Cartilage-Sparing Otoplasty: An Overview of the Mustardé and Furnas Suture Techniques.

Otoplasty is commonly used to treat prominauris. Cartilage-sparing techniques for otoplasty are well popularized. The most common cartilage-sparing otoplasty techniques include the Mustardé and Furnas techniques. This article discusses the preparation, surgical steps, postoperative care, and associated complications for Mustardé and Furnas otoplasty in detail.

Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis.

Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Sixty-eight studies with a total of 5,546 patients used autografts (n = 5,382) or alloplastic implants (n = 164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs. 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98 vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95 vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.

Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review.

Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management.

The Merits of the External Rhinoplasty.

The authors present their views on the merits of external rhinoplasty in the context of a renewed awareness of the endonasal approach. Why do we continue to perform rhinoplasty via an open approach? The benefits of this technique such as its unparalleled exposure, the opportunity for technical precision, and the ability to better preserve nasal function are thoroughly explored. The criticisms of this technique are presented and discussed. The authors thoughts on rhinoplasty as a whole are examined.

Nasal reconstructive surgery for vasculitis affecting the nose: our two-centre international experience.

PURPOSE: To recommend an international multidisciplinary medical and surgical algorithm of treatment in nasal vasculitis, which will create a more streamlined approach. METHODS: A two-centre, international retrospective analysis of granulomatosis with polyangiitis (GPA) and levamisole-associated vasculitis (LAV) cases presenting between 2005 and 2019 was carried out. Demographic data, and surgical and medical treatment were recorded. Patients' signs and symptoms were analysed, and recommended treatment strategies outlined with key surgical procedures described. RESULTS: Forty-one GPA patients and 11 LAV patients were included in the study with a mean age of 38.6 and 38.8 years, respectively. A stepwise surgical management approach with reconstructive options is described and includes: (1) examination under general anaesthesia, biopsy, and insertion of silastic nasal splints; (2) septal perforation repair (with caution); (3) mild-to-moderate saddle nose reconstruction with costal cartilage; (4) severe saddle nose reconstruction with osseocartilaginous rib grafts; (5) soft-tissue reconstruction techniques. CONCLUSIONS: The management of nasal vasculitis is a particular challenge in facial plastic surgery. It requires a close collaborative approach with a physician skilled in the medical management of vasculitis. Surgery must be planned judiciously, with realistic patient expectations and only after a sustained period of remission. For more severe saddle deformities, the modified osseocartilaginous Andrews technique gives excellent long-term results.

Once Upon a Rhinoplasty: The History of the "Queen" of Facial Plastic Surgery.

The history of rhinoplasty is absolutely fascinating. It is replete with mysterious practices, intrigue, and imaginative thoughts. If necessity is the mother of invention, then sex, crimes, and punishment lay a legitimate claim to being the mother of rhinoplasty. The history of rhinoplasty is a global saga spanning the millennia. Practitioners of the art and science have included those demonstrating the most admirable traits espoused in the Hippocratic Oath, as well as those to whom the word "charlatan" might more aptly be applied. The truth of a story is illustrated in its telling, and we have attempted to be true historians. We recognize that observers and narrators, now well past (sic), have determined many of today's truths, and therefore their stories become our truths whether they were so or not. We have attempted to reference many who have contributed to the advance of this amazing surgical procedure, recognizing that we may have included some who have demonstrated marginal merit to be so. Assuredly, we have also unintentionally omitted some whom we should have included. From them we ask forbearance. Let the story begin, "Once upon a time…".

Nasal Reconstruction in Granulomatosis with Polyangiitis: A Two Decade Review.

Background: Granulomatosis with polyangiitis (GPA) leads to progressive destruction of the nasal tissues resulting varying degrees of saddle deformity and nasal obstruction. Reconstructive techniques are numerous, but there are no large series reporting their results. Objective: This study sought to measure complications and outcomes after rhinoplasty for GPA. Methods: We conducted a retrospective review of 42 patients with GPA who underwent nasal reconstruction of saddle nose deformity between 2005 and 2019 using primarily costal cartilage and soft tissue grafts. Results: Thirty-six patients met the criteria for inclusion. All were followed for a minimum of 12 months. Six patients required revision surgery due to infection or GPA flare ups. Five patients had complications. All patients were given a questionnaire at 12 months to rate their degree of satisfaction with their appearance and breathing. Conclusion: The findings of this study suggest that the use of strong cartilage grafts and the timing of surgery result in improvement in breathing and appearance after rhinoplasty in patients with GPA. Clinical Trial Registration number: REB # 21-125.

Management of the Prominent Ear.

This article incorporates the opinions and preferred surgical options in managing patients of 3 prominent facial plastic surgeons who have large otoplasty practices. Six different questions covering the management of prominent ears are answered by the 3 practitioners. Nonsurgical options for the treatment of prominent ears are discussed. The role of cartilage-cutting and cartilage-sparing techniques as well as individual preferred otoplasty techniques are thoroughly covered. Postoperative management of these patients is presented by the individual surgeons.

The use of autogenous costal cartilage graft in septorhinoplasty.

