Dr. Ahmed El-Guindy, MD - Professor of Otolaryngology-Facial Plastic Surgery, Tanta University, Tanta, Egypt

Rhinoplasty is the most intellectually and technically challenging ENT procedure. Rhinoplasty rewards clear creative thinking, careful planning and uncompromising surgical techniques. From a patientís perspective, it should meet his/her expectations and fulfill his/her satisfaction. From a surgeonís perspective, it should conform to aesthetic and functional standards. Many techniques were used to achieve these goals.

to evaluate the use of the operating microscope during open approach rhinoplasty for achievement of preoperative goals precisely and accurately.

Materials and Methods
A retrospective study was conducted on 82 patients with various nasal aesthetic deformities or functional deviations, for whom the operative microscope was used during incision, dissection, septum reconstruction, hump removal and alar cartilage remodeling. The results were checked against patientís expectations and satisfaction, and against conformance to aesthetic nasal measures and functional clinical parameters. Efficacy and Efficiency of the technique were evaluated.

91.4% of the surgeries met patientís expectations while 93.3% fulfilled patientís satisfaction. 85.4% of cases conformed to aesthetic nasal measures while 92.7% to functional clinical parameters.

Discussion and Conclusion
The use of the operative microscope during open approach rhinoplasty afforded a better illumination especially in the depth, stereoscopic vision and magnification that allowed better preservation of delicate structures and accurate dissection in the targeted planes. Moreover, as an extra advantage over endoscopy, both hands were free. It is user friendly as ENT surgeons are skilled in microsurgery. It is superb in photodocumentaion and unpreceded in training courses as it offers to trainees an image identical to what the surgeon sees. Therefore, the introduction of the operating microscope is a value-add to achieve effective and efficient rhinoplasty in a precise and accurate manner.

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