Hyperplastic scars and keloids: part II: Surgical and non-surgical treatment modalities

Aberrant wound healing results in unsightly scarring, hypertrophic scarring, and keloid formation, causing functional and cosmetic deformities, discomfort, psychological stress, and patient dissatisfaction. Scar management, both surgical and non-surgical, continue to be important issues for the facial plastic surgeon. Many techniques for the management of hypertrophic scars and keloids have been proven through extensive use, but few are supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article presents an overview of the available therapies and provides recommendations for the treatment of abnormal scarring. The recommendations focus on the management of hypertrophic scars and keloids. Strategies for the management of keloids and hypertrophic scars are of continuing interest and studies are necessary to understand the basic mechanisms causing aberrant wound healing. In addition, an overview of new developments in molecular wound management and gene therapy, as they relate to facial plastic surgery, is provided.     

Tobacco and otorhinolaryngology: Epic and disaster

More than 500 papers are retrieved from the PubMed database by the keywords “Tobacco” and “Otorhinolaryngology”, none of which, however, is devoted to the history of a plant that has a major impact on our specialty and practice. The present report describes and analyzes how tobacco conquered the world, the conflicts it triggered and the impact it has had in our field over the past centuries.     

Anosmia: diagnosis and management

Disorders of the sense of smell can be frustrating for both the patient and physician. Ongoing research in this field has provided insight into the possible mechanisms for smell loss; however, therapy is still limited. Commercially distributed smell testing kits and newer screening tests using material available in all clinical settings have made diagnosis and measurement of the degree of impairment available to all physicians. A detailed history and physical examination are the most powerful tools in the evaluation of smell disorders, whereas imaging studies are reserved for preoperative planning or detailed assessment of positive physical findings.     

Ranula: Pathogenesis and management

The term ‘ranula’ implies a transparent cystic swelling in the floor of the mouth which is usually unilateral. The current aetiological theory is that these cysts arise from the sublingual salivary glands and present as two clinical types: (1) the simple ranula (which has an epithelial lining) or (2) the plunging ranula (which is an extravasation pseudocyst). This is poorly understood and 8 cases presenting to the Royal National Throat, Nose and Ear Hospital, London, over the previous 10 years are described to illustrate the difficulties in management. Treatment consists of excision of the associated sublingual glands which are the origin of these lesions.     

Mucositis: biology and management

PURPOSE OF REVIEW: Oral mucositis is a common regimen-limiting toxicity of radiation therapy and concomitant radiosensitizing chemotherapy for treatment of head and neck cancers. In addition to its symptomatic impact, oral mucositis increases the likelihood of unplanned breaks or delays in treatment, reduction in chemotherapy dose, use of feeding tube placement or total parenteral nutrition, the need for an intravenous line, opioid use and hospitalization. RECENT FINDINGS: Recent research has demonstrated that chemoradiation-induced mucosal injury is the result of a complex series of biological and cellular events that take place predominantly in the submucosa, with the epithelium being the target tissue. From these findings, novel biologically based preventive treatments are being developed, with a number of agents currently in clinical trials. The implications of recent advancements in radiation therapy treatment planning and delivery are also considered. SUMMARY: Mucositis is a common and serious complication secondary to chemoradiotherapy for head and neck cancer that has a profound effect on morbidity, compliance and treatment outcomes. Currently available interventions are directed at minimizing local radiation exposure and providing symptomatic relief. In the near future, a number of new treatment modalities can be expected to be introduced for reduction of severity and duration of mucositis.     

Thyroidectomy: Technique and applications

Thyroid surgery over the past century and a half has evolved from an operation associated with considerable mortality and morbidity to a generally safe operation with relatively few complications. However, the risk of vocal cord paralysis and hypocalcemia remains and can be quite devastating to patients experiencing these problems. An adequate knowledge of the anatomy and surgical techniques regarding thyroidectomy is paramount to successful outcomes in this patient population. In this article we review the pertinent anatomy and surgical techniques and discuss their application.     

Chemotherapy: present and future

Vestibular schwannomas (VS) are among the most common benign tumors of the central nervous system. Bilateral VS are the hallmark of neurofibromatosis type II, commonly leading to complete deafness and cranial nerve deficits as a result of tumor progression or treatment with surgery or radiation. Effective medical therapies are needed to address tumor progression and treatment-related morbidity. This article reviews the standard therapies for VS, summarizes the molecular biology of these tumors, and describes potential targets for chemotherapeutic agents. The article also defines and recommends the use of specific clinical end points in future drug trials, describes previous and current experience with anti-VEGF and anti-EGFR agents, and delineates areas of future research.     

Genioplasty: technique and applications

The chin is an element as important in facial profile as the nose and the forehead. It is subject to morphological anomalies in the sagittal (retrogenius or progenius), vertical (excess or insufficient height), or transversal (laterogenius) axes. Genioplasty used alone or in complement to other maxillomandibular osteotomies, allows for the correction of these malformations by modifying the position of the chin bones in three planes. Many types of genioplasty may be used to reach the desire goal, such as advancement, retraction, or adjustment of height or of symmetry. This genioplasty also has functional applications, notably in the treatment of obstructive sleep apnoea disorders. The anatomic bases of genioplasty and the interest of cephalometric analysis in diagnosing chin position anomalies are reviewed as well as the different operative steps for horizontal advancement osteotomy and the specific principles and indications for other types of genioplasty.     

恐声症：鉴别和患病率

耳鸣是人群中的一种常见症状。1993～2003年发表的10项耳鸣流行病学研究资料显示，耳鸣的患病率为3％～30．3%不等。自从20世纪80年代中期耳鸣习服治疗（tinnitus retraining therapy，TRT）理论首次提出后，听力学家重新开始关注耳鸣作为一种疾病对患者的影响，同时开始试验和论证不同的诊断和治疗方案，以求获得更有效的治疗效果。近年来，随着对耳鸣研究的不断深入，对耳鸣的发病机制和临床特征有了更清楚的认识，同时，对许多不同类型的耳鸣疾病也有了新的认识，     

Tympanoplasty: problems and realization

The authors describe how to provide safety and effectiveness of tympanoplasty, the principle of standard preparation and performance of the operation. They think it necessary to thoroughly assess stability of intralabyrinthine pressure and retrochochlear functions, to normalize humoral immunity and rheological blood properties, function of the acoustic tube, to choose optimal preserver and technique of reconstruction, how to evaluate postoperative outcome. Adequate use of the techniques widens the spectrum of reparative operations on the middle ear applied in practice.