Presently, there is no consensus on which patient-reported outcome measurement (PROM) instrument is best suited to assess the aesthetic outcomes of rhinoplasty. In this regard, at least seven different validated PROMs are available from the literature, each one with advantages and disadvantages. In this article, we review the development, validation, international translation, and clinical application of the Utrecht Questionnaire (UQ). The UQ was developed in 2009 with the idea to be a short and practical tool for the rhinoplasty surgeon to assess the aesthetic outcomes of rhinoplasty. The questionnaire was then validated in 2013. Body image in relation to nasal appearance is quantified with five simple questions on a 5-point Likert scale and a Visual Analogue Scale score. We discuss how the UQ can easily be incorporated and become an important asset in a rhinoplasty practice. Practical benefits, such as its role in the shared decision-making process, patient expectations management, identification of unsuitable patients, avoiding revision surgery, and the evaluation of the surgeon's personal performance curve, are exemplified. Currently, the UQ has been translated and validated in four languages, providing scientific opportunities to generate and compare international data for advances in rhinoplasty. We describe some of the significant scientific contributions of leaders in the field of rhinoplasty that used the UQ.

A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

Subjektive Bewertungen der Lebensqualität haben als Ergebnisqualität in den letzten Jahrzehnten an Bedeutung gewonnen. Die Anzahl der prospektiven Studien zur Lebensqualitätsmessung mit krankheitsspezifischen Messinstrumenten ist überschaubar. Ziel war es, die Lebensqualität nach primärer und Revisionsseptorhinoplastik eines einzelnen Chirurgen in einem HNO(Hals-Nasen-Ohrenheilkunde)-Zentrum zu untersuchen.

Zusammenfassung Hintergrund Subjektive Bewertungen der Lebensqualität haben als Ergebnisqualität in den letzten Jahrzehnten an Bedeutung gewonnen. Die Anzahl der prospektiven Studien zur Lebensqualitätsmessung mit krankheitsspezifischen Messinstrumenten ist überschaubar. Ziel war es, die Lebensqualität nach primärer und Revisionsseptorhinoplastik eines einzelnen Chirurgen in einem HNO(Hals-Nasen-Ohrenheilkunde)-Zentrum zu untersuchen. Studiendesign und Untersuchungsmethoden Präoperativ und mindestens ein Jahr postoperativ wurden 2 krankheitsspezifische Lebensqualitätsmessinstrumente eingesetzt: der ROE(„rhinoplasty outcome evaluation“)- und der NOSE(„nasal obstruction symptome evaluation“)-Score. Weitere Informationen, insbesondere Alter, Geschlecht und Voroperationen, wurden erfragt. Ergebnisse Es wurden 237 Patienten in die Studie eingeschlossen, 208 (87,8 %) weibliche, 29 (12,2 %) männliche. Das Durchschnittsalter lag bei 30,3 ± 8,9 Jahren, der durchschnittliche Beobachtungszeitraum bei 19,3 ± 7,4 Monaten. Alle Operationen wurden von demselben Chirurgen (F. R.) durchgeführt. Mit dem Messinstrument NOSE zeigte sich eine signifikante Verbesserung der Obstruktion im Gesamtkollektiv (präoperativ 49,8 ± 26,2, postoperativ 19,1 ± 21,3; p < 0,001), ohne signifikanten Unterschied in Bezug auf primäre vs. Revisionsoperation. Der ROE-Score verbesserte sich signifikant, beide Kollektive (primär und sekundär operierte) zeigten beide Kollektive eine signifikante Verbesserung nach der Intervention. Postoperativ fielen die Patienten mit einer Primärintervention durch eine signifikant höheren Lebensqualität ( p < 0,001) auf. Schlussfolgerung Die krankheitsspezifische Lebensqualität nimmt nach primärer Septorhinoplastik wie nach Revisionsoperation signifikant zu. Der NOSE-Score stieg in beiden Interventionsgruppen postoperativ signifikant an.

