Columellar strut grafts versus septal extension grafts during rhinoplasty for airway function, patient satisfaction and tip support.

IMPORTANCE: Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice. OBJECTIVE: Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs. MAIN OUTCOMES AND MEASURES: Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon's ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability. RESULTS: A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ "obstructed" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG. CONCLUSION AND RELEVANCE: While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance.

"A banana a day keeps wound failure away": comparing the utility of fruit, pig, and synthetic skins for suturing practice.

OBJECTIVES: To investigate how suturing orange and banana peels, pig skin, and synthetic skin compares with the experience of suturing human skin. DESIGN: Interventional study of simple interrupted, vertical mattress, and subcuticular suturing on the four test materials. PARTICIPANTS, SETTING: Fifteen consultants and six trainees in surgical and emergency medicine specialties at a New South Wales regional teaching hospital. MAIN OUTCOME MEASURES: The primary outcome was completion of simple interrupted, vertical mattress, and subcutaneous sutures. Secondary outcomes (assessed in a questionnaire) were similarity of suturing each material to suturing human skin, suitability of each material for practising each suture type, and similarity of each material to human anatomic skin types. RESULTS: All 21 participants completed simple interrupted sutures in bananas and pig and synthetic skins, and 15 in orange skin (P = 0.002). All 21 participants completed vertical mattress sutures in pig and synthetic skins, 18 in bananas, and six in oranges (P < 0.001). The numbers of completed subcuticular sutures were lower for the two fruits (orange, zero; banana, two) than for pig and synthetic skins (each, 21; P < 0.001). Banana peel was rated as somewhat similar to human skin and recommended for practising simple interrupted and vertical mattress suturing. CONCLUSIONS: Bananas are not only useful as healthy snacks between theatre cases, but also for practising and improving simple and vertical mattress suturing skills. However, less portable and nourishing materials are required for subcuticular suturing practice, such as pig skin or synthetic skin.

Sectional Anatomy Quiz - IV.

In this series we present a quiz about identification of salient and important anatomical landmarks present at a given level on the computed tomography (CT) image. The representative image is followed by further images showing examples of various commonly encountered pathologies that can be seen at this level in clinical practice. Readers are expected to identify highlighted structures in all the images and appreciate how a given abnormality can alter the appearance of normal structures. The aim of this series is to foster understanding and interpretation of the CT component of the single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies help nuclear physicians in interpretation by the nuclear medicine professionals.