eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Rhinoplasty, Short Nose: Workup

Author: Joseph L Leach Jr, MD, Associate Professor of Otololaryngology, University of Texas Southwestern Medical School
Contributor Information and Disclosures

Updated: Mar 6, 2008

Workup

Laboratory Studies

  • Obtain benzoylecgonine levels for patients in whom cocaine abuse is suspected to exclude recent cocaine use. Such patients should have abstained from cocaine use for more than a year.
  • A complete blood count, serologic tests for syphilis, a tuberculin skin test, rheumatoid factor, and an erythrocyte sedimentation rate are helpful in determining infectious or autoimmune etiologies.
  • Aerobic, anaerobic, and acid-fast cultures of nasal secretions may be indicated.
  • An antineutrophil cytoplasmic antibody test, if positive, is highly specific for Wegener granulomatosis.

Imaging Studies

  • Preoperative photographs should be taken from at least 4 different views. Most surgeons prefer 6 standard views, including frontal, right and left laterals, right and left obliques, and basal views.
  • Although not mandatory, preoperative radiography or CT scanning may indicate the extent of bone or cartilage loss.
  • Chest radiography is helpful in determining infectious or autoimmune etiologies.
  • Although plain radiographic studies and CT scanning often are performed around the time of trauma to the nose and mid face, these studies are not essential for reconstruction of the short nose. Using a careful physical examination to determine the amount of bony and cartilaginous deficiency is more reliable.

Other Tests

  • Acoustic rhinometry is often used to verify subjective descriptions of nasal obstruction.

Diagnostic Procedures

  • A tissue biopsy may be necessary to confirm the presence of neoplastic or autoimmune disease. Biopsies for this indication are notoriously unreliable, however. Biopsy is probably best performed when cancer is strongly suspected.

More on Rhinoplasty, Short Nose

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Follow-up: Rhinoplasty, Short Nose
Multimedia: Rhinoplasty, Short Nose
References
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References

  1. Aiach G, Monaghan P. Treatment of over-reduction of the nose and subsequent deformities. Br J Oral Maxillofac Surg. Aug 1995;33(4):250-61. [Medline].

  2. Swanepoel PF, Fysh R. Laminated dorsal beam graft to eliminate postoperative twisting complications. Arch Facial Plast Surg. Jul-Aug 2007;9(4):285-9. [Medline].

  3. Gruber RP, Pardun J, Wall S. Grafting the nasal dorsum with tandem ear cartilage. Plast Reconstr Surg. Sep 15 2003;112(4):1110-22; discussion 1123-4. [Medline].

  4. Anderson JR. Considerations and components of the aesthetic face. In: Rees R, ed. Rhinoplasty: Emphasizing the External Approach. Vol 3. New York, NY:. Thieme Medical Publisher;1986:1-63.

  5. Banks P, Tanner B. The mask rhinoplasty: a technique for the treatment of Binder's syndrome and related disorders. Plast Reconstr Surg. Nov 1993;92(6):1038-44. [Medline].

  6. Cleary KR, Batsakis JG. Sinonasal lymphomas. Ann Otol Rhinol Laryngol. Nov 1994;103(11):911-4. [Medline].

  7. Colton JJ, Beekhuis GJ. Use of Mersilene mesh in nasal augmentation. Facial Plast Surg. Jul 1992;8(3):149-56. [Medline].

  8. Crumley RL, Lanser M. Quantitative analysis of nasal tip projection. Laryngoscope. Feb 1988;98(2):202-8. [Medline].

  9. Daniel RK. Rhinoplasty and rib grafts: evolving a flexible operative technique. Plast Reconstr Surg. Oct 1994;94(5):597-609; discussion 610-1. [Medline].

  10. Davis RE, Wayne I. Rhinoplasty and the nasal SMAS augmentation graft: advantages and indications. Arch Facial Plast Surg. Mar-Apr 2004;6(2):124-32. [Medline].

  11. Dyer WK 2nd, Beaty MM, Prabhat A. Architectural deficiencies of the nose: treatment of the saddle nose and short nose deformities. Otolaryngol Clin North Am. Feb 1999;32(1):89-112. [Medline].

  12. Ellis E 3d, Sinn DP. Use of homologous bone in maxillofacial surgery. J Oral Maxillofac Surg. Nov 1993;51(11):1181-93. [Medline].

  13. Ersek RA, Delerm AG. Processed irradiated bovine cartilage for nasal reconstruction. Ann Plast Surg. Jun 1988;20(6):540-6. [Medline].

  14. Frodel JL Jr. Management of the nasal dorsum in central facial injuries. Indications for calvarial bone grafting. Arch Otolaryngol Head Neck Surg. Mar 1995;121(3):307-12. [Medline].

  15. Gilbert SE. Overlay grafting for lateral nasal wall concavities. Otolaryngol Head Neck Surg. Oct 1998;119(4):385-8. [Medline].

  16. Godin MS, Waldman SR, Johnson CM Jr. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. A 6-year experience. Arch Otolaryngol Head Neck Surg. Oct 1995;121(10):1131-6. [Medline].

  17. Gruber RP. Lengthening the short nose. Plast Reconstr Surg. Jun 1993;91(7):1252-8. [Medline].

  18. Gruber RP. The short nose. Clin Plast Surg. Apr 1996;23(2):297-313. [Medline].

  19. Helie F, Fournier J. Destructive lesions of the median line secondary to cocaine abuse. J Otolaryngol. Feb 1997;26(1):67-9. [Medline].

  20. Horton CE, Matthews MS. Nasal reconstruction with autologous rib cartilage: a 43-year follow-up. Plast Reconstr Surg. Jan 1992;89(1):131-5. [Medline].

  21. Kangesu L, Goodacre TE, Stanley PR. Survival of irradiated glutaraldehyde preserved bovine cartilage in nasal reconstruction: a retrospective study. Br J Plast Surg. Oct 1991;44(7):483-5. [Medline].

  22. Kobayashi S, Yoza S, Ohmori K. Reconstruction of a short nose by full-thickness tissue transfer with osteotomy. Ann Plast Surg. Dec 1997;39(6):628-32. [Medline].

  23. Kridel RW, Konior RJ. Dome truncation for management of the overprojected nasal tip. Ann Plast Surg. May 1990;24(5):385-96. [Medline].

  24. Kridel RW, Konior RJ. Irradiated cartilage grafts in the nose. A preliminary report. Arch Otolaryngol Head Neck Surg. Jan 1993;119(1):24-30; discussion 30-1. [Medline].

  25. Leach J. Interlocking calvarial bone grafts: a solution for the short, depressed nose. Laryngoscope. Jun 2000;110(6):955-60. [Medline].

  26. Naficy S, Baker SR. Lengthening the short nose. Arch Otolaryngol Head Neck Surg. Jul 1998;124(7):809-13. [Medline].

  27. Owsley TG, Taylor CO. The use of Gore-Tex for nasal augmentation: a retrospective analysis of 106 patients. Plast Reconstr Surg. Aug 1994;94(2):241-8; discussion 249-50. [Medline].

  28. Riechelmann H, Rettinger G. Three-step reconstruction of complex saddle nose deformities. Arch Otolaryngol Head Neck Surg. Mar 2004;130(3):334-8. [Medline].

  29. Sheen JH. Tip graft: a 20-year retrospective. Plast Reconstr Surg. Jan 1993;91(1):48-63. [Medline].

  30. Song C, Mackay DR, Chait LA, et al. Use of costal cartilage cantilever grafts in negroid rhinoplasties. Ann Plast Surg. Sep 1991;27(3):201-9. [Medline].

  31. Staffel G, Shockley W. Nasal implants. Otolaryngol Clin North Am. Apr 1995;28(2):295-308. [Medline].

  32. Stella JP, Epker BN. Systematic aesthetic evaluation of the nose for cosmetic surgery. Oral Maxillofacial Surg Clin North Am. 1990;2:273-287.

  33. Wolfe SA. Lengthening the nose: a lesson from craniofacial surgery applied to posttraumatic and congenital deformities. Plast Reconstr Surg. Jul 1994;94(1):78-87. [Medline].

  34. Yabe T, Muraoka M. Treatment of saddle type nasal fracture using Kirschner wire fixation of nasal septum. Ann Plast Surg. Jul 2004;53(1):89-92. [Medline].

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Further Reading

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Keywords

short nose rhinoplasty, depressed nose, saddle nose, pug nose look, saddle-nose deformity, porcine deformity, cocaine abuse, neoplasms, Binder syndrome, Wegener's granulomatosis, rhinoplasty, Wegener granulomatosis

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Contributor Information and Disclosures

Author

Joseph L Leach Jr, MD, Associate Professor of Otololaryngology, University of Texas Southwestern Medical School
Joseph L Leach Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Phi Beta Kappa, Texas Medical Association, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Gregory Branham, MD, Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine
Gregory Branham, 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 Physician Executives, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Dean Toriumi, MD, Department of Otolaryngology, Associate Professor, University of Illinois Medical Center
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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