Soft and Firm Alloplastic Implants in Rhinoplasty: Why, When and How to Use Them: A Review of 311 Cases.

BACKGROUND: Modern rhinoplasty is not just a reduction procedure. An optimal nasal esthetic result occasionally requires augmenting the nasal tip, the dorsum or the lateral wall with autografts or alloplasts. A large number of nasal implant types have been reported in the medical literature. OBJECTIVE: The goal of this article is to demystify the role and indications of nasal implants in rhinoplasty. As well, it offers both the novice and experienced nasal surgeon a basic, simplified and organized approach to the use of soft and firm nasal implants in rhinoplasty. METHODS: This article presents the authors experience with 311 rhinoplasties using both soft and firm alloplastic implants. The indications for both types of alloplasts are discussed, the surgical technique detailed and the outcomes analyzed. RESULTS: A total of 311 nasal implant cases were reviewed. This series revealed a low incidence of postoperative infection (5.57% for soft implants and 0.1% for the firm ones). The revision rate was 2.7% for the soft implants group and 7.1% for the firm implants group. 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 .

Acceptability and reliability of multiple mini interviews for admission to otolaryngology residency.

OBJECTIVES/HYPOTHESIS: To evaluate the acceptability and reliability of the Multiple Mini Interview (MMI) for the selection of applicants to an Otolaryngology-Head and Neck (OTL-HNS) residency program. STUDY DESIGN: Prospective observational study. METHODS: Canadian medical graduates applying to the OTL-HNS residency program at McGill University in 2011 and 2012 underwent a 7-station MMI. Upon completion, the major stakeholders commented on and rated various aspects of the MMI using a 7-point Likert scale. Descriptive statistics were used to analyze the quantitative portion of the exit survey, while content analysis and thematic description was applied to qualitative data. Interrater reliability was examined with intraclass correlation coefficients. RESULTS: Data was collected from 45 applicants and 18 evaluators. The majority of applicants (>80%) felt that the MMI helped them present their strengths and was free of any gender, cultural, or age bias. Assessors (>85%) agreed the MMI evaluated a valid range of competencies, and that it tested more aspects of an applicant than did traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred it over the traditional interview. Overall, interrater reliability of the MMI was good. CONCLUSION: This is the first study to examine how the MMI interview process can be adapted for admission to an OTL-HNS residency program, while showing both good acceptability for all major stakeholders and good reliability.

Discrimination of falls and blows in blunt head trauma: a multi-criteria approach.

In the discrimination of falls versus blows, the hat brim line (HBL) rule is mentioned in several textbooks as the most useful single criterion. Recent studies, however, have found that the HBL rule is only moderately valid and that its use on its own is not recommended. The purpose of this 6-year retrospective study was to find additional individually useful criteria in the distinction of falls from blows. Overall, the following criteria were found to point toward blows: more than three lacerations, laceration length of 7 cm or more, comminuted or depressed calvarial fractures, lacerations or fractures located above the HBL, left-side lateralization of lacerations or fractures, more than four facial contusions or lacerations, presence of ear lacerations, presence of facial fractures, and presence of postcranial osseous and/or visceral trauma. Based on the most discriminating criteria, a decision tree was constructed to be potentially applicable to future cases.

Skull fracture with brain expulsion in a one-level jumping-fall.

Here presented is the case of a one-level jumping-fall with extensive skull fractures and brain expulsion. The body was found on the basement floor at the foot of the stairs. At the autopsy, the skull was extensively fractured, with about half of the brain expulsed several feet away from the body. The cause of death was established as a craniocerebral trauma with brain expulsion. The circumstances and manner of death were still unclear at that time. A low fall seemed very unlikely considering the severity of the skull and brain damage. The police investigation clearly revealed that the man, in a paranoid psychotic state, attacked his wife with a knife and then was witnessed by his children to have hit his head several times with a hammer. Afterwards, they saw him running to the top of the basement stairs and jumping to the bottom of the stairs head first.