The midline central artery forehead flap: a valid alternative to supratrochlear-based forehead flaps.

Importance: This study clarifies the pedicle geometry and vascular supply of a midline forehead flap for nasal reconstruction. It reports on the vascular reliability of this flap and its ability to reduce hair transposition to the nose, a major complicating factor of previous forehead flap designs.

Objective: To compare the vascular reliability of 3 different pedicle designs of the forehead flap in nasal reconstruction (classic paramedian, glabellar paramedian, and central artery flap design) and evaluate hair transposition rates and aesthetic results.

Skin graft survival on subcutaneous hinge flaps: an algorithm for nasal reconstruction.

Objectives/hypothesis: To assess the survival of full-thickness skin grafts and perichondrial cutaneous grafts when placed on subcutaneous soft tissue flaps used in nasal reconstruction.

Study Design: Retrospective case series from a secondary-care cutaneous cancer practice.

Methods: Twenty-eight patients with nasal defects secondary to basal cell carcinoma excision were included.

Defining the protruding ear.

Objective: Although protruding ears are one of the most frequently occurring congenital deformities in the craniofacial area, there is no clear consensus in literature as to the definition. Our aim was to provide a clear delineation for the definition of prominent ears, deduced from the anthropometry of normal (nonprotruding) ears.

Methods: We performed a prospective cohort study to assess the anatomy of the normal auricle in children using computer-assisted anthropometry in photographs of 102 children aged 5 to 18 years.

New insights into facial anthropometry in digital photographs using iris dependent calibration.

Background: In facial and reconstructive surgery objective assessment of anatomy is crucial to evaluate surgical results. Photographic computer-assisted anthropometry substitutes clinical measurements. The constancy of the horizontal iris diameter (IDh) allows iris dependent calibration of photographs, replacing the need for a scale.

Reconstruction of nasal tip and columella.

Reconstruction of nasal tip and columella defects is demanding area with a range of reconstructive options, varying in complexity depending on requirements from simple skin grafting to multiple stage reconstruction with regional flaps. A framework is suggested to aid the reader in choice of reconstruction by classifying the defect based on size and the requirements of one to three layer (full thickness) reconstruction.

Eighteen years of experience in Mohs micrographic surgery and conventional excision for nonmelanoma skin cancer treated by a single facial plastic surgeon and pathologist.

Objectives/hypothesis: To determine and compare the efficacy of Mohs micrographic surgery (MMS)- and conventional excision (CE)-confirmed resection of nonmelanoma skin cancers (NMSCs).

Study Design: Retrospective cohort study.

Methods: A retrospective cohort study of NMSCs treated in a tertiary referral center by a single facial plastic surgeon and a group of five histopathologists over an 18-year period.

Full-thickness skin grafts and perichondrial cutaneous grafts following surgical removal of cutaneous neoplasms of the head and neck.

The objective of the study is to determine efficacy in terms of survival rate and cosmesis of "normal" full-thickness skin grafts (FTSGs) as compared to perichondrial cutaneous grafts (PCCGs) in facial reconstruction. A chart review of all facial reconstructions using FTSGs and PCCGs between 1995 and 2005 was undertaken. All patients were treated by the same surgeon.

Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence.

Background: There is no consensus about the value of objective measurements of nasal patency.

Objective: To assess the correlation between the subjective sense of nasal patency and the outcomes found with rhinomanometry and acoustic rhinometry.

Type Of Review: Structured literature search.

Free cartilage grafts and healing by secondary intention: a viable reconstructive combination after excision of nonmelanoma skin cancer in the nasal alar region.

Objective: To assess the feasibility and outcome of free cartilage grafts left to heal by secondary intention in the reconstruction of nasal alar skin defects.

Design: We describe the retrospective analysis of 13 patients who were treated in a single department with the use of free cartilage grafts in combination with secondary intention healing for reconstruction of the alar subunit and lateral nasal wall defects after Mohs surgery for cutaneous cancer. Outcome measures included patient and surgeon satisfaction, alar retraction, cartilage extrusion, nasal valve collapse, revision rate, and time to healing.

Secondary intention healing after excision of nonmelanoma skin cancer of the head and neck: statistical evaluation of prognostic values of wound characteristics and final cosmetic results.

Background: Most data on secondary intention healing of skin cancer defects in the head and neck are empirical and descriptive. This study statistically evaluates the prognostic value of several wound characteristics and location on the final cosmetic result of skin defects left to heal by secondary intention after tumor removal.

Methods: A chart review of all facial reconstructions using secondary intention healing performed in one center between 1992 and 2001 was undertaken.

Nasal valve surgery; our experience with the valve suspension technique.

Objective: To describe and evaluate our experience with the surgical technique of nasal valve suspension for treating nasal valve insufficiency.

