The quantification and distribution of nasal sebaceous glands using image analysis.

The distribution of sebaceous glands in nasal skin is of interest because the presence of these adnexal structures significantly influences the outcome of healing. Using whole nasal skins dissected from cadavers, we prepared tissue sections from the nasal bridge to the nasal tip, both from the midline and lateral aspects. The sebaceous glands in these sections were analyzed for the following parameters: (1) size of the glands, (2) width of luminal cross-sections, and (3) depth of the glands. These parameters were studied using a Leitz Quantimet 500 Plus image analyzer and software to quantify the results. We found that the superior or proximal nasal skin contains fewer, smaller, more superficially located sebaceous glands. The inferior or distal nasal skin contains increased numbers of sebaceous glands which are markedly larger in size. The glands in the distal nose have larger lumina, are situated both superficially and deep in the dermis, and also occupy a greater percentage of the dermis. We identified an anatomical breakpoint on the nasal skin, marking the transition from superficial, small sebaceous glands to superficial-and-deep, enlarged glands. The columella was found to be similar to the proximal nasal skin.

The external shaving technique in aesthetic rhinoplasty.

External shaving is an accepted technique in the treatment of rhinophyma. The application of external shaving to aesthetic rhinoplasty is also valuable in the treatment of a thick, sebaceous nasal tip that does not respond to standard reduction rhinoplasty. External shaving will reduce the thickness of the nasal tip skin and enhance tip definition. Fifty consecutive patients undergoing external shaving were followed over a 5-year period. The majority of the cases were secondary rhinoplasties. The results reveal a very high success rate, with one significant complication, a hypertrophic scar, and two minor complications. Proper diagnosis, patient selection, and surgical technique produce predictable and favorable aesthetic results.

Rhinoplasty. Ancillary procedures.

Assessing facial balance before attempting correction of nasal proportions is critical. Modifications of facial structures, which alter perception of the nose, even with seemingly minor disproportion, can do much to enhance final results. Many of these procedures are conceptually simple, rapidly executed, and overwhelmingly gratifying.

Anatomy of aesthetic surgery of the nose.

The nose is divided anatomically into its component aesthetic parts. The preoperative examination of each of these parts, as well as techniques to modify them, have been reviewed. It is stressed that the nose is aesthetically more than the sum of its parts. No component may be completely ignored, because the result we strive for must take into account the effect of each upon its counterparts.

Diazepam and fentanyl as adjuncts to local anesthesia.

A method is presented for supplementing local anesthesia with intravenous diazepam and fentanyl. Ease of administration and high patient acceptance in over 1500 cases is discussed.

Selected Jewish views of life and medical practice.

PIP: This article discusses some basic tenets of Judaism as they apply to 3 health care delivery issues: death, abortion, and triage. The most pervasive value in Judaism is the utter sanctity of life and an obligation to prevent disease. Orthodox Jewish thought requires the following criteria and standards of death: unresponsive coma, absence of spontaneous respiration and movement, absence of reflexes, absence of pupillary response to light, absence of oculocephalic response, substance screening, and radioisotope angiography to differentiate true brain death from other causes. General endorsement of euthanasia is rejected, but, in cases where these criteria have been met, further medical support systems can be discontinued. Jewish law generally prohibits abortion, except in cases where pregnancy poses a threat to the woman's life. However, those from the conservative denomination accept abortion in cases where there is a probability of severe physical deformities or profound retardation. Those from the reform movement recognize psychological factors as being as important as physical factors in the determination of the appropriateness of abortion; moreover, they stress that the decision regarding abortion should rest with the pregnant woman and her family. Triage, the allocation of health care on the basis of priority, is generally rejected in favor of serving people on a first-need basis.^ieng