Dorsal Preservation Surgery: A Novel Modification for Dorsal Shaping and Hump Reduction.

BACKGROUND: A new technique for dorsal preservation rhinoplasty that minimizes recurrent hump deformity is introduced. OBJECTIVES: The authors sought to present a novel dorsal roof flap (DRF) technique for modifying the nasal hump and dorsum while reducing morbidity. METHODS: Twenty-two primary and 3 secondary rhinoplasty patients had 1 of 2 types of nasal DRF depending on hump composition. A triangular roof flap was created utilizing 2 incisions from W-point to lateral Keystone junction in cartilaginous humps (cartilaginous DRF) and to the nasion in osseocartilaginous humps (osseocartilaginous DRF). Then, septal strip excisions were conducted to lower the profile followed by nasal base narrowing. The DRF was then lowered to the desired profile line, any excess lateral wall height trimmed, and the DRF sutured to the upper lateral cartilages. Preoperative and postoperative nasolabial and nasoglabellar angles were measured on the photos. RESULTS: Mean follow-up was 10.3 (standard deviation, 4.41) months (range, 6-20 months). A total 22 humps were V-shape and 3 were S-shape. The composition of the hump was cartilaginous in 5 cases, bone in 7 cases, and combined in 13 cases. A cartilaginous DRF was utilized for the 5 cases with a cartilaginous hump and osseocartilaginous DRF was employed in the other 20 cases. There were no complications observed in the follow-up period and thus no revisions. CONCLUSIONS: The DRF technique allows preservation of the nasal dorsum and elimination of the dorsal hump while minimizing hump recurrence.

Reducing Dorsal Hump Recurrence Following Push Down-Let Down Rhinoplasty.

BACKGROUND: Hump recurrence is a commonly encountered problem following dorsal preservation (DP) rhinoplasty when surgeons are learning the procedure. OBJECTIVES: The aim of this paper was to compare the different methods for the prevention and treatment of dorsal problems following DP surgery. METHODS: One hundred and fifty primary rhinoplasty patients were included in our study. Their noses were classified in terms of both hump shape (V- or S-shaped) and height. All patients had a DP rhinoplasty by either a push-down (PD) or a let-down (LD) technique. The PD method was used for humps <4 mm and the LD for humps >4 mm. Follow-up evaluations were made with physical examination and photographs at 1 week, 3 months, and 12 months. RESULTS: Mean follow-up was 12.68 [1.78] months. Seventy-eight humps were V-shaped and 72 were S-shaped. PD was used for 67 cases, LD for 83 cases. Eight patients (5.3%, 8/150) had a visible dorsal hump problem after DP surgery. Based on their preoperative hump shape, 3 cases were V-shaped and 5 were S-shaped. All recurrent cases had a preoperative hump deformity >4 mm. The revision procedures were as follows: 4 patients had a PD procedure, 3 had a LD procedure, and 1 patient was treated by classic open resection rhinoplasty. CONCLUSIONS: There is a correlation between preoperative hump height and eventual hump recurrence. The complication rate can be decreased with additional technical maneuvers and proper patient selection.

An Extremely Rare Condition: Unilateral and Isolated Temporalis Muscle Hypertrophy.

Unilateral and isolated temporalis muscle hypertrophy is an extremely rare condition causing cosmetic problems and pain in the temporal region. Up to date, 8 isolated and unilateral cases were reported in the English literature. In this article, the authors report 2 new cases of unilateral isolated temporal muscle hypertrophy.

Electrical burns: Highlights from a 5-year retrospective analysis.

BACKGROUND: Electrical burns are the third most common cause of burn injuries, after scald and flame burns. In spite of decreasing mortality rates as advancements are made in treatment modalities and medical equipment, significant complications and socioeconomic consequences still accompany electrical burns. Analyzed in the present study were data from patients hospitalized for electrical burns between 2008 and 2012 in the Samsun Training and Research Hospital, the only burn care center in the Black Sea region of Turkey. METHODS: Data from 94 patients (84 males, 10 females) hospitalized for electrical burns between 2008 and 2012 were retrospectively evaluated. Patient age, gender, occupation, presence of coexisting trauma, burn degree, burned percentage of total body surface area (TBSA), voltage of the electric current (low or high), medical cost (per day and total), and infection rates were analyzed. RESULTS: Mean patient age was 26.4±13.2 years. Ten patients were female (10.6%) and 84 were male (89.4%). High-voltage burns were sustained by 47 patients (50%) and low-voltage burns by 42 (44.7%); the remaining 5 were flash burns. Mean burned TBSA was 21.8±19.8% in high-voltage injuries and 11.9±6.9% in low-voltage injuries. Seven patients had accompanying soft tissue lacerations, major bone fractures, or epidural hematomas. Findings of infection were encountered in 31 patients (32.9%), and appropriate treatments were initiated according to culture results. Mean duration of hospitalization was 21.3±19.8 days in patients with high-voltage burns and 8.6±6.2 days in patients with low-voltage burns. Mean hospital stay was 2.5-fold longer, and total medical costs were 4-fold higher in patients with high-voltage burns. CONCLUSION: Young adult males who were injured in industrial accidents constituted the majority of high-voltage burn patients. Incidence of these injuries may be reduced by improvements in training regarding the safe use of electrical devices, and correct installation and safe maintenance of power grids, as well as by a review of occupational safety regulations.

A Rare Cutaneous Adnexal Tumor: Malignant Proliferating Trichilemmal Tumor.

Proliferating trichilemmal tumors (PTTs) are neoplasms derived from the outer root sheath of the hair follicle. These tumors, which commonly affect the scalp of elderly women, rarely demonstrate malignant transformation. Although invasion of the tumors into neighboring tissues and being accompanied with anaplasia and necrosis are accepted as findings of malignancy, histological features may not always be sufficient to identify these tumors. The clinical behavior of the tumor may be incompatible with its histological characteristics. Squamous-cell carcinoma should certainly be considered in differential diagnosis because of its similarity in morphological appearance with PTT. Immunostaining for CD34, P53, and Ki-67 is a useful adjuvant diagnostic method that can be used in differential diagnosis aside from morphological findings. In this study, we aimed to present the case of a 52-year-old female patient with clinicopathological features. We reported a low-grade malignant proliferating trichilemmal tumor in this patient and detected no relapse or metastasis in a 24-month period of follow-up.

Simultaneous cheek and lower eyelid reconstruction with combinations of local flaps.

Cheek defects are common facial defects, especially after tumor ablation. Although primary repair yields the best aesthetic outcome, wide defects require flap resurfacing. Among the flap techniques, the cervicofacial rotation/advancement flap is one of the most common. In cases with eyelid involvement, it is very unlikely that a local flap would single-handedly resurface the defect and additional flaps must be used.This article presents our clinical experience with 14 patients with cheek defects for whom cervicofacial rotation/advancement flaps were used. In 3 of the 14 patients, local flaps that include the laterally based Tripier flap, the Fricke flap, the nasojugal flap, and the median forehead flap were combined with the cervicofacial flap to reconstruct the lower eyelid defects in accordance with the principle of individually reconstructing different anatomic subunits. All infraorbital defects were resurfaced with residual cheek and cervical skin with a good color and texture match. In patients whose eyelids were intact, no malposition was observed.Posteriorly based cervicofacial rotation/advancement flaps offer a very reliable and convenient method for resurfacing infraorbital and medial cheek defects. When a lower eyelid defect is also present, its individual reconstruction as a separate facial subunit needs to be considered using a combination of smaller local flaps.