Application of Trotter Approach for Large Intralingual Thyroglossal Duct Cyst in an 88-Year-Old Patient.

Thyroglossal duct cysts (TDCs) are the most common congenital cyst formations in the neck, typically occurring at midline infrahyoid positions in younger patients. Traditional management has used the Sistrunk procedure to minimize recurrence rates. Reports on elderly patients are sparse, and currently only 16 cases have been reported in patients older than 70 years and 4 patients older than 80 years. This report describes the oldest known patient with TDC who had a purely intralingual location requiring a Trotter approach and a Sistrunk procedure for symptomatic management.

Middle Eastern Rhinoplasty: Relationship of the Nasal Spine and Caudal Septum to Tip Projection and Columellar-Labial Angle.

OBJECTIVE: To measure the anterior nasal spine length (ANSL) and septal caudal extension (SCE), as well as assess the strength of association between these variables and tip projection in the Middle Eastern nose. Our secondary aim was to assess if columellar-labial angle (CLA) or columellar-spinal angle (CSA) vary as a function of ANSL and/or SCE. STUDY DESIGN/SETTING: Prospective single institutional study. SUBJECTS: Middle Eastern primary rhinoplasty patients without nasal trauma or prior endonasal surgical history. METHODS: Photographic and intraoperative caliper measurements were used to determine Goode ratio (GR), CLA, CSA, ANSL, and SCE. Associations between numeric variables were examined with scatterplots, including use of LOWESS curves and Pearson correlation coefficients. Linear regression models were used for predicting quantitative variables (GR, CLA, CSA). Logistic regression models were used for predicting overprojection status based on GR. RESULTS: In total, 102 patients met inclusion criteria (82 females, 20 males). Mean ANSL and SCE were 8.6 mm and 14.9 mm, respectively; ANSL and SCE had a strong positive association with each other. SCE and ANSL were found to have low predictability for GR, CLA, or CSA. CONCLUSION: Determinations of projection status using the GR method do not appear to be related to ANSL or SCE values in our Middle Eastern study group. Relationships of absolute columellar-labial or columellar-spinal angles are likely more complex than isolated value implications of SCE or ANSL.

The subcutaneous melolabial island flap for nasal alar reconstruction: a clinical review with nuances in technique.

OBJECTIVES/HYPOTHESIS: To describe our experience with surgical reconstruction of whole subunit nasal alar skin losses following Mohs ablative surgery, using a subcutaneous melolabial island flap with emphasis on a simplified technique to minimize facial scarring and optimize facial contour. STUDY DESIGN: Retrospective review of case series. METHODS: A single surgeon's results in 48 consecutive patients spanning 7 years were analyzed by comprehensive chart review. Details of wound site and flap-specific complications were noted. Favorable nuances in surgical technique differing from standard approaches are graphically described. RESULTS: Loss of melolabial sulcal depth was the most commonly seen donor-site complication (8%). No cases of flap compromise were seen. An unexpectedly high frequency of subjective nasal obstruction was seen (37%) after the second stage, more common when cartilage grafts were underutilized, and with through-and-through defects at inception. External contour was uniformly good to excellent. CONCLUSIONS: The described variation in subcutaneous melolabial island flap transfer provides reliable soft tissue replacement for whole subunit alar skin losses with favorable donor-site scarring and resultant contour. Attention to proper utilization of supportive cartilage grafts and ancillary debulking procedures is often necessary to optimize functional outcomes.

Aesthetic parotid surgery: evolution of a technique.

OBJECTIVES/HYPOTHESIS: Described is a technique adopted for surgical management of benign parotid neoplasms with an emphasis on facial reconstruction and prevention of postparotidectomy sequelae. STUDY DESIGN: Observation/surgical technique. METHODS: Patients chosen in the last 10 years with benign parotid neoplasms with the application of this technique. RESULTS: In over 150 cases of benign parotid neoplasms performed in the last 10 years by the senior author using this technique, no cases of clinically significant Frey syndrome were identified. Two cases of marginal nerve paresis transpired, but spontaneously resolved within several months. No cases of postoperative hematoma, wound infection, salivary fistula, or hypertrophic scar formation were noted. Subjectively, patient satisfaction was uniformly high relating to scar appearance and facial contour. There have been no local recurrences to date despite six cases of nonviolated tumor capsule abutting the resection margin. CONCLUSIONS: The application of a superficial musculoaponeurotic system-platysma flap can alleviate the depression in the retromandibular region following superficial parotidectomy for moderately sized benign neoplasms. It has also shown to help prevent postparotidectomy sequelae of Frey syndrome.