Clinical effectiveness and safety of collagen sheet for dorsal augmentation in rhinoplasty.

In Asian rhinoplasty, dorsal augmentation often requires the use of alloplastic materials because sufficient amounts of autograft are difficult to harvest. Given considerations of aesthetics, costs, and the characteristics of the oriental nose, silicone or Gore-Tex is commonly used when augmenting the nasal dorsum to a great extent. Such materials can often result in postoperative complications and foreign-body sensations. Moreover, extrusion or visualization of the implant may occur because of thinning of the skin over time. Permacol collagen implants are specifically indicated for soft tissue reinforcement and repair of the head and face in plastic and reconstructive surgery. The handling versatility of the flexible collagen sheet allows it to be layered over itself until the requisite thickness and desired shape are obtained. A total of 50 patients who underwent nasal augmentation rhinoplasty between December 2007 and May 2011 were observed for at least 24 months. Depending on the nasal dorsum, we layered the collagen sheet up to a maximum of 4 times and we have not seen any case of severe resorption or overcorrection in the nasal configuration. Collagen implant material is safe for use in select rhinoplasty patients because of its low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic because of the low quality or lack of available autologous grafts.

Utility of psychological screening for the diagnosis of pediatric episodic vertigo.

BACKGROUND/OBJECTIVES: Childhood episodic vertigo has been reported to be associated with migraine or childhood periodic syndromes such as benign paroxysmal vertigo of childhood. There is discrete evidence that unexpected recurrent vertigo is associated with a high level of depression and anxiety in adults. However, only a few studies describe the frequency and characteristics of psychiatric comorbidity in vertiginous children. The aim of this study is to evaluate the incidence and characteristics of emotional and behavioral problems using outpatient-based psychological screening tools in children with episodic vertigo attacks. METHODS: A total of 105 patients and 138 controls, aged 4 to 17 years, were enrolled. All were identified with a primary complaint of recurrent episodic vertigo. All patients received a complete battery of audiological and vestibular tests. Psychological assessment was performed using standardized questionnaires, including Strength and Difficulties Questionnaire (SDQ), Children's Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS: Compared with community controls, children presenting vertigo attacks had significantly higher mean scores on almost all scales of SDQ, CDI, and SCARED, except two parameters, namely, prosocial behavior and separation anxiety. About half of the patients, compared to 10 to 11% of the controls, had significant levels of distress that could adversely impact treatment outcomes and might need psychiatric consultation. Significant distress or impairment in social interactions was more prominent in older ages. CONCLUSION: Our findings suggest that children/adolescents with recurrent episodic vertigo should be screened for possible associated psychological symptoms.

Unruptured translabyrinthine meningocele without CSF otorrhea.

Labyrinthine meningocele can be classified into translabyrinthine and perilabyrinthine type. We describe a case of rare unruptured translabyrinthine meningocele (TLM). It is rare to encounter an unruptured TLM because it is usually diagnosed after rupture as a labyrinthine fistula, cerebral spinal fluid otorrhea, and subsequent meningitis. We provide for the first time an intraoperative photo and video of a case of an unruptured TLM that developed through an inner ear malformation in a single-side deaf child, which was preoperatively misdiagnosed as congenital cholesteatoma in preoperative temporal bone computed tomography. TLM without CSF otorrhea in an unruptured state merit attention because of its importance during the workup of congenital cholesteatoma or cochlear implantation in spite of its rarity of reports.