A New Risk of Using Alkaline Drops in Patients With Laryngopharyngeal Reflux.

Laryngopharyngeal reflux (LPR) is common in the otolaryngologist's office, and a multimodal treatment regimen is employed often. Counseling patients on lifestyle modifications is important. Alkaline water consumption has been recommended as a nonmedical "antacid" for its value in deactivating pepsin, a proteolytic enzyme responsible for laryngeal tissue inflammatory changes in LPR. Alkaline water can be found as premade bottled water, or it can be made at home by titrating regular-pH water with concentrated alkaline drops. We present a patient who mistakenly instilled the alkaline drops into her eye, causing alkali-related chemical burns to the sclera and cornea, which subsequently resulted in scar.

Sublabial Approach to Tip Rhinoplasty: A Cadaver Model.

OBJECTIVES: The main objective of this study was to investigate the utility of the sublabial approach in gaining proper exposure for tip rhinoplasty maneuvers in a cadaver model. Additional objectives included identifying types of grafts that can be placed sublabially and whether these methods can be translated successfully to human subjects. METHODS: Ten (N = 10) fresh-preserved cadavers were dissected at our academic institution from August 18, 2019 through February 5, 2020. Photographs of the cadavers were taken with permission from the anatomy laboratory manager using an iPhone 10 (Apple Inc., Cupertino, CA). Standard rhinoplasty views were taken of all ten cadavers. RESULTS: Grafts were harvested and designed from septal (80%), auricular (50%) and rib cartilage (40%). The division of depressor septi muscle was accomplished in all ten (100%) cadavers to address tip ptosis. Placement of the columellar strut and shield grafts resulted primarily in the improvement of nasal projection as well as rotation in all (100%) cadavers. Premaxillary augmentation was not always indicated but helped to improve an acute, retrodisplaced nasolabial angle in three (30%) cadavers. Lateral osteotomies via this approach addressed the nasal bony pyramid in all ten (100%) cadavers. The swinging door technique enabled correction of the caudal septum in six (60%) cadavers. CONCLUSIONS: Several rhinoplasty techniques can be successfully performed on cadavers via the sublabial approach and we hope this work can be translated to human subjects.

Rugby-related adult maxillofacial trauma injuries: a NEISS database study.

PURPOSE: The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future. METHODS: The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009-2018). Descriptive statistics were organized and presented. Chi-squared testing (χ2) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables. RESULTS: A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice. CONCLUSIONS: When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.

"Not Above, Not Below: Right in the Middle!"-Novel Filler Technique for Temporal Augmentation and Rejuvenation.

The temporal region is challenging to treat due to its thin skin, which has the propensity toward showing irregularities. The literature on temporal hollowing augmentation suggests placing the filler either into the subcutaneous space or within the temporalis muscle. However, these techniques have been based upon opinion rather than supporting anatomical and clinical data. We introduce a novel injection technique to avoid complications and achieve lasting results. This novel technique was confirmed with a cadaver model, in vivo model, and application to a human subject. The anatomical layers of the temporal region were highlighted: the skin, subcutaneous tissue, temporoparietal fascia (superficial temporal fascia), deep temporal fascia, superficial temporal fat pad, and temporalis muscle. Particular emphasis was placed on identifying the frontal branch of the superficial temporal artery to avoid vascular complications. We believe the potential space between the temporoparietal fascia and the deep temporalis fascia is the safest, most efficacious plane to inject the temporal region with a 27-gauge cannula. Our future goal is to recruit and present a larger series of patients receiving this injection.