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 .

A pooling-based genome-wide association study implicates the p73 gene in chronic rhinosinusitis.

BACKGROUND: p73 is a gene that may confer a genetic susceptibility to the development of chronic rhinosinusitis. OBJECTIVE: To verify an association between p73 and chronic rhinosinusitis, identified in a pooling-based genome-wide association study in a human population. METHODS: Prospective recruitment of 206 patients and 196 postal code-matched controls. DNA extraction, followed by pooling, high-density single nucleotide polymorphism (SNP) genotyping, and individual genotyping, was carried out. Gene sequencing was carried out in 10 patients and 1 control. RESULTS: Statistical analysis of SNP rs3765731 revealed a significant difference in minor allele frequency between the case and control groups. Minor allele A was more frequent in the healthy group, with an odds ratio of 0.6533, whereas G had a higher association with the disease state. Subgroup analysis of allele frequencies showed A to be associated with a lesser likelihood of developing chronic rhinosinusitis. Homozygous AA patients with severe disease had a sevenfold lesser risk of chronic rhinosinusitis compared with GG homozygotes (odds ratio 0.14). Sequencing did not reveal any amino acid changes conferring a change of function in secreted proteins. CONCLUSION: We have demonstrated an association between rs3765731 and chronic rhinosinusitis. Minor allele A has a protective effect compared with major allele G. Interaction with other signaling proteins and induction of other genes will better explain this mechanism.