Endoscopic resection of forehead osteomas: Technical notes.

INTRODUCTION: Forehead osteoma is an uncommon benign bone tumor that causes cosmetic disfigurement and occasional pain. Traditional excision directly over the lesion creates a visible scar on the forehead. PROCEDURE: We describe a method of endoscopic resection of the forehead osteoma, via incisions within the hairline. The access incision was hidden behind the frontal hairline and the dissection plane went in the subperiosteal layer. The injury of the nerve branch and vessel can be easily avoided and endorsed by manipulating the endoscope. CONCLUSION: Aesthetic considerations are important features in the craniomaxillofacial region. Especially for patients who are not willing to accept the risk of a prominent forehead scar. Endoscopic resection of forehead osteomas might be a useful tool in forehead osteoma resections. It might be an alternative tool in an Oral and Maxillofacial Surgeon's and in a Plastic Surgeon's repertoire.

[Comparative study of C-reactive protein and procalcitonin in the severity diagnosis of pyelonephritis in children]. / Étude comparative de la protéine C-réactive et de la procalcitonine dans le diagnostic de sévérité des pyélonéphrites aiguës de l'enfant.

OBJECTIVE: The aim of this study is to compare two biologic parameters; C-reactive protein (CRP) and procalcitonin (PCT) in the detection of acute renal lesions assessed by DMSA scintigraphy in the urinary tract infection in child. DESIGN: In a prospective study, serum PCT, CRP and leukocyte counts were measured for children admitted, between January and December 2010, with a first episode of febrile urinary tract infection. RESULTS: Seventy-five children were enrolled in the study. Thirty-three patients had renal lesions (group A) and 42 had a normal DMSA scintigraphy (group B). The mean PCT level was significantly higher in group A than in group B (8.81 ng/mL versus 1.7 ng/mL, P=0.01). In this study, using receiver operating characteristic (ROC) curve, we identified that the optimal cut-off value with ideal sensitivity and specificity for PCT in detection of renal lesions was 0.76 ng/mL and for CRP, it was 70 mg/L. The sensitivity, the negative predictive value and the indice of Youden of the cut-off value of PCT were significantly higher than CRP (82% versus 70%; 84% versus 70% and 0.58 versus 0.25). CONCLUSIONS: This study confirmed that the serum PCT level was more sensitive and specific than the CRP in the detection of renal lesions in the first urinary tract infection in child.

A c.3216_3217delGA mutation in AGL gene in Tunisian patients with a glycogen storage disease type III: evidence of a founder effect.

Glycogen storage disease type III (GSD III) is an autosomal recessive disorder characterized by excessive accumulation of abnormal glycogen in the liver and muscles and caused by deficiency in the glycogen debranching enzyme, the amylo-1,6-glucosidase (AGL). In this study, we report the clinical, biochemical and genotyping features of five unrelated GSD III patients coming from the same region in Tunisia. The concentration of erythrocyte glycogen and AGL activity were measured by colorimetric and fluorimetric methods, respectively. Four CA/TG microsatellite markers flanking the AGL gene in chromosome 1 were amplified with fluoresceinated primers. The full coding exons and their relevant exon-intron boundaries of the AGL gene were directly sequenced for the patients and their parents. All patients showed a striking increase of erythrocytes glycogen content. No AGL activity was detected in peripheral leukocytes. Sequencing of the AGL gene identified a c.3216_3217delGA (p.Glu1072AspfsX36) mutation in the five patients which leads to a premature termination, abolishing the AGL activity. Haplotype analysis showed that the mutation was associated with a common homozygote haplotype. Our results suggested the existence of a founder effect responsible for GSD III in this region of Tunisia.

Asymptomatic carriage of Leishmania in family members of patients with visceral leishmaniasis in Central Tunisia.

