1.4\ Rhinoplasty

1.4.1\ Discussion

Rhinoplasty is performed to restore or enhance the appearance of the nose. There are a wide variety of rhinoplasty techniques, ranging from functional versus aesthetic, open versus closed, augmentation versus reduction, and primary versus secondary. The classic open rhinoplasty features in-fractures of the bilateral nasal processes of the maxilla, which have a characteristic appearance on CT (Fig. 1.23). In addition, different portions of the nose can be altered (i.e., tip, dorsum, nasion, columella, or a combination of these). Both natural and synthetic materials can be used for augmentation rhinoplasty, including cartilage grafts, bone grafts (Figs. 1.24 and 1.25), silicone (Fig. 1.26), polytetrafluoroethyl-

ene (Fig. 1.27), and fillers (Fig. 1.28). The implants are sometimes purposefully positioned such that they appear asymmetric on imaging, but the cosmetic results are considered satisfactory. Kirschner

(K) wires may also be used for support when there is total nasal collapse or septal cartilage warping. Although some complications are clinically evident, imaging after rhinoplasty is occasionally requested to evaluate complications related to olfactory dysfunction, retained foreign body (Fig. 1.29), infection (Figs. 1.30 and 1.31), implant extrusion (Fig. 1.32), nerve injury (Fig. 1.33), deformity (Fig. 1.34), and nasal obstruction, which may be due to collapse of the nasal valves and resultant laminar flow (Fig. 1.35). Normally, airflow through the nasal cavity is turbulent (Fig. 1.36). Intracranial complications related to rhinoplasty are very rare.

Fig.1.26  Rhinoplasty with a silicone dorsal tip and columellar nasal implant. Axial (a), sagittal (b), and coronal (c) CT images show an L-shaped silicone implant that provides dorsal, tip, and columella augmentation. A

smaller additional piece of silicone is present to the right of the main implant (arrow). Axial CT image in another patient (d) demonstrates a perforation (arrow) in the implant for sutures or to promote tissue ingrowth

Fig. 1.27  Rhinoplasty with polytetrafluoroethylene implant. Sagittal (a) and axial (b) CT images show the thin sheet of slightly hyperattenuating implant material

Fig.1.28  Augmentation rhinoplasty with filler. Axial CT image shows the hyperattenuating hydroxyapatite within the subcutaneous tissues of the right lateral nasal wall and dorsum (arrow)

used for dorsal augmentation (arrow). Bilateral osteotomies of the frontal processes of the maxilla are also present (arrowheads)

Fig. 1.29  Retained foreign body. The patient presented with swelling at the operative site. Coronal CT image shows a metallic foreign body embedded in the right nasal process of the maxilla (arrow). The metallic foreign body was suspected to be a broken osteotome because the other end of the osteotome was discovered in the operating room rhinoplasty kit

Fig. 1.30  Cellulitis. The patient experienced swelling of the nose after reduction rhinoplasty. Axial (a) and sagittal (b) CT images demonstrate diffuse inflammatory changes

in the subcutaneous tissues of the nose. There is no discrete fluid collection

a

b

Fig. 1.33  Cranial nerve V2 injury. The patient presented with dysesthesia after rhinoplasty. Axial (a) and sagittal (b) CT images demonstrate perforation of the incisive canal by the metallic Kirschner wire (arrows)

Fig. 1.34  Hardware deformity. Frontal radiograph shows a bend (arrow) in the columellar Kirschner wire after trauma