Are preservation rhinoplasty techniques safer than structural ones?

This narrative review paper evaluates the preservation rhinoplasty (PR) technique in all aspects. The literature survey was performed in PubMed, EBSCO, UpToDate, and Proquest Central databases of Kirikkale University, Google and Google Scholar databases. The advent of the preservation rhinoplasty (PR) approach has led to a radical shift in the mindset surrounding rhinoplasty procedures. K-area (keystone region) loss, lateral cartilage collapse, and nasal stenosis are all avoidable with preservation measures. The nasal bones, the superior lateral cartilage, the quadrilateral cartilage, and the perpendicular blade of the ethmoid meet at the point known as Zone K. The variety of problems that might develop due to carelessness in this area demonstrates the significance of maintaining the nose's stability and structure. The three components of a preservation rhinoplasty (PR) procedure are (1) preserving the scroll ligament complex by elevating the soft tissue envelope (STE) in a subperichondrial-subperiosteal plane, (2) preserving the nasal dorsum without creating an open roof deformity, and (3) preserving the alar cartilages and achieving the desired shape using sutures rather than excision. Dorsal preservation is one of the three components that make up PR. However, the two concepts are not synonymous. PR involves elevating a skin sleeve from the subperichondrial-subperiosteal plane, preserving the osteocartilaginous dorsum, maintaining the alar cartilages with minor excision and using sutures to achieve the desired form.

Is it possible to define the ideal lips?

SUMMARY: The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual's face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthetics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person's lips are of great importance in the perception of beauty by humans. The appearance of the lips in part determines the attractiveness of a person's face. In females, fuller lips in relation to facial width as well as greater vermilion height are considered to be attractive.

Use of intranasal corticosteroids in adenotonsillar hypertrophy.

OBJECTIVES: This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy. METHOD: The related literature was searched using PubMed and Proquest Central databases. RESULTS: Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system. CONCLUSION: Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

Open rhinoplasty: effectiveness of different tripplasty techniques to increase nasal tip projection.

PURPOSE: To study the effectiveness of 3 different tipplasty techniques to increase nasal tip projection (NTP). MATERIALS AND METHODS: NTP of 61 patients who underwent open rhinoplasty were retrospectively studied in 3 different tipplasty techniques used to increase NTP. Using a standard measurement technique, the preoperative and postoperative NTP ratio was measured for every patient preoperatively and at least 1 year after surgery. The study population of 61 patients was divided into 3 groups. Group 1 (n-32) underwent the author's routine nasal tip procedure (columellar strut, conservative cephalic trim of the lateral crura, and transdomal mattress sutures). Group 2 (n = 10) underwent the routine procedure and, in addition, has further medical recruitment of the lateral crura. Group 3 (n = 19) underwent the routine procedure and, in addition, has a tip cartilage graft. RESULTS AND CONCLUSION: The mean gain NTP postoperatively was highest in group 3 and lowest in group 1, and this was statistically significant. Causes of these differences in the NTP gain are discussed.

Eagle syndrome: classic and carotid artery types.

OBJECTIVE: To present a number of cases with elongated styloid process (Eagle) syndrome and to discuss the clinical presentation of this disorder. METHODS: A clinical study of patients operated on at King Abdul-Aziz University Hospital, Riyadh, from 1992 to 1996. RESULTS: The study group consisted of seven patients (six females and one male ranging in age from 20 to 43 years). Symptomatically, two distinct groups of patients could be identified: the classic syndrome (including three patients), which occurs in the tonsillectomized patients, and the styloid-carotid artery syndrome (including four patients), which occurs independently of tonsillectomy. In the first type, patients usually complain of spastic and nagging pain in the pharynx radiating to the mastoid region. In the second group, patients usually complain of attacks of syncope in association with pharyngeal pain referred to the course of the carotid artery. Diagnosis is made by history taking, palpating the tonsillar fossa, and radiographic demonstration of the process. Three-dimensional computed tomography reconstruction images were found to be very reliable in measuring the actual length of the styloid process and the stylohyoid ligament. CONCLUSION: This unusual disorder should be considered in the differential diagnosis of facial pain in some patients and as the cause of syncope in other patients. The paper discusses the embryologic, anatomic, pathogenetic, clinical, and therapeutic aspects of elongated styloid process with calcified stylohyoid ligament and the differential diagnosis is detailed.

Simultaneous open rhinoplasty and alar base excision: is there a problem with the blood supply of the nasal tip and columellar skin?

In a prospective study, 15 consecutive patients who underwent simultaneous open rhinoplasty and alar base excision were included to investigate whether there is a problem with the blood supply of the nasal tip and columellar skin. During the surgical procedure in these patients, there was transection of the columellar arteries and external nasal arteries, and frequently of the alar branches of the angular artery. Yet, none of the patients had any evidence of ischemia of the nasal tip or columellar skin, and there was primary wound healing with a thin-line transcolumellar scar in all patients. Techniques to avoid injury to the lateral nasal artery and nasal tip plexus are discussed. It was concluded that simultaneous open rhinoplasty and alar base excision is safe as long as certain surgical principles are applied.

Complicated neonatal submandibular suppurative sialadenitis.

Acute suppurative infection of salivary glands in the neonatal period is a rare entity; and almost always involves the parotid glands. A rare case of neck abscess in association with right submandibular suppurative sialadenitis in a 7-day-old baby is presented. The possible etiology, diagnosis, and management of this uncommon disease are discussed.

Open rhinoplasty: columellar scar analysis in an Arabian population.

This prospective study included 50 consecutive Saudi Arabian patients who underwent open rhinoplasty. All patients had a minimum follow-up of 1 year after surgery. The columellar scar was assessed objectively and subjectively at the final follow-up. An unsatisfactory scar was considered present if anything other than a barely visible, level, and thin-line scar without notching was evident. Objectively, 39 patients (78 percent) were considered to have a satisfactory columellar scar. The percentage of unsatisfactory scars (22 percent) was higher than expected prior to performing the study, and one patient was actually conscious about the deformity. Causes and prevention of unsatisfactory columellar scars were discussed.

Alterations in nasal sensibility following open rhinoplasty.

Alterations of nasal sensibility following open rhinoplasty were studied both subjectively and objectively. In a prospective study, 25 patients were included. All patients underwent open rhinoplasty using a middle columellar incision. Subjective questioning and objective testing of nasal sensibility using the Semmes-Weinstein monofilaments were obtained preoperatively and both 3 weeks and 1 year after surgery. The match-paired Student's t-test was used for statistical analysis. At 3 weeks after surgery, there was subjective and significant objective alteration of sensibility in the area of skin supplied by the external nasal nerve (nasal tip and adjacent upper columella). This altered sensibility, however, recovered by 1 year after surgery. The recovery was thought to be due either to recovery of the external nasal nerve itself, or to collateral sprouting from the nerves supplying the adjacent areas of nasal skin.

Prevalence of severe to profound sensorineural hearing loss in children having family members with hearing impairment.

The purpose of this paper is to study the prevalence rate of hearing impairment among children with siblings and family members having hearing and speech disorders. A random survey of 6,421 Saudi infants and children between 2 months and 12 years of age was conducted in the Riyadh area. Children with no or few siblings and those who were firstborn were at relatively higher risk, and there was a strong association between children in the hearing-impaired group among those having living siblings with deafness. Those children who had family members with hearing and speech problems were at twice the risk of their counterpart groups regarding hearing impairment.

Relevant demographic factors and hearing impairment in Saudi children: epidemiological study.

A representative sample of 6421 Saudi children were clinically examined and screened for hearing loss. Hearing impairment was detected in 494 children (7.7 per cent). In 326 of the children it was due to chronic secretory and suppurative otitis media (5.07 per cent) and in 168 of them sensorineural hearing loss (2.6 per cent). The study revealed that parental education, low income, and employment of the mother showed a slightly higher at risk rate of hearing impairment. Children from related parents were also at a higher risk of hearing impairment and they demonstrated a marked adverse effect on the incidence of hereditary sensorineural hearing impairment. Comparison with other surveys of school children in developed and developing countries has been carried out.

Consanguinity and hereditary hearing impairment among Saudi population.

Hereditary sensorineural hearing loss is a preventive disease. A random sample survey of 6,421 Saudi infants and children was conducted tos study the prevalence of consanguineous marriage and its effect on the prevalence of hereditary sensorineural hearing loss. First cousin consanguineous marriage was found among the parents of 21.1% of the children studied and second cousin consanguinity was present in 23%. The overall prevalence of hereditary sensorineural hearing loss was 1.7%. A higher prevalence of 2.8% of this type of deafness of more distant consanguinity and 1.4% among non-consanguineous families' children. The study showed that consanguinity is widely practiced among the population surveyed and demonstrated a marked adverse effect on the incidence of hereditary sensorineural hearing impairment.