The multiplication of scientific articles related to the fast-growing interest in preservation rhinoplasty (PR) may lead to confusion in the decision-making process, thus requiring a need for guidelines through a focus on benefit-risk ratio and revisions. This study analyzes a 352 consecutive primary rhinoplasties series during a 3 year (2016 to 2019) period with 1-year follow-up. The evaluation of the most appropriate procedure to the patient\'s nasal anatomy and expectations requires to correlate (1) a convenient classification of nasal profile lines; (2) a review of the dorsum preservation techniques (DP) classified as: full DP, DP + resurfacing, bony cartilaginous disarticulation, and finally traditional rhinoplasty; (3) the role of septoplasties, subdividing this series in two main groups; (4) analyzing the revisions in the different subgroups and to the literature. Thirty-five revisions (9.94%) were done. Correlations between profile lines, surgical procedures, and revisions show (1) 129 straight noses underwent full DP in 88 cases with 5.68% revisions; however, DP+ hump resurfacing in 32 patients with no revision. (2) Among 71 tension noses, 33 underwent full DP with 6 revisions (18.18%), while 32 patients had bony cap resurfacing, 1 revision (3.13%). (3) Among 109 kyphotic noses, 64 patients underwent DP + resurfacing with 10 revisions (15.63%); 27 patients had cartilage-only DP with two revisions (7.41%). (4) In the 43 difficult noses group, revisions were done equally in DP + resurfacing and cartilage-only subgroups. Septum stability modifies the correlations, introducing Cottle\'s septorhinoplasty in the paradigm. The revision rate is jumping ×2.50% when a septoplasty is associated with the rhinoplasty. Correlated to the benefit-risk ratio and the revisions, the following guidelines may be suggested in primary rhinoplasty: (1) Straight noses: full DP, (2) tension noses: DP + dorsum resurfacing and/or Cottle\'s variations, (3) kyphotic noses: cartilage-only DP, and (4) difficult noses: traditional rhinoplasties.

OBJECTIVE: To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction.
METHODS: An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus.
RESULTS: The group defined nasal septoplasty as a surgical procedure designed to correct a deviated nasal septum for the purpose of improving nasal function, form, or both. After 2 iterative Delphi method surveys, 20 statements met the standardized definition of consensus, while 13 statements did not. The clinical statements were grouped into 8 categories for presentation and discussion: (1) definition and diagnosis, (2) imaging studies, (3) medical management prior to septoplasty, (4) perioperative management, (5) surgical considerations, (6) adjuvant procedures, (7) postoperative care, and (8) outcomes.
CONCLUSIONS: This clinical consensus statement was developed by and for otolaryngologists and is intended to promote appropriate and, when possible, evidence-based care for patients undergoing septoplasty with or without inferior turbinate reduction. A complete definition of septoplasty with or without inferior turbinate reduction was first developed, and additional statements were subsequently produced and evaluated addressing diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes. Additionally, a series of clinical statements were developed, such as \"Computed tomography scan may not accurately demonstrate the degree of septal deviation,\" \"Septoplasty can assist delivery of intranasal medications to the nasal cavity,\" \"Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty,\" and \"Quilting sutures can obviate the need for nasal packing after septoplasty.\" It is anticipated that the application of these principles will result in decreased variations in the care of septoplasty patients and an increase in the quality of care.

Use of nasal continuous positive airway pressure (CPAP) is increasing as a means of respiratory support for respiratory distress syndrome in many premature neonates across the United States. Nasal CPAP is less invasive and may be as effective as mechanical ventilation in premature infants, and has been shown to cause less lung damage in premature neonates. Because of the increased use of nasal CPAP in neonates, especially younger and more fragile neonates, the presence of nare and nasal septum breakdown may be seen as a complication. Currently, all nasal CPAP systems use a hat and prong or mask type of delivery system. This appears to be effective for many neonates, but for some, it is difficult to appropriately fit the hat and prongs. The result of an inappropriately fitted device can be mild to severe nare and nasal septum damage. This article will discuss the need for nasal CPAP and the mechanics of nasal CPAP, but more importantly, serve to guide caregivers in the appropriate physical assessment and care of a neonate on nasal CPAP with the goal of preventing skin breakdown and nasal damage.

A multidisciplinary working group of experts met in 2006 in order to establish a list of recommendations concerning the aesthetic and functional rhinoplasties. These experts tried to answer various practical problems while relying, on one hand, on a critical analysis of the literature, and on the other hand, on a consensus within the group. Six topics were approached. The management of the preoperative consultation, the surgical environment, the contra-indications, the materials used, the management of the post operative period, some particular pathological situations. This collective reflexion thus did not relate to the surgical techniques but to the methodology of treatment of patients who are candidates for rhinoplasty. It comes out clearly from this collective work that surgical indication can only be addressed after having clarified all the technical and psychological aspects. The use of computer graphics is recommended. Cartilage autograft are recommended as a priority.

Repair of the twisted nose presents a challenge, as often functional problems as well as aesthetic deformities must be addressed. Traditional correction of the deviated nose involves septal correction, separation of both upper lateral cartilages from the septum and bony pyramid manipulation after osteotomies. Nowadays autogenous cartilage grafts are being used for repositioning, reinforcement, recontouring and reconstruction of virtually every component of the nasal skeleton. These restructuring techniques follow the modern principles mentioned above and may well be applied to the deviated asymmetric nose. The grafting manoeuvres increase the stability of the realigned cartilaginous nasal framework, including the nasal septum, but may also be used for camouflaging purposes. The large number of possible individual anatomic variations including facial asymmetry does call for a systematic approach based on succinct individualised analysis.