Cadaveric study of the nasal periosteum and implant position after augmentation rhinoplasty.

Augmentation rhinoplasty is one of the most common cosmetic procedures done in Asia. A technique believed to be helpful in reducing complications is subperiosteal placement of silicone implant. A deeply placed implant should benefit from having thicker soft tissue coverage. Tough periosteal tissue is hoped to provide better implant fixation and prevent undesirable mobility. Experienced surgeons often claim that they can preserve the nasal periosteum and achieve complete implant coverage via nasal rim incision(s). However, success of implant placement and preservation of periosteal integrity after nasal augmentation has never been studied before.Nose augmentation with silicone implant was conducted in 12 fresh cadavers with the closed technique used in real practice. Open dissection of the nose was then carried out to verify implant position and the integrity of the periosteum. Factors that could affect the outcomes, including blade sizes of periosteal elevators, use of Aufricht retractor, and surgeon's experience, were analyzed.We found that all silicones could be implanted in the subperiosteal plane independent of instruments, surgeon's technique, and experience. Nonetheless, the covering nasal periosteum was always torn at its periphery and disconnected from the surrounding bone. As a result, lateral sides of the inserted silicones were not immediately covered with the periosteum.In conclusion, the surgeon's experience, the size of the periosteal elevator, and the Aufricht retractor did not affect the success of implant placement in the subperiosteal plane. Periosteal coverage was always incomplete and did not provide immediate implant fixation as previously understood.

The epidemiology of mandibular fractures treated at Chiang Mai University Hospital: a review of 198 cases.

BACKGROUND: Mandibular fractures constitute a substantial proportion of maxillo-facial trauma cases in Chiang Mai. The present study investigated the prevalence, sex, age group, alcohol consumption, crash helmet use, causes, site, treatment, and postoperative result of mandibular fractures at Chiang Mai University Hospital, Thailand. MATERIAL AND METHOD: The medical records and radiographs of 198 patients treated for mandibular fracture at Chiang Mai University Hospital over a 1.5 year period (from 1 January 2005 to 30 June 2006) were reviewed Data on the patients' age, sex, alcohol and helmet use, mechanism of injury, site of fracture, treatment modality, and post-operative result were recorded and assessed. RESULTS: Men of 21 to 30 years of age sustained the most mandibular fractures. The ratio of males to females was 5:1. Most fractures were caused by motorcycle accidents (MCA) (75.75%), followed by body assault (13.63%), and falls (4.54%). Alcohol consumption was a contributing factor at the time of injury in 79% of fractures according to the information available. The most common fracture sites were, in descending order the parasymphysis (45.3%), angle (19.51%), condyle (15.68%), symphysis (13.24%), body (3.83%), and ramus (2.09%). Nearly 3/4 of all cases were treated by open reduction (76%). CONCLUSION: The incidence and causes of mandibular fracture reflect trauma patterns within the community and can provide a guide to the design of programs geared toward prevention and treatment.