The rhinoplasty consult.

Correction of a crooked nose is a common request among patients seeking rhinoplasty or revision rhinoplasty surgery. The rhinoplasty consult is an opportunity for both the surgeon and the patient to obtain an understanding of the potential outcomes from rhinoplasty surgery. This includes the possible surgical outcomes as well as the potential for patient satisfaction with the procedure. Effective communication between physician and patient is the cornerstone to the successful and effective rhinoplasty consult.

Bilobed flaps in nasal reconstruction.

The bilobed flap is a local transposition flap useful for the repair of nasal defects commonly seen after Mohs surgery. The bilobed flap has benefits over other nasal transposition or advancement flaps because it distributes wound closure tension over a larger surface area through the use of 2 lobes. This property is especially helpful for defects of the caudal portion of the nose, where the skin is less elastic. This article discusses the bilobed flap for nasal reconstruction along with the appropriate selection, design, and placement of the flap and the potential complications.

Nuances of profile management: the radix.

Profile refinement is one of the most common reasons patients seek consultation for rhinoplasty. Emphasis on creating a natural-appearing nasal dorsum demands a methodic nasal and facial analysis. Areas of dorsal excess and deficiency are identified, quantitated, and considered when determining surgical goals. The radix is an essential component of the profile and is carefully assessed from the standpoint of projection and position. Height and contour are evaluated at the radix, rhinion, and nasal tip. Each component of the dorsal profile is individually classified as overprojected, underprojected, or of appropriate height. Case studies demonstrate the necessary surgical steps to create a more balanced profile.

Prevalence of biofilm-forming bacteria in chronic rhinosinusitis.

BACKGROUND: Recently, biofilms have been implicated in the pathogenesis of recalcitrant chronic rhinosinusitis (CRS). We sought to determine the prevalence of biofilm-forming cultures obtained from patients with CRS and clinical factors that may contribute to biofilm formation. METHODS: Endoscopically guided sinonasal cultures were obtained in duplicate from CRS patients with evidence of mucopurulence. Bacterial swabs were sent for microbiological characterization and were simultaneously evaluated for biofilm-forming capacity by a modified Calgary Biofilm Detection Assay. Biofilm formation was based on concomitant values of biofilm-forming Pseudomonas aeruginosa O1 (PAO1) (positive control) and non-biofilm-forming mutants sad-31 (type IV pili) and sad-36 (flagella K; negative control). Samples, with growth greater than the sad-31 mutant, were designated as biofilm formers. RESULTS: Sinonasal cultures were obtained from 157 consecutive patients (83 female patients) over a 4-month period. Forty-five samples (28.6%) showed biofilm formation. Among patients with a prior history of functional endoscopic sinus surgery (FESS), 30.7% (n = 42) showed biofilm growth. For patients naive to surgical intervention (n = 20), only 15% showed biofilm formation. A positive, statistically significant correlation existed between biofilm formation and number of prior FESS procedures. Polymicrobial cultures, Pseudomonas aeruginosa, and/or Staphylococcus aureus comprised 71% of samples. Chi-squared analysis showed an association with prior infections, but not with any pharmacologic therapy or comorbidies. CONCLUSION: We show a high percentage of CRS patients (28.6%) whose sinonasal mucopurulence has biofilm-forming capacity. Postsurgical patients had a high prevalence of biofilm-forming bacteria, a possible reflection of the severe nature of their disease. Additional studies are warranted.

A sinonasal inverted papilloma of mixed histology: implications for management of all sinonasal papillomas.

Sinonasal papillomas are classically categorized by their histology. Inverted, cylindrical, and fungiform are the three subtypes used to describe these lesions, and their medical and surgical management is often based on the specific subtype. We describe a case of a sinonasal papilloma with all three subtypes represented within the same surgical specimen. To our knowledge, this represents the first such case in the literature and has implications for the management of all sinonasal papillomas.

Endoscopic-assisted reduction of anterior table frontal sinus fractures.

In this study, we examined salvage operations after reexploration in head and neck reconstruction and analyzed ways to solve problems. Free flap reconstruction of the head and neck lesion was carried out for 513 cases in our hospital over the past 12 years. Twenty-one cases of reexploration were caused by postoperative thrombosis (4.1%). We could only salvage seven cases (33.3%) of 21 cases from flap thrombosis. All seven cases were included in the category of venous thrombosis, and they were undertaken within 3 days postoperatively. Our results have shown that once thrombosis occurs, there is little possibility of flap salvage, particularly 3 days after operation and in infectious cases. When no flow phenomena are observed and no flap salvage is deemed possible, aggressive treatment such as a second free flap or next pedicle flap should be chosen as soon as possible to avoid any delay in postoperative treatment.

Analysis in otoplasty.

The normal auricle has a well-recognized shape, and significant deviation from "normal" is immediately evident. In particular, prominent ears are readily apparent and are a relatively frequent cause of patient concern. Correction of the outstanding ear requires a careful understanding of the discrete elements that compose the normal ear. Careful anatomic analysis to determine the precise cause allows appropriate preoperative planning for the correction of a protruding ear.