Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review.

BACKGROUND: Surgical revision rate of rhinoplasty is from 5% to 15% in literature. OBJECTIVE OF REVIEW: In the context of post-rhinoplasty deformities, we aim to investigate the modalities of using injectables, their impacts on revision rate of rhinoplasty as well as their influences on the surgical strategy. TYPE OF REVIEW: We realized an international literature review to collect informations on main studies reporting series of exclusive secondary medical rhinoplasties or mixed primary/secondary medical rhinoplasties, as well as per-operative injection. SEARCH STRATEGY: The databases of the National Library of Medicine, Cochrane Library, Embase and Web of science were explored using the following Boolean string: (rhinoplasty OR nose) AND (injectable OR fillers OR hyaluronic acid OR calcium hydroxylapatite). The search was limited to the English language literature for studies published from 2007 up to December 2019. RESULTS: Fifteen cohort studies were included. Hyaluronic acid was the most commonly used injectable for rhinoplasty revision. Patient satisfaction rates varied between 80% and 100%. Reinjections were necessary in about 20 to 50% of cases whatever the used injectables. Minor complications (swelling, bruising, erythema) were frequent after filler injections (4%). Severe complications such granulomas or vascular embolism causing skin necrosis/visual impairment were rare (0.4%). Their physiopathology, management and prevention are detailed. CONCLUSIONS: The use of injectables seems to reduce the need of secondary surgical rhinoplasties. It can be expected that an evolution in surgical practices will result from injectables using, but it will be possible only if the technique is perfectly understood to avoid potentially serious vascular complications.

[Attic emptying in cholesteatoma and precholesteatoma states. Technique, indications and results]. / L'évidement attical dans les états cholestéatomateux et précholestéatomateux. Technique, indications, résultats.

A surgical procedure different from the open or closed technique is presented. The attic is emptied through the meatus after a retromeatal access to the antromastoidal cavities. By blocking the aditus ad antrum, the procedure produces an antrio-attic microcavity with no recessus. Results of resection of epidermal lesions are quite satisfactory with a low rate of residual pathology. Retraction pouches do not develop because the mastoid is excluded and no attic recessus is formed. Surveillance of the cavity is easy and the disadvantages of functional sequellae inherent in open techniques are avoided. The preliminary results would confirmed the quality of the procedure. In 22 cases, there were 3 residual perles on the windows and 2 retraction pouches (anterior and posterosuperior). This technique is indicated in precholesteatoma states with poor prognosis and cholesteatomas of the attic. For more advanced lesions, this technique is less reliable and the open procedure is required.

[Sudden isolated cochlear deterioration in children]. / Détériorations cochléaires brusques, isolées, chez l'enfant.

Within a general study on the long-term outcome of tonal auditive thresholds in children, the authors analyzed 26 cases of sudden onset cochlear deterioration (unilateral or bilateral deficiency without former pathology, or sudden worsening of a known perception loss). The patients were hospitalized and followed the standard treatment course for sudden hearing loss. The characteristics of the former hearing deficiency, the original causes of the deafness or the sudden deterioration, and the short, medium and long-term audiometric thresholds were studied to determine possible prognostic factors. Sudden deafness, fluctuating hearing loss, progressive hearing loss, sudden cochlear deteriorations and the nosologic situation do not appear to have much signification in this poorly defined field of perception deficiency in children. Certain terminologies or classifications would appear simply to hide our ignorance of the true mechanisms underlying these problems.

[Cherubism. Apropos of a major case]. / Le chérubisme. A propos d'un cas majeur.

Cherubism is a benign, hereditary giant-cell lesion located in the mandible and both maxillaries, which appears during childhood as a painless bilateral swelling, progressing until puberty and then receding spontaneously without normally requiring any treatment. In a previous publication, the authors had presented the case of three young children from the same Algerian sibship, who were eventually all operated when surgery proved to be necessary. The case published in this presentation is that of a young Italian girl presenting with a monstrous form of cherubism. In view of this malignant form, the authors decided to perform surgical treatment in several steps in order to decrease this abnormality as much as possible, considering the physical and psychological consequences reported.

[Severe aplasia of the ear: management and surgical indications]. / Aplasies majeures de l'oreille: prise en charge et indications chirurgicales.

Severe aplasia of the ear raises both a cosmetic and a functional problem. Surgery is often performed starting at four or five years of age but early management is essential. The need for a hearing aid should be evaluated at the age of six months. At birth, the infant should have investigations for concomitant malformations, which are common, and for etiologic factors. Functional surgery to create a canal, tympanic membrane, and chain of ossicles should be performed only in bilateral forms. Satisfactory cosmetic results can be achieved by cartilage autografting according to Brent's technique.

[Muco-epidermoid tumors of the parotid gland. Diagnostic and therapeutic attitudes]. / Les tumeurs muco-épidermoïdes de la parotide. Attitude diagnostique et thérapeutique.

On the basis of a retrospective series of thirteen cases treated between 1969 and 1989, the authors have studied the diagnostic and therapeutic issues connected with mucoepidermoid parotid tumors. The diagnosis is histopathological, but it is sometimes difficult to establish because of the histological polymorphism of these tumors. The degree of malignancy is variable and generally low. It is determined according to clinical and histopathological criteria, although there is not always a correlation between these criteria and the malignancy of evolution. Surgical exeresis is sufficient to cure most of these tumors. However, postoperative radiation therapy is indicated in case of tumoral invasion. Out of the ten cases of mucoepidermoid parotid tumor, nine were treated in first intention with exclusive surgery, and one case underwent postoperative radiation therapy. No local recurrence was noted. Out of the three patients who had a second-intention surgical exeresis, one died after repeated recurrence in spite of the complementary radiation therapy.