The assessment of outcomes in aesthetic rhinoplasty is highly relevant because patient satisfaction and improved health-related quality of life (QoL) are the predominant factors in determining success. The patient-reported outcome measures (PROMs) employed in rhinoplasty research studies are remarkably diverse, thus yielding difficulties with data analysis. The aim of this article is to provide a comprehensive review of the literature to reveal the relevance of the QoL assessment for rhinosurgeons.

Zahlreiche Komplikationen, die nach Rhinoplastiken beobachtet werden, könnten durch Minimierung der Resektion von Stützstrukturen und durch strukturelle Stabilisierung vermieden werden. Da Langzeitkomplikationen nach einer Rhinoplastik stark von der vorgegebenen anatomischen Situation abhängen, liegt es in der Hand des Arztes für plastische Rhinochirurgie, anatomische Varianten zu erkennen und die chirurgische Technik entsprechend zu adaptieren, um Komplikationen zu vermeiden. Die chirurgischen Techniken der Rhinoplastik haben sich in der jüngeren Vergangenheit stark verändert, weg von den reduktiven Exzisionsmethoden hin zu Repositionierung und Restrukturierung von vorhandenem Gewebe. Eine konservative Reduktion und der Erhalt von Stützstrukturen der Nase können das ästhetische und das funktionelle Ergebnis maximieren. Die Kontrolle der Nasenspitzenkontur und die Wiederherstellung des mittleren Gewölbes der Nase sind Schlüsselkomponenten der erfolgreichen Rhinoplastik. Moderne Techniken führen zu guten Langzeitergebnissen. In dieser Arbeit werden diese Techniken vor dem Hintergrund des Ziels nachhaltiger Ergebnisse dargestellt.

Diced cartilage wrapped in fascia or modeled with tissue sealant has successfully been used as dorsal onlay grafts in rhinoplasty. The use of autologous material introduces the risk of donor site morbidity, and sometimes availability is limited.

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

Abstract Cephalic malposition of the lower lateral cartilages (LLC) gained increasing awareness as a distinct anatomical entity within the last years. It has become clear that this type of deformity is not amenable to traditional rhinoplasty techniques. Repositioning of the lateral crus of the LLC enables the surgeon to achieve significant and reliable changes in the shape and function of the nose. The authors present their technique for repositioning of the cephalically malpositioned LLC. Their method is based on a turn-in flap that is positioned along the caudal margin of the repositioned LLC. This flap straightens a convex LLC and gives reliable structural support to the caudal alar margin. In this article, they discuss the various indications of this technique, introduce a new, more precise concept for evaluation of the axis of the lateral crus of the LLC, and highlight additional details of this reliable technique.

Congenital deformities of the nasal cartilage are extremely rare. Often, they remain undiscovered until an open approach is completed during rhinoplasty. We present a case of unilateral congenital agenesis of the middle and lateral crura of the alar cartilage. A new concept for dome reconstruction using conchal cartilage is introduced. Additionally, current concepts of embryology are summarized, which will help understanding the pathophysiology of such rare deformities.

Post-paralytic facial nerve syndrome (PFS) summarizes specific symptoms that result from an incomplete or poor recovery of the facial nerve after peripheral facial palsy. Selective chemodenervation using botulinum toxin A (Btx A) and mime therapy represent the therapeutic standard for treating PFS. We report on a 35-year-old male who was suffering greatly from unilateral PFS-specific movement disorders, including periorbital contractions and oculofacial synkinesis that did not respond to Btx A administration. We present a surgical alternative to overcome periorbital movement disorders by selective neurolysis and review therapeutic options for this rare syndrome. In conclusion, selective neurolysis appears to be an efficient alternative treatment method of PFS in which the quality of life is severely impacted due to movement disorders and there was no therapeutic benefit from Btx A.

