Controversies in Revision Rhinoplasty.

Revision rhinoplasty is a complex operation with many variables that may influence the final esthetic and functional outcome of the procedure. Cartilage forms the structural framework of the lower two-thirds of nose and is essential for long-term support and maintenance of a patent nasal airway. The use of autologous cartilage grafting is the primary source of this material, limited by donor site quantity, quality, and harvest morbidity. Alloplastic materials, solid and injectable, are often used for augmentation purposes and may have devastating consequences. This article discusses past and current treatment concepts for various nasal deformities using available autologous grafting techniques.

Rhinoplasty of the Aging Nose.

The process of aging leads to countless bodily changes on both a macro- and microscopic scale. No organ system is unaffected; however, the nose is especially susceptible. Sun damage, hormone levels, regenerative capability, tissue elasticity, bone resorption, and the effects of gravity contribute to produce classic signs and symptoms. Rhinoplasty of the aging nose requires a comprehensive understanding of aging facial anatomy combined with surgical techniques designed to resist these ubiquitous remodeling forces over time.

Management of nasoethmoid fractures.

PURPOSE OF REVIEW: The management of nasoethmoid or naso-orbito-ethmoid (NOE) fractures requires a thorough knowledge of the central facial anatomy, surgical techniques, available tools and patient factors to obtain optimal restoration of aesthetic form and function. This review article describes the current methods of NOE fracture diagnosis, classification, surgical techniques and complication management, with a review of the current literature published over the past 18 months. RECENT FINDINGS: Advanced imaging modalities, bioabsorbable versus titanium rigid fixation, nasolacrimal duct stenting, NOE fracture management in children and the elderly, and novel techniques of medial canthopexy. SUMMARY: The treatment of NOE fractures has not changed dramatically in the last 5 years. Advanced surgical techniques, intraoperative computed tomography and absorbable plating hold promise requiring future research prior to broad implementation.

Inner ear dysfunction in caspase-3 deficient mice.

BACKGROUND: Caspase-3 is one of the most downstream enzymes activated in the apoptotic pathway. In caspase-3 deficient mice, loss of cochlear hair cells and spiral ganglion cells coincide closely with hearing loss. In contrast with the auditory system, details of the vestibular phenotype have not been characterized. Here we report the vestibular phenotype and inner ear anatomy in the caspase-3 deficient (Casp3(-/-)) mouse strain. RESULTS: Average ABR thresholds of Casp3(-/-) mice were significantly elevated (P < 0.05) compared to Casp3(+/-) mice and Casp3(+/+) mice at 3 months of age. In DPOAE testing, distortion product 2F1-F2 was significantly decreased (P < 0.05) in Casp3(-/-) mice, whereas Casp3(+/-) and Casp3(+/+) mice showed normal and comparable values to each other. Casp3(-/-) mice were hyperactive and exhibited circling behavior when excited. In lateral canal VOR testing, Casp3(-/-) mice had minimal response to any of the stimuli tested, whereas Casp3(+/-) mice had an intermediate response compared to Casp3(+/+) mice. Inner ear anatomical and histological analysis revealed gross hypomorphism of the vestibular organs, in which the main site was the anterior semicircular canal. Hair cell numbers in the anterior- and lateral crista, and utricle were significantly smaller in Casp3(-/-) mice whereas the Casp3(+/-) and Casp3(+/+) mice had normal hair cell numbers. CONCLUSIONS: These results indicate that caspase-3 is essential for correct functioning of the cochlea as well as normal development and function of the vestibule.