Surgery of the nasal tip.

One of the most challenging aspects of cosmetic rhinoplasty is nasal tip refinement. In efforts to control tip rotation, projection and architecture, surgeons face constant tradeoffs between tip position and dorsal reduction. Open structure rhinoplasty allows direct visualization of bony-cartilaginous deformities, preservation of nasal structural integrity and precise nasal tip alteration. The open rhinoplasty technique involves, control of tip projection and rotation, reshaping of nasal tip cartilage, minimal resection of the nasal dorsum and lower lateral cartilage and preservation or reinforcement of major tip supports. The advantage of open structure rhinoplasty includes preservation of inherent nasal supporting elements and precise nasal reshaping which are essential for aesthetically pleasing and predictable postoperative results.

Association of skull base and facial fractures.

A retrospective analysis of 268 trauma patients with facial fractures who received computed tomography of the head was undertaken to assess an association with skull base fractures. The incidence of skull base fracture was compared to facial fractures of various anatomic locations. Skull base fractures were significantly increased in orbital wall/rim fractures (36.0%, P = .0823). In contrast, skull base fractures related to orbital floor (27.3%, P = .6191) and maxillary/zygomatic (29.4%, P = .1148) fractures were not significantly greater and were infrequently seen with mandible (4.0%, P = .0454) and nasal (7.7%, P = .0345) fractures. The incidence of skull base fracture was directly associated with the number of facial fractures per patient; one facial fracture (21.0%), two facial fractures (30.4%), and three or more facial fractures (33.3%) (P < .05). The incidence of skull base fractures was related to the location of facial fractures and the number of facial fractures per patient. The results provide additional clinical information to facilitate the prompt detection and diagnoses of skull base fracture.