Closed Rhinoplasty: A Single Surgeon Experience of 238 Cases over 2 Years.

Closed rhinoplasty is currently losing favour as a method of rhinoplasty reshaping procedure. Open rhinoplasties are usually performed by surgeons because of the greater degree of visualisation of the cartilages and bones within the nose that need to be reshaped. Because of the criticisms of closed rhinoplasty the senior author performed an audit of his outcomes to determine whether closed rhinoplasty still has a role to play in the armamentarium of the plastic surgeon. We conducted this study as a retrospective review of all closed rhinoplasty operations performed by a single surgeon over a two-year period (from 1st January 2016 to 31st December 2017). The operative technique is provided. An independent panel of 3 assessors (2 board certified consultant plastic surgeons and one lay member of the public) rated outcomes of the closed technique based on photographic series. Statistical analysis was performed using Cohen's Kappa and Friedman test. Additionally, the length of follow up period, revision rates, and post-operative complications (general and aesthetic) were examined. A total of 242 cases of rhinoplasty were performed (8 open and 234 closed rhinoplasty; 225 primary and 17 revision operations). The first consultant surgeon gave a score in a range from 4.2/5 to 4.9/5 with a mode of 4.8 and a mean score of 4.7/5. The second consultant surgeon gave a range of 4.1/5 to 4.9/5 with a mode of 4.4 and mean score of 4.3/5. The lay panel member scored the cases in a range from 4.4/5 to 5/5 with a mode of 4.8 and a mean score of 4.9/5. Cohen's coefficient was 0.72 showing substantial agreement across the panel. The complication rate for the recorded data was 0.8% with two cases of soft tissue infection treated with oral antibiotics. The results of this paper advocates the benefits of the closed approach in aesthetic rhinoplasty. Surgeons should appreciate that both open and closed approaches are complimentary. The favouring of a single approach is indicated in the scenarios discussed. The remaining cases seem to produce equivocal results and the choice of procedure should be based on patient anatomy, outcome aims, and the ability of a surgeon to perform their preferred technique.

Infected transcartilaginous ear piercings. A case report and review of the literature / Pericondritis del pabellón auricular por piercings. Reporte de un caso clínico y revisión de la literatura

Background: transcartilaginous perforations have become a prominent practice among adolescents and young adults in recent years,which are associated with an increased risk of complications since it is frequently performed without sterile technique and by unqualified individuals. The transgression of the integrity of the skin and cartilage of the ear favors infections such as cellulitis, chondritis, perichondritis or abscesses that can cause serious deformities. Methods: we present a clinical case compatible with a perichondritis secondary to ear perforations with three abscesses. Results: the three abscesses were drained with sterile technique and successfully managed with outpatient antibiotic treatment. In relation to the pathophysiology, the trauma in the auditory pavilion produces the extraction of the adjacent perichondrium, causing devascularization of the cartilage and microfractures, which together with the transgression of the skin, increase the susceptibility to infection. In addition, subpericardial bleeding and inflammatory reaction decrease the blood supply, which limits the immune response and the effectiveness of antibiotics. In some cases, incision and drainage are required. The signs of perichondritis include pain, swelling, and erythema of the skin. Clinically, perichondritis can be differentiated from cellulitis of the pinna, in that the first usually does not involve the earlobe. The fluctuating swelling leads us to an abscess. Conclusions: the administration of broad-spectrum antibiotics should be immediately administered and include coverage for Pseudomonas aeruginosa since it is responsible for the majority of post-perforation cartilage infections (up to 95 percent of cases). Due to the increase of post-perforation infectious complications, all physicians should be familiar with its diagnosis and treatment.(AU)