Correction of complex facial scars frequently requires individualized, multimodal strategies, which are composed of various therapeutic measures. This report provides information on techniques for correction of contractures, atrophic scars, scars within hair-bearing regions of the face and auricular keloids. Additionally, we present adjuvant procedures in a subject-related manner.

Die Korrektur komplexer Narben im Gesichtsbereich erfordert individuell angepasste, oft multimodale Therapiekonzepte. Der vorliegende Beitrag erläutert unterschiedliche Techniken zur Korrektur von Kontrakturen, atrophen Narben, Narben in behaarten Gesichtsbereichen und Keloiden im Bereich der Ohrmuscheln. Darüber hinaus werden adjuvante Verfahren innerhalb der einzelnen Themenkomplexe vorgestellt.

The objective of the study was to assess the short-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. The study is a prospective, randomized, single-blinded, placebo-controlled, crossover trial. A total of 22 patients (age range 21–72 years; median age 41 years) were randomized into two treatment arms. Using a bipolar radiofrequency system, the first group (VP-group) received RFVTR (verum = V) first (at t1) followed by a placebo treatment (P) 6–8 weeks later (at t2). The PV-group was treated with placebo first at t1 and received RFVTR at t2. Subjects in both groups underwent identical procedures in an office-based setting. Delivery of radiofrequency energy was the only difference between the two groups. The outcome measures assessed were rhinomanometry, physician’s evaluation of the degree of hypertrophy of the inferior turbinates and patients’ estimation of nasal obstruction. Physician and patient evaluations were documented using a score ranging from 0 = none to 4 = severe. Evaluation was performed 6–8 weeks after every intervention. No intraoperative or postoperative complications occurred. Inferior turbinate hypertrophy improved significantly in both groups after RFVTR was performed (VP-group: p < 0.001; PV-group: p = 0.002). Nasal obstruction also decreased only after RFVTR (VP-group: p = 0.004, PV-group: p = 0.002). This study confirmed the safety of bipolar RFVTR as an office-based treatment of nasal obstruction due to inferior turbinate hypertrophy. We could prove that RFVTR is superior to placebo for reduction in turbinate hypertrophy and subjective improvement in nasal obstruction. To our knowledge, this is the first level I study proving the short-term efficacy of a bipolar radiofrequency system.

BACKGROUND:Delayed recovery after facial palsy results in aberrant nerve regeneration with symptomatic movement disorders, summarized as the postparalytic facial nerve syndrome. The authors present an alternative surgical approach for improvement of periocular movement disorders in patients with postparalytic facial nerve syndrome. The authors proposed that endoscopic brow lift leads to an improvement of periocular movement disorders by reducing pathologically raised levels of afferent input.METHODS:Eleven patients (seven women and four men) with a mean age of 54 years (range, 33 to 85 years) and with postparalytic facial nerve syndrome underwent endoscopic brow lift under general anesthesia. Patients' preoperative condition was compared with their postoperative condition using a retrospective questionnaire. Subjects were also asked to compare the therapeutic effectiveness of endoscopic brow lift and botulinum toxin type A.RESULTS:Mean follow-up was 52 months (range, 22 to 83 months). No intraoperative or postoperative complications occurred. During follow-up, patients and physicians observed an improvement of periorbital contractures and oculofacial synkinesis. Scores on quality of life improved significantly after endoscopic brow lift. Best results were obtained when botulinum toxin type A was adjoined after the endoscopic brow lift. Patients described a cumulative therapeutic effect.CONCLUSIONS:These findings suggest endoscopic brow lift as a promising additional treatment modality for the treatment of periocular postparalytic facial nerve syndrome-related symptoms, leading to an improved quality of life. Even though further prospective investigation is needed, a combination of endoscopic brow lift and postsurgical botulinum toxin type A administration could become a new therapeutic standard.

