Cartilage-Sparing Otoplasty: A New Approach.

SUMMARY: Ear protrusion is the primary indication for otoplasty. Many methods have been developed for addressing this defect, based on cartilage-scoring and excision and suture-fixation techniques. Disadvantages include irreversible distortion of the anatomy, irregularities, or overcorrection, or forward bulging of the conchal bowl. One of the most common long-term sequelae of otoplasty is an unsatisfactory result. A novel, cartilage-sparing, suture-based technique has been developed that aims to minimize the risk of complications and provide a natural-appearing aesthetic result. The method is based on two to three key sutures that shape the concha into the desired natural appearance while preventing a conchal bulge, which otherwise could appear if no cartilage is removed. Furthermore, these sutures support the neo-antihelix created by four further sutures anchored to the mastoid fascia, thus achieving the two main goals of otoplasty. The sparing of cartilaginous tissue means that the procedure is reversible if needed. In addition, permanent postoperative stigmata, pathologic scarring, and anatomical deformity can be avoided. This technique was used on 91 ears in 2020 and 2021, with only one ear (1.1%) requiring revision. Rates of complications or recurrence were low. The presented technique appears to be a rapid and safe method for treating the prominent ear deformity, providing aesthetically pleasing results.

Correction of Metopic Craniosynostosis Using Limited Incision Strip Craniectomy Versus Open Fronto-Orbital Reconstruction: An Assessment of Aesthetic Outcomes.

BACKGROUND: Metopic craniosynostosis is traditionally repaired with fronto-orbital advancement (FOA) or, alternatively, limited short scar strip craniectomy (LSSSC) followed by helmet therapy. There is controversy among surgeons regarding resultant head shape outcomes between the 2 methods. This study aims to assess how surgeons perceive the postoperative aesthetic results of the 2 metopic craniosynostosis repair methods. METHODS: A retrospective analysis was performed on 13 (n = 6 LSSSC; n = 7 FOA) patients who presented for surgical correction of isolated metopic craniosynostosis via either LSSSC (followed by helmet therapy) or FOA. Clinical photographs at 1 year postop were shown to 10 craniofacial surgeons who rated the aesthetic outcomes on a Likert scale of 1 (poor) to 5 (excellent) and guessed which surgical method was performed. RESULTS: Mean age at the time of the procedure was younger in LSSSC than FOA (3.1 ±â€Š1.0 versus 17.5 ±â€Š8.5 months; P < 0.001). Mean blood loss was significantly lower with LSSSC versus FOA (202.0 ±â€Š361.2 versus 371.43 ±â€Š122.9 mL; P < 0.001), as was mean blood transfusion requirement (92.5 ±â€Š49.9 versus 151.3 ±â€Š51.2 mL; P < 0.001) and mean duration of the operation (3:06 ±â€Š0:24 versus 7:53 ±â€Š0:31 hours; P < 0.001). Mean surgeon scores of aesthetic outcomes were similar between groups: LSSSC, 3.27 ±â€Š1.09; FOA, 3.51 ±â€Š0.95 (P = 0.171). When asked to identify which procedure patients had received, only 63.8% of responses were correct. CONCLUSIONS: Limited short scar strip craniectomy offers an important alternative to traditional open FOA and should be considered as an option for children diagnosed with metopic craniosynostosis.

Secondary Rhinoplasty for Unilateral Cleft Nasal Deformity.

BACKGROUND: Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. METHODS: The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty. RESULTS: The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided. CONCLUSION: Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.

Early Pediatric Nasal Reconstruction Utilizing the Tagliacozzi Flap.

The Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were required to position the medial arm fasciocutaneous flap over the nasal construct. The arm was immobilized for 3 weeks to allow for vascularization of the recipient bed. The child successfully tolerated the splint. She has improved breathing and nasal contour.

[REVIEW OF COMMON PATHOGENS IN THE BONE AND BLOOD CULTURES AND ANTIBIOTIC TREATMENT IN PATIENTS WITH STERNAL OSTEOMYELITIS].

