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Objectives A relatively neglected aspect of cleft lip nasal deformity is the effect of septal deviation and inferior turbinate hypertrophy (ITH) on the functional airway. In particular, ITH in the noncleft side can be especially problematic, because it reduces the healthy nasal area, creating bilateral nasal obstruction that might affect the growth of the maxillofacial skeleton. Although these anatomic and functional changes are documented, few recommendations have been developed regarding the proper approach to ITH. The aim of the present study was to asses the ITH severity and determine the degree of nasal airway patency in patients who have undergone primary correction of the nasal septum during lip repair compared to patients operated on without primary septal correction. Methods The study population included two groups. One group consisted of twenty unilateral cleft lip palate UCLP patients who have previously undergone primary rhinoseptoplasty as part of their treatment plan. The control group consisted of twenty UCLP patients operated on without rhinoseptal correction. The Nasal Obstructive Symptom Evaluation (NOSE) scale and nasal endoscopy were used to assess nasal obstruction. Results The overall untreated group reported severe symptoms across all NOSE scale dimensions more frequently than children who have undergone primary rhinoseptoplasty. The difference was statistically significant for each dimensions (p < 0.05). The mean NOSE score for group A and group B was 21.4 ± 9.4 and 70.8 ± 17.2 respectively ( p < 0.0001). In group A turbinate size decreased significantly ( p  < 0.05) compared to pre-operative data. Comparing the two groups a statistically significant difference in turbinate size was observed (p < 0.0001). Conclusion The results of the present study confirm that there is a significant degree of ITH and nasal airway dysfunction in patients with UCLP. Early septal repositioning during primary cleft lip repair results in a statistically significant reduction in IT size and improvement of nasal patency. [ABSTRACT FROM AUTHOR]

Background Nasal symptoms are a major problem affecting the quality of life of lowlanders deployed at high altitude. Study was carried out in fresh male inductees inducted in high altitude of 11,500 ft (3500 m) above sea level to evaluate the nasal obstruction using the subjective Nasal obstruction and symptom evaluation (NOSE) score and rhinomanometry during the stay in high altitude. Methods A prospective study was carried out in 100 males inducted into high altitude. The subjects were evaluated using the subjective assessment tool, NOSE scale and rhinomanometry on induction and after 2 months. The data were analysed for NOSE scale in the 1st and 2nd visit by test for equality of proportions and the total nasal airway resistance (Pa) has been expressed as mean ± standard deviation and compared across severity of NOSE score using one way ANOVA and between 1st and 2nd visit using paired t test. Results and conclusions Out of the 100 subjects, 77 came for the 2nd review after 2 months. There was statistically significant worsening in the subjective feeling of nasal obstruction during the stay in high altitude without any significant change in the nasal airway resistance. [ABSTRACT FROM AUTHOR]

Background Optimization of treatment of the unilateral cleft lip nasal deformity (uCLND) is hampered by lack of objective means to assess initial severity and changes produced by treatment and growth. The purpose of this study was to develop automated 3D image analysis specific to the uCLND; assess the correlation of these measures to esthetic appraisal; measure changes that occur with treatment and differences amongst cleft types. Methods Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle were assessed using computer-vision techniques. Subjects included infants before and after primary cleft lip repair (N = 50) and children aged 8–10 years with previous cleft lip (N = 50). Two expert surgeons ranked subjects according to esthetic nose appearance. Results Computer-based measurements strongly correlated with rankings of infants pre-repair (r = 0.8, 0.75, 0.41 and 0.54 for Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle, p < 0.01) while all measurements except Alar-Cheek Definition correlated moderately with rankings of older children post-repair (r ∼ 0.35, p < 0.01). Measurements were worse with greater severity of cleft type but improved following initial repair. Abnormal Dorsum Deviation and Columellar Angle persisted after surgery and were more severe with greater cleft type. Conclusions Four fully-automated measures were developed that are clinically relevant, agree with expert evaluations and can be followed through initial surgery and in older children. Computer vision analysis techniques can quantify the nasal deformity at different stages, offering efficient and standardized tools for large studies and data-driven conclusions. [ABSTRACT FROM AUTHOR]

Open rhinoplasty and Abbe flap techniques are traditionally useful tools for the reconstruction of secondary bilateral cleft lip nasal (BCLN) deformity. We aimed to investigate the long-term outcomes of simultaneous columella and philtrum reconstruction using prolabial flap combined with Abbe flap in secondary BCLN deformity. From January 2009 to July 2014, 26 patients (17 males and 9 females; mean age 21 years) with secondary BCLN deformity were recruited. All patients had severe short columella and philtrum deficiency. The whole superiorly based prolabial flap was harvested and trimmed for columella reconstruction. An Abbe flap from the central lower lip was elevated to reconstruct the esthetic philtral unit. No flap necrosis occurred postoperatively. The average follow-up was 2.7 years. The columella length was 4.7 ± 1.3 mm preoperatively and 10.4 ± 2.1 mm postoperatively. The philtrum length increased to 14.4 ± 2.6 mm postoperatively from a preoperative 8.9 ± 2.4 mm. Regarding the overall impression of the reconstruction, 22 patients ranked it as very good or good. In secondary BCLN deformity, the prolabial flap combined with Abbe flap technique is an effective alternative for the treatment of severe short columella complicated with severe philtrum deficiency. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnoea (OSA) results from the recurrent collapse of the upper airway during sleep. Nasal abnormalities influence the stability of the pharynx. The aim of this study was to evaluate the volumetric and anatomical changes of the nasal cavity in patients with OSA. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to grade nasal obstruction. Sleep-related breathing disorders were evaluated by polysomnography. The nasal airway volume was obtained from computed tomography scans through volumetric reconstruction of the nasal airway. Alterations to the nasal anatomy were identified by nasal fibre-optic endoscopy. Ninety-four patient charts were analyzed. The final sample comprised 32 patients with severe OSA, 16 with moderate OSA, 23 with mild OSA, and 20 without OSA. Three groups were established based on nasal obstruction and OSA. The groups were compared for nasal airway volume ( P = 0.464) and body mass index ( P = 0.001). The presence of nasal septum deviation and inferior turbinate hypertrophy were related to the NOSE score ( P = 0.05 for both), apnoea–hypopnoea index ( P = 0.03 and P = 0.05, respectively), and nasal airway volume ( P = 0.71 and P = 0.78, respectively). In this nasal airway evaluation of OSA patients, the presence of sites of obstruction was correlated with the severity of OSA; this was not the case for the evaluation of the nasal airway volume dimensions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the outcome of a component columella augmentation technique in cleft nose rhinoplasty. This prospective study included rhinoplasty procedures in bilateral cleft nose patients treated by component columella augmentation technique. After surgery, all patients were followed up daily for the first week, and then at 1 month and 6 months postoperative. The following four parameters were assessed: nasal tip projection, infratip lobule length, infratip lobule-to-base distance, and columella–labial angle. Thirteen rhinoplasty patients were included. Tip projection was increased (5.6 ± 3.5 mm) in all cases postoperatively ( P < 0.05); the increase was seen mostly in the lobule-to-base length (4.5 ± 0.4 mm), with a minimal change in lobule length (1.1 ± 3.6 mm). Preoperative and postoperative lobule lengths were not statistically different ( P > 0.05). With this technique, it is not necessary to involve the upper and lower lips. Therefore, the non-aesthetic vertical scars and tissue distortion that may occur with local flaps are easily avoided. Compared to composite augmentation, each part of the deformity (cartilage and skin) is precisely and separately restored with this technique. [ABSTRACT FROM AUTHOR]

