Rhinoplasty: panel discussion.

Should one use an open or closed rhinoplasty approach? How appropriate is the endonasal approach in modern-day rhinoplasty? Should the tip lobule be divided or preserved? Are alloplastic implants inferior to autologous implants? Does release and reduction of the upper lateral cartilages from the nasal dorsal septum always require spreader graft placement to prevent mid one-third nasal pinching in reduction rhinoplasty? Over past 5 years, how have rhinoplasty techniques and approaches evolved?

Evaluation of drill-induced heat transmission in an orbital model.

PURPOSE: To evaluate the influence of saline irrigation on temperature rise in orbit bones and the optic canal during high-speed drilling. METHODS: An experimental study measuring temperature rise in an orbit during high-speed drilling was conducted. The orbital rims, sphenoid bone, and optic canals of 6 unpreserved caprine orbits were drilled with a 3.1-mm diamond drill bit at 35,000 rpm. Each orbit was divided into groups receiving no irrigation, continuous or intermittent external irrigation at 5-second intervals during the procedures. The temperature rise of each site was compared among the groups, along with the duration of drilling. RESULTS: The mean (± SD) temperature elevation in the optic canal without irrigation was 2.38 °C (± 0.30 °C). This was significantly higher than in the canals receiving intermittent irrigation (0.90 °C ± 0.40 °C; p < 0.001) and continuous irrigation (0.66 °C ± 0.40 °C; p < 0.001). Mean temperature rise in the orbital rim without irrigation was significantly higher (3.51 °C ± 1.30 °C) than with intermittent (1.05 °C ± 0.31 °C; p < 0.001) and continuous (0.98 °C ± 0.61 °C; p < 0.001) irrigation. Mean temperature rise in the sphenoid was significantly higher (3.68 °C ± 1.66 °C) without irrigation than with intermittent (1.36 °C ± 1.17 °C; p = 0.005) and continuous (0.90 °C ± 0.33 °C; p < 0.001) irrigation. There were no statistically significant differences between any of the intermittent and continuous irrigation groups. CONCLUSIONS: The presence of either continuous or intermittent irrigation during orbital drilling procedures significantly decreases the temperature rise in the region adjacent to the surgical site. This has important implications for surgical technique when operating near the optic canal. Further studies regarding potential effects on the optic nerve are warranted.

Minimally invasive video-assisted thyroidectomy 2.0: expanded indications in a tertiary care cancer center.

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) advantages include a smaller incision, less extensive surgical dissection, improved visualization secondary to rigid fiberoptics, and decreased postoperative pain. The aims of our study were to report our experience using expanded indications of MIVAT. METHODS: A retrospective chart review of a single surgeon's initial experience was carried out at a tertiary academic cancer center. RESULTS: In all, 53 patients were identified, of whom 40 underwent total thyroidectomy and 13 underwent hemithyroidectomy. Thyroid volume, nodule size, incision length, and surgical time were all examined. Most common pathology was well-differentiated papillary thyroid cancer (69.8%): 42% of patients had evidence of thyroiditis found on pathology; 17% of patients had temporary vocal cord paralysis, with only 1 case of vocal cord paralysis persisting >6 months (1.9%). Six patients (11%) experienced temporary hypocalcemia, requiring postoperative calcium supplementation; no patients experienced permanent hypocalcemia. CONCLUSIONS: The use of MIVAT with expanded indications shows complication rates comparable to those of traditional open thyroidectomy.

Mitek anchor-augmented static facial suspension.

OBJECTIVE: To evaluate the efficacy of the Mitek minianchor suture system as an adjunctive procedure for static facial suspension and assess its ability to improve functional and aesthetic outcomes in patients with complete facial paralyses. METHODS: A retrospective review of 5 patients who underwent adjunctive static facial suspension with the Mitek GII minianchor suture system at a tertiary care academic center. A bone anchor in the maxilla connected to 2 suture arms was used. One suture arm elevated the oral commissure on the paralyzed side. The second suture arm adjusted for upper lip segment asymmetry and Cupid's bow deviation, or lateralized the external nasal valve. Outcome was evaluated by photodocumentation and clinical examination. RESULTS: There was an average of 76.9% improvement in vertical symmetry of the oral commissure (range, 43%-100%), an average of 65.0% improvement in horizontal deviation of the Cupid's bow (range, 50%-100%), and an average of 85.3% improvement in symmetry of upper lip segments (range, 67%-100%). All patients experienced improvement in oral-nasal competency. CONCLUSIONS: The Mitek minianchor suture system is a safe and effective adjunctive method to improve facial symmetry and oral-nasal competency in patients with facial paralyses. Its multivector design approximates the ideal positions of key anatomical points of the midface during static facial suspension surgery.

Salvage surgery with free flap reconstruction: factors affecting outcome after treatment of recurrent head and neck squamous carcinoma.

OBJECTIVE: To determine factors predicting the outcome after salvage surgery with microvascular flap reconstruction for recurrent squamous cell cancer (SCC) of the head and neck. STUDY DESIGN: This is a retrospective analysis of patients treated at an academic medical center. METHODS: One hundred six patients underwent salvage surgery and microvascular flap reconstruction after prior unsuccessful cancer treatment using surgery, radiation, or chemotherapy. All patients had a follow-up interval after salvage surgery of at least 24 months unless cancer rerecurrence occurred within 24 months after salvage surgery. Factors including age, sex, comorbidity level, tobacco use, alcohol use, disease-free interval since prior therapy, prior radiation, prior chemotherapy, prior surgery, recurrent tumor T class, recurrent tumor N class, recurrent cancer stage, and tumor location were examined to determine their association with cancer rerecurrence after salvage surgery. Successful treatment was defined as patients who remained free from cancer rerecurrence for a minimum 2 year period after salvage surgery. RESULTS: Advanced recurrent T class (P = .02) was significantly associated with cancer recurrence. Recurrent cancer stage and patient smoking status approached statistical significance (P = .06). CONCLUSION: Patients with recurrent T1 and T2 class are the best candidates for salvage surgery and microvascular flap reconstruction for treatment of recurrent SCC of the head and neck. Patients with T3 and T4 class recurrent cancers and patients who continue to smoke after initial diagnosis and treatment of head and neck SCC are poor candidates to undergo salvage surgery.