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Rhinoplasty: Looking Good, Breathing Better

Dr. Tuckson speaks with plastic and reconstructive surgery specialist Dr. Ziad Katrib.
Season 15 Episode 2 Length 27:42 Premiere: 10/13/19

About

Join host Dr. Wayne Tuckson, a colorectal surgeon, as he interviews experts from around the state to discuss health topics important to Kentuckians.


Funding for this program is made possible in part by:


About the Host

A native of Washington, D.C., Dr. Wayne Tuckson is a retired colon and rectal surgeon based in Louisville. For more than 20 years, he has served as host for Kentucky Health, a weekly program on KET that explores important health issues affecting people across the Commonwealth. A graduate of Howard University School of Medicine, Tuckson is a past president of the Greater Louisville Medical Society and is a recipient of the Community Service Award from the Kentucky Medical Society, the Thomas J. Wallace Award for “Leadership in Promoting Health Awareness and Wellbeing for the Citizens of Jefferson County” given by the City of Louisville and the Lyman T. Johnson Distinguished Leadership Award given by the Louisville Central Community Centers.


Rhinoplasty: Looking Good, Breathing Better

The human nose is essential for respiration and is one of the main visual focus points during human interaction. Innovations in rhinoplasty – the surgical reconstruction of the nose – have enabled individuals to achieve a much higher quality of air flow as well as improved cosmetic appearance.

In this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes a Louisville facial reconstructive surgeon to discuss how rhinoplasty helps patients and review several successful case studies.

Dr. Ziad Katrib is an assistant professor for facial plastic reconstructive surgery in the department of head and neck surgery at the University of Louisville and is a member of U of L Physicians Group.

Katrib, who specializes in rhinoplasty, says that some of his patients need surgery to correct injuries, and some to remove skin cancer, but the main portion of his practice uses surgery to correct breathing deficiencies in patients who may also want to make cosmetic changes. Problems on the outside of the nose often indicate problems inside the air passageways too, Katrib notes.

“As ENTs (ear, nose, and throat doctors), we have a deeper understanding potentially of the functional consequences of those surgeries,” he says, “so for us, anyone having any nose surgery should breathe better – that’s the number one goal. Even if I see somebody with purely cosmetic desires, I ultimately can do some things in surgery to help them breathe better.”

Surgical Techniques for Rhinoplasty and Reconstructive Surgery

Many surgeries Katrib performs correct breathing difficulties caused by an issue with the septum. The septum is the wall between the two nostrils, made of bone and cartilage. In some patients, the septum is deviated or crooked and may have been that way since birth, or caused by injury. Other patients may have a hole in their septum causing air to pass between both passages inside the nose, often caused by intranasal drug use. Issues with the septum can affect the rest of the nose as well, even causing it to slide down out of position and closer to the mouth.

If Katrib needs to find tissue to replace part of the septum, he looks to the rib, to the ear, and to the scalp. He can insert this tissue where needed and eventually it will integrate with the rest of the nose. For patients with a broken nose where the septum has been pushed sideways, Katrib will place small casts (that are actually hoses) in the nasal passages once he has moved the septum back into place to hold it steady. No screws or wires are used, and the patient usually improves quickly after having the hoses inserted for a week and then removed.

An ancient surgical procedure is still widely used and effective for more complex surgeries that are reconstructive in nature, rather than repairing an intact nose. The “forehead flap” technique dates back almost 3,000 years and requires grafting skin from a person’s forehead down to the nose and then letting it gradually fill in the contour of the nose and replace the missing tissue.

“There’s a large amount of blood supply going to the forehead in a vertical fashion,” Katrib says, “so you can take a piece of tissue and rotate it down and make it the right shape, the right size, and the right thickness, and use that to replace the nose. It’s a multiple stage procedure.”

The tissue is left connected for four weeks. “During that time, it’s living off of an artery and vein that we find in the eyebrow with an ultrasound, so it has an umbilical cord, if you will, while it’s learning to live off of the nose,” Katrib explains. “During that time, there’s blood vessels growing into that flap, and then four weeks later, you can safely divide that umbilical cord and the flap will survive from the tissue in the nose.”

Katrib says that patients often ask him if their sense of smell will be affected by surgery. He says that most of the time their sense of smell will be more acute, and that can also make food taste better. Nasal surgery does not improve sleep apnea, a disorder where throat muscles relax and block regular respiration while a person slumbers, but it does enable patients with sleep apnea to use their CPAP machines (Continuous Positive Airway Pressure) more effectively and comfortably to keep breathing passageways open.

“I tell patients that the surgery, as far as the functional part, is for daily breathing – when you’re awake, walking around, living your life, or exercising, you’ll breathe better and you’ll smell better,” Katrib says.

