Postoperative pain management with ketorolac in facial plastic surgery patients.

OBJECTIVE: To evaluate the benefit of intraoperative locally or intramuscularly injected ketorolac in combination with local anesthetic versus local anesthetic alone on postoperative pain in patients undergoing facial plastic surgery. METHODS: Prospective randomized trial of 140 consecutive patients undergoing facelift, and/or forehead lift at a private facial cosmetic surgery practice by one surgeon. Outcome measurement included the requirement for pain medication (none, morphine, acetaminophen with codeine, or plain acetaminophen) at 1, 12, and 24 hours postoperatively. RESULTS: Ninety-five patients receiving locally injected ketorolac required significantly less postoperative analgesic (p<.05) than both the 20 patients who received intramuscularly injected ketorolac and the 25 patients who received local anesthetic alone at 12 and 24 hours. Those patients receiving no ketorolac required significantly more (p<.05) analgesic 1 hour postoperatively. CONCLUSION: Intraoperative locally injected ketorolac is an effective and safe means of reducing postoperative analgesic requirements.

The 'bikini lip reduction': A detailed approach to hypertrophic lips.

Excessively large lips represent an occasional but significant challenge in aesthetic surgery. Previously described techniques focus largely on the simple excision of a strip of tissue to reduce the lips, without specific attention to the resultant lip contour or to the volume relationship between the lips. The present paper describes a new technique for lip reduction, called the 'bikini lip reduction'. This technique not only reduces the volume of the lips, but also restores an attractive labial contour, as well as an ideal volume relationship between the upper and lower lips. Because it is based on aesthetic analysis, this technique consistently yields both smaller and more aesthetically appealing lips. Simply stated, the bikini lip reduction consists of excision of a 'bikini top' (two cups and a middle strap) from the upper lip and a 'bikini bottom' (a triangle) from the lower lip. The aesthetic results and the patient satisfaction achieved through the bikini lip reduction technique have been very satisfactory.

Adenoidectomy: selection criteria for surgical cases of otitis media.

OBJECTIVE: Nasopharyngeal adenoids may serve as a mechanical obstruction to the eustachian tube and contribute to the pathophysiology of otitis media (OM). The purpose of this study was to determine whether abutment of adenoids laterally against the torus tubaris affects the outcome of patients requiring pressure equalization tubes (PET) for OM. STUDY DESIGN: Randomized, controlled, prospective clinical trial. METHOD: Patients requiring PET for recurrent acute OM or OM with persistent effusion were randomized into two groups: 1) PET placement and 2) PET placement and adenoidectomy, regardless of whether the adenoids were abutting or not abutting the torus tubaris. Patients were followed for a minimum of 1 year to determine rate of treatment failure, defined as recurrence of acute OM (>3 times/year), OM with effusion, or reinsertion of PET. RESULTS: Of the 34 patients in the abutting group, 16 patients underwent only PET insertion, of whom 8 (50%) failed, whereas 18 patients had combined PET placement and adenoidectomy, of whom 3 (17%) failed. There was a statistical difference between these two groups (P < 05). Of the 29 patients in the nonabutting group, 24 patients underwent only PET insertion, of whom 9 (37.5%) failed, whereas 5 patients underwent combined PET placement and adenoidectomy, of whom 2 (40%) failed. There was no statistical difference between these two groups (P =.92). CONCLUSION: This study demonstrates that the position of hypertrophied adenoids may alter the final otologic outcome of patients requiring PET insertion for OM. Patients with adenoids abutting the torus tubaris may benefit most from an adjuvant adenoidectomy.

The use of fibrin glue in the correction of pollybeak deformity: a preliminary report.

