Rhinoplasty Technique for Improving Nasal Base Aesthetics: Lateral Columellar Grafting.

BACKGROUND: One of the most important factors in nasal base aesthetics is symmetry. In the age of social media, the expectations of rhinoplasty patients and the rate of requests for a more symmetrical nose have increased. In this article, a lateral columellar grafting technique that can be applied to augment the more defective side of the columella and obtain a more symmetrical nasal base is presented. METHODS: A total of 86 patients (women, 79; men, 7) were included in this study. The surfaces of the right and left lateral margins of the columella were evaluated from the basal view at the final stage of surgery, and a lateral columellar graft was placed on the more defective side. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation questionnaire before and 1 year after surgery. RESULTS: The median age of the patients was 28.3 years (range, 18-56 years). Eighty-two patients were primary rhinoplasty patients, and 4 patients were secondary rhinoplasty patients. The median Rhinoplasty Outcome Evaluation score was 68.3 points before surgery and 92.3 points 1 year after surgery, showing a significant increase ( P = 0.003). Patient satisfaction was found to be excellent in 93% of the included patients. CONCLUSIONS: Using the lateral columellar grafting technique, greater symmetry of the columella and nostrils can be obtained by augmenting the more defective side of the lateral columellar surface.

Septal Bony Paste Graft: A Life-Saving Material in Rhinoplasty Camouflage.

BACKGROUND: Although cartilage tissue is a priority material in both structural grafting and camouflage, in some special cases, there is not enough material for camouflage due to cartilage insufficiency after it is used in structural grafting. In these cases, it is vital that the bony parts of the septum be prepared as a paste graft and applied for camouflage. METHODS: The author retrospectively reviewed 62 rhinoplasty patients in whom septal bony paste grafts were applied during surgery from April 2018 to December 2019. A total of 56 patients were female, and 6 were male. The average age was 28 years old (range 18 to 52). The follow-up period ranged between 12 and 29 months (mean: 20.5). Septal bony paste grafts were prepared using a microrasp attached to a motor system. RESULTS: Septal bony paste grafts were used for camouflage of osteotomy lines in 59 patients, dorsum smoothing in 47 patients, camouflage of tip grafts in 36 patients, and camouflage of dorsal onlay grafts in 21 patients. No serious complications related to septal bony paste graft application, including functional or aesthetic complications, were encountered. CONCLUSION: A septal bony paste graft can be applied for camouflage in rhinoplasty in cases where there is not sufficient cartilage tissue for this purpose. A microrasp attached to a motor system can be used for effective and rapid preparation of the septal bony paste graft. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Skin Tensioning Concept in Rhinoplasty Using a Semifixed Support Mechanism.

BACKGROUND: As the skin on the nose shows outwardly, if we do not consider the volume of skin on the nose that is reduced, the results may be unsatisfactory. Although redraping the skin over a wide area may help, excess skin cannot be adequately controlled in some cases. MATERIALS AND METHODS: During skin tensioning, a semifixed support mechanism was applied to keep the nasal tip stable and maintain its position while simultaneously allowing stretching and mobility in accordance with its normal function. The dorsal and infratip/columellar skin was stretched by using the support of the most projected part of the nasal tip. The skin was pulled posteriorly to obtain sufficient tensioning and excised at the columellar incision line. RESULTS: Of the 94 patients who underwent skin tensioning, 82 were women, and 12 were men. The ages of the patients ranged from 18 to 59 years. Ninety-one patients were primary rhinoplasty patients, and 3 patients were secondary rhinoplasty patients. Skin tensioning was performed in 31 patients with overprojection, 24 patients with thick skin, 17 patients with low skin elasticity, 12 patients with excessive skin elasticity, 7 patients with an advanced long nose, and 3 patients with scar tissue due to previous surgery. No serious complications, either functional or aesthetic, related to skin tensioning was encountered. CONCLUSION: The skin tensioning technique using a semifixed support mechanism helped to achieve a required reduction with a sufficiently defined appearance of the nose in patients with difficult skin.

SELF: A Novel Algorithm for Deciding the Position of Lateral Osteotomies in Rhinoplasty Patients with Minimal External Deviation.