INTRODUCTION: Reconstructive septorhinoplasty in complex nasal deformities often requires harvesting a large amount of tissue for grafting. Autogenous septal cartilage has generally been considered the gold standard grafting material. The aim of this paper was to report our experience with the use of costal cartilage grafts in cases with significant structural deformities and insufficient septal cartilage. DESIGN: Retrospective chart review. PATIENTS: Between 1998 and 2006, 37 patients underwent septorhinoplasty using costal cartilage as the primary source for grafting. Twenty-two men and 14 women with a median age of 42 were enrolled in the study. Patient demographics, indications for surgery, and immediate and late complications were reviewed. The follow-up range was 3 to 72 months. CONCLUSIONS: Autogenous costal cartilage graft is a viable option in reconstructive septorhinoplasty. We advocate the use of this graft in septorhinoplasty cases requiring a large volume of tissue and insufficient septal cartilage.

Incisionless otoplasty: a reliable and replicable technique for the correction of prominauris.

IMPORTANCE: This study evaluates the postoperative outcomes achieved with incisionless otoplasty for the correction of prominauris. OBJECTIVE: To determine whether incisionless otoplasty is a reliable and replicable technique in correcting prominauris. DESIGN, SETTING, AND PARTICIPANTS: This study consisted of a retrospective electronic medical record review for 72 patients undergoing incisionless otoplasty for the correction of prominauris by a single surgeon from November 2006 to April 2013. Follow-up ranged from 1 to 87 months. The patients were operated on at both St Joseph's Health Centre (a community hospital) and The Cumberland Clinic (private practice) in Toronto, Ontario, Canada. All patients undergoing an incisionless otoplasty for the correction of prominauris were eligible. Participants' ages ranged from 3 to 55 years, with the majority being adults. Seventy patients were followed up for outcomes. INTERVENTIONS: Incisionless otoplasty. MAIN OUTCOMES AND MEASURES: Number and type of sutures used, perioperative complications, and postoperative follow-up including complications and revisions. Complications included infection, hematoma, bleeding, perichondritis, suture granuloma, suture exposure, and suture failure. RESULTS: A mean (SD) 2.5 (0.8) sutures were used in the left ear, 2.48 (0.75) in the right ear, and 4.69 (1.75) in total. The number of sutures used in the left vs right ear was not significantly different (P = .60). All patients had horizontal mattress sutures placed for correction of prominauris. There were no serious perioperative complications such as infection, bleeding, hematoma, perichondritis, or cartilage necrosis. Follow-up data were extracted and analyzed in 70 patients, with a mean follow-up time of 31 months. Complications were seen in 10 patients (14%): 4 were due to suture failure, 3 were due to suture exposure, 2 were due to granuloma formation, and 1 was due to a Polysporin (bacitracin zinc/polymyxin B sulfate) reaction. Nine patients (13%) needed a revision to achieve a desirable result. CONCLUSIONS AND RELEVANCE: The technique of incisionless otoplasty used in this study was well tolerated and effective in both pediatric and adult patients, producing favorable outcomes with minimal complications. This procedure is less invasive than its open counterpart and seems at least equally effective in longevity.

Detailed analysis of graft techniques for nasal reconstruction following Wegener granulomatosis.

BACKGROUND: Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge for the reconstructive surgeon. Various grafting options have been proposed, but achieving good outcomes can be difficult. METHODS: We conducted a retrospective analysis of 10 patients with WG who underwent reconstruction of saddle nose deformities by the senior author (A.G.) between 2005 and 2009. All patients were reconstructed using costal cartilage grafts. RESULTS: Primary surgery was functionally and cosmetically successful in 8 of 10 patients. Two patients experienced complications (graft resorption and columellar necrosis) requiring revision surgery; subsequently, they achieved good outcomes, with no further complications. There were no complications at the costal cartilage donor site. At the conclusion of the study, all patients were satisfied with their reconstructions. CONCLUSIONS: With a multidisciplinary team approach to pre- and postoperative patient management and careful surgical technique, reliable and excellent functional and cosmetic outcomes can be achieved with costal cartilage grafts.

Timectomía transesternal en miastenia gravis / Transsternal thymectomy in miastenia gravis

La timectomía parece tener un efecto benéfico en la evolución de los pacientes con miastenia gravis. Las indicaciones para realizar la timectomía deben ser generalizadas para incluir a todos los pacientes que presenten la enfermedad.Los resultados varían desde la remisión completa, la disminución de lo síntomas y los requerimientos medicamentosos,hasta evitar la aparición de timoma así como de otras enfermedades autoinmunes. Creemos que la vía de elección para la timectomía es la exploración mediastinal transesternal, que asegura una resección completa con una morbilidad aceptable y una mortalidad nula como en esta serie. Los pacientes con miastenia gravis candidatos a cirugía deben de ser manejados con coricoesteroides pre, trans y postoperatorios, evitando la combinación con anticolinesterasásicos. Es importante que colaboren estrechamente elneurólogo, el anestesiólogo y el cirujano en el manejo de estos pacientes para asegurar resultados muy satisfactorios en la gran mayoría de los casos.