Oral Commissure Lift: A Retrospective Analysis of Complication Rates and Overall Outcomes.

BACKGROUND: Downward-turning oral commissures and sagging mouth corners can present an unfavorable impression. We introduced a new oral commissure lift procedure and investigated its effectiveness and complication rates. METHODS: Patients who underwent oral commissure lift in the plastic surgery clinic between January 2010 and December 2017 were enrolled retrospectively. Pre-and postoperative photographs were evaluated to measure oral commissure angles and analyze surgical complications, including visible scarring, unnatural appearance, and asymmetry. Many patients underwent a oral commissure lift with a simultaneous facelift. To exclude potential bias, we compared angular changes between patients receiving both oral commissure lift and facelift, with those receiving only oral commissure lift. Moreover, oral commissure angles of patients only receiving facelift were also measured. Statistical significance was set at p < 0.05. RESULTS: Oral commissure lift was performed in 51 patients. The mean ages and follow-up periods were 46.7 ± 11.9 years, and 25.2 ± 22.9 months, respectively. The preoperative mean angles of the right and left oral commissures measured - 3.1 ± 4.0° and - 3.4 ± 3.7°, respectively, and postoperative mean angles measured 3.6 ± 3.2° and 3.3 ± 3.5°, respectively. Postoperative changes in oral commissure angles were statistically significant (p < 0.05). The low complication rate included undercorrection in one patient, asymmetry in one patient, and visible scarring in three patients. We found no statistically significant differences in the studies excluding bias. CONCLUSIONS: The new oral commissure lift procedure for correcting sagging oral commissures was simple, safe, and effective with a low complication rate. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nasal Stenosis Treated With a Composite Skin Graft.

A 58-year-old female patient was presented, who complained about breathing and aesthetic difficulties due to external nasal valve obstruction and nasal deformity that developed after nasal trauma surgery. Nasal stenosis recurs easily after surgery, especially if internal nasal stenosis is not adequately managed. Nasal stenosis in this case was well treated using a composite skin graft.

Retained Eyeglasses in the Orbital Cavity After Penetrating Facial Trauma.

This study describes a 68-year-old man who was presented to the emergency department with left orbital cavity penetration by his eyeglasses. The eyeglasses had entered the orbit and at presentation his eyesight could not be measured. The foreign body was extracted carefully and panfacial bone fractures were then reduced through lateral rhinotomy combined with a lip-splitting incision. When planning removal of an unusual foreign body from the orbital cavity, care should be taken not to injure the optic nerve, periorbital musculatures, or the eyeball.

Frontal Sinus Osteoplastic Flap Surgery Using a Surgical Navigation System.

OBJECTIVE: To report the case of a 38-year-old woman who underwent osteoplastic flap surgery for recurrent frontal sinus mucocele. During surgery, the exact shape of the frontal sinus was duplicated using a surgical navigation system. METHODS: In this case report, the authors suggest intraoperative surgical navigation systems are useful for accurately determining the dimensions of the frontal sinus for osteoplastic flap surgery. RESULTS: The patient underwent successful and safe osteoplastic flap surgery using a surgical navigation system. CONCLUSION: Surgical navigation is useful and safe for frontal sinus osteoplastic flap surgery.

Importance of adhesiolysis in revision surgery for vibrant soundbridge device failures at the short incus process.

The objectives of the study were to report a vibrant soundbridge (VSB) implant revision surgical method involving adhesiolysis at the short incus process under local anesthesia and demonstrate successful hearing performance after surgery. Three cases of VSB surgery, performed in 2016, were enrolled. All cases had diagnoses of device failure. This 'seven-incision line' exposed the floating mass transducer directly, after which the three steps (adhesiolysis, curettage, and hydrocortisone injection) were performed. Upon fitting the VSB, sound fields were evaluated immediately and at 3 months after the revision. During the revisions of surgery, all patients achieved immediate hearing gains and noticed differences in the outer devices with different amplifications. Satisfactory improvements in hearing thresholds and speech recognition abilities were confirmed by improvements of 20-30 dB in hearing loss 3 months after revision surgery. The VSB implant revision surgical method involving adhesiolysis is safe and efficient for patients who experience a VSB device failure. This method will reduce the requirement for surgery under general anesthesia, reduce the overall period of clinical therapy and, therefore, minimize patients' medical costs. Level of Evidence 4.

Transplanted tissue-engineered cartilage.

OBJECTIVE: To evaluate the feasibility of transplanting sculpted autogenous tissue-engineered cartilage (TEC) with the hope that it will retain precise 3-dimensional morphologic features after transplantation. Transplanted TEC is described in terms of the gross morphologic and histologic characteristics in contrast to pretransplanted TEC. METHODS: Synthetic scaffolds of a polyglycolic acid and poly-l-lactic acid polymer, coated with chondrocytes derived from rabbit auricular cartilage in concentrations ranging from 2.7 x 10(6)/mL to 6 x 10(7)/mL, were incubated in vivo on the dorsum of a rabbit for 8 weeks and then retrieved. The resultant TEC specimens were then sculpted into defined shapes and transplanted into a different location in the same rabbit, where they were allowed to incubate for another 8 weeks. The specimens were then retrieved and compared with the TEC before transplantation according to size, weight, and histomorphometric analysis. RESULTS: Thirteen chondrocyte-laden templates were successfully engineered to develop TEC. In each case, they were sculpted and transplanted to a different site in the same rabbit. Eight weeks after transplantation, all sculpted TEC specimens lost their original 3-dimensional morphologic features and experienced a significant decrease in mass. Histologically, the staining intensity of both hemotoxylin-eosin and safranin O was dramatically reduced following transplantation. In addition, there was a reduction in chondrocyte viability. Two consistent histologic findings were a foreign-body reaction to the synthetic polymer and ongoing cellular activity directed toward the formation of bone. CONCLUSIONS: Transplanting autogenous TEC does not allow the preservation of precise morphologic features that are needed for clinical implantation. The osteogenic progression and foreign-body reaction must also be controlled.

Nasal reconstruction: the state of the art.

PURPOSE OF REVIEW: Cutaneous malignancies of the nose are common problems and create the need for nasal reconstruction within many otolaryngology practices. In spite of the fact that such reconstruction is an ancient art, there continue to be innovations and advances that allow for more predictable and functional long-term results. RECENT FINDINGS: Analyzing the nasal defect through an organized algorithm can be useful in many circumstances, especially when one needs to consider vectors of tension, minimizing alar base asymmetry, resultant scars, and preservation of the intranasal airway. Application of the principle of aesthetic subunits has greatly improved the cosmetic results for many large nasal defects, and there have been some proposals to modify the original definitions and concept. Structural reconstruction is paramount with complex defects that involve the nasal framework or with those that are located in functionally critical areas. Autogenous cartilage grafting remains the gold standard, but the use of alloplastic and homograft materials for grafting continues to be reported as an alternative. Internal lining repair is essential with larger defects and the versatility of intranasal flaps is understood, but at times not available. Other flaps have been described and may be useful on such occasions. SUMMARY: There are many considerations during nasal reconstruction, and the surgeon must be facile with a variety of options within his/her armamentarium.