| 书目名称 | Rethinking Rhinoplasty and Facial Surgery | | 副标题 | A Structural Anatomi | | 编辑 | Howard D. Stupak | | 视频video | | | 概述 | Provides a reference that is applicable to otolaryngologists, facial plastic surgeons, oral surgeons, and dentists.Reviews and analyzes conventional rhinoplasty and facial structural treatment.Present | | 图书封面 |  | | 描述 | .This volume presents a novel logic-based, simplified understanding and approach to the external nose and face for aesthetics, airway, and sleep treatments that have mostly been under-recognized in the past. Key features of the text include an engineer’s approach to simple rhinoplasty, (Release, Resize, Reposition, Reinforce) instead of the typical step-wise procedure algorithm. It also includes a logical explanation of how facial skeletal anatomy is the true cause of sleep apnea and aesthetic deformity with the physics and evidence of how this works, and a review of conventional rhinoplasty/facial structural treatments, with an analysis of why these are flawed and need improvement. Finally, rhinoplasty surgical strategy is discussed using a Rhinoplasty Compass(TM) diagram.. .Rethinking Rhinoplasty. and Facial Surgery appeals to the surgeon who has grown frustrated with the aesthetic and breathing results of the conventional treatment paradigm. It also appealsto the otolaryngologist, plastic or oral surgeon who avoids working on the external nose and nasal valve because of the perceived complexity of graft-style rhinoplasty or oversimplicity and limitations of basic septoplasty an | | 出版日期 | Book 2020 | | 关键词 | Nasal Airway; Nasal Valve; Nasal Deformity; Obstructive Sleep Apnea; Oral Breathing; Facial Aesthetics; he | | 版次 | 1 | | doi | https://doi.org/10.1007/978-3-030-44674-1 | | isbn_softcover | 978-3-030-44673-4 | | isbn_ebook | 978-3-030-44674-1 | | copyright | Springer Nature Switzerland AG 2020 |
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Front Matter |
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The Problem We Face: The “Compartmentalized” Conventional View of Facial/Nasal Anatomy |
Howard D. Stupak |
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Abstract
Disciplines involving the understanding of structure, like rhinoplasty, facial surgery, and otolaryngology have achieved great strides by incorporating statistical evidence-based medicine (EBM) in the twentieth century, moving from an anecdotal art-form to a science-based series of algorithms. Despite these advances, a focus on specific therapeutic “maneuvers” and whether these tactics result in improvement has resulted in a general disregard for the probing into the structural origins of the physical causation of disorders. With an inquiry into the origins of these causative forces, disorders can be reversed or prevented much more efficiently and naturally than the statistically driven accumulated maneuvers that fuel our treatment algorithms.
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The Invisible Forces in Our Nasal Airway: Air Flow and Cavity Negative Pressure |
Howard D. Stupak |
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The sensation of reduced ability to breathe through the nose is very common among patients. Most clinicians consider a laundry-list of etiologies that are the possible causes of these problems. In reality, there may be a more useful differentiation of cause of this sensation between true nasal obstruction due to physical blockage from the nostrils through the nasal cavity, and secondary obstruction, known as nasal disuse or underuse which is due to nocturnal mouth-breathing. This entity known as nasal underuse causes a spectrum of problems that overlaps the diagnosis of nasal allergy, with enlarged/inflamed turbinates and nasal mucosa. The diagnostic differentiation between nasal obstruction and nasal underuse is critical to performing successful surgery, as in the long-term, nasal underuse is not treatable with nasal surgery, despite popular treatments. In contrast, nasal underuse can only be treated with strategies that encourage mouth-closure.
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Nasal Function and Sleep Disorders |
Howard D. Stupak |
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The function and structure of the nose and genesis of obstructive sleep apnea (OSA) are inter-connected, but not necessarily in the expected fashion. Obstructions during sleep are in essence, a slackening in the tone of the jaws, causing release of the tongue and palate into the airway. Nasal obstruction is not required to cause this state, but it can be an exacerbating factor. Clinical and modeling data are presented to support this concept. The aerodynamics of how the nose affects the airway are also discussed at length, including a consideration of gravitational forces, negative pressure, and the consideration of the tongue and palate as airfoils subjected to airflow forces.