Objective: The pathogenesis of MSFB development remains unclear, but it has been suggested that poor sinus ventilation is associated with disease development; such a ventilation is influenced by anatomical variation of the paranasal sinuses. Thus, we sought to determine whether sinonasal anatomical variations were associated with MSFB development. Methods: Thirty-one patients with MSFB and 28 gender-matched control patients were included in the present study. The presence or absence of Haller cells and a concha bullosa were scored, and the angle of septal deviation and the minimal and maximal lengths of the infundibulum were measured on preoperative computed tomography images. Results: In the MSFB group, both a concha bullosa (61.3% vs. 28.6%, p=0.006) and Haller cells (41.9% vs. 30.4%) were present at higher frequencies than in the control group, although the between-group difference in Haller cell occurrence was not statistically significant (p=0.348). In addition, MSFB patients had a significantly lower mean infundibular width (3.23±0.69mm vs. 3.99±1.17mm, p<0.001) and a longer infundibular length (9.71±1.43mm vs. 8.23±1.72mm, p<0.001) than controls. Conclusions: Sinonasal anatomical variations, especially the presence of a concha bullosa, and/or a narrow and long infundibulum, may play roles in the development of maxillary sinus fungal balls (MSFBs). [ABSTRACT FROM AUTHOR]

Objectives Evaluation of the aesthetic outcome and functional aspect after surgical correction of bifid nose by combined Millard forked flap with external rhinoplasty Background Bifid nose is a rare congenital anomaly that results during facial development but the explicit mechanism is not clearly understood. Clinical findings are quite variable with a wide range of severity. Surgical correction still represents great challenge to facial plastic surgeons; extensive deformities in many cases, rarity of condition and paucity of publications are contributing factors. Methods Surgical correction of six patients with bifid nose by a combined Millard forked flap with external rhinoplasty Results The aesthetic and functional outcomes were acceptable for all patients and parents. There were no considerable postoperative complications. Conclusions This approach is highly effective for various grades of bifid nose. Early management is preferable to avoid psychological morbidity. Secondary rhinoplasty is usually needed for cosmetic refinement. [ABSTRACT FROM AUTHOR]

Objectives Nasal dermoids are congenital anomalies constituting 3.7–12.6% of dermoids in the head and neck. Most of lesions are superficial but there is always a risk that it may end blindly within the deep structures of the nose or extend intracranially. Complete excision, regardless of extension, is essential and must be balanced against cosmoses. This study reviews the clinical characteristics and imaging findings as well as the appropriate surgical approach adopted for 29 cases managed at Mansoura University Hospitals. Methods A retrospective analysis was performed in 29 patients admitted for management of nasal dermoid between Jan 2001 and Jan 2015 at the Otolaryngology department of our tertiary referral university hospital. Recorded data included patient's demographics, complaint, lesion's site, pre-operative radiological findings, surgical technique, intra-operative findings, and post-operative squeal. Results This series included 12 (41%) female and 17 (59%) male children, with a mean age of 2.5 years. Twenty seven children presented with a nasofrontal swelling of which 20 had an apparent sinus. Other presentations included a swelling in the inner canthum (1), nasal tip and columella (1). Nine (31%) patients had a history of infection and two patients gave a positive history of meningitis. Intracranial extradural extension was identified in 10 patients (34.5%) during preoperative imaging. Surgical modalities included local excision and direct closure (12), open rhinoplasty (7), bicoronal excision and craniotomy (10). In 9 cases, the tract was adherent to the dura but was carefully dissected and in one case resection required excision of a segment of dura and reconstruction. In a follow up period of 1–8 years, recurrence was detected in one case and the cosmetic results were satisfactory. Conclusions Those lesions are rare and require early precise surgical planning to achieve complete en bloc excision. This study reports a low morbidity associated with management of nasal dermoids with intracranial extension. [ABSTRACT FROM AUTHOR]

Objectives To determine the most common mechanisms of traumatic nasal deformity referred to pediatric otolaryngology. To examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents’ and surgeons’ ratings of post-reduction nasal symmetry. Methods Case series and chart review within an urban, tertiary pediatric otolaryngology practice. Results 100 cases of traumatic nasal deformity met inclusion criteria over a 3-year study period. The mean age at presentation was 13 years (4 weeks–18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports-related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%) and alcohol-related (2%). Of these 100 cases, 22% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. 21 of 22 post-reduction patients were assessed for nasal symmetry at the postoperative visit (7–10 days following surgery). The operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) satisfied in 81% of cases. Both parent and surgeon were satisfied with post-reduction symmetry 33% of the time. Conclusion The most common sources of traumatic nasal deformity in children and adolescents vary by age. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases, however a result in which both parent and surgeon agree with successful re-establishment of symmetry occurs in only one-third of cases. [ABSTRACT FROM AUTHOR]

