Deviation in the Standard of Care During Rhinoplasty (Nose Job)

Evaluate breaches in the standard of care to evaluate a Deviation in the Standard of Care During Rhinoplasty (Nose Job)

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a medical history obtained?
    Yes
    No
    Answer unknown
    Why is this important?
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's care and enables the clinician to make the most judicious use of additional tests. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions and continued care.
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  • With which of the following risk factors did the patient present? Why is this important?
    Answer this question
    Current use of cocaine is an absolute contra-indication for rhinoplasty. Not only are current cocaine users prone to surgical site failure, they are also at increased risk for anesthetic complications.
    (2009) 42 EOTCNA 3 483-493

  • Was a psychological evaluation obtained prior to surgery? Why is this important?
    Answer this question
    Body dysmorphic disorder (BDD) occurs in approximately 5% of patients seeking cosmetic surgery. Cosmetic surgery is not generally recommended for patients with BDD..
    (2003) 56 EJPRAS 6 546-551

  • Was a complete physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk.
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  • Was an internal nasal evaluation performed? Why is this important?
    Answer this question
    An internal nasal examination must include direct inspection with a nasal speculum and possibly fiber-optic nasal examination, when warranted.
    (2005) 23 EDERMC 3 529-540

  • Were pre-operative photographs obtained? Why is this important?
    Answer this question
    Standardized pre-operative and post-operative photo-documentation is essential both in the analysis, and the evaluation of the results.
    (2005) 23 EDERMC 3 529-540

  • Which of the following diagnostic laboratory studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    A preoperative basic health assessment is typically performed within 30 days of planned surgery. At least a limited assessment is mandated by the Joint Commission on Accreditation of Healthcare Organizations on all patients, but a more thorough evaluation is necessary to obtain a comprehensive view of patient risk factors.
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  • Was the desired surgical outcome discussed with the patient and documented? Why is this important?
    Answer this question
    It is imperative that the surgeon clearly delineates the limitations of the proposed procedure.
    (2005) 23 EDERMC 3 529-540

  • Were the potential risks and complications explained to the patient? Why is this important?
    Answer this question
    The risks of visible intranasal or external scarring need to be explained. If scar revision is required, this must also be discussed and documented.
    (2005) 23 EDERMC 3 529-540

  • Was a pre-operative evaluation performed? Why is this important?
    Answer this question
    The surgical planning for each case must be tailored to the unique deformities and functional problems presented.
    (2005) 23 EDERMC 3 529-540

  • Was an informed consent obtained? Why is this important?
    Answer this question
    The laws of most states require that surgeons obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • What type of surgery was being performed? Why is this important?
    Answer this question
    Rhinoplasty may be performed to improve the function of the nose, (reconstructive) the appearance of the nose (cosmetic), or a combination of both where a trauma has occurred.
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  • Which of the following surgical techniques was utilized? Why is this important?
    Answer this question
    When surgical factors and the patient’s expectations are assessed accurately, the most favorable incisions, approach, and tip sculpture technique can be chosen.
    (2004) 12 EFPSCN 1 51-80

  • Was the surgical technique utilized appropriate for the patient? Why is this important?
    Answer this question
    Patients who need only conservative or minimal tip refinement and rotation are approached with a non-delivery (cartilage-splitting or retrograde eversion) approach.
    (2004) 12 EFPSCN 1 51-80

  • Was proper post-operative positioning of the patient maintained? Why is this important?
    Answer this question
    The patient must be maintained in the reverse Trendelenburg position with the head elevated (supine position with head is higher than the feet).
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  • Was post-operative care provided? Why is this important?
    Answer this question
    The care of a patient after rhinoplasty is directed toward patient comfort, reduction of swelling and edema, patency of the nasal airway, and splint compression with stabilization of the nose.
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  • Was oral decongestant therapy recommended post-operatively? Why is this important?
    Answer this question
    Patients awake in the recovery room with an intra-nasal dressing in place and are unable to breathe through the nose. Post-operative prescriptions must include oral decongestants, an antibiotic and nasal saline spray.
    (2005) 23 EDERMC 3 529-540

  • Were verbal and written discharge instructions provided? Why is this important?
    Answer this question
    Discharge instructions must include a brief time-line of the healing process, self-care issues and any behavioral restrictions, such as no nose blowing, no straining, and no manipulation of the nose. The patient must sleep with a slight elevation of the head. The patient must abstain from engaging in any contact sports or other activity that may lead to nasal trauma, for at least four weeks after the surgery.
    (2005) 23 EDERMC 3 529-540

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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