Alar vestibular advancement flap in management of cleft nose deformity

The cleft lip nasal deformity presents a challenge for the rhinoplastic surgeons due to three main reasons; the surgical scarring from previous surgical reconstructive attempts, the congenital anatomic deficiency, and growth changes to the size and extent of the deformity. Many techniques have been described to address this problem. Most of the described techniques attempt to manage some aspects of the cleft deformities, however complete correction of all nasal deformities remains a remote goal. The aim of the present work was to evaluate the lateral alar vestibular advancement flap in correcting the cleft nose deformity. 9 patients with a unilateral cleft nose-lip deformity who underwent a previous operation to repair their cleft Lip early in there lives were included in the present study. The Laterally based alar-vestibular advancement flap technique was performed on all of them with the necessary work on the lower lateral and septal cartilages to attain a better looking cartilaginous framework of the lower third of the nose in order to correct the cleft nose deformity. Patients and surgeon's satisfaction is recorded for all surgeries one week and three months postoperative. 8 patients [%88.9], recorded full satisfaction with the surgery outcome and one patient [%11.1] was unsatisfied and needed a second surgery 6 months later to insert a shield graft to camouflage a minor tip asymmetry. The laterally based alar-vestibulatr advancement flap approach utilizes many of the known cleft nose rhinoplasty procedures into a single more universal technique. Using this approach with the open rhinoplasty techniques, stability and symmetry of the nasal tip could be achieved

septal body: revisited

The term septal body refers to a thickened area of the nasal septum that is located superior to the inferior turbinate and anterior to the middle turbinate. Despite its important role in changing nasal airflow resistance, little attention was given to it. Clinically, a well developed septal body may be misdiagnosed as high septal deviation. The aim of the present work was to reassess the histological characteristics of the septal body mucosa and the morphometric differences between it and the adjacent septal mucosa. This information was then used to determine the exact location and surface area of the septal body. The study was performed on 30 cadaveric specimens [60 sides]. Serial numbered sections of the whole septal mucosa were stained with hematoxylin and eosin as well as PAS alcian blue stains. Morphometric analysis was performed to determine the histological differences between the septal body mucosa, the anterior septal mucosa, and the inferior septal mucosa. The precise boundaries of the septal body area were then defined in a way similar to the Mohs micrographic surgical technique. The histological characteristics of the septal body mucosa included: thick [more than 60 microns] pseudo stratified ciliated respiratory epithelium with goblet cells, abundant seromucinous glands, and many blood sinusoids. Morphometric analysis showed that the septal body mucosa had thicker epithelium and more glandular acini and blood sinusoids than the rest of the septal mucosa. Mapping of the septal body area showed that its anterior end is 2.2 cm +/- 0.3 behind the caudal edge of the septal cartilage, and its inferior border is 1.1 cm +/- 0.2 above the floor of the nose. The mean horizontal diameter of the septal body was 2.0 cm +/- 0.15, and the mean vertical diameter was 1.5 cm +/- 0.11. The present study determined the morphometric characteristics of the septal body as well as its location and surface area. The intimate relationship of the septal body to the internal nasal valve and the histological characteristics of its mucosa should stimulate research into its potential role in modifying nasal airflow pattern and resistance, and controlling the ability of the nose to change the humidity and temperature of the inspiratory air stream

Ransoral midmandibular hemiglossotomy direct anterior approach to clivus and anterior cervical regions

The skull base has always been challenging to access surgically. The critical neurovascular structures involved with lesions of this region, the depth of surgical field required, and the obstruction of operative exposure by important soft-tissue structures contribute to the difficulties in accessing this region. Approach to the rhinopharynx, odontoid process and clivus through the natural pathways of the face produces a greatly restricted surgical field which cannot always be used. We reintroduce the Transoral Midmandibular Hemiglossotomy [TMH] direct anterior approach for a wider access to the skull base and the cervical spine region. Under general anaesthesia and after tracheostomy tube insertion in place, a midmandibular split, midtongue split is performed in order to directly approaching the clivus and anterior cervical regions for tumor management using the surgical microscope. 13 patients with primary or recurrent chordoma were included in the present study. Four cases were primary chordoma and nine cases were recurrent. Intraoperatively, the mean longitudinal diameter of the operating field was 18.3 cm, while the mean of the transverse diameter was 7.8 cm. The mean depth of the operative field was 18.3 cm. The transoral midmandibular hemiglossotomy direct anterior approach provides a direct access to lesions of the clival and cervical region with minimal morbidity. It gives the surgeon a wider access to the operative field than conventional transoral ortransnasal approaches

respiratory nasal mucosa after endoscopic sphenopalatine artery coagulation. A histological and histochemical study

