Rhinoplasty. The Difficult Nasal Tip: Total Resection of the Alar Cartilages

There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices.     

Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review

Tip surgery, the most important part of the rhinoplasty procedure, has entered a new era in the past few decades. Various treatment protocols have been attempted. To date, however, opinions on the management of the Asian tip have not been solidified. To generalize and provide appropriate guidelines for the treatment of typical Asian tips, an English literature search from 1977 to March 2007 was conducted. Finally, a total of 26 papers were selected for review. The full text of each paper was read carefully, and data were extracted. Then all extracted information was imported into Microsoft Excel. Nine articles treating 11 groups of patients described the suitable techniques for Asian nasal tips, with 81.8% of the groups advocating that the protocol include a grafting technique, 64% reporting use of the grafting technique alone, and 9% applying cartilage reduction and a suturing technique. Of the 11 (18%) groups, 2 attempted more than one technique. Because of the Asian nasal tip's innate qualities, success with nasal tip plasty for Asians depends on the combined application of appropriate suturing, grafting, and defatting, with grafting techniques contributing the most.     

Effects of Different Corticosteroids on Edema and Ecchymosis in Open Rhinoplasty

A double-blind, randomized trial with placebo control was planned to evaluate the effects of corticosteroids (betamethasone, dexamethasone, methylprednisolone) in approximately equivalent doses (8 mg dexamethasone/day), and to compare their effects with that of tenoxicam, an antiinflammatory drug, on both the edema and ecchymosis in open rhinoplasty with osteotomies. For this study, 40 patients were divided randomly into five groups of 8 patients each, which received, respectively, betamethasone (group 1), dexamethasone (group 2), methylprednisolone (group 3), tenoxicam (group 4), and placebo (group 5). Open rhinoplasty with osteotomies was performed by the same surgeon with the patient under general anesthesia. Drugs were administered just before the induction of anesthesia and continued for 3 days. Only acetaminophen was used to control postoperative analgesia. Digital photographs of each patient were taken on postoperative days 1, 3, and 7. Scoring was performed separately for eyelid swelling and ecchymosis by three observers independently using a graded scale from 0 to 4. No statistically significant differences existed among the five groups in terms of age, sex, duration of surgery, amount of bleeding, and intravenous fluid administration during the surgery. On postoperative days 1, 3, and 7, no differences in the levels of ecchymosis or edema among the steroid groups, the tenoxicam group, and the control groups were observed. In conclusion, the authors observed no significant differences among the different kinds of steroids administered in equivalent doses (8 mg dexamethasone/day). Steroids used in these doses were not effective in preventing or reducing edema and ecchymosis after open rhinoplasty with osteotomies. Tenoxicam also was not effective. No complications caused by the use of steroids were observed during the 6-month follow-up period.     

Influence of Age on Rhinoplasty Outcomes Evaluation: A Preliminary Study

Background

The aim of this study was to evaluate the satisfaction of patients who underwent rhinoplasty by using the Rhinoplasty outcomes evaluation (ROE) questionnaire and determine the influence of patient age on the outcomes.

Methods

We conducted a longitudinal study to assess patients’ pre- and postoperative degrees of satisfaction with their results. The study was done at a tertiary-care medical center. The ROE questionnaire was applied twice in the same visit and aimed at measuring the patient’s satisfaction in both pre- and postoperative moments.

Results

The initial sample of this study was composed of 112 patients, 61 of whom have answered the ROE questionnaire. A mean difference of 50.5 (P < 0.0001) was observed between the pre- and postoperative satisfaction scores. No statistically significant difference was observed on the mean difference between pre- and postoperative satisfaction scores (CHANGE) according to sex (P = 0.673), the follow-up time period (P = 0.629), or the kind of surgical procedure (P = 0.904). The mean postoperative score of the <30-year-old group was lower than the mean of 30 to <50-year-old (P < 0.003) and ≥50-year-old groups (P < 0.009).

