Rhinoplasty complications

Question 1

General complications

Answer 1

Bleeding
Scarring
Infxn
Septal perf
Need for revision surgery (20%)

Question 2

Dorsal irregularities

Answer 2

May occur if bony or cartilaginous dorsum was not precisely contoured

Question 3

Rocker deformity

Answer 3

Arises when the lateral osteotomy is carried too far superiorly into the thick frontal bone
When nasal bones are medialized, the osteotomized bony segment protrudes laterally beyond the radix
Tx: Percu osteotomy at point of bony irregularity

Question 4

“Open sky” deformity

Answer 4

When dorsal hump is reduced to the point where there is a gap in the midline b/w nasal bones
Palpable and visible
Tx: osteotomies or filling gap w/ soft cartilage graft

Question 5

Saddle nose deformity

Answer 5

Occurs when not enough cartilaginous septal support in middle 1/3 of nose
Manifests as a concavity along dorsum
Can also occur w/ over resection of septal cartilage or loss of septal cartilage as complication of untreated infxn, hematoma, cocaine abuse, other inflam/autoimmune d/o
Severity varies
Tx: provide septal support and augment the nasal dorsum w/ cartilage grafts

Question 6

Pollybeak deformity

Answer 6

Convexity of the cartilaginous dorsum/supratip
Etiologies: cartilaginous, soft tissue
Cartilaginous: dorsum has been relatively underresectied vs bony dorsum
Tx: reducing cartilaginous dorsum
Soft tissue: excessive scar formation in supratip often from overresection of dorsum or tip in pt w/ thick skin
Tx: steroid injxn

Question 7

Inverted-V deformity

Answer 7

Can occur along the nasal dorsum when ULCs lose their attachments to the nasal bones and/or the septum and collapse inward
Collapse exposes the contour of the caudal edge of the nasal bones
Tx: placement of spreader grafts assists in resuspending the ULC to the septum and opening the nasal valve

Question 8

Nasal bossae

Answer 8

Irregular knoblike protuberances of the LLCs that cause asymmetries of the nasal tip
May occur from irregularities of the cartilages themselves or from contractive scar forces acting on weakened cartilages

Question 9

Pinched tip

Answer 9

When the domes are excessively narrowed via a dome division or aggressive interdomal/transdomal suturing techniques

Question 10

Alar retraction

Answer 10

May occur 2/2 scarring or aggressive cephalic excision
Tx: usu requires supporting the LLCs w/ grafts
Severe alar retraction may warrant an auricular composite graft of skin and cartilage to replace the scarred vestibular mucosa