Introduction Traditional Figueroa nasoalveolar molding (NAM) requires weekly or biweekly adjustments to remove acrylic from the palatal plate to narrow the alveolar gap. These frequent adjustments create a burden for patients living far from a hospital. To minimize this burden, we developed a modified NAM technique using simplified lip taping and a passive palatal plate. Herein we present our clinical experience and outcomes using the traditional and modified methods. Material and methods In this blinded, retrospective study of 66 patients with complete unilateral cleft lip and palate, 33 received the traditional NAM and 33 received the modified NAM. Pretreatment and posttreatment facial photographs and clinical charts were used to compare efficacy (nostril height ratio, nostril width ratio, columellar angle, nasal base angle), efficiency (molding frequency), incidence of complications (facial irritation, mucosal ulceration), and medical cost. Results Traditional and modified NAM did not differ in treatment efficacy for nostril height ratio (0.88 ± 0.14 vs. 0.90 ± 0.12), nostril width ratio (2.22 ± 0.39 vs. 2.38 ± 0.50), columellar angle (73.5 ± 9.1 degrees vs. 71.3 ± 11.8 degrees), nasal base angle (5.1 ± 2.4 degrees vs. 5.9 ± 2.7 degrees), or alveolar gap width (2.0 ± 2.0 mm vs. 2.0 ± 1.7 mm) (all p > 0.05). Traditional NAM was less efficient, i.e., required more adjustments (8.6 ± 2.0 vs. 6.7 ± 1.1), and cost more (22016.4 ± 2012.7 New Taiwan dollars vs. 20137.6 ± 1173.4 New Taiwan dollars) (both p < 0.001). Conclusions Both NAM techniques similarly improved nasal deformities and reduced alveolar gaps, but the modified technique was more efficient and cost less in terms of insurance reimbursement and supplies (labial tapes). [ABSTRACT FROM AUTHOR]

Undisturbed nasal breathing is essential for normal breathing physiology as a whole. Nasal septal deformities (NSD) are well known as a factor which can remarkably and substantially affect the quality of nasal and pulmonary breathing. However, it is well known that type 5 and type 6 nasal septal deformities may cause only a moderate, unilateral nasal obstruction or none at all. The effects of nasal obstruction on the respiratory and cardiovascular systems have been well studied so far: right ventricle problems, ischemic heart diseases, sleep disorders, mucociliary clearance system disturbances, paranasal sinus pathology, have all been described as a result of impaired nasal breathing. The connection between the upper and lower respiratory systems has been recognized in allergic rhinitis and asthma as well, resulting in the united airways concept. Most recently, the ostensible connection between chronic rhinosinusitis (CRS) and acute myocardial infarction has been said to be proven. However, the results of this study might have not been well founded since there are no direct and clear proofs that CRS as a chronic inflammatory process has anything to do with the acute coronary syndrome (ACS). On the other hand, a large international study on the incidence of NSD in CRS patients, based on the Mladina classification, showed that NSD were present in a high incidence and that the most frequent deformities were types 5 (36.18%) and 7 (29.92%). The vast majority of those types 7 consisted of types 3 and (again) types 5 or types 6 (76.32%). The fact that in CRS patients a remarkably high incidence of type 5 septal deformity can be seen, gives rise to thinking that this factor perhaps plays a role in the onset of ACS. Acute coronary syndrome is one of the leading causes of death all over the world. Traditional risk factors such as family history, overweight body, smoking, stress, hypertension, hypercholesterolemia, diabetes mellitus, coronary artery calcium score, C-reactive protein, lipoprotein, homocysteine, lipoprotein-associated phospholipase A2, as well as high-density lipoprotein functionality perhaps cannot account for the entire risk for incident coronary events. Several other potential risk factors have been identified in an effort to improve risk assessment for ACS. This article reviews one of them: the possible influence of an unusual, so far unknown predisposing factor: type 5 or type 6 nasal septal deformities. They have been found as pure, isolated types or as a part of combined nasal septal deformity (type 7). [ABSTRACT FROM AUTHOR]

