The Limits of Evidence in Rhinoplasty.

The broad trend toward minimally invasive methods in most surgical fields is contrasted by rhinoplasty: Extended open approaches, an increasing number of grafting techniques, donor site depletion, and extensive osteotomies seem to indicate a trend away from minimally invasive methodology for this particular procedure. This article intends to analyze which factors are involved in this and related developments in rhinoplasty.Evidence-based methodology sets the standards for scientific analysis.

Narrowing and Operated Appearance of the Middle Nasal Third after Hump Resection without Middle Vault Reconstruction.

Background: Little is known about the incidence of narrowing and an operated appearance of the dorsum after hump resections if the dorsum is not reconstructed with spreader grafts or spreader flaps.

Methods: Patients who had undergone a composite hump resection (n = 22) or a component hump resection (n = 25) were interviewed and photographed with a minimum follow-up of 12 months. Four expert rhinoplasty surgeons and four laypersons rated the appearance of the middle third of the dorsum on the preoperative and postoperative en face photographs.

The "Segmental SMAS Model": A Didactic Concept of Face and Neck Lift Anatomy.

Profound understanding of the surgical anatomy of the face and neck is the key to successful face lift surgery. The "Segmental SMAS Model" presented herein is the result of a decade-long effort in teaching fellows a logical and coherent anatomic model of face lift anatomy. The superficial musculo-aponeurotic system (SMAS) consists of segments with distinct surgical characteristics.

Minimally invasive techniques in rhinoplasty.

Purpose Of Review: To present criteria of minimally invasive surgery, which include minimal and hidden incision lines, reduced injury to tissue and application of endoscopic techniques, when feasible; to analyze techniques in rhinoplasty for their minimally invasive character - in light of recent publications; and to discuss the techniques that best meet the criteria of minimally invasive surgery.

Recent Findings: The nose consists of about 60 percent soft tissue and 40 percent skeletal elements. Surgery causes injury to both tissue types through various mechanisms, including mechanical traction, separation, incision, heat, desiccation, and others.

Finesse in Caucasian Endonasal Rhinoplasty: The S.O.F.T. Concept.

The nasal anatomy of Caucasian people includes thin skin, limited soft tissue volume, a high dorsum, strong cartilaginous framework, and narrow elliptical nasal inlets. A smooth dorsal contour, a well-defined tip, a naturally soft-feeling tip, and a functionally patent nasal valve constitute key objectives for Caucasian rhinoplasty. The author's focus on minimal-impact surgery has resulted in multiple novel techniques, embedded in a coherent algorithmic concept termed the S.

The Use of Botulinum Toxin Type A in the Healing of Thyroidectomy Wounds: A Randomized, Prospective, Placebo-Controlled Study.

Background: Recent research has indicated that botulinum toxin type A may have an inhibitory effect on the formation of fibroblasts and thus possibly decreases the severity of scar formation. Therefore, a trial was designed to assess the effects of botulinum toxin type A on scar formation after thyroid surgery.

Methods: A double-blind, randomized, controlled trial was designed.

Nuances in component nasal hump reduction.

Importance: Nasal hump reduction is a frequent manoeuvre in rhinoplasty. Over the last years, composite hump reduction has been advocated in favour of component hump reduction. The latter allows a more controlled and stepwise approach in reducing the nasal dorsum by deprojecting the cartilaginous dorsum separately from the bony dorsum.

Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance.

Background: Complete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor tissue and allows to identify residual tumor tissue could be Fluorescein Sodium.

Methods: Retrospective chart analysis on 7 patients with benign parotid gland lesions that were operated using Fluorescein Sodium intravenously and the application of the YELLOW 560 nm filter of the operating microscope.

Technique in Cleft Rhinoplasty: The Foundation Graft.

Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side.

A Co-Culture Model of Fibroblasts and Adipose Tissue-Derived Stem Cells Reveals New Insights into Impaired Wound Healing After Radiotherapy.

External radiation seems to be associated with increased amounts of cytokines and other cellular modulators. Impaired microcirculation and fibrosis are examples of typical long term damage caused by radiotherapy. Adipose tissue-derived stem cells (ASC) are discussed to enhance wound healing, but their role in wounds due to radiotherapy is poorly understood.

Safety Approach to Otoplasty: A Surgical Algorithm.

An algorithm was developed through an evolution of refinements in surgical technique with the goal to minimize risk and morbidity in otoplasty. Key principles were avoidance of cartilage incisions and transections and the use of multiple surgical techniques to distribute the "surgical load" evenly among these techniques. The present retrospective study was designed to test safety and efficacy of the concept in 100 consecutive patients and to discuss the results in light of the literature.

Minimally invasive surgery of the anterior skull base: transorbital approaches.

Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.

The stairstep graft: an alternative technique in nasal valve surgery.

Importance: The stairstep graft is a novel method to modify the lateral anchoring point of lateral grafts for nasal valve correction.

Observations: Eight consecutive patients with a diagnosis of nasal valve collapse were included in the study. The novel method of stairstep grafts was performed to reinforce the lateral crus and to widen the nasal valve.

Orbital compartment: effects of emergent canthotomy and cantholysis.

The objective of this study was to determine the effect of orbital decompression procedures on the intraocular pressure (IOP). The orbital compartment syndrome represents an emergency situation. Due to the elevated IOP vision loss may ensue.

Endoscopic forehead approach for minimally invasive benign tumor excisions.

Importance: Direct transcutaneous resection has been a widely accepted standard for the removal of benign forehead lesions. In recent years, the endoscopic approach has become more prevalent because of its noninvasiveness. To date, only a few studies with limited case numbers have reported on this technique.

Correcting the lobule in otoplasty using the fillet technique.

Importance: Correction of the protruded lobule in otoplasty continues to represent an important challenge. The lack of skeletal elements within the lobule makes a controlled lobule repositioning less predictable. OBJECTIVE To present a new surgical technique for lobule correction in otoplasty.

Effects of botulinum toxin A on patient-specific keloid fibroblasts in vitro.

Objectives/hypothesis: To test whether therapeutic effects of botulinum toxin A on patient- specific keloid tissue can be reproduced on the cellular level. Specifically, effects on cell proliferation and expression of growth factors and cytokines relevant for wound healing were to be tested.

Study Design: Experimental study including patient specific cell cultures of keloids.

Prelamination to reconstruct internal nasal lining.

The reconstruction of internal lining in nasal reconstruction is critical to the final result. Most established techniques carry important drawbacks, which include limited available lining surface area, compromise of nasal physiologic function, or donor site morbidity. In this report, we demonstrate a technique that is reliable, technically facile, and allows for the reconstruction of large surface areas: the creation of a bilaminated forehead flap by in situ split-thickness skin grafting.

Feasibility of the custom-made titanium cranioplasty CRANIOTOP(®).

Background: With decompressive craniectomy for ischemic stroke, traumatic brain injury, and skull-infiltrating tumors, the need for cranioplasty has increased. Different materials for custom-made cranioplasties have been evaluated, but a gold standard could not yet be established. We report our experience with the new custom-made titanium CRANIOTOP(®)cranioplasty (CL Instruments, Germany).

Netherton syndrome - Why ENT surgeons should be aware of this rare disease - report of a case.

Background: Comèl-Netherton syndrome is an inherited ichthyosis that is associated with highly impaired epidermal cornification and barrier function. Literature sparsely reports of the occurrence of early onset skin cancer in people with Netherton syndrome. To the best of our knowledge the suitability of the severely altered skin in patients with Netherton syndrome for techniques of facial plastic reconstructive surgery has not been discussed in literature yet.

Effects of external radiation in a co-culture model of endothelial cells and adipose-derived stem cells.

Background: The inflammatory response clinically observed after radiation has been described to correlate with elevated expression of cytokines and adhesion molecules by endothelial cells. Therapeutic compensation for this microvascular compromise could be an important approach in the treatment of irradiated wounds. Clinical reports describe the potential of adipose-derived stem cells to enhance wound healing, but the underlying cellular mechanisms remain largely unclear.

Preformed titanium cranioplasty after resection of skull base meningiomas - a technical note.

Introduction: Meningiomas of the fronto-basal skull are difficult to manage as the treatment usually includes extensive resection of the lesion, consecutive reconstruction of the meninges and of the skull. Especially after removal of spheno-orbital and sphenoid-wing meningiomas, the cosmetic result is of utmost importance. In this technical note, we present our institutional approach in the treatment of skull base meningiomas, focussing on the reconstruction of the neurocranium with individually preformed titanium cranioplasty (CRANIOTOP(®), CL Instruments, Germany).