BACKGROUND: Supratip fullness, also known as pollybeak deformity, is one of the most common postoperative complications of rhinoplasty. The deformity can result from many different causes, some of which are related to the surgical technique and can be prevented. Poor redraping of thick, inelastic skin and thick subcutaneous tissues over the reduced cartilaginous framework may result in the creation of a subcutaneous "dead space," leading to the formation of excessive subcutaneous scar and a soft tissue pollybeak in some cases. OBJECTIVE: To evaluate the effectiveness of a homologous fibrin glue (Tisseel; Baxter AG, Vienna, Austria) in the prevention and correction of the soft tissue pollybeak deformity. DESIGN: Prospective study. PATIENTS AND METHODS: Thirty patients were treated with fibrin glue to achieve better adherence of the skin to the underlying skeletal framework. Ten patients had no previous nasal surgery. The remaining 20 patients presented with the complication of pollybeak deformity. In this group, 14 patients had undergone 1 previous surgical procedure, 3 had undergone 3 previous rhinoplasties, and 3 had undergone 4 or more previous procedures. RESULTS: There were no intraoperative or postoperative complications. Follow-up ranged from 2 to 34 months, with all patients achieving successful aesthetic outcomes. CONCLUSION: Fibrin glue is an excellent adjunct to rhinoplasty procedures because it successfully eliminates the dead space that can cause soft tissue pollybeak deformity.

Endoscopically facilitated reduction laryngochondroplasty.

Endoscopic verification of the level of excision of the thyroid cartilage in reduction laryngochondroplasty maximizes the aesthetic result of the operation and prevents possible injury to the vocal cords. A prominent thyroid cartilage is identified with male sex. Reduction of the thyroid cartilage prominence (Adam's apple), also known as laryngochondroplasty, is often requested by patients undergoing male-to-female transsexual surgery. Some women, and even occasional slender men, with a markedly pronounced thyroid cartilage prominence also request this treatment to refine their neck contour. Topographic studies place the true vocal cords at a level corresponding to halfway up the thyroid cartilage. Because of the proximity of the thyroid cartilage prominence to the attachment of the true vocal cords, any anatomic variation may lead to injury to the phonatory apparatus during the cartilage excision. Attempts to avoid this occurrence may result in overconservative reduction of the thyroid prominence and less-than-optimal aesthetic results. Herein we describe a combined endoscopic and external surgical approach to reduction laryngochondroplasty.

Estimating implant size in chin augmentation: A simplified approach.

A receding chin, colloquially known as a weak chin, is a significant aesthetic impediment to a pleasing face. Multiple techniques exist to evaluate the poorly projecting chin, but most are imprecise when it comes to choosing the proper implant size. This choice is further complicated by the impracticality of commercially available chin implants. Most implant manufacturers offer only three to four categories of implants (small, medium, large, etc) that differ in size from one company to another, making the choice of the proper implant size a real challenge. The present paper discusses a new approach to precise sizing of the chin implant, based primarily on the degree of chin convexity (curvature of the chin pad) in the profile view. Examples of mentoplasties performed using the chin convexity principle are presented.

Un menton fuyant est un obstacle esthétique important à un visage agréable. Il existe de multiples techniques pour évaluer cette mauvaise projection du menton, mais la plupart sont imprécises lorsqu'il s'agit de choisir un implant de bonne dimension. Ce choix est compliqué par le caractère peu pratique des implants de menton mis en marché. En effet, la plupart des fabricants n'offrent que trois ou quatre catégories d'implants (petit, moyen, grand, etc.), dont la dimension varie d'un fabricant à l'autre, ce qui transforme lp=e choix du bon implant en véritable défi. Le présent article présente une nouvelle démarche pour établir la dimension exacte de l'implant du menton, fondée principalement sur le degré de convexité du menton (la courbe du coussinet du menton) selon une vue de profil. Des exemples de mentoplasties exécutées selon le principe de convexité du menton sont présentés.

Dacron implants in rhinoplasty: a review of 136 cases of tip and dorsum implants.

The achievement of successful results in rhinoplasty may require the use of autografts, homografts, or alloplastic materials. Among the alloplasts, Dacron is an easily handled and manipulated synthetic material, readily applicable to nasal augmentation. The following represents the indications, surgical technique, outcome results, and analysis of our experience with Dacron mesh implants to the nasal tip, dorsum, and lateral walls in 136 patients.

Endoscopic repair of a nasal septal perforation.

The repair of septal perforations represents a challenging problem, with numerous techniques existing to address the defect. The use of sinonasal endoscopy represents a novel approach to solving this problem. By using the endoscope, excellent visualization and exposure can be achieved without excessive dissection. In addition, the use of the camera and monitor allows for excellent teaching capabilities.