Aim Quantification of visual attention directed towards cleft stigmata and its impact on the perception of selected personality traits. Methods Forty observers were divided into two groups and their visual scan paths were recorded. Both groups observed a series of photographs displaying full frontal views of the faces of 18 adult patients with clefts, nine with residual cleft stigmata and nine with digitally-corrected stigmata (each patient only appeared once per series). Patients that appeared with residual stigmata in one series appeared digitally corrected in the other series and vice versa. Visual fixation times on the upper lip and nose were compared between the original and corrected photographs. Observers subsequently rated personality traits as perceived using visual analogue scales and the same photographs that they had observed in the series. Results In faces depicting cleft stigmata observers spent more time looking at the oronasal region of interest, followed by the eyes (39.6%; SD 5.0 and 35.1%; SD 3.6, respectively, p = 0.0198). Observers spent more time looking at the cleft lip compared with the corrected lip (21.2%; SD 4.0 and 16.7%; SD 5.0, respectively, p = 0.006). The differences between questionnaire scores for faces with cleft stigmata compared with faces with corrected stigmata for withdrawn-sociable, discontent-content, lazy-assiduous, unimaginative-creative, unlikeable-likeable, and the sum of individual personality traits were not significant. Conclusion According to these findings, cleft lip and cleft nose have an attention-drawing potential with the cleft lip being the major attention drawing factor. These data do not provide supportive evidence for the notion reported in literature that patients with clefts are perceived as having negative personality traits. [ABSTRACT FROM AUTHOR]

Hallermann–Streiff syndrome (HSS) is a rare congenital abnormality affecting mostly the head and face area. Craniofacial deformities, which are present in 98–99% of cases, are the principal abnormalities detected. We focus here on a particular subset of these deformities: atrophy of the skin of the centre of the face and nose. Two patients diagnosed with HSS were treated in our department. Both patients underwent nasal lipofilling to treat the atrophy of the nasal skin, as described by Nguyen et al. In both cases, a satisfactory improvement in nasal skin colour and texture was observed. A functional gain was also reported by the parents and observed during follow-up consultations. Lipofilling thus appears to be an excellent option for treating craniofacial deformities in children. [ABSTRACT FROM AUTHOR]

Résumé Même si leur intérêt était connu depuis longtemps, la démocratisation de la voie externe a permis le développement important des techniques de sutures en rhinoplastie ces vingt dernières années. Aujourd’hui, elles sont très couramment utilisées et constituent une technique fiable pour contrôler la forme et la position des cartilages alaires. Les auteurs dressent la liste des différents types de sutures dont dispose le chirurgien. Pour chacune d’elle, il décrit sa réalisation et les effets que celle-ci entraînera sur la forme de la pointe du nez. Summary Suture techniques are widely used and can be very useful and efficient to support the nasal tip and correct its deformities. Nevertheless, they are so powerful that they have to be performed very precisely if the surgeon does not want to create cosmetics as well as functional problems. The authors describe the main tip sutures and their effects, expected or not. [ABSTRACT FROM AUTHOR]

Résumé Premier temps chirurgical d’une rhinoplastie, les voies d’abord permettent d’exposer par différents types d’incisions et plans de dissection la charpente ostéocartilagineuse de la pyramide nasale avant d’effectuer des gestes de réduction ou d’augmentation sur celle-ci. Cette exposition peut s’effectuer par une voie dissimulée ou une voie d’abord externe dont le choix dépend du type de nez ainsi que des habitudes du chirurgien. Plus que s’opposer, les voies d’abords dissimulées et externes se complètent et doivent être connues et maîtrisées des chirurgiens réalisant des rhinoplasties. Summary In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach – the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty. [ABSTRACT FROM AUTHOR]

