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    Correction of the crooked nose using custom-made high-density porous polyethylene extended spreader grafts
    (Springer, 2006) Gürlek, A; Ersoz-Ozturk, A; Celik, M; Firat, C; Aslan, S; Aydogan, H
    Correction of the crooked or deviated nose, a complex cosmetic and functional problem, is a big challenge for the rhinoplasty surgeon. Although corrections using a wide range of surgical techniques to straighten the nose and maximize nasal function have been proposed, recurrence is very common because of cartilage memory and scar contracture. Therefore, to prevent recurrence and to maintain the correction of the septum, a permanent support that is stable and strong, with the ability to maintain its given shape after placement on one or both sides of the septum, is needed. For this purpose, the authors planned to use a pair of custom-made high-density porous polyethylene (HDPP) extended spreader grafts. In this study, the concept and technique of HDPP, composed of a nonresorbable alloplastic material for correction of the crooked nose, and the authors' experience using it, are presented. Currently, HDPP is readily available on the market as a thin plain sheet (0.85 x 38 x 50 mm) that can be cut to an appropriate size for spreader grafts. Ingrowths of fibrous tissue inside and around HDPP stabilize the upper lateral cartilages and septum in their new corrected position and maintain the corrected/straightened position. This material was used in 20 patients with crooked noses (9 with C-type and 11 with S-type noses). During a mean follow-up period of 18 months (range, 8-30 months), there were no complications, recurrences, or extrusions. Functional evaluation was performed using a visual analog scale before surgery and 6 months after surgery. Patients were asked to score their nasal breathing on a scale ranging from 0 to 100. The mean preoperative value was 32.50% +/- 11.18%, and the postoperative value was 88.75% +/- 8.71%. In conclusion, the use of custom-made HDPP extended spreader grafts is a safe, effective, reliable, and permanent method for correction of the crooked nose. In the long term, the authors believe that custom-made HDPP extended spreader grafts provide functional recovery and increased strength against further trauma or forces of scar contracture, and have the ability to prevent recurrence attributable to cartilage memory.
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    Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty
    (Springer, 2006) Gurlek, A; Fariz, A; Aydogan, H; Ersoz-Ozturk, A; Eren, AT
    A double-blind, randomized trial with placebo control was planned to evaluate the effects of corticosteroids (betamethasone, dexamethasone, methylprednisolone) in approximately equivalent doses (8 mg dexamethasone/day), and to compare their effects with that of tenoxicam, an antiinflammatory drug, on both the edema and ecchymosis in open rhinoplasty with osteotomies. For this study, 40 patients were divided randomly into five groups of 8 patients each, which received, respectively, betamethasone (group 1), dexamethasone (group 2), methylprednisolone (group 3), tenoxicam (group 4), and placebo (group 5). Open rhinoplasty with osteotomies was performed by the same surgeon with the patient under general anesthesia. Drugs were administered just before the induction of anesthesia and continued for 3 days. Only acetaminophen was used to control postoperative analgesia. Digital photographs of each patient were taken on postoperative days 1, 3, and 7. Scoring was performed separately for eyelid swelling and ecchymosis by three observers independently using a graded scale from 0 to 4. No statistically significant differences existed among the five groups in terms of age, sex, duration of surgery, amount of bleeding, and intravenous fluid administration during the surgery. On postoperative days 1, 3, and 7, no differences in the levels of ecchymosis or edema among the steroid groups, the tenoxicam group, and the control groups were observed. In conclusion, the authors observed no significant differences among the different kinds of steroids administered in equivalent doses (8 mg dexamethasone/day). Steroids used in these doses were not effective in preventing or reducing edema and ecchymosis after open rhinoplasty with osteotomies. Tenoxicam also was not effective. No complications caused by the use of steroids were observed during the 6-month follow-up period.