AIMS: This study concentrates on microbiological data collection of deep sternal wounds to delineate early and correct antibiotic therapy. BACKGROUND: Deep sternal wound infection, mediastinitis and sternal osteomyelitis are devastating and life-threatening complications of median-sternotomy incisions after cardiac surgical procedures. The incidence of surgical wound infection in sternotomies should be similar to that in any clean surgical procedure (i.e. approximately 2%). Nonetheless, the infection rates are higher among heart disease patients, due to the fact that these patients are burdened with a high number of risk factors in comparison with the general population. RESULTS: In line with other publications, the most commonly cultured organism from deep sternal wound and blood cultures was found to be Staphylococcus. In comparison, the most commonly cultured Gram-negative organisms were Pseudomonas and all gram-negative organisms combined together represented approximately 50% of all cultures. Three dominant organisms were isolated from wound and blood cultures: Staphylococcus, Pseudomonas and Acinetobacter. We found that 40% of blood cultures were identical to prior wound cultures, in comparison to 30% of bone cultures. Furthermore, 20% of the organisms isolated from the wound and 13% of the organisms isolated from the bone later on cross over to involve the blood. CONCLUSIONS: Empiric antibiotic regimen should be broad spectrum and cover both gram-positive as well as gramnegative organisms. We demonstrate that antibiotic regimen during sepsis may rely partially on preliminary wound cultures. Furthermore, antibiotic treatment for a relatively short period of two weeks is adequate, alongside thorough surgical revision with debridement of all foreign bodies, and reconstruction with vascularized soft tissue flap (pectoral major).

Immunology, autoimmunity, and autoantibodies in Parkinson's disease.

Recent revelations of immune alterations in Parkinson's disease have led to the convergence that an autoimmune mechanism may play a role in the etiopathogenesis of this neurodegenerative disease. In the current study, 77 Parkinson's disease patients and 77 matched healthy controls were analyzed for the presence of seven autoantibodies previously found to be associated with central nervous system manifestations namely: antineuronal-cells, anti-brain lysate, anti-dsDNA, anti-phosphatidylserine, anti-cardiolipin, anti-serotonin, and anti-melanocytes antibodies. Patients underwent systematic assessments of demographics, clinical, and biochemical manifestations. Three autoantibodies were found to be more prevalent among Parkinson's disease patients (antineuronal cells10.3% vs. 1.3%, p = 0.017; anti-brain lysate 9.1% vs. 1.3%, p = 0.032; anti-dsDNA 10.3% vs. 2.6%, p = 0.049). Clinical manifestations of Parkinson's disease, particularly dyskinesia and depression, were found to be associated with the presence of these autoantibodies.

Parkinson's disease, autoimmunity, and olfaction.

Parkinson's disease (PD) is a common progressive neurodegenerative disorder, mainly classified as a movement disorder which manifests among others nonmotor symptoms such as olfactory dysfunction. The etiopathogenesis of this disease has yet to be elucidated, though it seems to be interconnected with a complex set of genetic, environmental, and immunological interactions. This review unfolds the immune alterations observed in PD patients by describing the increase in the innate immune components including complement and cytokines within their substantia nigra and cerebrospinal fluid (CSF). These alterations extended to the adaptive immune response with the elevation of T cells and autoantibodies (anti-alpha-synuclein and anti-GM1-ganglioside) in the peripheral blood and CSF of PD patients. Interestingly, another etiopathogenic triad has recently emerged linking PD to autoimmunity through olfactory dysfunction. Smell deficit is one of the earliest signs of PD and a unique observation suggesting olfactory declines to be a consequence of autoimmune mechanisms. Therefore, we considered several undisputed autoimmune diseases known for their olfactory consequences as template examples that may shed more light on the relationship between autoimmunity and PD. We hope that understanding the nature of this disease may lay the ground for successes in the quest to halt the progressive neurodegenerative process.