Evaluation of Dislocation Risk Factors With Total Hip Arthroplasty in Developmental Hip Dysplasia Patients: A Multivariate Analysis.

BACKGROUND: This study aimed to investigate the risk factors for dislocation in patients diagnosed with developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty. METHODS: We retrospectively reviewed 40 patients who developed dislocation and compared them with 400 patients in the control group without hip instability. Patients-, surgery-, and implant-related factors were investigated. Risk factors were evaluated using multivariate logistic regression. RESULTS: The mean follow-up period was 32.3 months. The mean time to dislocation was 4.4 months. There were 7 men (17.5%) and 33 women (82.5%) in the dislocation group and 83 men (20.7%) and 317 women (79.3%) in the control group (P = .627). Diabetes mellitus (DM; P = .032) and history of previous hip surgery for DDH were associated with dislocation (P < .001). The subtrochanteric shortening osteotomy (P = .001), acetabular inclination (P = .037), acetabular anteversion (P < .001), femoral head size (P < .001), and postoperative infection (P = .003) were associated with dislocation. Major predictors of hip dislocation after total hip arthroplasty in patients with DDH were previous hip surgery (odds ratio [OR], 6.76; 95% confidence interval [CI], 1.86-24.6; P = .004), high hip center (OR, 2.90; 95% CI, 1.31-6.38; P = .008), DM (OR, 2.68; 95% CI, 1.06-6.80; P = .037), and acetabular inclination (OR, 2.62; 95% CI, 1.09-6.26; P = .03). CONCLUSION: Patients with DM and previous hip surgery should be informed about increased dislocation rates. Using a larger head diameter and restoration of the true hip rotation center are essential to prevent hip dislocation in these patients. Furthermore, accurate positioning of the acetabular inclination and anteversion are also important.

Response to Commentary on: Dorsal Roof Technique for Dorsum Preservation in Rhinoplasty.

Rhinoplasty is a sophisticated surgery that needs high technical skills with knowledge. The DR technique is a refined technique to deal with the selected cases which are challenging for rhinology (wide dorsum, base and humpy nose). Still, so many things are unknown and one life span will be never enough to solve it. However, the author thinks that any solution fills the gaps, is the only thing we can improve the medicine. LEVEL OF EVIDENCE V: 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.

Dynamic Video-Photograph Studio: A New Rhinoplasty Documentation.

BACKGROUND: Photographic documentation of the nose is the standard procedure for many surgeons who perform rhinoplasty across the world. One of the most challenging views in the photograph documentation is the frontal view that requires special photographic skills and may create a bias. Our dynamic video recording process allows us to improve the quality of patient evaluation, making the assessment more convenient and enabling the documentation of high-level rhinoplasty database. OBJECTIVES: Our main goal was to present our selected video recording process that ensures standardized, high-quality documentation of the data from rhinoplasty patients. As per our knowledge, this tool has not been published before. METHODS: We have invented a rotational platform-based chair that allows us to make a dynamic evaluation of the patients under standardized photograph settings (patient's position, camera, and lighting features) through a video recording. RESULTS: We demonstrated that the quality of our rotational video recording process is similar to that of standardized photographs. However, this additional dynamic evaluation helps to avoid Photoshop® corrections which may result in bias. CONCLUSIONS: This high-quality patient evaluation represents advancement in the photograph-documentation process in the modern era of rhinoplasty. This new dynamic video recording process prevents image misinterpretation, helps improve the quality of patient evaluations, makes the process more convenient, and enables the documentation of high-quality data for rhinoplasty patients. Moreover, this new recording process is an excellent tool for educational purposes and presentations. LEVEL OF EVIDENCE V: 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.

Dorsal Roof Technique for Dorsum Preservation in Rhinoplasty.

BACKGROUND: Management of the nasal dorsum is an important part of rhinoplasty. Hump removal results in the destruction of the internal valve and keystone area, which are reconstructed with either spreader flaps or grafts for aesthetic and functional reasons. OBJECTIVES: The goal of this work was to present the dorsal roof technique for both dorsum reduction and narrowing during rhinoplasty. METHODS: Fifty-two patients (35 females, 17 males) underwent septorhinoplasty surgery with the dorsal roof technique. During the follow-up period, all patients were photographed in the standard views. Photos were examined by two independent plastic surgeons. The pyramidal angles of the patients were measured with a protractor preoperatively and 1 year postoperatively. A rhinoplasty outcomes evaluation questionnaire was administered to all patients at the 1-year follow-up visit. Functional improvement was assessed utilizing self-evaluated nasal patency. The chi-square test was employed for statistical analyses. Data were evaluated retrospectively. RESULTS: Of the 52 patients, 44 completed the 1-year follow-up period and rhinoplasty outcomes evaluation questionnaire. During the follow-up period, no irregularity or residual hump was detected. Significant narrowing was achieved (P < 0.001). High patient satisfaction was achieved, and no functional or aesthetic complications were encountered. CONCLUSIONS: Whenever possible, the dorsal roof technique is preferred to resection or camouflage the dorsum. This technique allows treatment of the wide dorsum, wide nasal base, and dorsal hump without resection, thus maintaining the integrity of the dorsal bone-cartilage complex.

