eMedicine Specialties > Plastic Surgery > Nose

Rhinoplasty, Maxillary Augmentation: Treatment

Author: Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Coauthor(s): Adam J Cohen, MD, Assistant Professor, Department of Ophthalmology, Northwestern University Feinberg School of Medicine; Consulting Surgeon, Myers Wyse Center for the Eye; Director, Center for Facial Rejuvenation; Founding Partner, HC Consulting, Inc; Edward W Chang, MD, DDS, Consulting Staff, Department of Cosmetic Services, Head and Neck Surgery, Kaiser Permanente of Northern California at Santa Rosa; Edward Farrior, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of South Florida Health Sciences Center; Donald R Laub Jr, MS, MD, FACS, Associate Professor of Surgery and Pediatrics, University of Vermont College of Medicine; Interim Chief, Plastic and Reconstructive Surgery, Fletcher Allen Health Care
Contributor Information and Disclosures

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.

More on Rhinoplasty, Maxillary Augmentation

Overview: Rhinoplasty, Maxillary Augmentation
Workup: Rhinoplasty, Maxillary Augmentation
Treatment: Rhinoplasty, Maxillary Augmentation
Follow-up: Rhinoplasty, Maxillary Augmentation
Multimedia: Rhinoplasty, Maxillary Augmentation
References
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References

  1. Cinelli JA. Correction of combined elongated nose and recessed naso-labial angle. Plast Reconstr Surg. Feb 1958;21(2):139-42. [Medline].

  2. Byrd HS, Hobar PC. Alloplastic nasal and perialar augmentation. Clin Plast Surg. Apr 1996;23(2):315-26. [Medline].

  3. Hinderer UT. Nasal base, maxillary, and infraorbital implants--alloplastic. Clin Plast Surg. Jan 1991;18(1):87-105. [Medline].

  4. 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].

  5. Cook TA, Wang TD, Brownrigg PJ, Quatela VC. Significant premaxillary augmentation. Arch Otolaryngol Head Neck Surg. Oct 1990;116(10):1197-201. [Medline].

  6. 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].

  7. Flowers RS. Augmentation maxilloplasty. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. Mosby: St Louis; 2000:129-150.

  8. Romo T 3rd, Shapiro AL. Aesthetic reconstruction of the platyrrhine nose. Arch Otolaryngol Head Neck Surg. Aug 1992;118(8):837-41. [Medline].

  9. Brink RR. Premaxillary augmentation. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. St Louis: Mosby; 2000:119-127.

  10. Tolleth H. Aesthetics and plastic surgery. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. Mosby: St Louis; 2000:3-11.

  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].

  12. Foda HM. Mersiline mesh in premaxillary augmentation. Aesthetic Plast Surg. May-Jun 2005;29(3):169-73. [Medline].

  13. Mathog RH, Leonard M, Bevis R. Surgical correction of maxillary hypoplasia. Arch Otolaryngol. Jul 1979;105(7):399-403. [Medline].

  14. Nassif PS, Kokoska MS. Aesthetic Facial Analysis. Facial Plast Surg Clin of North Am. November 1999;7(1):4.

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Further Reading

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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

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Contributor Information and Disclosures

Author

Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, and Sarasota County Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Cohen, MD, Assistant Professor, Department of Ophthalmology, Northwestern University Feinberg School of Medicine; Consulting Surgeon, Myers Wyse Center for the Eye; Director, Center for Facial Rejuvenation; Founding Partner, HC Consulting, Inc
Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Surgeons
Disclosure: Nothing to disclose.

Edward W Chang, MD, DDS, Consulting Staff, Department of Cosmetic Services, Head and Neck Surgery, Kaiser Permanente of Northern California at Santa Rosa
Edward W Chang, MD, DDS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and California Medical Association
Disclosure: Nothing to disclose.

Edward Farrior, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of South Florida Health Sciences Center
Edward Farrior, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Florida Medical Association
Disclosure: Nothing to disclose.

Donald R Laub Jr, MS, MD, FACS, Associate Professor of Surgery and Pediatrics, University of Vermont College of Medicine; Interim Chief, Plastic and Reconstructive Surgery, Fletcher Allen Health Care
Donald R Laub Jr, MS, MD, FACS is a member of the following medical societies: American Association for Hand Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, AO Foundation, International College of Surgeons, International College of Surgeons US Section, Northeastern Society of Plastic Surgeons, and Vermont State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Fred Menick, MD, Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Arizona
Fred Menick, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: none None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George Peck, Jr, MD, Consulting Staff, Department of Plastic Surgery, St Barnabas Hospital of New Jersey
George Peck, Jr, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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