Conclusion

The ROE questionnaire is a tool for evaluating the outcomes of different surgical indications for correcting nasal deformities. The kind of surgical procedure had no influence on the mean difference between pre- and postoperative satisfaction scores. By using this tool we found that the younger age group reported lower postoperative satisfaction scores than older patients.

     

鼻整形术中应用自体耳软骨治疗鼻尖低平的效果和安全性

目的 探究鼻整形术中应用自体耳软骨治疗鼻尖低平的效果和安全性。方法 选取于河南大学附属 南阳南石医院2021年1月-2023年1月接受鼻整形手术治疗的100例患者为研究对象,以随机数字表法分为对 照组和观察组,每组50例。对照组应用膨体假体填充实施鼻整形手术治疗,观察组应用自体耳软骨实施鼻 整形手术治疗,比较两组临床疗效、鼻部形态改善情况及并发症发生率。结果 观察组临床治疗总有效率 为94.00%,高于对照组的80.00%,差异有统计学意义（ P ＜0.05）;观察组术后鼻长、鼻尖高度、鼻尖角、 鼻尖宽水平均优于对照组,差异有统计学意义（ P ＜0.05）;观察组并发症发生率为4.00%,低于对照组 的22.00%,差异有统计学意义（ P ＜0.05）。结论 鼻整形术中应用自体耳软骨治疗鼻尖低平可有效改善鼻 长、鼻尖情况,提高治疗效果,且并发症较少。     

Comparing the Clinical and Economic Impact of Laparoscopic Versus Open Liver Resection

Background  

Laparoscopic liver resection has thus far not gained widespread acceptance among liver surgeons. Valid questions remain regarding the relative clinical superiority of the laparoscopic approach as well as whether laparoscopic hepatectomy carries any economic benefit compared with open liver surgery.     

The Effects of Additional Tumor Cavity Sampling at the Time of Breast-Conserving Surgery on Final Margin Status,Volume of Resection,and Pathologist Workload

Introduction  

Margin status is an important prognostic factor for local recurrence after breast-conserving surgery (BCS) in patients with breast malignancy. It is unclear whether the removal of additional tumor cavity margins reduces the reoperation rate and is cosmetically acceptable. This study compares the reoperation rates, volume of breast excised in cm³, and number of pathology slides examined in two groups of patients who underwent BCS with or without four or five additional margins (BCS + M).     

Anatomic Variation of the Optic Strut: Classification Schema,Radiologic Evaluation,and Surgical Relevance

Objective Anatomic variability of the optic strut in location, orientation, and dimensions is relevant in approaching ophthalmic artery aneurysms and tumors of the anterior cavernous sinus, medial sphenoid wing, and optic canal.Methods In 84 dry human skulls, imaging studies were performed (64-slice computed tomography [CT] scanner, axial view, aligned with the zygomatic arch). Optic strut location related to the prechiasmatic sulcus was classified as presulcal, sulcal, postsulcal, and asymmetric. Morphometric analysis was performed.Results The optic strut was presulcal in 11.9% specimens (posteromedial margin bilaterally anterior to limbus sphenoidale), sulcal in 44% (posteromedial part adjacent to the sulcus''s anterior two thirds bilaterally), postsulcal in 29.8% (posteromedial margin posterior to the sulcus''s anterior two thirds), and asymmetric (left/right) in 14.3%. Optic strut length, width, and thickness measured 6.54 ± 1.69 mm, 4.23 ± 0.69 mm, and 3.01 ± 0.79 mm, respectively. Optic canal diameter was 5.14 ± 0.47 mm anteriorly and 4.79 ± 0.64 mm posteriorly. Angulation was flat (>45 degrees) in 13% or acute (<45 degrees) in 87% specimens.Conclusions Anatomical variations in the optic strut are significant in planning for anterior clinoidectomy and optic-canal decompression. Our optic strut classification considers these variations relative to the prechiasmatic sulcus on preoperative imaging.     