INTRODUCTION: In Tunisia, asymptomatic carriage of Leishmania is poorly documented. OBJECTIVE: The aim of the present study was to estimate the frequency of asymptomatic infection among the family members of patients with patent visceral leishmaniasis by using the Western blotting kit based on 14 and 16kDa bands. MATERIAL AND METHODS: We tested 94 sera collected from 24 patients with patent visceral leishmaniasis and 70 from their families' members. RESULTS: The rate of seropositivity was 100% in the group of patients and 54.3% in the group of families' members. The analysis of the Western blotting patterns showed that the 33kDa, 24kDa and to a lesser extent the 22kDa band were very indicative of patent visceral leishmaniasis in contrast to asymptomatic infection where these bands were very rarely detected. CONCLUSION: The results reported herein showed the high frequency of asymptomatic carriers of Leishmania among the families' members of visceral leishmaniasis cases and the usefulness of the Western blotting as a screening technique and in distinguishing between patent visceral leishmaniasis and the asymptomatic carriage of Leishmania.

[Facial infantile aggressive fibromatosis: a frequent localization of an exceptional tumor!]. / La fibromatose agressive faciale chez l'enfant: une localisation fréquente d'une tumeur exceptionnelle !

INTRODUCTION: Although fibromatosis is considered as benign tumor, it can have significant morbidity, particularly when it occurs in the head and neck. Their propensity for infiltrative local growth with encroachment on vital structures and their tendency to recur make fibromatoses of the head and neck extremely challenging lesions. CASE REPORT: We report the case of a 10-year-old boy with desmoid fibromatosis of the upper lip. For this patient, the medical treatment has been decided to avoid a mutilating surgery. He had a good result with chemotherapy using methotrexate and vinblastine. DISCUSSION: According to the literature, surgery is the most common treatment of fibromatosis in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations. Chemotherapy using methotrexate and vinblastine may be a reasonable choice.

[Weight variation after reduction mammary surgery: retrospective study of 100 cases]. / Profil pondéral après chirurgie mammaire de réduction: étude rétrospective à propos de 100 cas.

INTRODUCTION: Patients desiring breast reduction are often in overweight, and describe interferences with their daily life and minor psychological problems. We undertook this study to establish the pre- and postoperative weight pattern by age and histological breast type. PATIENTS AND METHODS: A retrospective review was performed on 100 consecutive patients who underwent bilateral reduction mammaplasty for macromastia (>300g per breast) in 2007. The patients were categorized by age in two groups: group 1 (G1) comprising the 50 younger patients (mean age: 35.5 years) and group 2 (G2) comprising the 50 older (mean age: 47.2 years). We obtained data points including: preoperative and postoperative weight pattern according to age and histological subtypes, calculation of body mass index (BMI), data from surgery including amount of resection, postoperative course and complications. RESULTS: Patients consulting for breast reduction are moderately overweight (mean BMI: 28.22 confounded all ages). Preoperative weight loss is low despite systematic surgeon request (<0.5 % on average waiting time of 6.45 months). The postoperative weight loss is higher in young patients with glandular form of HTM (respectively -4.76 kg for glandulofibrous type and -3kg for fibrous, which corresponds to a loss of 6.5 and 4.1 % of their body weight). The impact of surgery on the patient's psychological condition is better in young patients. CONCLUSION: This study demonstrated that postoperative weight loss after breast reduction are significant only in young patients with a constitutional type of macromastia (glandular or mixed forms). We believe that in addition to the functional improvement associated with surgery, these young patients lose weight they initially take to harmonize their silhouette.

[Surgical treatment of sequelae of deep breast burns: a 25-year experience]. / Traitement chirurgical des séquelles de brûlures profondes du sein : 25ans d'expérience.