Résumé La correction du nez tordu ou dévié peut être très complexe et nécessite l’utilisation d’une large gamme de techniques chirurgicales. La demande des patients est souvent mixte, esthétique et fonctionnelle, en particulier dans les cas post-traumatiques. La qualité de la respiration postopératoire est donc aussi importante que la correction de la déviation nasale : la septoplastie extracorporelle ou encore les spreader grafts sont tout particulièrement efficaces, non seulement dans la correction de la déformation de la pyramide nasale, mais aussi dans la résolution des problèmes respiratoires fonctionnels. La reconstruction et le bon support de la cloison sont des composantes nécessaires à un nez droit. La déformation esthétique peut être difficile à corriger en raison de la mémoire de l’os et du cartilage. Bien que les déformations mineures puissent être corrigées avec des techniques simples, un geste plus agressif est souvent nécessaire dans les cas plus complexes. Malgré les tentatives de correction de la déformation grâce aux différentes techniques décrites ici, il peut persister une déviation postopératoire. La discussion préopératoire est très importante et permet d’expliquer au patient qu’il est très difficile d’obtenir un nez parfaitement droit. Summary Correction of a twisted or crooked nose can be very complex and require the use of a broad range of surgical techniques. Patient needs are often mixed – aesthetic and functional – particularly in post-trauma cases. The quality of postoperative breathing is therefore as important as correction of the nasal deviation. Extracorporeal septoplasty or spreader grafts are very effective not only in correction of the nasal pyramid deformation, but also in resolution of functional respiratory issues. Reconstruction and proper support of the septum are necessary components for a straight nose. Aesthetic deformation can be difficult to correct owing to the memory of the bone and cartilage. Although minor deformations can be corrected with simple techniques, a more aggressive procedure is often necessary in the most complex cases. Despite attempts to correct deformation thanks to the various techniques described here, a postoperative deviation can persist. Preoperative discussion is very important and enables the surgeon to explain to the patient that it is very difficult to obtain a perfectly straight nose. [ABSTRACT FROM AUTHOR]

Résumé Qu’elles soient paramédianes, supérieures ou latérales, effectuées par voie endonasale ou percutanée, les ostéotomies ont pour objectif de modifier la forme de la partie osseuse du nez. Loin d’être systématiques, elles peuvent être utilisées seules ou en association les unes aux autres. Leurs principales indications sont la correction d’une asymétrie de la voûte osseuse, la réduction d’une voûte large et la fermeture d’un toit ouvert après résection d’une bosse ostéocartilagineuse importante. Dans tous les cas, elles doivent être réalisées avec la plus grande prudence afin d’éviter toute complication et après analyse précise du nez pour ne pas créer de gêne obstructive ou de déformation de type V inversé, marche d’escalier, nez pincés ou ensellure. Summary Osteotomies are performed to modify the shape of the bony part of the nose, therefore they should not be done systematically. Main indications are correction of deviated nose, narrowing of bony vault and roofing of an open roof after important hump resection. The nose should be very precisely analyzed before osteotomies if the surgeon doesn’t want to create deformities such as step, inverted V, pinched nose or saddle nose. When too narrowed, bones can also block the airway and lead to functionnal problems. [ABSTRACT FROM AUTHOR]

Résumé Il y a plusieurs sortes de nez courts, en fonction de la hauteur du dorsum, de son ensellure, de la hauteur latérale du nez, de l’existence d’une rétraction narinaire, ou bien encore de la situation de l’angle naso-frontal, ou de l’ouverture de l’angle naso-labial. Ces cas sont traités, la plupart avec des greffes de cartilage et une voie fermée. Summary Short noses are not only depending on the length of the dorsum, but also if there is a saddle deformity, or a too lower situation of the fronto-nasal angle, or an open naso-labial angle or a rim retraction. All the cases are treated, often with the help of cartilage grafts and with a closed approach. [ABSTRACT FROM AUTHOR]