BACKGROUND: Although the different techniques and instruments described for lateral osteotomies date back decades, the literature on deciding the position of lateral osteotomies between the sides is limited. In general, the position of lateral osteotomies is decided by frontal view and palpation, but this is not always easy, especially in minimally deviated noses. METHODS: The SELF algorithm, which includes 4 developmentally related parameters, was used to decide the position and number of lateral osteotomies. Parameters of the SELF algorithm are septal position in nasal floor, external alar length, lateral pyramidal length and frontal pyramidal deviation's starting side. After considering and evaluating these parameters, either double lateral or high lateral osteotomy was performed on the side where the bony wall was considered to be longer. RESULTS: Out of 521 patients whose lateral osteotomy level was decided by applying the SELF algorithm, 493 were female, and 28 were male. The ages of the patients ranged from 18 to 59 years. Based on the SELF algorithm, 401 double lateral and 85 high lateral osteotomies were performed on the side with the longest anterior-posterior distance of the bony pyramid. No serious complications, either functionally or aesthetically, were encountered related to lateral osteotomies performed based on the SELF algorithm. CONCLUSIONS: There is a relationship between the position of the septum at the nasal floor, external alar length, lateral pyramidal projection and frontal deviation, as the tissues in the nose are shaped in relation to each other during development. The SELF algorithm based on these parameters can provide assistance to the surgeon in terms of selecting the position and number of lateral osteotomies, especially in minimally deviated noses. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

External Splinting Is Not Mandatory After All Rhinoplasties: A Prospective Randomized Trial.

BACKGROUND: Although casts or external splint materials are commonly applied on the external nose after rhinoplasty, their beneficial effects have not been previously demonstrated in controlled studies. METHODS: A total of 40 adult patients who underwent primary rhinoplasty were included in this prospective study. The patients were randomized into 2 groups to use an external splint or not after surgery. Only surgical taping was applied to the nasal dorsum of the patients for whom external splints were not used. The periorbital edema and ecchymosis levels of the patients were recorded on the second and seventh days after surgery. Moreover, all patients had a computed tomography scan at the third postoperative week to measure the distance between the beginning of the osteotomy line on the right and left sides and the midline. RESULTS: On the second and seventh postoperative days, the levels of periorbital edema and ecchymosis were significantly lower in the patients with taping than in the patients with splints (P < 0.05 for each). No statistically significant difference was observed in terms of the difference in the distance between the beginning of the osteotomy line on the right and left sides to the midline between the group with external splints and that with tape (P = 0.661). CONCLUSIONS: External splinting may not be used in cases where osteotomy is not performed or in patients where the osteotomies are sufficiently stable. Thus, the disadvantages of external splinting are avoided, and at the same time, periorbital edema and ecchymosis are less common.

A Promising New Technique for Correcting a Deviated Nose: Partial Disarticulation of Keystone Area.

Correction of the septum is essential for the correction of deviated nose. If no intervention is made to the septum that does not start from midline at the keystone area, either the crookedness will persist or thicker spreader grafts will need to be placed at the opposite side of the crookedness or further camouflaging will be required. The latter may cause dorsum to get wider. In the present study, partial disarticulation of keystone (PDK) method is presented for the correction of septum that does not start from the midline at the keystone area. This retrospective study included 18 patients in whom PDK method was employed to correct nasal deformity. The keystone area was repositioned by disarticulating the cartilage from the bone on the anterior part of the junction of the ethmoid bone with the septal cartilage. The patients were followed up for the duration of 12 to 33 (mean: 22.5) months. No patients developed a serious complication or required revision surgery. The PDK method can be applied to patients if dorsal septum does not start from the midline at the keystone area. This is a minimally invasive, time-saving method that has a short learning curve and decreases the possibility of further widening of dorsum.

CSF gusher in cochlear implantation: The risk of missing CT evidence of a cochlear base defect in the presence of otherwise normal cochlear anatomy.