INTRODUCTION: Deep chest burns in prepubescent girl prevent the development of the mammary gland, because scar contracture becomes an inextensible envelope. In adults, scar contracture can deform the breast shape. The aim of this work is to define the interest of tissue expansion in breast reconstruction of prepubescent's and adult's post-burns scars. PATIENTS AND METHODS: We conducted a 25-year retrospective study including patients treated surgically for deep thoracomammary burns. We studied following parameters: surgical techniques step by step, average time between each intervention, and morphologic and aesthetic results achieved. RESULTS: Twenty-eight patients have been operated between 1983 and 2008. Each patient has been operated on average 4.5 times (two to 12 times) during 6.3 years on average (1-19 years). Adult patients have showed a higher number of response (5.5 on average) than prepubescent girls (2.4 on average). Number of skin expansion has been 1.2 (0 to three) per patient. Sixty-two expanders have been placed (one to eight), 390cm(3) volume on average (180-1200). Delay of skin expansion has been about 7 months (4-10). Twenty-five breast implants have been raised on average 11 months (6-17) after debridement. Three changes of breast implant have occurred on average 5.3 years after insertion (3-8). Reconstruction of the areolonipple complex and controlateral symetrisation were conducted generally in the same time, 1 year after the last intervention. All patients will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculocutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence satisfied cosmetic and morphologic results. These results, analyzed over a period of 25 years, show a qualitative change and decreased postoperative complications. DISCUSSION: Locoregional tissue expansion provide very clever results. In pre-pubescent grils, skin expanded flaps allow a near-normal mammary gland development. In adult women, they make the envelope that will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculo-cutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence.

[Fat grafting in facial burns sequelae]. / La lipostructure dans les séquelles de brûlures faciales.

INTRODUCTION: Fat graft is now part of the armamentarium in face plastic surgery. It is successfully used in burn scars. The aim of our study is the discussion of the value of this technique in optimizing cosmetic result of burns face sequelae. PATIENTS AND METHOD: Fifteen adult patients (10 females and five males) with scars resulting from severe burns 2 to 9 years previously were selected. The patients were treated by injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman's technique. Two to three injections were administered at the dermohypodermal junction. Ages, sexes, aetiology of burn, facial burn sequelae, recipient sites, quantity of fat injected, aesthetic results are discussed. RESULTS: Patient age ranged from 21 to 55 years (average: 38). The mean follow-up of the study was 66 months (23-118). Patients received 7.5 (5-11) facial restorative surgeries before fat graft. Patients underwent two sessions of fat transfer, 33cc average per session. We did not report any complications. The clinical appearance, discussed by three surgeons and subjective patient feelings, after a 6-month follow-up period, suggests considerable improvement in the mimic features, skin texture, and thickness. The result is good in 86% of cases and acceptable in the other cases. DISCUSSION: Burns sequelae offer local conditions which justify special cannula can cross fibrosis and explaining the value of multiplying the sessions. Indications for lipostructure include four distinct nosological situations, sometimes combined. Lipostructure can restore a missing relief, filling a localized depression, reshape a lack of face volume or smooth a scarring skin. CONCLUSION: Fat graft seems to complete and improve the results of the standard surgical approach in burned face.

[Long-term follow-up of cemento-osseous dysplasia: a contralateral recurrence before radiotherapy]. / Évolution à long terme de la dysplasie cémento-osseuse: une récidive controlatérale avant radiothérapie.

INTRODUCTION: Cemento-osseous dysplasia is a benign fibro-osseous lesion of the jaws. Its complications are very rare. OBSERVATION: A panoramic x-ray was made to complete the pre-radiotherapy oral assessment of a 71-year-old female patient presenting with lung adenocarcinoma. This revealed a periapical fibro-osseous lesion on tooth n° 46. She had presented with a similar lesion on tooth n° 36, 16 years before. This had been treated by extraction and alveolar curettage. No surgical treatment was suggested for this recurrence on tooth n° 46. DISCUSSION: The diagnosis of focal cemento-osseous dysplasia is usually made on radiological and clinical data. The risk for transition to a florid form is unknown. Exeresis surgery before radiotherapy is discussed.