Antecedentes: las perforaciones transcartilaginosas se han convertido en una práctica destacada entre adolescentes y adultos jóvenes en los últimos años, que están asociados con un mayor riesgo de complicaciones, ya que se realiza con frecuencia sin técnica estéril y sin calificación individuos. La transgresión de la integridad de la piel y el cartílago del oído favorece infecciones como la celulitis, la condritis, la pericondritis o los abscesos que pueden causar graves deformidades. Métodos: presentamos un caso clínico compatible con una pericondritis secundaria a las perforaciones del oído con tres abscesos. Resultados: los tres abscesos se drenaron con técnica estéril y se manejaron con éxito con tratamiento antibiótico ambulatorio. En relación con la fisiopatología, el trauma en el pabellón auditivo produce la extracción. del pericondrio adyacente, causando la desvascularización del cartílago y las microfracturas, que junto con la transgresión de la piel, aumenta la susceptibilidad a la infección. Además, el sangrado subpericárdico y la reacción inflamatoria disminuyen la sangre. suministro, lo que limita la respuesta inmune y la efectividad de los antibióticos. En algunos casos, se requiere incisión y drenaje. los Los signos de pericondritis incluyen dolor, hinchazón y eritema de la piel. Clínicamente, la pericondritis puede diferenciarse de la celulitis de el pinna, ya que el primero generalmente no involucra el lóbulo de la oreja. La hinchazón fluctuante nos lleva a un absceso. Conclusiones: la administración de antibióticos de amplio espectro debe administrarse inmediatamente e incluir cobertura para Pseudomonas aeruginosa desde Es responsable de la mayoría de las infecciones de cartílago posteriores a la perforación (hasta el 95 por ciento de los casos). Debido al aumento de post-perforación complicaciones infecciosas, todos los médicos deben estar familiarizados con su diagnóstico y tratamiento...(AU)

Open and Closed Rhinoplasty.

Most surgeons recognize the broad utility of both endonasal and external rhinoplasty approaches. Most understand that there are situations when a given approach offers advantages and may be considered preferable. In this article, the anatomy, incisions, and approaches that are available to the surgeon are reviewed. General indications are discussed for the external and endonasal approaches. The pros and cons of each approach are discussed, and further thoughts on the decision-making process are provided.

Alternativa diagnóstica en los cánceres laríngeos. Punción aspiración con aguja fina transcartilaginosa laríngea. Análisis costo-beneficio / Diagnostic alternative in laryngeal cancers.Transcartilaginous fine needle aspirationbiopsy. Cost-benefitanalysis / Alternativa diagnóstica nos cânceres laríngeos. Punção aspiração com agulha fina transcartilaginosa laríngea. Análise de custo-benefício

El cáncer de laringe es la segunda neoplasia maligna de cabeza y cuello en adultos. Hemos decidido la búsqueda de un método diagnóstico eficaz y eficiente de las tumoraciones laríngeas sospechosas de malignidad. Se realiza la punción aspiración con aguja fina transcartilaginosa laríngea (PAAF TCL) en las lesiones laríngeas de estadios TNM altos (III y IV) como método diagnóstico alternativo a la tradicional biopsia por microcirugía laríngea. Se logra así la optimización de recursos institucionales y el beneficio de los pacientes en función del tratamiento de los mismos.

Laryngeal cancer is the second leading cause ofhead and neck malignant neoplasms in adults. Wedecided to search for effective diagnostic method oflaryngeal tumors suspicious of malignancy. Transcartilaginous Fine Needle Aspiration Biopsy (TF-NAB) is performed in laryngeal lesions of high levelTNM stage (III and IV) as an alternative to traditionalbiopsy by laryngeal microsurgery. It achievesthe optimization of institutional resources and thebenefit of patients according to their treatment.

O câncer de laringe é segunda neoplasia maligna de cabeça e pescoço em adultos. Decidimos buscar um método diagnóstico eficaz e eficiente das tumorações laríngeas com suspeitas de malignidade.Realiza-se a Punção Aspiração com Agulha Fina Transcartilaginosa Laríngea (PAAF TCL) nas lesões laríngeas de estádios TNM altos (III e IV) como método diagnóstico alternativo à tradicional biopsia por microcirurgia laríngea. Obtém-se assim a otimização de recursos institucionais e o benefício dos pacientes em função do seu tratamento.

[Surgical approaches in rhinoplasty]. / Voies d'abord en rhinoplastie.

In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach--the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty.