[What rhinoplasty surgeons should know about body dysmorphic disorder (BDD)]. / Die Körperdysmorphe Störung: Was Rhinochirurgen darüber wissen sollten.

Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by an excessive concern with a non-existing or slight defect in physical appearance. BDD patients frequently show impaired judgment regarding the psychiatric origin of their concerns and often seek aesthetic treatment to resolve their appearance concerns. The central position of the nose in the face makes the nose one of the most common areas of concern in patients with BDD. Thus, aesthetic rhinoplasty is suspected to be one of the most frequently requested and performed surgical procedures in this population. However, there is a growing consensus that BDD should be considered a contraindication for aesthetic rhinoplasty, as favourable outcome is unlike [1-5]. In order to prevent patients from undergoing unsatisfying surgery and in the context of the increasing importance of medico-legal arguments, the rhinoplasty surgeon should be familiar with BDD. This article provides a focused review of issues pertaining to BDD that are relevant to the rhinoplasty surgeon.

Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation.

The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.

The golden ratio in facial symmetry.

Symmetry is believed to be a hallmark of appealing faces. However, this does not imply that the most aesthetically pleasing proportions are necessary those that arise from the simple division of the face into thirds or fifths. Based on the etymology of the word symmetry, as well as on specific examples and theories of beauty, we conclude that φ-value, a ratio also known as the golden ratio or the divine proportion, can also characterize symmetrical forms. Therefore, we propose the utilization of this ratio in facial aesthetics.

Superior semicircular canal dehiscence: prevalence in a population with clinical suspected otosclerosis-type hearing loss.

Superior semicircular canal dehiscence (SSCD) can present with a variety of symptoms that can be predominantly auditory, predominantly vestibular or both. It can mimic a wide range of otological disorders, in particular otosclerosis-like stapes fixation. Our study revealed that, in 5.3% of our patients with clinically suspected otosclerosis, SSCD was detected in high-resolution multi-detector computed tomography (HRMDCT) of the temporal bone. We therefore emphasise the value of HRMDCT with reconstructions in the plane of the superior semicircular canal and perpendicular to the superior semicircular canal in the diagnostic work-up of each patient with a tentative diagnosis of otosclerosis-type stapes fixation. Where there are doubts, VEMP testing should be performed. We believe that a number of unexplained complications after an uneventful stapedotomy procedure might be explained by a pre-operatively undetected dehiscent superior semicircular canal and therefore unwarranted surgery. The typical feature of the conductive hearing loss due to SSCD compared to otosclerosis is an air-bone gap which is much more prominent at low frequencies than at high frequencies.

Risk factors for recurrence of paranasal sinus mucoceles after ESS.

OBJECTIVE: Paranasal sinus mucoceles are benign, expansive processes filled with mucus and bordered by respiratory mucosa. The purpose of our study was to determine risk factors for recurrence of mucoceles after endoscopic sinus surgery (ESS) based on clinical and radiological characteristics. METHODS: We performed a retrospective review of 57 patients consecutively treated endoscopically for mucoceles between 1992 and 2002 at the UZ Leuven, a tertiary referral university hospital. RESULTS: Paranasal sinus mucoceles predominantly occurred in the maxillary sinus and the fronto-ethmoidal region (both 35%). In 69% of patients there was a history of sinus surgery (51%) or facial trauma (18%). Recurrence occurred in 5 of 49 patients who were treated by ESS in elective circumstances, while four of eight patients who underwent ESS at the moment of acute infection had recurrence (p = 0.004). Although all recurrences following elective ESS occurred in mucoceles related to previous facial trauma or sinus surgery, this relationship was not statistically significant (p = 0.2). In three patients, significant extension outside the sinus wall was present; three other patients had multiple mucoceles. Presence of multiple mucoceles and significant extension outside the sinus walls were also risk factors for recurrence (p = 0.002 and p = 0.001, respectively). In one patient with recurrence, the frontal recess was damaged during previous ESS. CONCLUSIONS: Three conditions can be considered risk factors for mucocele recurrence after ESS: surgery at a moment of acute infection, presence of multiple mucoceles, and significant extension outside the sinus wall.