[Eagle syndrome: a rare and atypical pain!]. / Le syndrome d'Eagle: une douleur mal connue et mal reconnue!

The styloid process projects down and forward from the inferior surface of the petrous bone. It arises from the second branchial arch. Its average length ranges from 22 to 33 mm. The styloid process hypertrophy, or Eagle syndrome, may be a source of cervicofacial pain and is very difficult to diagnose. The pathogenesis of this abnormality is unknown. Traumatic origin is usually admitted even if recent embryological data suggest a genetic origin with interindividual variations. The diagnosis is made on several elements: exacerbated cervical pain on neck hyperextension and sudden head movements, typical pain caused by palpation of the tonsillar fossa, diagnostic test with xylocain, and radiological investigation. Treatment is surgery and exeresis of the styloid process via a transoral or cervical approach.

[Rhinoplasty and reconstruction of the nasal dorsum: role of an autologous graft of the concha media]. / Rhinoplastie et chirurgie d'harmonisation du dorsum nasal: apport de la greffe autologue de cornet moyen.

BACKGROUND: Aesthetic and functional rhinoplasty can improve facial beauty. Surgical procedure may require autogenous grafts. These bone or cartilage grafts are harvested from different parts of the body. The objective of our study is to evaluate the use of nasal concha media as a new type of graft in rhinoplasty. MATERIALS AND METHODS: Patients consulted for aesthetic as well as for functional problems. They had dorsum deformities. The inclusion criteria had been the achievement of a harmonization surgery of the nasal dorsum, associated or not with another aesthetic or functional rhinoplastic intervention. The grafts are quickly and easily removed by endoscopic endonasal approach under optical control. The removed graft is then shaped and inserted by hidden approach during a rhinoplastic operation. Complications have been noticed for harvesting site and recipient site. RESULTS: Ten patients have benefited from this new technique from 2002 to 2007. They consulted for aesthetic as well as for functional problems in 9 cases. One person consulted for aesthetic matters only. The removal of these grafts has led to no complication. One case of infection has been noticed, and one dorsum irregularitie has been noticed. Aesthetic and functional results have been analysed over an average step back of two years and show at least comparable results to techniques already published. CONCLUSION: The concha media seems to serve well as graft material in some indications of rhinoplasty. The primary indication of this type of graft is in the harmonization surgery of the nasal dorsum. These grafts do not replace the other existent autologous grafts, but advantageously complete the technical arsenal of the rhinoplastician. A study involving a wider population should be done to validate the interest of this new type of filling graft in rhinoplasty.

[Bifid mandibular condyle: position of the supernumerary condyle]. / Bifidité du condyle mandibulaire: position du condyle surnuméraire.

INTRODUCTION: Bifid condyles are uncommon and include post-traumatic aberrant reorganization of the temporomandibular joint (TMJ) and congenital forms. CASE REPORT: We report two cases of unilateral bifid condyles, responsible for functional dysfunction of the TMJ. The first case, probably of congenital origin, was oriented frontally. The second case, oriented in the sagittal plane, was probably post-traumatic. Functional treatment was used for both patients. DISCUSSION: Bifid condyles is asymptomatic in most cases. Their most frequent clinical consequence is TMJ pain. Surgical treatment is rarely indicated. Determining the congenital or post-traumatic origin of bifid condyles is often difficult. The orientation of the supernumerary condyle head could help for the etiological diagnosis.

Facial plastic surgery and face recognition algorithms: Interaction and challenges. A scoping review and future directions.

