Rhinogenic Headache: Standardization of Terminologies Used for Headaches Arising From Problems in the Nose and Nasal Cavity.

OBJECTIVE: The use of different expressions between physicians frequently results in confusion in the process of diagnosis and treatment of patients with headaches due to problems in the nose and nasal cavity. The aim of this study was to assess the terminologies that have been used most frequently to standardize these terminologies. METHODS: Terminologies that are most frequently used in general, including rhinogenic migraine, sinus headache, rhinogenic contact point headache, middle turbinate headache syndrome, and rhinogenic headache, were found by searching PubMed, Web of Science, and Google Scholar. These terminologies were objectively assessed on the basis of existing research and definitions and the range of diagnoses by organizations with public credibility. RESULTS: There were many terminologies in use for headache related to nose; however, these were not logical expressions and only partly explained the phenomenon. Among the terms, "rhinogenic headache" was most appropriate in expressing and describing the related symptoms. CONCLUSION: The results indicated that the term "rhinogenic headache" is most appropriate for describing pain in the nose and eyes in patients with deformation within the nose or the nasal cavity due to external injuries or underlying diseases related to nose as observed on computed tomography.

Inframammary Flap Excision Method in Breast Augmentation: Improving Symmetry of NAC and IMF.

BACKGROUND: When we perform a breast augmentation through the inframammary fold (IMF) approach, incision placement at the new IMF is a key element of the planning process. In the majority of the previously published methods, the new IMF was planned based on the nipple-areola complex (NAC) position. However, these methods can lead to asymmetry in the IMF if the NAC is not symmetrical. METHODS: We present the IMF flap excision method for correction of asymmetries of NAC and IMF. The new IMF position was marked based on the ICE technique. We have redesigned the higher side IMF to the same height as the lower side. And then we removed the amount of the skin and soft tissue, which corresponded to the difference between the 2 IMF. We dissected the submuscular breast pocket higher than in the usual cases, making it easier to move the breast tissue downward. RESULTS: This method was performed on 21 patients, with an average follow-up time of 6 months (range, 2-9 months). The average correction amount of asymmetry of the NAC ranged from 3 to 15 mm and was maintained throughout the follow-up period. NAC downward positioning and symmetry of IMF were observed. Almost all patients showed improvement or complete resolution of their nipple asymmetry. CONCLUSION: The IMF flap excision method corrected the asymmetries in the NAC and IMF without additional scars. This method should be strongly considered in patients undergoing a primary breast augmentation procedure with mild NAC asymmetry.

Consideration of bone regeneration effect of stem cells: comparison between adipose-derived stem cells and demineralized bone matrix.

BACKGROUND: Currently, many studies have sought to address the regeneration of extensive bone defects using stem cells. Here, the authors injected adipose-derived stem cells and demineralized bone matrix (DBM) into areas of bone defect in rabbits and compared their effect on bone regeneration to study the clinical usefulness of stem cells. METHODS: This study used 20 male New Zealand white rabbits. Four craniectomies were made in 20 male New Zealand white rabbits' calvaria, and 4 different groups of experimental conditions were applied to each of the 4 cranial defects. To the first group, 0.2 mL of DBX, a commercially available clinical preparation ofDBM, was applied with fibrin glue. To the second group, 0.2 mL of adipose-derived stem cells, with confirmed bone differentiation ability, was applied with fibrin glue. To the third group, 0.1 mL of DBX, 0.1 mL of adipose-derived stem cells, and fibrin glue were applied. The fourth group of defects acted as the control and was left unaltered. After 6 weeks, regenerated bone from each defect site in each rabbit was collected and measured for volume change. Bone regeneration was assessed with three-dimensional skull bone computed tomography and histological analysis. RESULTS: Osteoblasts were confirmed in all defect groups after 6 weeks. Overall, bone regeneration was weakest in the control group, whereas other groups of defects showed distinct bone regeneration. In particular, group 3, to which adipose-derived stem cells and DBM were applied, demonstrated the most active regeneration. CONCLUSIONS: Both adipose-derived stem cells and DBM demonstrated regeneration effect on cranial defects in rabbits, but it is difficult to conclude which was better, because in each case the amount of regenerated bone was within the margin of error. However, as the most active bone regeneration was observed when both adipose-derived stem cells and DBM were applied together, this combination could be helpful in the correction of extensive bone defects.

Consideration of bone regeneration effect of stem cells: comparison of bone regeneration between bone marrow stem cells and adipose-derived stem cells.

BACKGROUND: Much controversy exists as to how stem cells efficiently differentiate and regenerate. To research how stem cell origin affects optimal differentiation and regeneration, the authors collected stem cells from bone marrow and fat and compared amounts of bone regeneration from both groups of cells. METHODS: This study used 16 New Zealand white rabbits raised in similar surroundings and conditions. After collecting stem cells from bone marrow and fat, osteoblast generation was induced. In each rabbit, 2 craniectomies (10 × 10 mm) were made into each rabbit's calvarium, and 0.2 mL (1 × 10(6) cells/mL) of bone marrow-derived and adipose-derived stem cells were transplanted into each defect. After 3 and 5 weeks of transplantation, computed tomography was conducted. After 6 weeks, regenerated bone tissue was collected and measured for volume, and biopsy was performed. RESULTS: Both bone marrow- and adipose-derived stem cells were effective in bone regeneration of the defect. Bone marrow stem cells demonstrated greater differentiation into osteoblasts, but there was no difference in the amount of measured regenerated bone volume after 6 weeks. CONCLUSIONS: Adipose-derived stem cells differentiate directly into osteoblasts less often than do bone marrow-derived stem cells. However, the total amount of regenerated bone is almost the same because of the effect of indirect bone regeneration. As adipose-derived stem cells are easily accessible and have the potential to abundantly proliferate into mesenchymal cells, they could be an effective bone regeneration material.

Aesthetic Correction of a Protrusive Forehead through Repositioning of the Anterior Wall of the Frontal Sinus.

Facial skeletal remodeling was revolutionized more than 30 years ago, by the work of Tessier and other craniofacial surgeons. However, the need to correct the skeleton in the upper third of the face is not frequently diagnosed or treated in aesthetic facial surgery. Here, we report on the aesthetic correction of a protrusive forehead. A patient visited our hospital for aesthetic contouring with a prominent forehead. The anterior wall of the frontal sinus was removed with a craniotome via the bicoronal approach. After the excised bone was repositioned, it was fixed with a titanium mesh plate and screws. An electric burr was used to contour the supraorbital rim and frontal bone. Once the desired shape was achieved, the periosteum was replaced, and the wound was closed in layers. When performed properly, frontal sinus contouring could significantly improve the appearance in patients with a prominent forehead. Plastic surgeons must carefully evaluate patients with a prominent forehead for skeletal remodeling that involves the accurate and safe repositioning of the anterior wall of the frontal sinus.