Aesthetic analysis in rhinoplasty: surgeon vs. patient perspectives: a prospective, blinded study.

OBJECTIVE: To determine how patients seeking cosmetic rhinoplasty analyze themselves compared to their surgeon's analysis. Simply stated, "Does your surgeon view your nose the same as you?" STUDY DESIGN: Prospective, blinded study. METHODS: All primary rhinoplasty consultations completed a nasal analysis questionnaire. The patients' facial plastic surgeons completed an identical questionnaire. The results were compared and analyzed. RESULTS: Data underwent statistical analysis and subsequent factor analysis was performed. 132 patients participated in the study. Questions were grouped together based on factors: overall appearance, skin quality, tip dimensions, straightness, nostril show, and width. The only factor with reasonable surgeon/patient correlation was factor 1, overall appearance, with correlation 0.6473, p<0.001. CONCLUSIONS: Surgeons and patients are in agreement with the overall appearance of the nose, but differ in their analysis regarding the details. This information can be used to guide future discussions during consultations and most importantly help to better gauge and manage patient expectations.

The cleft-columellar angle: a useful variable to describe the unilateral cleft lip-associated nasal deformity.

Objective : To study a method for quantification of the severity of either the unilateral cleft lip deformity or the associated cleft nasal deformity. A standard method would be useful for defining surgical outcomes. Design : Using a developed rating questionnaire and patient photographs, 26 nonexpert volunteers rated 14 children with untreated unilateral cleft lip according to the severity of their overall deformity, as well as the individual lip and nose deformities. The cleft-columellar angle was measured as defined by the intersection of a line in the parasagittal plane and a line perpendicular to the columellar base along the midcolumellar line. The association between deformity ratings and the cleft-columellar angle was modeled using mixed-model regression analysis. Setting : Tertiary care academic medical center. Results : After accounting for within-rater and within-child effects, the cleft-columellar angle explained a statistically significant portion of the variance in the rated severity for lip deformity (49%, p  =  .0012), nasal deformity (57%, p  =  .0001), and overall deformity (57%, p  =  .0005). Conclusions : Measurement of the cleft-columellar angle in two-dimensional digital photography is simple and correlative, capturing a substantial portion of nonexpert severity ratings of the constellation of deformities seen with the unilateral cleft lip deformity. Given its ease of application, the cleft-columellar angle is a useful variable in the description of the unilateral cleft lip deformity and may find utility across institutions as cleft surgeons seek to advance surgical care through outcomes research.

The effect of rhytidectomy on the nasal valve.

OBJECTIVES: To determine the effect of deep-plane rhytidectomy on the cross-sectional area of the nasal cavity in the vicinity of the nasal valves and to compare this quantitative measure with patients' subjective assessment of their postoperative nasal airway. DESIGN: An inception cohort of 17 patients undergoing rhytidectomy (either cheek-lift or face-lift) for facial rejuvenation was evaluated with acoustic rhinometry. Initial measurements were taken approximately 1 week prior to surgery, followed by postoperative measurements at 1 week and again at 1 month (a total of 18 measurements per patient). Patients undergoing simultaneous nasal procedures were excluded. Control subjects consisted of patients undergoing facial plastic procedures other than rhytidectomy or septorhinoplasty (n = 3). The main outcome measure was cross-sectional area of both the internal and external valve regions as determined by acoustic rhinometry. The setting was an ambulatory surgery center at a large academic institution. RESULTS: Seventy percent of patients (12 of 17) reported subjective improvement of their nasal airway patency following rhytidectomy, whereas no control subjects (0%) reported any such change. Eighty-eight percent of patients (15 of 17) had a substantial increase in the dimension of their internal nasal valve area as measured with acoustic rhinometry at 1 week, with 70% of patients demonstrating increase at 1 month. Fifty-three percent of patients (9 of 17) demonstrated an increase in their external valve area at 1 week, and 59% had a persistent increase as measured at 1 month. No control subjects demonstrated any significant nasal valve area increases at either time. There was no correlation between age or body mass index and the measurement outcomes among participants. CONCLUSIONS: While there is a statistically significant increase in both the internal and external nasal valve cross-sectional areas at 1 month after rhytidectomy, the permanency of this effect is unknown. In support of these findings, a sizable proportion of patients undergoing rhytidectomy subjectively report an increase in their ability to breathe through their noses, lending credence to a postrhytidectomy melonasal effect.

Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin Sequence.

Pierre-Robin Sequence (PRS) is defined as the triad of micrognathia, glossoptosis, and cleft palate and affects approximately 1/8500 births. Airway obstruction is common in infants with PRS and results from glossoptosis leading to pharyngeal obstruction. Any procedure that increases the severity of glossoptosis, such as lingual frenulectomy, may increase the risk of obstruction or aggravate existing obstruction. This report discusses two cases of significant airway decompensation after lingual frenulectomy requiring surgical intervention in infants with PRS. We suggest that lingual frenulectomy be contraindicated in infants with PRS or suspected PRS due to the possible increased risk of airway obstruction.

Oncocytic neoplasms of the parotid gland: a 16-year institutional review.

BACKGROUND: Oncocytic neoplasms of the parotid gland are a rare collection of salivary gland tumors that include oncocytosis, oncocytoma, and oncocytic carcinoma. Mounting evidence has linked the presence of oncocytes to acquired mitochondrial dysfunction. OBJECTIVES: The study goals were to further delineate this poorly understood group of salivary gland tumors and to search for genetic alterations indicative of mitochondrial dysfunction. METHODS: Cases were identified by search of the surgical pathology archival files from 1984 through 2000. Corresponding medical records were reviewed. Tumor mitochondrial DNA (mtDNA) was evaluated for mtDNA mutations within the control region (C-tract). RESULTS: Twenty-one parotid oncocytic neoplasms were identified. Oncocytoma was the most frequent morphology (62%), followed by oncocytosis (28.5%) and oncocytic carcinoma (9.5%). One specimen displayed synchronous oncocytic morphologies (oncocytoma, oncocytosis, and oncocytic metaplasia). One oncocytoma specimen displayed the mtDNA C-tract alteration. CONCLUSIONS: Oncocytic neoplasia of the parotid gland is a rare form of salivary gland disease with obscure etiology. The presence of multiple oncocytic morphologies in a single specimen is suggestive of transition between forms. Although oncocytic tumorigenesis secondary to acquired mitochondrial dysfunction is a plausible mechanism, few of these tumors actually harbor mtDNA alterations within the control region.

Starting a cleft team: a primer.

Facial plastic surgeons have a comprehensive understanding of the challenges that patients with cleft lip and palate encounter in form and function. Because there are areas in the United States where access to cleft care is limited, opportunities exist for facial plastic surgeons to develop cleft teams to provide greater availability of services to patients. A consensus statement has been developed by the Cleft and Craniofacial Subcommittee of the Specialty Surgery Committee of the American Academy of Facial Plastic and Reconstructive Surgery that outlines strategies for facial plastic surgeons who are prepared to assume leadership roles in domestic multidisciplinary cleft team initiatives.

The cleft and craniofacial team: the whole is greater than the sum of its parts.

Cleft and craniofacial healthcare is complex, warranting a specialized, multidisciplinary approach. The modern cleft team is best suited to deliver appropriate care to both affected individuals and their families.