The Effects of Vibration and Pressure Treatments in the Early Postoperative Period of Rhinoplasty.

BACKGROUND: The early postoperative period can be distressing for the patients undergoing rhinoplasty since edema and ecchymosis are common complications. OBJECTIVES: To analyze the effects of the vibration and pressure treatments in the early postoperative period of rhinoplasty. METHODS: Sixty patients, who had undergone rhinoplasty, were randomized into 3 groups: group 1 (control group, n = 20) received classic nasal casting, group 2 (n = 20) received nasal cast with an elastic bandage to hold it on the face, and group 3 (n = 20) received vibration treatment in addition to that in group 2 following the rhinoplasty. They were evaluated preoperatively and postoperatively at 3 and 7 days in a prospective study. The postoperative edema and ecchymosis were scored by 2 independent surgeons. The postoperative pain was measured using the visual analog scale, and the necessity of anti-inflammatory medication (and the dose needed) and the cast comfort was questioned. The sebaceous activity of the nose skin was examined. A preoperative and postoperative seventh day sonographic study was performed to evaluate the tissue edema objectively. RESULTS: The pressure treatment decreased the edema and ecchymosis significantly compared with the control group. The vibration treatment minimized edema, ecchymosis, sebaceous activity of the nose skin, pain score, and the need for anti-inflammatory medication, and increased the cast comfort significantly compared with the other groups (P < 0.0001). CONCLUSIONS: Rapid regression of edema and ecchymosis may be achieved using the vibrating nasal cast technique that may minimize patient discomfort, pain, and sebaceous activity following rhinoplasty.

Lumbar spine posture and spinopelvic parameters change in various standing and sitting postures.

PURPOSE: This study aimed to compare differences in lumbosacral and spinopelvic parameters between pain developers and non-pain developers as well as the effects of various posture changes. METHODS: A total of 38 consecutive participants, 20 standing-induced low back pain developers (mean age: 27.7 ± 5.3; mean BMI: 22.64 ± 2.95) and 18 non-pain developers (mean age: 29.0 ± 7.5; mean BMI: 24.2 ± 1.87) (p > 0.05), were prospectively evaluated. Six sagittal plane radiographs were taken. Upright standing posture was used as the reference posture. Lumbar lordosis, lumbosacral lordosis, L1/L2 and L5/S1 intervertebral (IV) joint angles, pelvic incidence, pelvic tilt and sacral slope were measured on each radiograph. RESULTS: There were no significant differences in terms of age, BMI, SF-36 score, or Oswestry Disability Index scores between pain developer and non-pain developer groups (p > 0.05). Pain developers had significantly larger lumbar lordosis, larger L1/L2 intervertebral angles, larger pelvic incidences and sacral slopes in all postures (p < 0.05). The contribution of L5/S1 intervertebral angle to lumbar flexion was higher than that of the L1/L2 intervertebral angle during stair descent, the sitting and the leaning forward while sitting postures (p < 0.05). CONCLUSION: The current study supports the assertion that increased lumbar lordosis is associated with increased pain. Lumbar spine angles change in various postures. The changes were more prominent in pain developers than in non-pain developers. Larger lumbar lordosis due to larger pelvic incidence may be a risk factor for the development of standing-induced low back pain. These slides can be retrieved under Electronic Supplementary Material.

Superior-Based Transposition Flap: A Novel Technique in Rhinoplasty.

BACKGROUND: The cephalic trimming of the lower lateral cartilage (LLC) is an attempt to reduce tip bulbosity; unfortunately, it has the potential to cause a pinched nose deformity and valve collapse. OBJECTIVES: The author sought to use the superior-based transposition (ST) flap to reshape, relocalize, and reinforce the LLC as a support material for both internal and external valves with aesthetic corrections, leaving the scroll area untouched. METHODS: A total of 367 patients (female, 215; male, 152) were operated with the presented technique. The ST flap was simply used to prepare a cartilage flap based on the scroll area in the cephalic portion of the LLC, and then this flap was advanced over the remaining LLC. The data were evaluated retrospectively. RESULTS: Functionally, the ST flap was used to reshape and support the LLC and the internal valve by keeping the scroll intact and increasing the internal valve angle. The support and suspension of the LLC with this novel technique improve the functional results and prevent complications such as stenosis of both the external and internal valve angles. Aesthetically, the convexity and concavity of the LLC could be fixed with the adaptation of these two surfaces in different angles, thereby achieving a narrower, refined, and aesthetically pleasing tip. CONCLUSIONS: This study demonstrates that the ST flap can be one of the main maneuvers performed during rhinoplasty for many purposes, such as reshaping and supporting the LLC, increasing the tip rotation, achieving more aesthetically pleasing tips, suspending the internal and external valves, and protecting the scroll area.

Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty.

Over the last 100 years, more than 200 different methods have been described to correct prominent ear deformity. These techniques revolved around various combinations of postauricular incision, cartilage scoring, and strategic suture placement to reapproximate the antihelical fold and correct angular deformity. In the last two decades, fascial flap techniques have become prominent in otoplasty. This article gives a comprehensive review of the different surgical techniques employed to construct fascial flaps and their contributions to otoplasty.

Nasal Base Retraction: A Treatment Algorithm.

BACKGROUND: Nasal base retraction results from cephalic malposition of the alar base in the vertical plane, which causes disharmony of the alar base with the rest of the nose structures. Correcting nasal base retraction is very important for improved aesthetic outcomes; however, there is a limited body of literature about this deformity and its treatment. OBJECTIVES: Create a nasal base retraction treatment algorithm based on a severity classification system. METHODS: This is a retrospective case review study of 53 patients who underwent rhinoplasty with correction of alar base retraction by the senior author (S.T.). The minimum follow-up time was 6 months. Levator labii alaque nasi muscle dissection or alar base release with or without a rim graft on the effected side were performed based on the severity of the alar base retraction. Aesthetic results were assessed with objective grading of preoperative and postoperative patient photographs by two independent plastic surgeons. Functional improvement was assessed with patient self-evaluations of nasal patency. Also, a rhinoplasty outcomes evaluation (ROE) questionnaire was distributed to patients. RESULTS: Comparison of preoperative and postoperative photographs demonstrated that nasal base asymmetry was significantly improved in all cases, and 85% of the patients had complete symmetry. Nasal obstruction was also significantly reduced after surgery (P < 0.001). The majority of patients reported satisfaction (92.5%), with an ROE total score greater than or equal to 20. CONCLUSIONS: New techniques and a treatment algorithm for correcting nasal base retraction deformities that will help rhinoplasty surgeons obtain aesthetically and functionally pleasing outcomes for patients.

Correcting the Alar Base Retraction in Crooked Nose by Dissection of Levator Alaque Nasi Muscle.

BACKGROUND: Nasal base retraction results from cephalic malposition of the alar base in the vertical plane causing disharmonies in the alar base. In literature, there are some excisional procedures to correct this deformity, but it may result to nostril distortion, stenosis, or upper lip elevation. Here, a new technique is reported for the correction of nasal base retraction in crooked nose by manipulating the levator labii alaeque nasi muscle. METHODS: Sixteen patients, 6 women and 10 men ranging in age from 21 to 42 years, who have alar retraction with crooked nose, were operated, with a follow-up period of 12 months. Preoperative and postoperative frontal, profile, base, and oblique base views in a standard manner were taken and analyzed with Image software. RESULTS: Comparison of preoperative and postoperative photographs demonstrated that nasal base retractions were corrected in all cases without distortion and recurrence. Nasal obstruction was reduced after surgery, and self-evaluation of nasal patency scores significantly increased in all patients (P < 0.001). Functional and aesthetic outcomes were satisfactory for surgeons and the patients. CONCLUSIONS: Careful analysis to identify the deformity and proper selection of the technique will ensure a pleasing outcome. The new techniques presented for the correction of nasal base retraction and prevention of the recurrence of the dorsal deviation will help rhinoplasty surgeons obtain pleasing outcomes.

A New Way for Antihelixplasty in Prominent Ear Surgery: Modified Postauricular Fascial Flap.

BACKGROUND: Otoplasty procedures aim to reduce the concha-mastoid angle and recreate the antihelical fold. Here, we explained the modified postauricular fascial flap, described as a new way for recreating the antihelical fold, and reported the results of patients on whom this flap was used. MATERIALS AND METHODS: The defined technique was used on 24 patients (10 females and 14 males; age, 6-27 years; mean, 16.7 years) between June 2009 and July 2012, a total of 48 procedures in total (bilateral). Follow-up ranged from 1 to 3 years (mean, 1.5 years). At the preoperative and postoperative time points (1 and 12 months after surgery), all patients were measured for upper and middle helix-head distance and were photographed. The records were analyzed statistically using t test and analysis of variance. RESULTS: The procedure resulted in ears that were natural in appearance without any significant visible evidence of surgery. The operations resulted in no complications except 1 patient who developed a small skin ulcer on the left ear because of band pressure. When we compared the preoperative and postoperative upper and middle helix-head distance, there was a high significance statistically. CONCLUSIONS: To introduce modified postauricular fascial flap, we used a simple and safe procedure to recreate an antihelical fold. This procedure led to several benefits, including a natural-in-appearance antihelical fold, prevention of suture extrusion and granuloma, as well as minimized risk for recurrence due to neochondrogenesis. This method may be used as a standard procedure for treating prominent ears surgically.