Intraoperative cerebrospinal fluid (CSF) leakages from the cochleostomy site - known as gushers - are a serious complication of cochlear implantation surgery in cases of congenital deafness. They occur as the result of abnormal communication between CSF in the internal auditory canal and perilymph in the cochlea. Gushers are well recognized as occurring in a proportion of cases in which there is a clearly visible congenital malformation of the cochlea. In this report, we describe two cases in which pre-operative computed tomography (CT) scanning of the cochlea was initially reported as normal but gushers occurred during cochlear implant surgery. In both cases, more detailed review of the CT scans (peroperatively in the first case, pre-operatively in the second case) showed a defect at the cochlear base, in the absence of any other cochlear malformation. The aim of this paper is to draw attention to the risk of missing this abnormality and to encourage careful inspection of the cochlear base on CT scans in all cases, even when the rest of the cochlear appears normal.

A neglected giant parotid gland mass: excision and reconstruction with facial nerve preservation.

Carcinoma ex pleomorphic adenoma (CXPA) is a malignant transformed variant of pleomorphic adenoma (PA). Generally it presents with a rapidly growing mass in the parotid gland within a preexisting PA or following surgical resection of PA. Mainstream treatment modality is surgical resection followed by radiotherapy if necessary. Facial nerve preservation and complete resection of the tumor are the main principles of the operation. Giant malignant derivates are not seen frequently and constitute a challenging task for surgeons to achieve the main principles of resection. Prognosis of CXPA is poor and aggressive treatment should be performed immediately after the diagnosis. We present a 82-year-old woman with a giant malignant parotid gland mass who was successfully treated with surgery without any facial nerve injury.

Radiological quiz. Sudden sensorineural hearing loss due to multiple sclerosis.

OBJECTIVE: A case with sudden sensorineural hearing loss (SSNHL) owing to multiple sclerosis (MS) who had clinical and dramatic radiological improvement just after medical therapy was reported in this article. METHOD: Case report and review of related literature. RESULTS: A 22-year-old female patient with MS related SSNHL was presented in this article. Magnetic resonance imaging (MRI) revealed an MS plaque localized at pons extending from right cochlear nucleus to proximal part of the right cochlear nerve. Most dramatic recovery was present in the 5th day control MRI, where the plaque located on pons disappeared completely. On the 10th day control audiogram hearing recovery was observed and pure tone audiogram levels were almost normal. CONCLUSION: Sudden sensorineural hearing loss owing to MS is seen more common than expected. It has good prognosis. Magnetic resonance imaging is also thought to have an important role in diagnosis and treatment efficacy of SSNHL owing to MS.

Hybrid carcinoma of the parotid gland: ductal carcinoma and myoepithelial carcinoma.

Hybrid carcinomas are rare neoplasms which are characterized by two different types of tumors localized in a single topographic region of the lesion. Parotid gland is the most common involvement site of hybrid carcinomas among salivary glands. The aggressiveness of the hybrid tumor depends on its high-grade component. In this article, we present a 71-year-old male case with the left parotid gland hybrid carcinoma consisting of salivary duct carcinoma and myoepithelial carcinoma.

Novel endoscopic treatment of pharyngocele: endoscopic suture pharyngoplasty.

BACKGROUND: Pharyngocele or a lateral pharyngeal diverticulum (LPD) are rare lesions, which are bulgings of the pharyngeal mucosal surface through one of the weak areas of the pharynx. METHODS: The external approach has been the primary surgical treatment of pharyngoceles. The purpose of this article was for us to report an endoscopic successful treatment of pharyngocele by suture pharyngoplasty. RESULTS: Endoscopic suture pharyngoplasty does not require an external incision and hospitalization. After 3 months of abstinence from trumpet playing, the patient is back to his musical career. CONCLUSION: Because of the minimally invasive procedure, endoscopic suture pharyngoplasty can be performed in case of symptomatic pharyngoceles with a good result.

A new transnasal approach to nasolabial cyst: endoscopic excision of nasolabial cyst.

Nasolabial cyst (NC) is one of the midface lesions that are seen rarely. Nasolabial cyst is generally seen in females typically on the fourth and fifth decades and localized unilaterally. Diagnosis usually depends on clinical evaluation. Sublabial excision is the classic method, but endoscopic marsupialization is suggested in current literature. An NC that is totally excised endoscopically is introduced in this article. This is the first case of NC excised endoscopically that is described in English literature.