Reducing Dorsal Hump Recurrence Following Push Down-Let Down Rhinoplasty.

BACKGROUND: Hump recurrence is a commonly encountered problem following dorsal preservation (DP) rhinoplasty when surgeons are learning the procedure. OBJECTIVES: The aim of this paper was to compare the different methods for the prevention and treatment of dorsal problems following DP surgery. METHODS: One hundred and fifty primary rhinoplasty patients were included in our study. Their noses were classified in terms of both hump shape (V- or S-shaped) and height. All patients had a DP rhinoplasty by either a push-down (PD) or a let-down (LD) technique. The PD method was used for humps <4 mm and the LD for humps >4 mm. Follow-up evaluations were made with physical examination and photographs at 1 week, 3 months, and 12 months. RESULTS: Mean follow-up was 12.68 [1.78] months. Seventy-eight humps were V-shaped and 72 were S-shaped. PD was used for 67 cases, LD for 83 cases. Eight patients (5.3%, 8/150) had a visible dorsal hump problem after DP surgery. Based on their preoperative hump shape, 3 cases were V-shaped and 5 were S-shaped. All recurrent cases had a preoperative hump deformity >4 mm. The revision procedures were as follows: 4 patients had a PD procedure, 3 had a LD procedure, and 1 patient was treated by classic open resection rhinoplasty. CONCLUSIONS: There is a correlation between preoperative hump height and eventual hump recurrence. The complication rate can be decreased with additional technical maneuvers and proper patient selection.

Effect of Fat Grafting on Postoperative Intraabdominal Adhesions on a Rat Model.

BACKGROUND: We aimed to evaluate the effect of fat grafting on postoperative intraabdominal adhesions by promoting mesothelial healing on a rat model. METHODS: Thirty Wistar albino rats were grouped as control and fat grafted group. They all underwent laparotomy, anterior cecal wall abrasion and peritoneal injury. On postoperative day 14, all surviving rats were sacrificed and adhesions, fibrosis and inflammation were graded using quantitative scoring systems. RESULTS: Fat grafting significantly reduced adhesion formation compared to the control group (p <0.002), less fibrosis (p <0.025) and less inflammation (p <0.024). CONCLUSIONS: Autologous intraperitoneal fat grafting promotes mesothelial healing in serosal and peritoneal injury rat model. The present study underlines the benefits of the pluripotent stem cell reservoir fat tissue and points to a new area of use. Results are promising for reducing adhesions, adhesion related morbidities and cost burden via a simple, cheap and applicable method; autologous fat grafting.

Preoperative Simulation in Planning Rhinoplasty: Evaluation from Patients' and Surgeons' Perspectives.

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preoperative simulation, being shown appealing results of the surgeon's previous work and a personal reference from a patient with an appealing result. Within the health care professionals, it has been observed that experienced surgeons are more confident about using simulations, while inexperienced ones are daunted by being bound with a visual contract (p < 0.05). However, it has been noted that the preference of withholding the simulation or providing a copy to the patient was similar in all experience levels (p > 0.05). In conclusion, our findings suggest that the patients' self-consciousness regarding preoperative simulations seem to grow faster than the surgeons' confidence in their use. Level of evidence is Level V.

Rarely seen complication of motor vehicle accidents: Bilateral globe avulsion.

Avulsion of the globe is a rare condition that can occur with severe maxillofacial trauma. A few bilateral cases have been reported. The objective of this study was to present a case of this challenging condition in a 15-year-old male patient who was admitted to the emergency service after a motor vehicle accident.

Multiple Subungual Pyogenic Granulomas Following Levothyroxine Treatment.

Pyogenic granulomas are benign vascular lesions that can result from a large number of etiological factors. Drugs are one etiological factor involved in pyogenic granuloma development. In this study we present our experience of multiple pyogenic granulomas following levothyroxine administration suggesting that levothyroxine hormone replacement therapy might play an important role in the formation of pyogenic granuloma. We also reviewed the literatures regarding drug-induced pyogenic granulomas.

Simultaneous cheek and lower eyelid reconstruction with combinations of local flaps.

Cheek defects are common facial defects, especially after tumor ablation. Although primary repair yields the best aesthetic outcome, wide defects require flap resurfacing. Among the flap techniques, the cervicofacial rotation/advancement flap is one of the most common. In cases with eyelid involvement, it is very unlikely that a local flap would single-handedly resurface the defect and additional flaps must be used.This article presents our clinical experience with 14 patients with cheek defects for whom cervicofacial rotation/advancement flaps were used. In 3 of the 14 patients, local flaps that include the laterally based Tripier flap, the Fricke flap, the nasojugal flap, and the median forehead flap were combined with the cervicofacial flap to reconstruct the lower eyelid defects in accordance with the principle of individually reconstructing different anatomic subunits. All infraorbital defects were resurfaced with residual cheek and cervical skin with a good color and texture match. In patients whose eyelids were intact, no malposition was observed.Posteriorly based cervicofacial rotation/advancement flaps offer a very reliable and convenient method for resurfacing infraorbital and medial cheek defects. When a lower eyelid defect is also present, its individual reconstruction as a separate facial subunit needs to be considered using a combination of smaller local flaps.