Comparison of the Effects of Spreader Graft Versus Spreader Flap on Nasal Valve Angle in Open Approach Rhinoplasty.

OBJECTIVE: This study aimed to compare the spreader graft and flap techniques, which are used in nasal valve surgery, based on measurements of nasal valve angles using computed tomography. MATERIAL AND METHOD: In this retrospective study, all patients' right and left internal nasal valve angles were measured from coronal computed tomography images taken preoperatively and in the third postoperative month. A paired t-test and independent t-test were used to compare continuous numerical variables. RESULTS: There were 52 patients with 104 valves in the spreader flap group and 54 patients with 108 valves in the spreader graft group, with a mean age of 27.76 ± 8.16 years. The angles were found to be statistically significantly higher in the postoperative period (p<0.001) in all patients. While the angles did not differ significantly between the flap and graft groups in the preoperative period, they were significantly higher in the flap group in the postoperative period (p<0.001). DISCUSSION: It is essential to preserve nasal valve function in rhinoplasty. The findings show that a spreader flap is superior to a spreader graft, although both techniques increase internal nasal valve function. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cleft lip nose correction combining open rhinoplasty with the Dibbel technique.

Cleft lip nose rhinoplasty is a challenging procedure because of the different presentation and severity of the deformity. Due to this presentation type, there is still no standard procedure correcting all the components of the deformity although a number of techniques have been published in literature. In this study, the effectiveness of the combination of open rhinoplasty and the Dibbel technique with nasal sill augmentation was evaluated. We hereby report our experience with 7 patients who had unilateral cleft lip nose deformity with slumped lower lateral cartilage and underprojected and deformed dome, operated on between September 2010 and April 2013 by 1 surgeon. The mean age of the patients at the time of surgery was 24.5 years (18-38 years) and the patients were followed up for an average of 18.5 months (6-31 months). All patients were operated on with open rhinoplasty and Dibbel technique combination with nasal sill augmentation. Frontal, lateral, oblique, and basilar photographs were obtained preoperatively and postoperatively for each patient. Nasal projection, columella height, nasolabial angle, nasal sill symmetry, and base width were measured on the photographs for comparison of preoperative and postoperative results. All patients' medial and lateral cantus distances were used for photographic standardization. The results demonstrated that there was a statistically significant increase in nasal projection (2.13 ± 0.28 mm preoperatively versus 2.31 ± 0.08 mm postoperatively; P = 0.018), columella height (1.07 ± 0.25 mm preoperatively versus 1.21 ± 0.18 mm postoperatively; P = 0.028), nostril apex height (1.11 ± 0.15 mm preoperatively versus 1.22 ± 0.11 mm postoperatively, P < 0.028), nasolabial angle (77.71 ± 8.74 mm preoperatively versus 91.33 ± 6.49 mm postoperatively; P < 0.05), and nasal sill symmetry (0.42 ± 0.15 mm preoperatively versus 0.27 ± 0.07 mm postoperatively; P < 0.05), and a significant decrease of alar width (2.35 ± 0.44 mm versus 2.16 ± 0.32 mm postoperatively; P = 0.018) on the affected side in response to surgery. The results of this study demonstrated that the Dibbel technique and open rhinoplasty combination with nasal sill augmentation is an effective and safe method for the correction of cleft lip nose deformity in respect to nasal symmetry.

Transfer of the Fifth Finger to Replace an Amputated Thumb: A Preliminary Study.

Amputation of the thumb causes not only loss of significant functional use of the hand but also psychological and social problems. The procedures of toe-to-thumb transfer, pollicization, or metacarpal extension are recognized and well-documented options in thumb reconstruction. Although these techniques have been successfully applied, they have some disadvantages. This study aims to test the feasibility of the fifth finger for thumb reconstruction. The fifth finger was released following exploration of the digital artery, vein, nerve, and flexor and extensor tendons, including the flexor retinaculum. The digital vein and the extensor tendon of the fifth finger were separated at the level of the metacarpophalangeal joint. The proximal phalanx of the fifth finger was cut smoothly at the level of the metacarpophalangeal joint with a saw. The deep flexor tendons, digital arteries, and nerves were preserved. The proximal phalanx of the released fifth finger was fixed to the first metacarpal bone. The digital vein of the first finger was anastomosed to the digital vein of the fifth finger by microsurgery. Angiography was done after the transfer. Exploration till the flexor retinaculum enabled thumb transfer without any restriction of movement in all 10 cadaver fingers. The average total surgical time was 135 ± 12 minutes. Flow from both radial and ulnar arteries was demonstrated in the transferred fifth finger by angiography. The technique appears to be feasible for thumb reconstruction by preserving digital arteries and nerves in a relatively short time, but further important aspects have to be assessed in further clinical studies.

[Closed reduction of zygoma tripod and isolated arch fractures with Volkmann bone hook]. / Zigoma tripod ve izole ark kiriklarinin Volkmann kemik kancasi ile kapali redüksiyonu.

OBJECTIVES: This study aims to investigate the effectiveness of closed reduction technique for the management of zygoma tripod or arch fractures without internal fixation. PATIENTS AND METHODS: Between June 2011 - December 2013, medical data of seven patients (2 females, 5 males; mean age 49.1 years; range 34 to 76 years) who were treated using closed reduction technique with Volkman bone hook due to zygoma tripod and isolated arch fractures were retrospectively analyzed. Symmetry and functional findings of the patients were assessed at three and six months postoperatively. RESULTS: No complication related to the closed reduction technique was observed. Inadequate reduction was seen in one patient with isolated zygoma arch fracture who was admitted in late-stage. CONCLUSION: Closed reduction using a bone hook can be safely applied in the management of isolated zygoma arch fractures and non-complicated zygoma tripod fractures without fixation.

Axillary lipogranuloma mimicking carcinoma metastasis after silicone breast implant rupture: a case report.

Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. However, silicone implants have some well-known complications, such as implant rupture, which requires surgical intervention. Dissemination of silicone particles out of the implant causes a granulomatous reaction, a phenomenon known as silicone granuloma, in breast parenchyma as well as axillary, breast and chest wall lymph nodes, which mimics breast cancer metastasis. However, lipogranuloma after silicone breast implant rupture has not been reported in the literature, although it is a common complication after mineral oil or liquid silicone injection. We present a case report of an axillary lymphadenopathy resulting from lipogranuloma after silicone-gel-filled implant rupture. Review of the literature suggests that this is the first report of a lipogranuloma resulting from implant rupture.