Methods: Twenty patients with nasal valve insufficiency underwent nasal valve suspension (a total of 33 sides). The patients were prospectively studied and their nasal patency was rated per side pre- and postoperatively, by subjective self-evaluation on a scale from 1 to 10.

Reconstruction of nasal sidewall defects after excision of nonmelanoma skin cancer: analysis of uncovered subcutaneous hinge flaps allowed to heal by secondary intention.

Objective: To describe the experience of a single department using uncovered subcutaneous hinge flaps to repair the nasal portion and adjacent facial subunits of defects after skin tumor excision.

Design: Case series of 16 patients needing reconstruction for lesions of the alar subunit with 1 or more adjacent facial subunits after Mohs surgery for cutaneous malignant neoplasms.

Results: All flaps healed well by secondary intention, and the results were gauged at least satisfactory by the patients and surgeons.

Reconstruction of dorsal and/or caudal nasal septum deformities with septal battens or by septal replacement: an overview and comparison of techniques.

Objectives: The objectives of this study were to describe and compare two techniques used to correct nasal septum deviations located in the dorsal and/or caudal septum.

Study Design: The authors conducted a retrospective clinical chart review.

Methods: The authors conducted a comparison of functional and technical results between surgery in the L-strut of the septum in 114 patients with septal battens or by septal replacement by subjective self-evaluation and by examination of the position of the septum during follow up.

Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines.

In this article, we briefly review the aetiology and symptoms of nasal septal perforations, and focus on a surgical reconstruction technique of which the results were retrospectively studied. The technique described, involves the interposition of a connective tissue graft between differently designed local mucoperichondrial and/or mucoperiosteal flaps on each side of the perforation, thereby preventing opposing suture lines. On one side a rotation/advancement flap is derived from the septum, the nasal floor and lateral nasal wall while in the opposite nasal passage, bipedicled flaps from the septum and nasal floor and/or from the superior septum and under-surface of the upper lateral cartilage are created.

Sub-alar batten grafts as treatment for nasal valve incompetence; description of technique and functional evaluation.

Objective: To describe and evaluate the functional results of a surgical technique for treating nasal valve incompetence, in which a cartilage graft called a sub-alar batten graft is placed along the undersurface of the lateral crus of the lower lateral cartilage.

Methods: The functional outcomes of 27 patients who had sub-alar batten grafts placed on 39 sides were evaluated by means of clinical examination and subjective self-assessment.

Results: Of a total of 39 sides operated upon, 10 (26%) were rated as optimal, 15 (39%) as improved, 13 (33%) as equal and 1 (2%) as worse.

[The feasibility of the razor-blade shave technique in the diagnosis and treatment of benign and malignant skin lesions on the face].

The razor-blade shave technique uses a slightly-curved classic razor blade to shave and remove the exophytic part of a skin lesion and part of the intradermal structure down to the stratum papillare. It can then be sent for pathology investigations. This treatment is curative for many benign skin conditions.

Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum.

Objective: To describe and evaluate results of a surgical procedure to treat internal nasal valve insufficiency with the use of spreader grafts placed via an endonasal approach without division of the upper lateral cartilages from the nasal septum.

Design: Eighty-nine patients with complaints of nasal obstruction, at least partially due to internal nasal valve insufficiency, underwent this operation on 120 sides in a private practice setting. Only autologous material was used, and 3 different techniques for fixating the grafts were evaluated.

Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions.

Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear. In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage.

Bone resorption after alloplastic augmentation of the mandible.

Augmentation mentoplasty is a commonly performed operation especially in conjunction with rhinoplasty. While various materials have previously been used for this procedure, silastic has been the implant of choice for the last three decades. Concerns have been raised due to the occurrence of bone resorption beneath these implants.

Mohs micrographic surgery for facial skin cancer.

Although it is well established that conventional treatment modalities generally result in high cure rates for non-melanoma skin cancer, it has been demonstrated over recent decades that the highest overall cure rates are achieved using Mohs micrographic surgery. The key to Mohs surgery is the excision and control of complete peripheral and deep resection margins in one plane, allowing orientation, mapping and re-excision of microscopic tumour extension. These extensions can be followed without sacrificing inappropriate amounts of normal tissue, yielding high cure rates and maximum preservation of tissue.

Augmentation of the nasal dorsum using Gore-Tex: intermediate results of a retrospective analysis of experience in 66 patients.

Out of the numerous implant materials that have been used for augmentation of the nasal dorsum, autogenous cartilage is considered to be the optimal grafting material due to its versatility and long-term survival. However, in the case of extensive augmentation often an alternative grafting material is needed. Homologous cartilage seems an attractive option, but is not commonly used because of the fear of disease transmission, the long-term unpredictability and the possibility of warping.