avoid excessive manipulation of the area.
Follow-up
Patients are usually observed the day after surgery, then at 1 week, 1 month, 3 months, 6 months, and 1 year postsurgery. These regimens are tailored as the surgeon sees fit.
Complications
Complications related to the implant may arise.
If an autogenic implant is used, the possibility of donor site infection and scarring and autograft contamination exists.
Both synthetic and nonsynthetic grafts may extrude or become infected.
Patient dissatisfaction can also occur from an overcorrection or undercorrection or secondary to implant migration.
Paresthesias stemming from infraorbital nerve injury can result and persist indefinitely. Fortuitously, some paresthesias resolve within 6-12 months.
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References
Cinelli JA. Correction of combined elongated nose and recessed naso-labial angle. Plast Reconstr Surg. Feb 1958;21(2):139-42. [Medline].
Byrd HS, Hobar PC. Alloplastic nasal and perialar augmentation. Clin Plast Surg. Apr 1996;23(2):315-26. [Medline].
Hinderer UT. Nasal base, maxillary, and infraorbital implants--alloplastic. Clin Plast Surg. Jan 1991;18(1):87-105. [Medline].
Watanabe T, Matsuo K. Augmentation with cartilage grafts around the pyriform aperture to improve the midface and profile in binder's syndrome. Ann Plast Surg. Feb 1996;36(2):206-11. [Medline].
Cook TA, Wang TD, Brownrigg PJ, Quatela VC. Significant premaxillary augmentation. Arch Otolaryngol Head Neck Surg. Oct 1990;116(10):1197-201. [Medline].
Converse JM, Horowitz SL, Valauri AJ, Montandon D. The treatment of nasomaxillary hypoplasia. A new pyramidal naso-orbital mazillary osteotomy. Plast Reconstr Surg. Jun 1970;45(6):527-35. [Medline].
Flowers RS. Augmentation maxilloplasty. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. Mosby: St Louis; 2000:129-150.
Romo T 3rd, Shapiro AL. Aesthetic reconstruction of the platyrrhine nose. Arch Otolaryngol Head Neck Surg. Aug 1992;118(8):837-41. [Medline].
Brink RR. Premaxillary augmentation. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. St Louis: Mosby; 2000:119-127.
Tolleth H. Aesthetics and plastic surgery. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. Mosby: St Louis; 2000:3-11.
Fanous N, Yoskovitch A. Premaxillary augmentation for central maxillary recession: an adjunct to rhinoplasty. Facial Plast Surg Clin North Am. Nov 2002;10(4):415-22. [Medline].
Foda HM. Mersiline mesh in premaxillary augmentation. Aesthetic Plast Surg. May-Jun 2005;29(3):169-73. [Medline].
Mathog RH, Leonard M, Bevis R. Surgical correction of maxillary hypoplasia. Arch Otolaryngol. Jul 1979;105(7):399-403. [Medline].
Nassif PS, Kokoska MS. Aesthetic Facial Analysis. Facial Plast Surg Clin of North Am. November 1999;7(1):4.
Further Reading
Keywords
maxillary augmentation, premaxillary augmentation, maxillary retrusion, maxillary hypoplasia, craniofacial anomalies, Apert syndrome, Crouzon syndrome, rhinoplasty, midfacial retrusion, midface retrusion, lower jaw, prognathic, prognathic profile, columella-labial angle correction, maxillary bone, underdeveloped maxilla, maxilla, maxilla development, maxilla correction, intranasal approach, intraoral approach
Treatment: Rhinoplasty, Maxillary Augmentation