The 10th Costal Cartilage Graft in Secondary Cleft Rhinoplasty-A Versatile Rib.

Autologous costal cartilage for rhinoplasty is an excellent graft material providing both volume and quality of cartilage required for nasal reconstruction. Commonly, the 5th, 6th, 7th, and 8th rib costal cartilages have been harvested but other ribs such as the 10th rib are often overlooked and yet offer an excellent graft option for columellar, alar rim, nasal tip, and dorsal augmentation grafts. The use of the 10th rib costal cartilage in patients with complex secondary cleft nasal deformity has scant reference in the literature. We demonstrate our simple and quick 10th rib cartilage harvesting technique and elicit its use in secondary rhinoplasty and cleft lip nasal deformities. The advantages of harvesting the 10th rib cartilage and our long-term results demonstrating ease of harvest, stability, and predicable outcomes are with several clinical cases. The senior author has used the 10th rib graft successfully in a variety of challenging secondary cleft rhinoplasty procedures with excellent and consistent outcomes. We advocate the use of the 10th rib graft in such procedures as it is easy to harvest, is a dynamic cartilage graft, and offers predictable results with low levels of complications.

Combined correction of the nasal tip and upper lip in bilateral cleft lip patients: A novel approach.

Secondary nasal deformity in bilateral cleft lip is one of the great surgical challenges. The problems are an under projected tip, an infra-tip lobule merging with the pro-labium and a short columella. Upper lip vermillion border deformity is a further significant problem. We demonstrate our novel approach to management by classifying patients into 3 groups depending on the status of important features such as the anatomy of the prolabial skin island, length of columella and upper lip width and fullness. We demonstrate that cleft patients with nasal deformity and poor upper lip aesthetics can be managed with a single operation.

A modified reconstructive technique for paediatric congenital alar rim deformity.

Alar subunit retraction or notching whether acquired or congenital, can be challenging to reconstruct. Congenital cysts and benign lumps involving the nasal alar region can also result in acquired alar deformity once resected. Published reports describe different surgical methods, but we demonstrate a simple and highly satisfying technique. We present four paediatric cases with alar rim defects and demonstrate our modified surgical technique. All patients had an unremarkable recovery. Our outcomes demonstrate a minimal yet effective one-stage technique for correction of alar defects in paediatric patients that results in high patient satisfaction and allows for future secondary surgery if required.

Adrenal pseudocyst: Diagnosis and laparoscopic management - A case report.

Cysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal cysts can however present with severe abdominal pain and can be complicated by haemorrhage, rupture or infection. Adrenal pseudocysts appear to result from haemorrhage within a normal adrenal gland and can expand to accommodate massive amounts of fluid.We report the case of a 39-year-old woman who presented with worsening right upper quadrant pain. An ultrasound scan of the abdomen confirmed a large 29 cm × 20 cm × 17 cm cyst that appeared to originate in the upper pole of the right kidney causing displacement of the liver and right kidney.Following complete aspiration the cyst re-accumulated and an MRI scan demonstrated a thickened and irregular cyst wall with haemorrhagic fluid. Laparoscopic right adrenalectomy was performed and the histopathological diagnosis was confirmed as an adrenal pseudocyst.