Perioperative Outcomes of Laparoscopic Repeat Liver Resection for Recurrent HCC: Comparison with Open Repeat Liver Resection for Recurrent HCC and Laparoscopic Resection for Primary HCC

World Journal of Surgery - This study aims to determine the safety and efficacy of laparoscopic repeat liver resection (LRLR) for recurrent hepatocellular carcinoma (rHCC). Twenty patients...     

Videothoracoscopic Resection of Encapsulated Thymic Carcinoma: Retrospective Comparison of the Results Between Thoracoscopy and Open Methods

Background  Although videothoracoscopic (VTS) resection of thymoma has been reported to be a less invasive technique than open sternotomy, the usefulness of this method in the treatment of encapsulated thymic carcinoma has not yet been evaluated. We retrospectively compared the VTS and open methods (median sternotomy) to investigate whether VTS resection could be performed as successfully as open surgery to treat resectable thymic carcinoma. Methods  Between November 2002 and March 2007 a retrospective review was made of eight patients (four women and four men) with Masaoka stage I and II encapsulated thymic tumor. Four patients (the VTS group) underwent tumor resection by means of a three-port endoscopic technique. The other four patients (the open group) underwent tumor excision via a standard sternotomy approach. The resected thymic carcinoma tissues were all confirmed by histopathological examination. Results  No patient died nor did any major morbidity or recurrence occur during the mean follow-up period of 3.76 ± 1.43 years. The open group sustained more blood loss (246.3 ml more) and pleural drainage time (5.7 days more), and were hospitalized for a longer period (12.5 days more). However in the open group the tumor size was larger (38.6 cm³ more ) and the mean follow-up time was longer (1.4 years more). Conclusion  These results have encouraged us to treat more patients with encapsulated thymic carcinoma by means of VTS resection.     

Use of Aerosolized Bovine-Prepared Fibrin Glue for Skin Fixation After Primary Open Rhinoplasty: A Prospective Randomized and Controlled Trial

Background Fibrin glue has been used in diverse areas of plastic surgery. To the authors’ knowledge, no clinical controlled trial studies have reported its use for open rhinoplasty. Methods A prospective, randomized, masked clinical trial was designed to demonstrate that aerosolized bovine-prepared fibrin glue used in open rhinoplasty controls skin fixation (flap movement), edema, hematomas, ecchymosis, bleeding, and cosmetic results 1 and 12 months postoperatively. The results were reviewed by two blinded plastic surgeons who assessed postoperative photographs using the Strasser score. Other items such as columella scar, pain, surgery/recovery time, and patient satisfaction also were evaluated. Results A computer system was used to randomize 22 consecutive open primary rhinoplasties. Cosmetic analysis did not differ significantly between the group redraped with fibrin glue and the control group. Patient satisfaction was the only outcome that significantly favored the active group. None of the other items or adverse events significantly differed between the two groups, including operative time and pain. Conclusions Fibrin glue is believed to reduce bleeding and to improve the adherence of tissues. The only statistical difference in this study favored the patient satisfaction cosmetic score of the group that received fibrin glue.     

关节镜与开放手术治疗青少年四肢骨软骨瘤的比较

目的探讨关节镜与开放手术治疗青少年四肢骨软骨瘤的疗效。方法回顾性分析2014年1月~2019年7月我院70例青少年四肢骨软骨瘤的临床资料,其中开放手术切除38例,关节镜下切除32例。比较2组手术时间、术中出血量、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后住院时间、并发症及复发率。结果与开放组比较,关节镜组术中出血少[(8.7±2.7)ml vs.(42.6±12.8)ml,t=-15.903,P=0.000],术后第1天疼痛VAS评分低[(2.4±0.8)分vs.(6.5±1.0)分,t=-18.328,P=0.000],术后住院时间短[(1.8±0.6)d vs.(4.0±2.2)d,t=-5.615,P=0.000],2组手术时间、并发症无显著差异(P>0.05)。2组随访3个月~5年,中位数22个月,均无复发。结论关节镜与开放手术切除青少年四肢骨软骨瘤均安全可行,但关节镜手术具有出血少、术后疼痛轻、住院时间短的优势。