INTRODUCTION: Face recognition (FR) technology can be used in wide range of applications such as identity authentication, access control, and surveillance. Interests and research activities in face recognition have increased significantly over the past twenty years. Plastic surgery procedures can significantly alter facial appearance, thereby posing a serious challenge even to the state-of-the-art face matching algorithms. The purpose of this work was to detail the interaction between facial plastic surgery and facial recognition software and discuss the new challenges of this interaction. MATERIAL AND METHODS: The authors critically reviewed the literature from January 2000 to September 2019, to identify articles reporting interactions between facial plastic surgery and facial recognition algorithms and discuss the new challenges of these interactions. Controlled vocabulary terms and keywords were used in the search strategy and two authors independently analyzed data. Factors included in the analysis were: Author, Journal, Year, Scope, Study design, Plastic surgery, Data (volume, origin and processing), Identification accuracy and Conclusion (interaction/challenge). RESULTS: Forty-three research articles underwent data extraction and 28 articles were included in quantitative synthesis. Of the 28 articles, the most common study designs were experimental evaluation (n=15, 53,5%), Evaluation Study studies (n=7, 25%) and Review studies (n=4, 14,3%). Fifty percent of the articles have been published in the last 4 years (14 articles, 50%). Most of the study scope was informatics (64,3%). Only 10 articles were published in medical journals. Rhytidectomy (face lift) is the most challenging procedure for the FR algorithms. Data volume varied from 4 to 2878 subjects. The proposed algorithms provide at least 15 to 99% better identification performance. Among these, only two papers discuss the new challenges of the interaction between facial plastic surgery and Face Recognition Algorithms. CONCLUSION: In the context of advances in artificial intelligence, Internet connectivity and data integration, the purpose of this review is, to look forward to analyze the new interactions of facial plastic surgery and facial recognition algorithms, and to suggest avenues for future research and clinical application of this technology. Furthermore, to evaluate if plastic surgeons are prepared to discuss this technology with their patients. Plastic surgeons should be prepared to answer questions from patients about the fundamentals of facial recognition technology, and the potential effects of plastic surgery on facial recognition technology performance. Continued efforts are needed to provide scientifically rigorous data of facial biometric identification after facial plastic surgery and to include these notions in the routine consultation or consent process for patients seeking aesthetic facial surgery.

[Antineutrophil cytoplasmic antibodies and associated diseases]. / Anticorps anticytoplasme des polynucléaires neutrophiles et pathologies associées.

Antineutrophil cytoplasmic antibodies are classical serological markers of small-vessels vasculitis. However, they have been described in many other pathological situations. The aim of this study was to determine through our experience, the main antineutrophil cytoplasmic antibodies-associated diseases and to investigate antigen targets of these antibodies. Forty complete observations of antineutrophil cytoplasmic antibodies (ANCA) positive patients either by indirect immunofluorescence or by enzyme immunoassay were analysed. Only five (12.5%) patients have small-vessels vasculitis. Among these, antineutrophil cytoplasmic antibodies were detected only by Elisa in one patient and they were exclusively directed against bactericidal permeability increasing protein in another one. Our study confirms the presence of antineutrophil cytoplasmic antibodies in different diseases. It demonstrates that antineutrophil cytoplasmic antibodies should be investigated by Elisa when indirect immunofluorescence is negative. In small-vessels vasculitis, Proteinase 3 and myeloperoxidase are mainly but not exclusively the antigenic targets of antineutrophil cytoplasmic antibodies.

[Acute presentation in oral schwannoma]. / Présentation aiguë d'un schwannome intraoral.

OBSERVATION: We report an unusual presentation of an acute septic maxillary vestibular schwannoma in a 19-year-old female patient. The anatomopathological examination of the tumor showed Schwann cell proliferation and ulceration of infectious origin. DISCUSSION: Intraoral schwannomas are uncommon. They generally induce local pain on percussion and dysesthesia. Isolated intraoral schwannomas are very rarely linked with type I neurofibromatosis. They do not require any specific follow-up after exeresis.

[Mandibular fracture: a 10-year review of 685 cases treated in Charles-Nicolle Hospital (Tunis-Tunisia)]. / Particularités épidémiologiques et thérapeutiques des fractures de mandibule au CHU Charles-Nicolle de Tunis.

