[Sonographic evaluation of nasal tip skin stickness among patients undergoing rhinoplasty with or without defatting]

Background: Skin thickness has an important role in aesthetic results of rhinoplasty. Currently, some surgeons employ defatting technique to reduce subcutaneous tissues and decrease the thickness of skin during rhinoplasty

Objective: The aim of this study was to compare the nasal tip skin thickness with and without nasal tip skin defatting technique and to further evaluate the long term effects of this technique on rhinoplasty patients by sonography

Methods: In a case-control study, 111 rhinoplasty candidates were evaluated at a university referral hospital in northern Iran during January to August 2010. Before operation, all patients were investigated through physical exams. Later, the skin thickness of the tip and supra tip were measured by sonography. Patients with moderate to thick nasal skin were randomly allocated to case and control groups for defatting. Sonography results of 44 patients, obtained one and 12 months after the surgery, were compared with those found in two groups before the surgery using Wilcoxon test and Repeat Measure test

Findings: A total of 111 patients with mean age of 25.1 +/- 7.6 years including 16 [14.4%] men and 95 [86.6%] women were enrolled. Based on physical examinations, the skin type was thin in 20 [18.9%], moderate in 68 [59.4%], and thick in 23 cases [21.7%]. Considering the sonography results, the skin type was thin in 7 [6.8%], moderate in 83 [80.6%], and thick in 13 cases [12.6%]. There was no significant difference in the thickness of tip and supra tip skin between defatted cases and control group measured before surgery and within the follow-up period

Conclusion: Based on results found through this study, Sonography is a precise instrument in assessing the nasal skin thickness before rhinoplasty. Defatting technique was shown to be of no effect on reduction of skin thickness of tip and supra tip in moderate or thick skins following rhinoplasty

[Fracture of the tracheostomy tube and migration into the bronchus: a rare complication]

Tracheostomy is a surgical creation of opening secondly way into the trachea through the neck to establish an airway. Many complications have been described for this procedure. We encountered an unusual complication of tracheostomy which the metallic tracheostomy tube had been fractured and aspirated into right main bronchus of a 58-years-old man. The patient had no significant distress, and the broken piece was extracted by use of rigid bronchoscope. Breakage of tracheostomy tube may be a rare complication of tracheostomy procedure. We must be aware of this probability. Instruction the patient and his families and health workers is important also must be checked the patient regularly