Concomitant Overlap Steal Tip-plasty: A Versatile Technique to Simultaneously Adjust the Rotation, Definition, Projection, and Symmetry of the Nasal Tip.

BACKGROUND: Tip-plasty is a particularly challenging stage of aesthetic nose surgery. The diversity of nasal tip deformities has necessitated the development of numerous surgical techniques that can be difficult to master and may yield unpredictable surgical results when combined. OBJECTIVES: The authors describe how concomitant overlap steal tip-plasty (COST) can enable surgeons to address all of the aesthetic characteristics of the nasal tip simultaneously. COST involves lateral crural steal followed by medial crural overlap. METHODS: The medical records of 1617 patients who underwent primary open septorhinoplasty with COST were evaluated in a retrospective study. Pre- and postoperative patient photographs were compared for nasal length, nasolabial angle, tip projection, and deviation of the nasal axis. RESULTS: Pre- and postoperative mean nasal lengths were 5.66 cm and 5.17 cm, respectively (P < .05). The mean nasolabial angle was 86.95° preoperatively and 101.8° postoperatively (P < .05). The projection of the nasal tip was reduced from 3.09 cm to 2.53 cm, and tip symmetry was achieved by decreasing the nasal axis deviation from 7.76° to 1.71° (both P < .05). CONCLUSIONS: COST does not obviate all other tip-plasty techniques for specific situations. Once mastered, however, COST can become the only procedure needed to achieve all of the aesthetic goals of the nasal tip in most cases. LEVEL OF EVIDENCE 4: Therapeutic.

Injectable Cartilage Shaving: An Autologous and Long Lasting Filler Material for Correction of Minor Contour Deformities in Rhinoplasty.

BACKGROUND: Filler materials are gaining popularity in nonsurgical rhinoplasty the major advantages are the ability to camouflage the surface deformities, and also the soft and malleable consistency; while the major drawback of the safe fillers such as hyaluronic acid is short durability. In this study, we evaluated the injectable cartilage shaving as an autologous filler material for correction of minor contour deformities in rhinoplasty. METHODS: Injectable cartilage shaving was used for correction of surface irregularities in primary or secondary rhinoplasty, and long term results of 128 patients were evaluated. The source of cartilage was autologous septum, rib or less frequently, the ear concha. The material was injected with 14 to 18 gauge needles or blunted tip lipofilling cannulas with 1.3-1.7 mm internal diameters. It was performed whether during the septorhinoplasty or as a separate single procedure without elevation of the flap. Success was defined as the long term survival of the graft in the desired site and absence of recurrent deformity or complications such as extrusion, infection or displacement. RESULTS: Twenty seven males and 101 females underwent the procedure from May 2008 to January 2014. Mean follow up period was 31 (13-58) months. Ninety five percent of patients were satisfied or very satisfied with the results at the last follow up visits and touch up procedure was performed for the unsatisfied patients. CONCLUSION: Injectable cartilage shaving is a reliable filler to correct and camouflage the surface irregularities, and it is durable and predictable in long term follow ups.

"Mucosal pocket" myringoplasty: a modification of underlay technique for anterior or subtotal perforations.

PURPOSE: Chronic otitis media surgery is the most common procedure in otology in developing countries. Subtotal and total tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rate of graft failure. It was the goal of this study to test the anatomical and functional outcomes of a modified underlay myringoplasty technique. MATERIALS AND METHODS: In a prospective clinical study, 45 patients with subtotal or total TM perforation and inadequate anterior remnant underwent tympanoplasty (+/-mastoidectomy). The anterior tip of the temporalis fascia was secured in a mucosal pocket on the lateral wall of eustachian tube orifice. Data on graft take rate, preoperative and postoperative hearing status, and intraoperative findings were analyzed. RESULTS: We achieved the graft success rate of 91.1%, without lateralization, blunting, atelectasia, or epithelial pearls. Approximately 24% patients had air-bone gap within 25 dB before intervention, which increased to 71% postoperatively (P < .001). CONCLUSION: We believe that this technique could be a convenient and suitable method for cases with subtotal or total TM perforation and inadequate anterior remnant.

Pachyonychia congenita with woolly hair in a ten month old infant.

A 10-month-old female presented with severe progressive wedge-shaped thickening and discoloration of all twenty nails. Further evaluations revealed palmoplantar keratoderma along with recurrent acral blisters causing residual crusted ulcers which were present during the past six months. Other findings included scalp kinky hair and dental caries. Past medical and family history had remarkable findings such as natal teeth and similar skin lesions in her older brother since his infancy. The patients' clinical presentations and history are compatible with pachyonychia congenita presenting with concomitant features of both subtypes 1 and 2.