Twisted Nose: Preservation Rhinoplasty with Modified Push-Down/Let-Down Technique.

Background: The authors present a retrospective, comparative, and analytical cohort study, that aimed to prove the utility of unilateral or asymmetrical bony wedge resection to straighten the twisted nose as applied in let-down and push-down methods. The study involved objective angle measurements preoperatively and postoperatively on frontal view photographs.

Methods: Preoperative and postoperative angle measurements were made on frontal view photographs of 78 patients with twisted noses classified as type C and type I.

Preservation Rhinoplasty: The Endonasal Cottle Push-Down/Let-Down Approach.

Preservation rhinoplasty is a new term for an old technique. The authors have used the endonasal push-down and let-down techniques that are attributed to Dr Maurice Cottle throughout their careers on select patients with excellent success. The endonasal Cottle technique allows the authors to manage the nasal dorsum in a conservative fashion, reducing the need for routine restructuring of the middle third and nasal dorsum.

History of Dorsal Preservation Surgery: Seeking Our Historical Godfather(s) for the "Push Down" and "Let Down" Operations.

There are 2 approaches for lowering the osseocartilaginous nasal dorsum. The most frequently used method includes resection of the osseocartilaginous nasal dorsum. The second method is based on preservation of the osseocartilaginous nasal dorsum.

Avoiding the Unhappy Patient by Building Rapport in the Internet Age.

The dynamics of the doctor-patient relationship has been complicated as more patients seem to expect perfection in this age of selfies and Internet postings. The preoperative patient interview is critical to recognize both body language clues and subtle but apparent red flags to avoid rhinoplasty on potentially unhappy patients. This interview should include routine use of a body dysmorphic disorder screening questionnaire since legions of these patients are undiagnosed prior to surgery and few, if any, are ever satisfied with even an excellent surgical result.

An immunologic test for chronic rhinosinusitis based on free intranasal eosinophilic major basic protein.

Background: A histologic hallmark of chronic rhinosinusitis (CRS) is an eosinophilic inflammation, present with and without nasal polyposis and independent of atopy. Eosinophils migrate through nasal tissue including the epithelium into the nasal airway mucus, where they form clusters and degranulate, releasing granule proteins including the toxic major basic protein (MBP). Specific biomarkers for CRS, which could be used as a diagnostic test for CRS with a high sensitivity and specificity, are presently lacking.

Foreign bodies in the airways: a meta-analysis of published papers.

Background: Very recently, some attempts have been made to start a systematic collection of foreign bodies (FB) in view of using them to characterize the risk of chocking in terms of size, shape and consistency of the FB. However, most of the epidemiologic evidence on foreign bodies in children comes from single-center retrospective studies, without any systematic geographical and temporal coverage. This paper is aimed at providing an estimate of the distribution of foreign body's injuries in children according to gender, age, type of FB, site of obstruction, clinical presentation, diagnostic/therapeutic procedures, complications, as emerging from a meta-analytic review of published papers.

Immunologic response to fungus is not universally associated with chronic rhinosinusitis.

In the December 2009 issue of this journal, Orlandi et al presented a study in which peripheral blood mononuclear cells (PBMCs) from chronic rhinosinusitis (CRS) patients (5 from Texas, 5 from Utah) and seven nonhealthy controls were stimulated with fungal extracts. Despite the small numbers, they confirmed important aspects of previous studies: 1) CRS patients' PBMCs react to certain fungal stimuli by producing significantly (P < 0.05) higher amounts of interleukin (IL)-5 and IL-13 when compared to controls; 2) CRS patients have an enhanced humoral response (significantly elevated immunoglobulin [Ig] G levels to Alternaria); and 3) CRS patients react independently from an IgE-mediated allergy, as evidenced by that fact that nonallergic CRS patients also produced IL-5 in response to fungal stimuli.

Diagnosis and treatment of chronic rhinosinusitis: focus on intranasal Amphotericin B.

Chronic rhinosinusitis (CRS) is a chronic disease that affects 14.2% of the US adult population. Despite being widespread, little is known about the etiology of CRS.

An alternative method of middle vault reconstruction.

Surgery of the nasal valves is a challenging aspect of rhinoplasty surgery. The middle nasal vault assumes an important role in certain aspects of nasal valve collapse. Techniques that address pathologies of the middle vault include the placement of spreader grafts and the butterfly graft.

Effects of the nasal muscles on the nasal airway.

Background: The nasal muscles and their function are not clearly defined. The nasal muscles generally are thought to act synergistically to produce mimetic motion and affect the nasal airway. We proposed direct examination of the effects of the nasal muscles on the nasal airway.

Striking deposition of toxic eosinophil major basic protein in mucus: implications for chronic rhinosinusitis.

Background: The mechanisms by which eosinophilic inflammation damages the epithelium and contributes to recurrent acute exacerbations in chronic rhinosinusitis (CRS) have not been fully elucidated.

Objective: We tested the hypotheses that eosinophils deposit toxic major basic protein (MBP) in the mucus and that MBP reaches concentrations able to damage the sinonasal epithelium.

Methods: Tissue specimens with mucus attached to the tissue were carefully collected from 22 patients with CRS and examined by using immunofluorescence staining for MBP.

New paradigm for the roles of fungi and eosinophils in chronic rhinosinusitis.

Purpose Of Review: Chronic rhinosinusitis represents a challenge with its poorly understood pathophysiology and limited treatment options. Potential roles of fungi and eosinophils in the etiology and pathophysiology of chronic rhinosinusitis are summarized.

Recent Findings: Previously, the fungal role in chronic rhinosinusitis was limited to the rare subgroup, allergic fungal rhinosinusitis.

Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft.

Objectives/hypothesis: The ideal material for reconstructing the nasal septum in the deficient nose has not been found. Since 1986, the authors have used autogenous cartilage from the cavum conchae to successfully correct the anterior septum and the associated cartilaginous saddle. The long-term results in 26 patients with a destroyed septum and a saddle nose are reported.

Computed tomography for constructing custom nasal septal buttons.

Objective: To determine the efficacy of computed tomography in creating custom nasal septal buttons.

Design: Retrospective chart review and telephone follow-up.

Setting: Tertiary care referral center.

Features of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the histopathology similar to asthma?

Background: Asthma and chronic rhinosinusitis (CRS) coexist clinically in >50% of patients with CRS. Although epithelial damage and basement membrane thickening are well-known features of airway remodeling in asthma, they have not been described in CRS.

Objective: In this study, we tested the hypothesis that histopathologic features of asthma, namely, the chronic eosinophilic inflammation, epithelial damage, and basement membrane thickening of the airway mucosa, are also present in sinonasal specimens from patients with CRS.

A grading system for nasal dorsal deformities.

There is no uniform grading system for nasal dorsal deformities currently in general use among surgeons who perform rhinoplasty. Given the popularity of this procedure among both the general public and surgeons, it is time that there was a uniform system describing dorsal deformities. Such a system has value in the education of students of rhinology and cosmetic nasal surgery.

The chemotactic behavior of eosinophils in patients with chronic rhinosinusitis.

Objective: To characterize peripheral eosinophil migration in patients with chronic rhinosinusitis in the presence of nasal mucin and nasal tissue extracts.

Study Design: Prospective, controlled, ex-vivo.

Methods: Peripheral blood eosinophils, nasal mucin, and nasal tissue were harvested at the time of sinus surgery in 10 patients, as well as obtained in 10 healthy control subjects.

Intranasal antifungal treatment in 51 patients with chronic rhinosinusitis.

Background: Chronic rhinosinusitis (CRS) is the most common chronic disease that is frequently refractory to treatment.

Objective: We sought to establish the safety and demonstrate the clinical efficacy of intranasal antifungal drug therapy in patients with CRS in a pilot trial.

Methods: A prospective open-label trial used amphotericin B as a medical treatment in 51 randomly selected patients with CRS.

Detection of fungal organisms in eosinophilic mucin using a fluorescein-labeled chitin-specific binding protein.

Background: The ability to identify fungal hyphae in patients with chronic rhinosinusitis (CRS) has been inconsistent. A new fluorescein-labeled staining method targets chitin found in fungal cell walls.

Objective: We hypothesize that this method would be able to more consistently detect fungi within the mucin of CRS patients.