title: The frequency of surgical maneuvers during open rhinoplasty.
abstract: BACKGROUND
  The improved exposure afforded by the external rhinoplasty approach has allowed for more precise surgical maneuvers and makes more consistent results possible. This study examines the frequency and array of surgical maneuvers during primary aesthetic rhinoplasty in a single surgeon's practice.
  
  
  METHODS
  A retrospective review of 100 consecutive primary external cosmetic rhinoplasty patients with a minimum follow-up of approximately 1 year was conducted. Surgical maneuvers were reviewed and tabulated. Special attention was devoted to the number of cartilage grafts and suturing techniques used. Operative times and incidence of revision surgery were investigated.
  
  
  RESULTS
  The mean duration of surgery was 1 hour 50 minutes. The majority of rhinoplasties involved concomitant septal surgery for deviation and airway occlusion or cartilage harvesting. Osteotomies were performed on over 95 percent of patients. The dorsal hump was removed on 84 percent of the patients. The most common grafts used included alar rim grafts in 88 percent, subdomal grafts in 77 percent, and spreader grafts in 74 percent. Sutures used to contour the cartilage included transdomal sutures in 62 percent, followed by footplate approximation sutures in 32 percent. Seventy-seven patients had interdomal sutures placed as a component of subdomal grafting.
  
  
  CONCLUSIONS
  The senior surgeon has found that common incorporation of certain maneuvers offers more consistent, aesthetically pleasing, and superior functional outcomes. Careful review of this article may guide the reader to consider the more frequent use of some maneuvers or reduction of other maneuvers to reflect that of a streamlined and higher-volume rhinoplasty practice.
authors.affiliation: Cleveland, Ohio From the Departments of Plastic Surgery and Otolaryngology, University Hospitals Case Medical Center.
authors.forename: Diana
authors.initials: D
authors.lastname: Ponsky
authors.forename: Yashar
authors.initials: Y
authors.lastname: Eshraghi
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009667:Nose Deformities, Acquired / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods / Q000706:statistics & numerical data*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult