The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty.

Background: A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors' objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty.

Effect of depressor septi resection in rhinoplasty on upper lip length.

Importance: Resection of the depressor septi in rhinoplasty has been used to correct the smiling deformity. Studying the effects of this maneuver on the upper lip length is important for operative planning, as well as for patient counseling.

Objective: To define an approach to the resection of the depressor septi muscle during functional and aesthetic rhinoplasty and to determine whether performing this maneuver causes any measureable change in the length of the upper lip in the repose position.

The subalar graft and its role in nasal tip medialization and improved nostril symmetry.

Objectives: Relationships between nasal axis deviation and lower midfacial asymmetry or hypoplasia have been established in prior studies. We describe our experience with the subalar grafting technique in addressing nasal tip deviation associated with facial asymmetry. Indications in using this graft in isolation or in conjunction with other tip modification techniques are also investigated.

The effect of facial asymmetry on nasal deviation.

The impact of facial asymmetry on nasal deviation is an accepted but poorly understood part of plastic surgery and rhinology training. Recently, an increased understanding of the specific structural issues underlying this deformity has led to improved surgical techniques and patient outcomes.

Effect of midfacial asymmetry on nasal axis deviation: indications for use of the subalar graft.

Objective: To test the hypothesis that midfacial asymmetry specifically relevant to nasal tip deviation will be reflected in the measured soft-tissue attachments of the ala to the face.

Design: Retrospective photographic analysis of 35 consecutive patients seeking functional or aesthetic nasal surgery regardless of cause.

Results: Nasal axis had a significant correlation with the alar-facial angle on base view photographs (P < .

Is Susac syndrome (microangiopathy of the inner ear, retina, and central nervous system) an underdiagnosed cause of sensorineural hearing loss?

Susac syndrome is a rare disorder caused by the development of microangiopathic lesions in the inner ear, retina, and central nervous system. Although relatively few cases have been reported in the literature, this diagnosis is becoming more frequent as physician awareness increases. A high index of suspicion is needed to make the diagnosis because the signs and symptoms of Susac syndrome are those of a wide range of differential diagnoses.

The tripod theory of nasal tip support revisited: the cantilevered spring model.

Objective: To extrapolate on the tripod concept to create a more universal and multiethnic model that includes common anatomical configurations and strategies to avoid certain unwanted surgical outcomes.

Methods: Analysis of current surgical methods, scientific studies, and predominant theories to produce a new model of nasal tip support based on the biomechanical properties of the nasal cartilages.

Results: The nasal tip acts as a cantilevered spring that associates with other rigid and semirigid regions of the nose.

Augmentation of nasal tip projection using the inferior turbinate: review of technique and evaluation of long-term success.

Objectives: To introduce the use of inferior turbinate bone as an alternative autograft for augmentation of nasal tip projection and to assess maintenance of nasal tip projection, bone remodeling, graft shaping, and ease of harvesting.

Methods: Thirteen consecutive patients in need of increased nasal tip projection underwent closed rhinoplasty during a prospective nonrandomized study in a university teaching hospital setting. An autologous demucosalized inferior turbinate bone graft was used as a columellar strut.

Correction of caudal deflections of the nasal septum with a modified Goldman septoplasty technique: how we do it.

Correcting deviations of the caudal septum can be challenging because of cartilage memory, the need to provide adequate nasal tip and dorsal septal support, and the longterm effects of healing. The authors describe a minimally invasive, endonasal approach to the correction of caudal septal deviations. The procedure involves a hemitransfixion incision, unilateral flap elevation, and cartilage repositioning by limited dissection and excision.

Defining nasal cartilage elasticity: biomechanical testing of the tripod theory based on a cantilevered model.

Objective: To define the modulus of elasticity for nasal septum, auricular, upper lateral, and lower lateral cartilages.

Methods: Prospective enrollment of sequential patients undergoing septorhinoplasty. Test samples were obtained through routine surgical interventions using atraumatic harvesting techniques.

Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention.

Objective: To provide rhinologic surgeons with an understanding of acute negative-pressure pulmonary edema (NPPE) and its treatment.

Design: Case report and literature review of all published adult cases of NPPE. Patient factors, anesthetic variables, and outcomes are assessed.

Perforating double lateral osteotomy.

Reshaping of the bony vault in primary and revision rhinoplasty is a simple, yet precise, maneuver that requires both skill and experience in creating predictable outcomes. Different methods for remodeling the nasal pyramid using various types of osteotomies have been devised to achieve narrowing, straightening, and reduction in nasal height. However, the current options of techniques including medial, transverse oblique, low to low lateral, low to high lateral, and intermediate osteotomies do not address all types of deformities encountered.

Midline necrotizing nasal lesions: analysis of 18 cases emphasizing radiological and serological findings with algorithms for diagnosis and management.

Background: The aim of this study was to assess the principal signs and symptoms for severe necrotizing midline nasal lesions and give diagnostic and management algorithms.

Methods: Literature review and retrospective chart review were performed. Three patients with Wegener's granulomatosis (WG), six patients with sarcoid, eight patients with cocaine abuse, and one lymphoma patient were analyzed with respect to symptom complexes, laboratory results, and radiographic findings.

Autologous cartilage grafts enhanced by a novel transplant medium using fibrin sealant and fibroblast growth factor.

Objective: To introduce and assess a system for the delivery of fibroblast growth factor to autologous cartilage grafts using fibrin sealant and analyze whether this "enhancement" results in reduced rates of cartilage resorption and greater preservation of normal architectural features compared with "unenhanced" cartilage grafts.

Methods: Auricular cartilage segments measuring 1 cm(2) were harvested from 12 New Zealand white rabbits, morselized, and implanted into the subcutaneous dorsum of the upper back for 3 months. The conditions included (1) cartilage alone; (2) cartilage + fibrin sealant; (3/4) cartilage + acidic or basic fibroblast growth factor (aFGF or bFGF); and (5/6) cartilage + fibrin sealant + aFGF or bFGF.

Preoperative parathyroid localization: correlating false-negative technetium 99m sestamibi scans with parathyroid disease.

Objective/hypothesis: The recent trend toward minimally invasive directed parathyroid surgery has increased the surgeon's reliance on preoperative parathyroid localization. Technetium Tc 99m sestamibi scanning is generally viewed as the gold standard for preoperative localization, with reported sensitivities of 75% to 100% and specificities of 75% to 90%. However, in each reported series there exists a group of patients in whom preoperative localization is either equivocal or negative.