Rejuvenation of the aging eyelid.

Rejuvenation of the aging eyelid subunit provides a youthful appearance to one of the focal points of the face. As the age of our population increases, these procedures are likely to become increasingly more common. Accurate preoperative examination, assessment, and counseling are imperative to achieve an excellent result. As well, careful selection from the spectrum of available techniques, combined with meticulous surgical precision, will assist the surgeon in rejuvenating the individual patient. Although no one ideal surgical procedure exists, many safe and effective strategies have been developed as we have learned more about the effects of aging. This article aims to provide a history of techniques used in eyelid rejuvenation, as well as an overview of the evaluation process.

Rhinoplasty in the aging patient.

Rhinoplasty in the aging patient presents a unique challenge to the facial plastic surgeon. The effects of age on the skin, ligaments, and cartilage of the nose conspire with the relentless pull of gravity to create a ptotic tip and collapsing nasal sidewalls. Combined with the increased incidence of other comorbidities in the aged patient, the resulting functional and cosmetic problems that ensue can be difficult to overcome. The astute plastic surgeon, however, will not vary from a systemic and patient-centered approach to each individual problem. Moreover, armed with common tools such as cartilage grafting, tip-suturing techniques, and meticulous handling of fragile tissues, the surgeon can restore the nose to a more youthful appearance and functional state. Although once taboo, rhinoplasty in the aging patient is increasingly a rewarding procedure for both patient and surgeon alike.

Diagnosis of middle ear disease using tympanograms and digital imaging.

OBJECTIVE: The study investigates the ability of physicians with different levels of training to accurately identify middle ear (ME) pathology using tympanograms and tympanic membrane (TM) digital photographs. STUDY DESIGN AND SETTING: Groups of medical students, internal medicine residents, and attending and resident otolaryngologists were presented with a set of 50 matched tympanograms and photographs of TMs. The physicians were asked to differentiate between a normal and an abnormal-appearing TM. The sensitivity and specificity of diagnosis of ME pathology by physicians were compared with the gold standard, examining the ME cavity for pathology during myringotomy. RESULTS: The sensitivity did not vary among physicians with different levels of training; however, specificity improved with an increase in physician experience. CONCLUSIONS AND SIGNIFICANCE: This study establishes a baseline for accuracy of diagnosis of ME pathology using tympanograms and photographs of TMs as compared with binocular otomicroscopy and the gold standard, myringotomy. EBM RATING: B-2.

Revisiting outpatient tonsillectomy in young children.

OBJECTIVE: Postoperative same-day discharge is safe for most children undergoing tonsillectomy. However, young children with upper airway obstruction have a higher risk of postoperative complications. We review our tonsillectomy experience in children under 36 months to evaluate the safety of outpatient tonsillectomy in this population. STUDY DESIGN AND SETTING: We conducted a retrospective study of all children under 36 months who underwent tonsillectomy during a recent 2-year period at The Children's Hospital of Philadelphia. RESULTS: The indication for tonsillectomy in 96% of 421 children was upper airway obstruction. Eighteen percent required postoperative treatment to prevent respiratory compromise; 56% of these patients had no associated medical comorbidity. Patients younger than 24 months and those with medical comorbidities were more likely to require intervention. CONCLUSION AND SIGNIFICANCE: It is not possible to preoperatively anticipate which children will have postsurgical complications. We recommend planning an overnight admission for children younger than 36 months undergoing tonsillectomy.

McCune-Albright syndrome: a case report and review of the literature.

Nasal obstruction is one of the most common symptoms pediatric patients present to their physicians with. Usually this symptom is caused by allergic rhinitis or an upper respiratory infection, however, many conditions present with nasal obstruction. We present a 14-year-old patient with a rare cause of nasal obstruction, turbinate enlargement due to fibrous dysplasia, as diagnosed by CT scan and histopathologic analysis. Additionally, clinical history revealed precocious puberty, and a dermatologic exam revealed a café au lait macule, consistent with the McCune-Albright syndrome. This case illustrates the need to formulate a broad differential diagnosis and also consider the overall patient, not just the nasal cavity. The clinical presentation, diagnostic evaluation, long-term management plan and relevant literature are discussed.