The Hemostatic Effect of Desmopressin on Bleeding as a Nasal Spray in Open Septorhinoplasty.

BACKGROUND: Rhinoplasty is associated with intraoperative bleeding which affects the quality of the operation and may increase the time of surgery. The aim of this study was to assess the role of nasal spray of desmopressin on reduction in intraoperative bleeding during elective open rhinoplasty. METHODS: Conducting an interventional study in our hospital, all patient data including demographic information, medical history and laboratory tests before surgery were collected. Patients who were randomly divided into two study groups, received nasal desmopressin spray or placebo spray, 60 min before starting open septorhinoplasty. The measured variables included: bleeding volume, the operative field quality in regard to bleeding (Boezaart score), the surgeons' satisfaction in regard to bleeding during surgery (Likert scale), postoperative bruising, postoperative bleeding and menstruation. RESULTS: Thirty cases were studied; 13 (46.3%) people received placebo and 17 (56.7%) received desmopressin. The Boezaart score, satisfaction scores, bleeding volume, upper eyelid ecchymosis in the group receiving desmopressin were significantly better than the control group. Postoperative bleeding was also less in the desmopressin group, but not significant as other variables. In women of each group, menstruation had no effect on the amount of bleeding, surgical field quality and surgeon satisfaction compared with non-menstruation women. CONCLUSION: Nasal desmopressin use is an effective method for reducing intraoperative and postoperative bleeding and diminished postoperative ecchymosis which improves surgeons' satisfaction. So using the nasal form of desmopressin could be considered as method of controlling bleeding and ecchymosis in open rhinoplasty. 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 Authors www.springer.com/00266.

A Rare Case of Gestational Gigantomastia with Hypercalcemia: The Challenges of Management and Follow up.

BACKGROUND: Gigantomastia is a breast disorder marked by exaggerated rapid growth of the breasts, generally bilaterally. Since this disorder is very rare and has been reported only in sparse case reports its etiology has yet to be fully established. Treatment is aimed at improving the clinical and psychological symptoms and reducing the treatment side effects; however, the best therapeutic option varies from case to case. CASE PRESENTATION: The present report described a case of gestational gigantomastia in a 30-year-old woman, gravida 2, parity 1, 17 week pregnant admitted to Pars Hospital, Tehran, Iran, on May 2014. The patient was admitted to hospital at week 17 of pregnancy, although her breasts initially had begun to enlarge from the first trimester. The patient developed hypercalcemia in her 32nd week of pregnancy. The present report followed this patient from diagnosis until the completion of treatment. CONCLUSION: Although gestational gigantomastia is a rare condition, its timely prognosis and careful examination of some conditions like hyperprolactinemia and hypercalcemia is essential in successful management of this condition.

The Effect of Steri-Strip Dressing on Patients' Satisfaction and Reduction of Ecchymosis in Lower Eyelid, Malar and Cheek Following Rhinoplasty.

BACKGROUND: Early postoperative edema and ecchymosis are the most common factors to complicate initial patient perceptions about rhinoplasty. The current study was conducted to determine the effects of longer steri-strip tape on patient malar and cheek in terms of ecchymosis control and reduction. METHODS: Through a randomized controlled clinical trial, 64 patients who underwent rhinoplasty were randomly enrolled. One side of the patients' face was randomly selected for different experience of dressing while the main intervention was different length of tape and steri-strip dressing. In one group, the right side and in the rest, the left side of face was applied with steri-stip from the nose to lateral malar and cheek. In the opposite side of the face, steri-strip taping was done from the nose to medical malar and cheek. RESULTS: The mean area of ecchymosis after rhinoplasty through our trial was 1.55 mm and 2.31 mm, respectively in sides with and without steri-strip which differed significantly. When patients' age and sex were taken into account, the distribution of ecchymosis had no significant difference in this regard. CONCLUSION: The present study showed significant reduction in the area of post-rhinoplasty ecchymosis in lower lid, malar and cheek soft tissues as well as the obvious increase in satisfaction rate among intervention side of face in comparison to the control side. But longer steri-strip tape failed to control sub conjunctival bleeding or decrease it.

The extratemporal facial nerve and its branches: analysis of 42 hemifacial dissections in fresh Persian (Iranian) cadavers.

BACKGROUND: The facial nerve controls facial muscles and expressions. Variability in branching patterns of the nerve creates variability in facial animation, which is evident in facial plastic surgery both between patients and ethnic groups and between sides of the face. Identifying relationships between the main trunk of the facial nerve and its network of branches to soft tissues/bony fixed points contributes to safer aesthetic and reconstructive techniques. OBJECTIVE: The authors evaluate facial nerve branches in Persian (Iranian) cadavers, propose classification of the extratemporal nerve, determine topography of the nerve using fixed facial points, and define a new fixed point. METHODS: Twenty-one cadavers were dissected, for a total of 42 hemifaces. Bicoronal and preauricular to submandibular incisions were made to deglove the face. Coded data were analyzed using a statistical program. The average of various quantitative and qualitative data points was analyzed. Averaged quantitative variables were compared between groups. The primary fixed index to specify the main trunk of the facial nerve was a point on a line from the upper edge of the tragus to the tip of the mastoid. RESULTS: The study confirmed the variable branching pattern of the extratemporal facial nerve. Temporal branches on the zygomatic arch numbered 1 to 3. Distance from the nearest branch to the tragus was 20.62 ± 3.84 mm on the right and 21.33 ± 3.10 mm on the left. The variability in distribution may explain different facial expressions among ethnic groups. CONCLUSIONS: Research using cadavers may improve facial surgery procedures and clarify variability in the facial nerve branching patterns among different ethnic groups.

Anatomic variations of midfacial muscles and nasolabial crease: a survey on 52 hemifacial dissections in fresh Persian cadavers.

BACKGROUND: The midfacial region is a challenging area for plastic surgeons and may vary among different races. OBJECTIVES: The aim of this study was to determine the patterns of midfacial muscles in Persian (Iranian) subjects. METHODS: Hemifacial fresh cadaver dissection was performed. For each cadaver, demographics, side of dissection, variation in midfacial muscles (levator alae nasi, levator labii superioris, zygomaticus major [single and bifid], zygomaticus minor, and risorius), midfacial pattern (based on Pessa classification), nasolabial shape (concave, convex, straight) and length were obtained. RESULTS: Fifty-two hemifacial dissections were performed on 27 cadavers, of which 22 were male (81.4%). The mean age of the subjects was 40.1 +/- 14.8 years. The mean of nasolabial length was 46.4 +/- 8.3 mm (ranged from 28 to 63 mm). Straight form of nasolabial crease was the most frequent type (n = 26.50%). Levator alae nasi, levator labii superioris, and zygomaticus major were found in 100% of the subjects; however, it was not the same regarding other muscles. The incidence of bifid zygomaticus major was 19.2% (10 hemifacials) in our series. Midfacial pattern type 3 was the most common in our study, which found this type in 21 hemifacials (40.3%). We also found a new type of facial pattern in three cadavers. In this type, which is relatively similar to the type 5 of Pessa's classification, zygomaticus minor was absent and the zygomaticus major was bifid. CONCLUSIONS: This study revealed that midfacial pattern and nasolabial crease shape are different between Persian (Iranian) and Western subjects. It seems that based on these differences and some other unknown anatomic diversity between different races, some of the defined cosmetic frames may need minor revisions to be applicable for Persian faces. More studies in this field are recommended.

Surgical approach to hydrocarbon injection in upper extremities: case series.

BACKGROUND: Hydrocarbon injection, which mostly occurs in the upper extremity, is commonly seen in domestic and industrial accidents, or attempted suicide. Surgical approach to chemical cellulites and other complications in these patients is controversial. METHOD: This survey has been carried out on 21 patients admitted to general surgery unit of Loqman Hakim hospital, Tehran, Iran with the complaint of hydrocarbon injection in 2001-2005. RESULTS: The most common injected material was petroleum (in 8 patients). Anterior forearm was the most common injection site (in 16 patients). All of the patients had inflammation, swelling, and localized tenderness. Leukocytosis was present in 18 of 21 patients. Compartment syndrome happened in 13 patients; 5 with necrotizing fasciitis. All of the patients with compartment syndrome underwent fasciotomy and debridement. Split thickness skin graft was done for 10 patients after 2 weeks of admission. There was no mortality or limb loss during the study period. CONCLUSIONS: Prevention of the systemic complications, hospitalization, close monitoring and treatment of chemical cellulites are the main parts of the management of patients with hydrocarbon injection. Surgical intervention is recommended when compartment syndrome or other local complications occur.