OBJECTIVESTo describe the split hump technique (SHT) and to examine its effectiveness for correction of an overprojected nasal dorsum in patients undergoing aesthetic rhinoplasty.METHODSThis prospective study included 97 patients. Objective assessment was performed using a short, practical questionnaire. Investigation focused on nasal patency and the patient perception of body image in relation to nasal appearance using 5-point Likert scale questions and visual analog scales.RESULTSUse of the SHT resulted in a significant improvement in nasal patency and aesthetic nasal perception. Sum functional question scores decreased from 9.154 to 6.351 and aesthetic question scores from 13.897 to 6.825 (P < .001 for both). Mean aesthetic visual analog scale scores improved in all patients, from 3.346 to 7.782 (P < .001). Graphic illustration of this improvement revealed a gaussian curve of normal distribution around a mean (SD) improvement of 4.48 (1.93).CONCLUSIONSTraditional en bloc humpectomy maneuvers are frequently combined with spreader graft use to avoid postoperative inferomedial repositioning of the upper lateral cartilages and inverted-V deformity. The SHT for correction of the overprojected dorsum creates a paradigm change in this patient group. The transverse segments of the upper lateral cartilages are saved and repositioned instead of being resected as a part of an en bloc osseocartilaginous composite hump resection in a transverse plane. Several modifications of the SHT enable the surgeon to deproject the nose while keeping sufficient strength in the keystone area and augmenting dorsal width. Using statistical analysis of subjective patient data, we could prove a broad acceptance and appreciation for the SHT.

The growth of tumor cells can be regulated by a variety of cytokines. To investigate the pathogenesis of head and neck cancer and explore a new therapeutic approach for the carcinoma, the role of interleukin-6 (IL-6) in the growth of a human head and neck squamous cell carcinoma (HNSCC) cell line was examined. Whether or not IL-6 is increased in HNSCC and whether or not IL-6 antisense oligonucleotide treatment could decrease proliferation and angiogenic activity of HNSCC cell lines, was determined. Established human HNSCC cell lines were screened for IL-6 expression at both mRNA and protein levels. By using a 15-mer antisense phosphorothioate oligonucleotide targeting a sequence in the second exon of the IL-6 gene, modulation of IL-6 and vascular endothelial growth factor (VEGF) expression was examined in UMSCC IIA in cell supernatants by capture enzyme-linked immunosorbent assay (ELISA), and in cell lysates by reverse transcriptase-polymerase chain reaction (RT-PCR). In addition, cell growth was determined by cell count. Endothelial cell migration was measured using a modified Boyden chamber. IL-6 was identified in the supernatant of the cell culture medium, indicating that these cells secreted IL-6, and the mRNAs of IL-6 were shown to be present in the cell lysates. IL-6 antisense oligonucleotide treatment resulted in a significant reduction of IL-6 protein expression compared to the sense control. The antisense oligonucleotides targeting IL-6 mRNA, also, inhibited cell growth and IL-6 production as well as VEGF expression. The addition of conditioned medium from IL-6 antisense-treated tumor cells resulted in decreased endothelial cell migration and tubule formation. Taken together, these findings indicate that endogenous IL-6 plays an important role in the growth of HNSCC and exerts its action by an autocrine growth mechanism, and that therapeutic trials with antisense oligonucleotides targeted to IL-6 mRNA may have some value for the treatment of HNSCC due to a decrease of neovascularization.

Rhinophyma is a benign dermatological disease of the nose which affects primarily Caucasian men in their fifth decade of life. Its main characteristic is a slowly progressive hyperplasia of the sebaceous glands and the adjacent tissue with irregular thickening of the nasal skin and nodular deformation. It is defined as the end stage of acne rosacea. The main reasons for patients to seek medical help are cosmetic problems and functional impairments such as nasal airway obstruction or even difficulty in eating. Surgery is indisputably the treatment of choice for rhinophyma. This article gives an overview on the clinical and histopathologic findings of rhinophyma as well as the different treatment options with their pros and cons as described in literature.