Precise anatomical study of rhinoplasty: description of a novel method and application to the lateral crural steal.

IMPORTANCE: The prediction of nasal tip position in terms of projection, rotation, and length is a major challenge in rhinoplasty. Studies using preoperative and postoperative photographs lack accuracy owing to variable position, and computer-simulated models lack clinical applicability. OBJECTIVES: (1) To describe an accurate and reproducible technique to study the effect of surgical manipulations on the nasal tip; and (2) to describe the effect on the nasal tip cartilages of the lateral crural steal (LCS). DESIGN, SETTING, AND PARTICIPANTS: Cadaveric study in a tertiary hospital center using 10 cadaveric specimens. INTERVENTIONS: Heads were placed in a Mayfield head holder, and a 12.2-megapixel camera was fixed on a tripod in a perfectly still position and focused on the surgical field during all surgical manipulations. An external rhinoplasty approach was performed for all specimens, and a 4-mm LCS was achieved. MAIN OUTCOMES AND MEASURES: Measures include tip projection, tip rotation, and nasal length using preoperative and postoperative photographs. RESULTS: Our method was successfully performed on all specimens: LCS resulted in a significant mean increase in projection using the Goode ratio (mean, 0.05; P = .005) and rotation (mean, 13.2°; P = .005). However, absolute tip projection variation was inconsistent, ranging from -1.0 mm to 0.6 mm. Nasal length was significantly shortened in all cases (mean, 1.3 mm, P = .005). CONCLUSIONS AND RELEVANCE: We describe the first technique for precise anatomical study of tip position in rhinoplasty on cadaveric specimens. This technique was successfully applied to 10 consecutive nasal tips. We have shown a significant increase in projection using the Goode ratio and rotation with LCS. However, the effect on absolute projection is inconsistent. LEVEL OF EVIDENCE: NA.

Prevalence of K-RAS Codons 12 and 13 Mutations in Locally Advanced Head and Neck Squamous Cell Carcinoma and Impact on Clinical Outcomes.

Background. RAS gene mutations have an impact on treatment response and overall prognosis for certain types of cancer. Objectives. To determine the prevalence and impact of K-RAS codons 12 and 13 mutations in patients with locally advanced HNSCC treated with primary or adjuvant chemo-radiation. Methods. 428 consecutive patients were treated with chemo-radiation therapy and followed for a median of 37 months. From these, 199 paraffin embedded biopsy or surgical specimens were retrieved. DNA was isolated and analyzed for K-RAS mutational status. Results. DNA extraction was successful in 197 samples. Of the 197 specimens, 3.5% presented K-RAS codon 12 mutations. For mutated cases and non-mutated cases, complete initial response to chemoradiation therapy was 71 and 73% (P = 0.32). LRC was respectively 32 and 83% (P = 0.03), DFS was 27 and 68% (P = 0.12), distant metastasis-free survival was 100 and 81% (P = 0.30) and OS was 57 and 65% (P = 0.14) at three years. K-Ras codon 13 analysis revealed no mutation. Conclusion. K-RAS codon 12 mutational status, although not associated with a difference in response rate, may influence the failure pattern and the type of therapy offered to patients with HNSCC. Our study did not reveal any mutation of K-RAS codon 13.

Intermaxillary screw fixation in mandibular fracture repair.

PURPOSE: To be successful, mandibular fracture reduction requires restoring premorbid occlusion. Intermaxillary fixation (IMF) is a founding principle of accurate mandibular fracture repair. Although arch bars are currently the standard in securing IMF, IMF screws have many potential benefits and should therefore not be overlooked. The goals of this study were to evaluate the effectiveness of IMF screws in the management of mandibular fractures, describe the technique, and identify those who will benefit from it without compromising the end results. MATERIALS AND METHODS: Thirty-six consecutive patients with single or multiple displaced fractures of the mandible were treated using screw IMF. Open reduction internal fixation was then accomplished in the usual fashion. Postoperative plain films were used to evaluate fracture reduction and screw placement. Data were collected prospectively from clinical and radiologic evaluations at regular follow-up appointments. RESULTS: Thirty-five (97.2%) of 36 patients demonstrated normal occlusion at the follow-up examination 6 weeks postoperatively. One case of root fracture and four cases of root impingement by screws were observed at the follow-up examinations. CONCLUSIONS: Cortical bone screws offer a reliable alternative to more traditional methods of obtaining IMF in the treatment of mandibular fractures and present many advantages to the surgeon and the patient. Their use may be limited to specific clinical situations and potential consequences, of which the surgeon must be aware. Adequate preoperative planning is therefore essential to maximize successful results.

Complications of adenotonsillectomy revisited in a large pediatric case series.

OBJECTIVE: To document the most important postoperative adenotonsillectomy morbidities, with an emphasis on prolonged hospitalization and readmissions. DESIGN: Retrospective chart analysis. METHODS: We reviewed 2067 cases of adenotonsillectomies performed at our institution over a period of 6 years. RESULTS: Of these cases, 1927 patients had undergone tonsillectomy by electrocautery and adenoidectomy by suction-coagulator, of whom 9.3% required admission. The incidence of admissions owing to bleeding was 1.7%, whereas admissions owing to respiratory and gastrointestinal complications represented 3.7% and 5.2%, respectively. Compared with the literature and our institution's previous results, these morbidity values were found to be either comparable or significantly lower (p < .05). CONCLUSION: We attribute this improvement to our use of electrocautery-based techniques not only for tonsillectomy but also for adenoidectomy.