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The Human Facial Skeleton: Influence on the Airway and Aesthetics? An Analysis of Cause/Effect Parad |
Howard D. Stupak |
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The extent of protrusion of the facial bones has diminished over the course of hominid evolution and may be continuing to do so. This process may, through structural changes of the maxilla and mandible, be resulting in what we see as an aesthetic deformity of the receded chin. Beyond this simple aesthetic problem, the petite jaws may predispose individuals to mouth-breathing and extrusion externally of the nasal septum, resulting in nasal deformity and deviation. The structural problem may also relate to sleep disordered breathing.
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A Structural Model to Systematically Understand Nasal Framework: The Rhinoplasty Compass™ |
Howard D. Stupak |
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This chapter discusses using a prism-shaped model how the key structure in external nasal anatomy and the nasal airway is the nasal framework. The nasal framework consists of the anterior and inferior septum and the nasal bones superiorly. Superficially located to the framework is the canopy layer consisting of the paired alar cartilages and the skin and soft-tissue layer. Supporting the framework is the foundation layer, or substrate, consisting of the septal bones and pyriform aperture. Using the prism model, this key chapter analyzes the variations of framework external extrusion, from supero-inferior excess and deficiency (SI+/−) to antero-posterior excess and deficiency (AP+/−), and how combinations of these variations can be visualized on a compass-like structure, we call the Rhinoplasty Compass.. By categorizing patients on this compass, predictable esthetic, deviation, and functional phenotypes can be better understood.
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Modeling to Evaluate Conventional Procedures |
Howard D. Stupak |
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Using the newer perspective based on the data presented in the last five chapters, this chapter reviews the conventional procedures for the external nose and the nasal valve. Each traditional procedure is analyzed using the dynamic prism mode. With the understanding that the framework layer is pivotal in functional and aesthetic outcomes, looking at procedures from commercial devices to various types of grafts sheds new light on their utility.
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Rhinoplasty Strategy and Tactics Using the Rhinoplasty Compass™ |
Howard D. Stupak |
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Instead of considering “steps” in a procedure, which must be blindly followed for various “indications,” this chapter presents an alternative structure to consider surgery. These “stages” of a procedure permit more thoughtfulness and flexibility by the surgeon to use judgment instead of memorization. The stages include approach, release, re-size, reposition, and reinforcement. The surgeon thus does not simply “check a box” at the completion of steps, but must achieve satisfactory achievement of the stages objective before advancing. Using the Rhinoplasty Compass™ of framework, surgical strategies to modify the basic variations on framework are described, using the stage concept.
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Complementary Procedures to the Framework Strategy (The Canopy Layer) |
Howard D. Stupak |
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After developing an understanding of treating the framework/septal layer of the nose, attention is turned to treating the superficial canopy layer of the nose simply in a complementary fashion. Using the same stages described in Chap. 7, approach, release, re-size, and reposition, the alar cartilages, tip, and skin layer are discussed at length in regards to matching the previously restructured framework layers.
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Strategies for Addressing Mouth-Breathing Treatment with an “Adequate” Nose |
Howard D. Stupak |
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Now that we have discussed and analyzed strategies to surgically achieve an adequately functioning and appearing nose, additional treatments are still required in many cases to achieve jaw closure due to limited musculoskeletal tone of the maxilla and mandible, as we described in Chaps. 4 and 5. From surgical jaw expansion, orthodontic treatments to jaw closure straps and appliances, these strategies are considered and evaluated in this chapter.
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Breaking the Barriers Between Specialties: Toward a Universal Understanding of Anatomy and Function |
Howard D. Stupak |
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The solution to compartmentalization between the specialties described in Chap. 1 is the development of a concept of universality, where all specialists are equally aware of the knowledge of the others. Using this idealized concept, specialists would apply diagnosis and treatment not just according to the specifics of their specific procedural training but by seeing the bigger picture of the root cause of the physical causes of disease. While difficult to attain in the real-world, individual clinicians can help achieve this goal with as much exposure to others outside of their field as possible, not limiting their search to medicine and surgery alone. In this chapter, we take a critical eye to the established fields that treat the external facial skeleton, and the internal facial skeleton (airway and sinuses), and consider big-picture alternatives to conventional treatment.
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Back Matter |
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发表于 2025-3-21 17:07:15