A New Technique to Correct Saddle Nose Deformity in Failure of Diced Cartilage Grafts: Diced Cartilage Flap.

BACKGROUND: To correct saddle nose deformity, diced cartilage grafts have been commonly used over the past decade. However, following the correction of saddle nose deformity with diced cartilage graft, some problems like graft absorption or displacement may occur, which require revision surgery. Here, a new technique is presented for correcting saddle nose deformity when diced cartilage graft fails. METHODS: Twelve cases were admitted to my clinic with complaints of nasal dorsal irregularity and depressions, asking for tertiary rhinoplasty. Seven (four women and three men) of these patients, who had a gap smaller than 1 cm in the lower 1/3rd of nasal dorsum, were selected for the described technique. After the nasal dorsum is undermined through the supra-perichondrial and subperiosteal plane, the diced cartilage island attached to the nasal dorsal skin is released distally until the island can be transposed to the tip area. This island attached to the nasal dorsal skin proximally, is formed as a flap and moved caudally as an advancement flap and sutured to the posterior of the dome area. The patients were followed for minimum 1 year (12-20 months) with intervals of 3 months. RESULTS: All the patients and also the surgeon were satisfied with the results. No complications such as resorption of the grafts were observed in any of the cases. CONCLUSION: This is an alternative, new, practical technique for correcting saddle nose deformity in the lower 1/3 of the nasal dorsum, in which the diced cartilage graft technique has failed to correct. In addition, tip projection and upward rotation can be achieved with this technique. 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 46 Authors www.springer.com/00266 .

Depressor septi nasi modifications in rhinoplasty: a review of anatomy and surgical techniques.

The anatomy of the nasal muscles contributes a social harmony in aesthetic rhinoplasty because these muscles coordinate the nose and the upper lip while smiling. Sometimes this coordination can be interrupted by the hyperactivity or variations of these muscles and may result as a deformity because of their dynamic functions and relations with the nose. In our daily practice, we usually perform the rhinoplasty without considering the dynamic functions. When the patients recover the muscle functions after operation and start to use their mimics, such as smiling, the undamaged dynamic forces may start to rotate the tip of the nose inferiorly in a long-term period, correlated with their preoperative function. To avoid this unexpected rotation it is essential to remember preoperative examination of the smile patterns. To manage this functional part of rhinoplasty, we aimed to clarify the smiling patterns or deformities mainly focused on depressor septi nasi muscle in this article. This muscle creates downward movement of the nasal tip and shortens the upper lip during smiling. The overactivity of this muscle can aggravate the smiling deformity in some patients by a sharper nasolabial angle correlated with levator labii superioris alaeque nasi and orbicularis oris muscle activities. The article not only stresses the correction of this deformity, but also aims to guide their treatment alternatives for correlation of postoperative results and applicability in rhinoplasty.

Intraorbital wooden foreign body: clinical analysis of 32 cases, a 10-year experience.

BACKGROUND: We aimed to describe herein the clinical features, diagnosis and treatment of intraorbital wooden foreign body injuries. METHODS: A case series review of orbital injuries managed at Trakya University Faculty of Medicine between 2002 and 2012 was performed retrospectively. The clinical analysis of 32 intraorbital wooden foreign body injuries was reviewed. RESULTS: Among the 32 cases, injuries in 16 were caused by a tree branch, in 10 by a pencil, in 5 by a stick, and in 1 by a bush. With respect to preoperative vision, postoperative vision was improved in 69% of patients. Time lapse from injury to presentation was correlated with the size of the foreign body. The subjects were comparable in etiological factor, and distribution of injury according to orbit was as follows: superior 28%, medial 25%, lateral 22%, inferior 16%, and posterior 9%. Computerized tomography (CT) for foreign body was definitive in 72% (n=23) and suggestive in 28% (n=9). CONCLUSION: The diagnosis of orbital wooden foreign body is difficult because it may be missed clinically and from the imaging perspective. If a foreign body is suspected, optimal patient management should be done. Prior to the surgery, imaging modalities should be maximally utilized. A careful preoperative evaluation, imaging studies, which are event-specific, a high index of suspicion, and rigorous surgery and postoperative care are the keys in the management of orbital wooden foreign body injuries.

Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005-2011 and 2012-2017 in a Referral Center.

Background: Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. Methods: Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. Results: Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. Conclusion: Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery.