[Rigid fixation to prevent iatrogenic septal deviation]

This and similar studies show that surgeons can not rely on the immediate effect of scoring on the cartilage at the operation period. A straight septum on the operating table may deviate toward the opposite side by passing time. During a period of 5 years, 283 cases have undergone rhinoplasty and in 227 patients, septoplasty accompanied the operation. Patients were divided into two groups of 125 and 158 cases. In the first group, septal deviation was corrected mainly by cross hatching of the quadrilateral cartilage accompanied by other modalities. In latter group, who were operated on recently, different methods of rigid fixation of septum in addition to the previous classic manner were used. The outcome was over correction of septum toward the opposite side in 18 cases of the first group. No more iatrogenic over correction of septum was diagnosed in the second group, [P<0.0001]. We recommend rigid fixation for correction of septal deviation instead of simple cross notching

[Thick nasal skin 4 years experience with a proposed technique]

Soft tissue thickness over the tip of the nose varies considerably between patients, subcutaneous fat being thickest in the supratip area. Fat nose is a challenging issue to manage, and surgeons have not found the ultimate solution to handle this problem during the evolution of rhinoplastic surgery. Due to multiplicity of techniques and controversies published in literature, it becomes confusing for the operating surgeon to find the most appropriate and effective way of solving this frustrating dilemma. The focus of this paper is to introduce a new procedure for reducing the overlying soft tissue of nasal tip for better re-draping of skin over the nasal skeleton. The hallmark of this technique is to undermine the nasal skin in two layers. We believe that soft tissue trimming in biplane dissection, described in the paper, can minimize the thickness of the tip skin in a safe and homogenous manner. In this paper we have demonstrated a new dissection method of nasal soft tissue and trimming it in different areas of the nose for different purposes. In the authors' opinion this approach is one of the most effective way of handling unpliable thick nasal skin

[Halitosis and its treatment]

Halitosis is a general term used to describe an unpleasant offensive odor emanating from the oral cavity. Under normal conditions, breathing has a special and not a bothering odor, which is called human odor. Around 90% of all the causes of bad breath originate from the oral cavity, and more specifically, it has been reported that around 40% come from the dorso-posterior region of the tongue. Moreover, nonoral pathologic conditions, including upper and lower respiratory tract and gastro-intestinal infections, as well as some metabolic diseases, have also been identified as halitosis-inducing factors. Oral cavity malodor can be attributed to a variety of products arising from bacterial amino acids' metabolism. These metabolites include many compounds, such as indole, skatole and volatile sulfur compounds, like methyl mercaptan, hydrogen sulfide, dimethyl sulfide, which are the main components of bad breath originating from the oral cavity. The microorganisms that contribute to halitosis include gram negatives, anaerobes, klebsiella, and bacteroids. Local pathologic factors like poor oral hygiene, chronic gingivitis, dental caries, dental plaques, malignancies of the oral cavity and surrounding tissues, tonsillar chronic infections, foreign bodies in tonsils or oral cavity, fissured tongue and sino-nasal diseases can also induce halitosis. In addition, systemic pathologic etiologies like lower respiratory tract infections, gastro-intestinal disorders, blood dyscrasias, diabetes, liver cirrhosis, renal failure, vitamin deficiencies, especially vitamin C deficiency, and some drugs can cause halitosis. Local non-pathologic factors, such as smoking, dental prosthesis, saliva stasis, and systemic non-pathologic ones, like pregnancy, menstruation, menopause, fasting, old age, and some foods can bring about malodorous breath. Old age, salivary gland aplasia, diabetes, menopause, bad oral and dental hygiene, and spices can cause mouth dryness and reduce salivary flow and mouth washing, hence leading to a foul-smelling mouth. Complete and close physical examination and history taking can guide the physician toward the diagnosis and help to find the exact cause of halitosis. Bad odors of short time duration are mainly caused by infections, severe systemic diseases, foreign bodies, or recent drug therapy. In contrast, majority of long-lasting bad odors are due to poor oral hygiene, malignancies of the oral cavity or surrounding tissues, respiratory tract, or bronchiectasis. Intake of some foods and sleeping may result in intermittent halitosis. Eradication of halitosis inducing factors is the first step toward problem solving. Besides, care of the oral hygiene, teeth, gums, tongue brushing, and dental flossing help to overcome bad breath originating from the oral cavity