Isolated torsion of fallopian tube with associated torsed paratubal cystadenofibroma: A case report.

Cystadenofibromas (CAF) and adenofibromas (AF) are rare benign gynecologic neoplasms of epithelial origin. They can be composed predominantly of solid fibrous tissue, adenofibromas, or contain cystic components, as seen in cystadenofibromas; which can be further classified by their epithelial cell type (serous, mucinous, etc.). They most commonly arise from the ovary; however, CAF/AF associated with the fallopian tube have also been reported. CAF/AF is typically asymptomatic and found incidentally. Like other adnexal and ovarian masses, patients are at increased risk of ovarian/adnexal torsion, with increasing risk with lesion size. Herein, we present the case of a patient with isolated torsion of a fallopian tube with associated torsed paratubal serous cystadenofibroma. To our knowledge, this is the first reported case of isolated torsion of a fallopian tube with associated para-tubal cystadenofibroma.

Esophageal Food Impaction.

Esophageal foreign body impaction requires urgent or emergent removal depending on clinical symptoms. Radiographic evaluation is extremely valuable in guiding management, although not required. The case presented herein describes a 66-year-old male presenting with epigastric pain and globus sensation for three days, inability to tolerate both foods and liquids, and regurgitation. Fluoroscopic evaluation revealed a food impaction in the distal esophagus. Urgent endoscopy confirmed the diagnosis and revealed a peptic stricture secondary to Barrett's esophagus. Although computed tomography has largely replaced the fluoroscopic examination, it can still provide a definitive diagnosis in many cases.

Understanding Why Lateral Osteotomy During Rhinoplasty Can Be Performed Safely.

Background: Lateral osteotomy is a mainstay of rhinoplasty surgery and involves fracture of the nasal and maxillary bones to narrow or widen the nasal dorsal bridge and base. To avoid nasal midvault collapse following rhinoplasty, the accepted "high-low-high" lateral osteotomy technique advocates for the preservation of a triangular strut of maxillary bone when initiating the osteotomy. Objective: We evaluated the risk of starting a lateral osteotomy in the "high" position to leave the aforementioned triangular maxillary strut without risk of falling into the nasomaxillary suture line, which can result in an aberrant and uncontrolled fracture. Methods: We utilized high-definition computed tomographic scans to reconstruct layered 3-dimensional images of 20 patient skulls and measured the distance from the rhinion (most inferior point of the central nasal bone junction) to the nasomaxillary suture line and from the rhinion to the maxillary groove. Results: We found that the nasomaxillary suture line was reliably only halfway down the bony nasal pyramid and not in proximity to the maxillary groove. Conclusions: Our findings provide reassurance that a generous triangular strut can be preserved along the maxillary component of the piriform aperture without concern of falling into the nasomaxillary suture line. Thus, controlled lateral osteotomies can be performed safely to achieve aesthetic gains without fear of compromising midvault stability.

Upper Vault Septal Anatomy and Short Nasal Bone Syndrome: Implications for Rhinoplasty.

Introduction: This is a diagnostic study that investigates the clinical significance between patients with short and long nasal bones and the variation in upper septal composition that would delineate propensity for middle vault collapse. Methods: Computed tomographic scans of 16 female patients undergoing evaluation with sinus films were analyzed. Two measurements were taken from each scout image: nasal bone length and total nasal length. Patient scans were separated into 2 groups; patients whose nasal bone length was less than one-half their total nasal length were defined as patients with "short nasal bone" (n = 8), and those with nasal bones longer than one-half the length of their noses were defined as patients with "long nasal bone" (n = 8). Results: Key differences were identified between patients with short and long nasal bones. Total septal area in the upper vault was decreased in the short nasal bone group relative to that of the long nasal bone group (5.7 ± 0.6 cm2 vs 8.1 ± 1.0 cm2, P = .002). This was mainly the result of the decreased ethmoid bone component in the short nasal bone group when compared with the long nasal bone group (1.6 ± 0.6 cm2 vs 3.2 ± 0.8 cm2, P = .007).