Epistaxis is regarded as the commonest emergency requiring admission to the otolaryngology departments. Endoscopic coagulation of sphenopalatine artery is indicated in patients with posterior epistaxis unresponsive to nasal packing. Although many studies dealt with the efficacy of the procedure in controlling severe Epistaxis, few studied its effect on the nasal structure and functions. The aim of the present work was to study the effect of sphenopalatine artery coagulation on the secretory activities as well as the histological and histochemical changes of the nasal mucosa. The study was performed on 20 adult patients suffering from persistent or recurrent posterior epistaxis. Punch biopsies from the inferior turbinate were stained with hematoxylin and eosin and PAS alcian blue for histological examination while histochemical examination was done for the activity of succinic dehydrogenase, alkaline phosphatase and cholinesterase enzymes. Histologically; the nasal mucosa showed marked decrease in the size of both the seromucinous acini and blood sinusoids in the subendothelial connective tissue stroma in the post operative biopsies. Hitochemically; all enzymatic activities showed noticeable decrease in the postoperative biopsies. No degenerative changes were noticed in any postoperative biopsy. Sphenopalatine artery coagulation is an effective method in controlling recurrent or persistent posterior nasal bleeding that affects to some extent the secretory functions of the nasal mucosa on short term with no long term harmful effects

Prognostic factors for the olfactory outcome after endoscopic sinus surgery: age and gender

Gender and age have been shown to influence the function and the regenerative processes in the peripheral and central olfactory pathways. However, the potential predictive value of either age or gender, for the recovery of olfaction after surgery has not been determined yet. The aim of this study was to objectively evaluate the prognostic value of age and gender for the postoperative olfactory performance of patients with extensive nasal polyposis who have been treated with endoscopic sinus surgery. This study involves 116 patients who have been evaluated before and 6 months after surgery with Sniffin' Sticks, a combined test battery for olfactory threshold, identification and discrimination. After statistical adjustment for baseline scores and potential confounders [duration of symptoms, smoking, previous surgery, allergic rhinitis, aspirin-exacerbated respiratory disease and gustatory impairment] gender was found to have no significant influence on the recovery of all olfactory indices. On the contrary, patients older than 55 years were found to recover significantly slower and less efficiently than patients who were less than 35 years old or patients 36-55 years old. Moreover patients older than 55 years seemed to have significantly less possibilities to regain normosmia than patients whose age was less than 55 years. Gender does not seem to have any prognostic value with regard to the postoperative olfactory performance. Old age, however, seems to represent a strong independent negative predictor for the recovery of olfaction and the achievement of normosmia

combined use of endoscopic deep and superficial cervical liposuction for neck rejuvenation

Blunting of the cervicomental angle with age is caused by progressive laxity of the skin and the subcutaneous tissues, along with proliferation of fatty deposits and platysma muscle banding. This contributes to loss of slender neckline associated with youth, often a primary point of concern for patients. The goals for cosmetic neck surgery are to achieve a youthful neckline by establishing a well-defined mandibular line and a sculptured mento-hyoid angle. Over the last four decades, many techniques have been advocated to manage this problem. The aim of the current study is to evaluate the combined use of endoscopic deep and superficial cervical liposuction for neck rejuvenation. Eleven patients with class IV and V neck according to Dedo's classification were included in this study. Deep and superficial liposuction using the microdebrider machine was done on all patients together with many ancillary procedures for face and neck rejuvenation. Patient and doctor satisfaction immediately and three months postoperatively were done. good results for neck rejuvenation were achieved in all patients with no record of hematoma, dimpling or facial asymmetry. The combined use of endoscopic deep and superficial cervical liposuction of the neck, is less traumatic and results in a more precise management of cervical fat compared to the conventional liposuction technique alone

combined use of pericranial flap and titanium mesh in reconstruction of large medial orbital wall defects

This is the second article that describes the versatility and compatibility of the pericranial flap in management of the midfacial bony and soft tissue defects. 15 pericranial flaps were harvested and used in 12 patients complaining of medial or infer-medial orbital wall defects either as a complication of chronic destructive lesion [Wegner's granulomatosis] or post-surgically. Successful repair was achieved in all cases and no recurrence was reported during the follow up period of 14 to 16 months. Emphasis is made on the versatility and the high degree of flexibility of the pericranial flap in management of the midfacial boney and soft tissue defects. The titanium mesh provided the required support that is needed in large boney defects in order to achieve a more reliable and successful repair. The use of Allodermal graft helped in achieving more cosmetically acceptable results than before