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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e318255021e
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Training Rhinoseptoplasty, Sinusectomy, and Turbinectomy in an Animal Model

Dini, Prof. Dr. Gal Moreira; Gonella, Prof. Dr. Hamilton Aleardo; Fregadolli, Leandro M.D.; Nunes, Bruno M.D.; Gozzano, Ricardo M.D.

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Division of Plastic Surgery, Pontifícia Universidade Católica de São Paulo–PUC/Sorocaba/Brazil, São Paulo, Brazil

Correspondence to Prof. Dr. Dini, Division of Plastic Surgery of the Pontifícia Universidade Católica de São Paulo–PUC/Sorocaba/Brazil, Rua Vicencia Faria Versage, 318, Sorocaba, São Paulo, Brazil 18031-080 dr.gal@uol.com.br

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Sir:

Surgery in the nose, turbinates, or sinus represents a large series of challenges to the otolaryngologist, head and neck surgeon, or plastic surgeon. Different from other operations, a single millimeter can be the difference between perfection and an undesired result, which can occur even in expert hands. The nose presents extras challenges because both functional the aesthetic problems must constantly be addressed, and the healing process can distort the achieved perfect surgical result.14 Skill with these operations requires a long learning curve, which can sometimes cause, especially for the apprentice, problematic results. Traditionally, rhinoplasty performed for either aesthetic or functional purposes is often performed simultaneously with septoplasty and partial inferior turbinectomy. These will decrease the nasal resistance as treatment for chronic nasal airway obstruction refractory to other, more conservative methods of treatment. We propose the use of a sheep head as a model to simulate the technical steps of rhinoseptoplasty, sinusectomy, and turbinectomy.

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Domestic sheep heads were obtained from a local butcher shop and preserved in a freezer. Before dissection, the frozen head was kept for 10 minutes in a sink with running water (nearby temperature, 68 to 77°F) over its nose. Then, it was dried superficially with paper towel (kitchen roll) and placed in a plastic food storage container.

A V-shaped incision was performed in the middle portion of the skin of the columella extending to the cutaneous margin of the upper lateral crura. Then, we elevated the skin flap of the nasal dorsum at the level closest to the cartilage with a curved and delicate scissors. After this, a precise anatomical dissection of the nasal cartilages and bones of the model as is normally performed in human nose anatomical dissections was performed to identify similarities and discrepancies between the human and the animal model.

The caprine model has the benefit of similar structures such as bones, cartilages, and ligaments that can be dissected in a reproducible manner and modeled in different shapes as described in the literature for humans. There is plentiful septal cartilage for practicing a variety of grafts. Inferior turbinectomy was easy to perform, and the middle and superior were also at full range (Figs. 1 and 2).

Fig. 1
Fig. 1
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Fig. 2
Fig. 2
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Surgical outcome is determined by patient satisfaction with the result, resolution of symptoms, recurrence of disease, and need for revision or additional surgery. The anatomy of the nose and nasal cavities of the sheep was established in detail to constitute a guide for researchers as a convenient experimental model for operations. It can provide repeated training for rhinoseptoplasty, turbinates, and sinus procedures with all stages similar to those performed on humans at very low cost and with the possibility of surgical simulation even at home. This model has the potential to improve outcomes for clinical experience on human patients, providing greater opportunities for training in a procedure that requires knowledge, precision, and artistry.5

Prof. Dr. Gal Moreira Dini

Prof. Dr. Hamilton Aleardo Gonella

Leandro Fregadolli, M.D.

Bruno Nunes, M.D.

Ricardo Gozzano, M.D.

Division of Plastic Surgery, Pontifícia Universidade Católica de São Paulo–PUC/Sorocaba/Brazil, São Paulo, Brazil

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

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REFERENCES

1. Gunter JP, Rohrich RJ, Adams WP Jr. Dallas Rhinoplasty: Nasal Surgery by the Masters. 2nd ed. St. Louis: Quality Medical; 2007.

2. Gunter JP, Yu YL. The tripod concept for correcting nasal-tip cartilages. Aesthet Surg J. 2004;24:257–260.

3. Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: The importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg. 2004;114:1298–1308; discussion 1309–1312.

4. Dini GM, Albuquerque LG, Ferreira LM. The future of rhinoplasty and the Dallas rhinoplasty symposium. Plast Reconstr Surg. 2009;123:64e–65e.

5. Dini GM, Ferreira LM. Rhinoplasty and PubMed. Plast Reconstr Surg. 2006;118:289.

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