Imaging Studies
Photography
Standardized photographs of the patient are essential to the preoperative diagnosis and for the development of a mental surgical plan. Capturing high-quality patient photographs can be accomplished using 35-mm film or digital photography techniques, which are described in detail in other sources. Preoperative analysis of patient photographs allows the surgeon to define problem areas of the nose that may have been missed during the initial physical examination. Also, specific structural and anatomic deficits may become more apparent in certain photographic views.
A review of patient photographs the night before surgery can also serve to refresh the surgeon's memory, help anticipate likely intraoperative anatomy, and allow the surgeon to rehearse the projected operative plan. Photographs are also valuable in objectively revealing preoperative and postoperative findings. Such documentation is also helpful in critical self-analysis of techniques and long-term results.
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Basic closed technique for rhinoplasty. Drawing illustrating marginal (inferior dotted line), cartilage-splitting (blue dotted line), and intercartilaginous (red dotted-line) endonasal incisions.
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Basic closed technique for rhinoplasty. Endonasal incisions. Top dotted line marks the marginal incision, and the bottom incision marks the intercartilaginous incision. When combined, these 2 incisions permit the delivery of the alar cartilages outside the nose. Courtesy of A. John Vartanian, MD.
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Basic closed technique for rhinoplasty. Drawing illustrating septal incisions.
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Basic closed technique for rhinoplasty. Illustration underscoring the importance of leaving a robust (>15-mm) dorsocolumellar septal framework when performing septoplasty.
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Basic closed technique for rhinoplasty. The caudal edge of the alar cartilages can be palpated with the back of the scalpel. Courtesy of A. John Vartanian, MD.
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Basic closed technique for rhinoplasty. Marginal incision made by gently scoring the vestibular skin with a sterile blade. Courtesy of A. John Vartanian, MD.
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Basic closed technique for rhinoplasty. Drawing relevant anatomic landmarks on the patient's nose is helpful. Here, the alar cartilages are outlined, along with the tip-defining points, proposed area of cephalic resection, caudal border of the ascending process of the maxilla, osseocartilaginous junction, medial canthal line, and placement site for alar batten grafts. Courtesy of A. John Vartanian, MD.
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Basic closed technique for rhinoplasty. Delivery of the alar cartilage can facilitate a number of maneuvers. An area of cephalic cartilage is marked for excision. The excision is performed at a slanting angle to prevent sharply demarcated edges. A minimum of 6-8 mm of alar cartilage is left behind. Courtesy of A. John Vartanian, MD.
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Basic closed technique for rhinoplasty. Nasal base resection can narrow the interalar distance. A more lateral placement of the resection can also reduce alar flaring.
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Basic closed technique for rhinoplasty. Most dorsal convexities (humps) have a substantial cartilaginous component. Cartilaginous dorsal excision is best performed with a sharp No. 15 blade.
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Basic closed technique for rhinoplasty. Lateral intraoperative view of a patient demonstrating medial, lateral (black dots), and intermediate (blue dots) osteotomies. The relative location of the osteotomies is described in relation to the face (low) and the ceiling (high). Courtesy of A. John Vartanian, MD.