Successful Case Studies: “The Nose Is the Priority”

Several slides from Dr. Katrib’s practice show the different types of rhinoplasty surgeries he performs, with often striking results:

  • A patient presented with significant closure of her left nasal passage due to a deviated septum, leaving a small slit to breathe through. Katrib was able to open up the nostril and align the septum properly, resulting in much improved breathing as well as symmetry for both nostrils.
  • Another patient required what is called a revision rhinoplasty. Her initial surgery to improve breathing and reduce a hump in her nose did not achieve desired results, and her nose was sliding down and causing her upper lip to turn inward. Katrib used rib cartilage and part of the patient’s scalp to re-adjust the nose and lift up the patient’s upper lip, as well as excising the hump and adding tissue to her nose tip.
  • An elderly patient presented with most of his left nostril, including the tip, missing. A farmer who spent a lot of time outdoors, he was diagnosed with basal cell carcinoma, the most common type of skin cancer. His cancerous tissue had been removed by a dermatologist using the Mohs technique, where the skin cancer is excised in layers and each layer is immediately examined using a microscope (often in the room where surgery is performed) until all cancer cells are completely gone. Katrib used a forehead flap to replace the missing tissue, as well as some cartilage from the man’s ear.

“You can replace 100 percent of the nose with the forehead,” Katrib says. “Now, you create problems in the forehead, but the interesting thing about the forehead is that its ability to heal is incredible, so we don’t skin graft the forehead. We leave the patients with a hole in their forehead. And we have them put ointment on it. By three months, most people have a pretty good-looking forehead… It seems counter-intuitive at times to make one hole to fix another, but our saying is, ‘the nose is the priority.’”

According to Katrib, the best recommendation for patients who want to prevent damage to their nose is obvious: wear sunscreen. But the doctor doesn’t stop with that simple tip. “Less obvious is using sunscreen when someone’s younger,” he says. “I don’t think that’s emphasized as much as maybe it should be. Many of these skin cancers take decades to form.

“Probably the most important thing is counseling parents to protect their kids from the sun – that’ll do a large part,” he adds. “I think that my generation, my children will have a much lower rate of skin cancer because of public awareness nowadays.”

Season 15 Episodes

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S15 E24 Length 27:25 Premiere Date 05/24/20

Pain Management and Treatment of Addiction

S15 E23 Length 26:55 Premiere Date 05/17/20

Intestinal Microbiome: Care and Feeding for Your Health

S15 E21 Length 25:51 Premiere Date 05/03/20

Health Care Networks

S15 E20 Length 27:11 Premiere Date 03/29/20

Diabetes: It's More Than Just Sugar

S15 E19 Length 26:56 Premiere Date 03/22/20

Filling Prescriptions: Why Can't I Just Buy Online?

S15 E18 Length 26:46 Premiere Date 03/15/20

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S15 E17 Length 27:03 Premiere Date 02/23/20

Rural Health Care Practices: Serving a Region In Need

S15 E16 Length 28:46 Premiere Date 02/15/20

Pediatric Anesthesia: Making Surgery Easier for Kids

S15 E15 Length 26:54 Premiere Date 02/09/20

Rehabilitation: Getting Back to the New Normal

S15 E14 Length 27:26 Premiere Date 02/02/20

Microclinic: Simple Solutions for Complex Problems, Part 2

S15 E13 Length 27:35 Premiere Date 01/26/20

Microclinic: Simple Solutions for Complex Problems, Part 1

S15 E12 Length 27:26 Premiere Date 01/19/20

Changing Curriculum to Meet Unique Patient Needs

S15 E11 Length 27:14 Premiere Date 01/12/20

Colon Cancer: Can We Prevent Unnecessary Deaths?

S15 E10 Length 26:56 Premiere Date 01/05/20

Infections and Other Urinary Tract Problems

S15 E9 Length 27:02 Premiere Date 12/15/19

Health Insurance for All: What Does It Mean?

S15 E8 Length 27:50 Premiere Date 11/24/19

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S15 E7 Length 28:42 Premiere Date 11/17/19

Natural Approaches to Health and Nutrition

S15 E6 Length 26:52 Premiere Date 11/10/19

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S15 E5 Length 27:37 Premiere Date 11/03/19

Breast Cancer: Determining Your Risk

S15 E4 Length 27:36 Premiere Date 10/27/19

Cystic Fibrosis: Improvements in Outcomes

S15 E3 Length 26:53 Premiere Date 10/20/19

Rhinoplasty: Looking Good, Breathing Better

S15 E2 Length 27:42 Premiere Date 10/13/19

Child Psychiatry

S15 E1 Length 27:15 Premiere Date 10/06/19

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