INTRODUCTION: The epidemiology and treatment of mandibular fracture vary from one country to another. The aim of this study was to present the current demographic pattern and treatment regimens of mandibular fractures in Tunisia. METHODS: The medical records and radiographs of 685 patients treated for mandibular fracture at the Maxillofacial and Plastic Surgery Department in the Tunis Charles-Nicolle Hospital between 1995 and 2004 were retrospectively studied. The relevant parameters were: age, sex, etiology, anatomical site of fracture, and treatment. RESULTS: The prevalence of mandibular fractures was higher in male patients (sex ratio 6:1). Traffic accidents were the main cause of these lesions (45%), followed by assault (22%). Angle fractures were the most common (24.8%) followed by parasymphyseal fractures (22.2%). The most frequent treatment was closed reduction with maxillo mandibular locking in 388 patients (56.6%). Transosseous wiring was the most commonly used method in open reductions. Tooth loss and neurological sensitive deficiency were the most common sequels. DISCUSSION: Our epidemiological data correlates to published data for developing countries. Analyzing this data can help to improve the management of maxillo-facial trauma in Tunisia. Therapeutic options vary according to the type of fracture but also depend on the economical status of the country.

[Frontal meningioma en plaque: a rare presentation for a common tumor!]. / Méningiome en plaque frontal: forme rare d'une tumeur commune!

INTRODUCTION: En plaque meningioma are a morphological subgroup of meningioma defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone. We present an exceptional case due to its localization and evolution. CASE: A 41-year-old female patient consulted for progressive swelling of the left frontoparietal region. CT-scan revealed thickening of the cranial medulla, without cerebral lesion. The tumor was removed. Histological analysis confirmed en plaque meningioma which recurred 7 years after. DISCUSSION: En plaque meningioma are a rare subtype of meningioma which rarely affects the skull vault. Relapse is frequent.

Phenotypic spectrum of fucosidosis in Tunisia.

Fucosidosis (OMIM 230000) is a rare autosomal recessive lysosomal disorder due to deficient α-L-fucosidase activity(EC 3.2.1.51), leading to the accumulation of fucose-containing glycolipids and glycoproteins in various tissues. This study contained the largest ever Tunisian survey of fucosidosis patients, diagnosed during the period 1987-2007. The clinical pictures and outcomes of these patients are compared with literature data. Ten patients (8 boys and 2 girls) from six unrelated families were diagnosed at a mean age of 29 ± 10.3 months. Six of the patients were diagnosed as having the more severe phenotype. The other four cases presented the low progressive phenotype. This distinction was determined by the presence or absence of angiokeratoma and age of death. For all of the patients in our survey, early motor development was more severely delayed than described in the literature. Six patients presented psychomotor decline during the second year of life. Clinical features consist of variable mental retardation (all patients), progressive spastic quadriplegia (6/10 cases), coarse facies (9/10 cases), growth retardation (7/9 cases), visceromegaly (3 cases), angiokeratoma corporis diffusum (4 cases), recurrent bronchopneumonias (all cases), seizures (4 cases) and variable degrees of dysostosis multiplex (all cases). Portal cavernoma, never described in the literature, was observed in one patient. The outcomes were severe in this survey, probably owing to restricted health care; death occurred in 6 of the 10 patients before age 10 years, following recurrent pulmonary infections and neurological deterioration. No intrafamilial variability was noted in the multiplex families. The clinical presentation and outcomes of some of these patients were consistent with the continuous clinical spectrum of severity in fucosidosis attested by most clinical studies.

[Fractured zygoma: a review of 356 cases]. / Les fractures de l'os zygomatique : à propos de 356 cas.

INTRODUCTION: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world. METHODS: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004. RESULTS: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases. DISCUSSION: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.

[Columella defects: yet a challenge!]. / Les pertes de substance de la columelle : encore un défi !

The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.