Résumé La demande de rhinoplastie secondaire peut correspondre à un réel défaut qu’il faut corriger mais également parfois à un résultat tout à fait correct mais mal accepté par le patient. C’est d’un examen soigneux et d’une enquête clinique et paraclinique que découlera la prise en charge. Du simple conseil de retour vers le chirurgien initial jusqu’à la reprise complexe d’un nez cicatriciel dont la structure ostéocartilagineuse a été très altérée, toutes les situations peuvent se rencontrer. Les auteurs analysent les situations les plus fréquentes et proposent des principes de prise en charge conformes à leur expérience. Les techniques utilisées en rhinoplastie secondaire ne sont pas différentes de celles de la chirurgie primaire mais leur mise en œuvre est particulière : difficultés de dissection et d’exposition, bilan anatomoclinique qui ne sera complet qu’en peropératoire, couverture muqueuse quelques fois aléatoire. Ces conditions particulières associées quelques fois à l’impossibilité de garantir au patient d’obtenir exactement le résultat qu’il attend font à la fois l’intérêt et la difficulté de la rhinoplastie secondaire. Summary Secondary rhinoplasty is very usual. Some patients are not satisfied by the previous surgery because the result is poor with obvious defaults but, sometimes, the result is good but the patient expects perfection. These two different situations will not lead to the same answer from the surgeon. Techniques of secondary rhinoplasty are the same than primary, but are often more difficult to perform because of scar tissue, retraction and loss of lining. The authors analyse the more frequent deformities in secondary rhinoplasty and the way they fix it. [ABSTRACT FROM AUTHOR]

Résumé Le nez et les fosses nasales assurent la ventilation, le conditionnement de l’air inspiré et l’olfaction. Ils peuvent être le siège de pathologies inflammatoires, infectieuses et tumorales ou d’anomalies architecturales préopératoires voire postopératoires, altérant ces fonctions, pour lesquelles l’examen clinique sera d’un rendement variable. Nous verrons tout d’abord, après un bref rappel physiologique, l’examen dit « de débrouillage » qui permettra au chirurgien non ORL de sélectionner les patients justifiant d’une exploration fonctionnelle préopératoire plus poussée. Nous présenterons ensuite les explorations complémentaires existantes : consultation ORL et endoscopie des fosses nasales, imagerie, technique de mesure du flux aérien nasal. À l’issue de ce bilan complémentaire, le praticien doit être en mesure : de savoir s’il existe ou non une obstruction nasale préopératoire et de la quantifier et de la rattacher à une cause, de dépister les contre-indications à la rhinoplastie mais aussi de connaître les structures anatomiques pouvant être à l’origine de troubles ventilatoires postopératoire, de prévoir d’emblée un geste adapté, qu’il soit esthétique pur ou esthético-fonctionnel. Au total, il existera 3 groupes de patients : ceux qui ne présentent aucune contre-indication au geste de rhinoplastie, ceux qui présentent une indication de geste esthético-fonctionnel, ceux qui présentent une contre-indication à la rhinoplastie. Summary Nose and nasal cavity provide ventilation, inspired air conditioning and olfaction. They may be the seat of inflammatory, infectious and malignant disease, or preoperative or postoperative architectural abnormalities, altering these functions, for which clinical examination will be a variable return. First of all, we’ll see, after a brief physiological reminder, descrambling examination which allows non-ENT surgeon to select patients justifying a further preoperative functional exploration. In total, there will be three groups of patients: those who have no cons-indication to rhinoplasty, those with an indication of aesthetic and functional rhinoseptoplasty, those with cons-indication for rhinoplasty. [ABSTRACT FROM AUTHOR]

Median cleft lip is a midline vertical cleft through the upper lip. This is a very rare anomaly described in the literature. Median cleft lip is caused by the failure of fusion of the medial nasal prominences. In this case report, a 4-month-old boy with a median cleft associated with a mass of the upper lip is presented. The patient has no other anomalies of the nose or alveolus. The patient has normotelorism. A Z-plasty technique was used on the skin of the base of the columella. A vertical excision of the cleft with muscle approximation was performed on the white roll and the wet-dry border of either side of the defect of the upper lip. Postoperatively, the patient had a satisfactory result. The incisive scars were not visible. Cupid's bow was appropriately aligned, and the height of the upper lip was equal on both sides. [ABSTRACT FROM AUTHOR]

A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption. Pathological examination revealed the presence of necrosis and chronic inflammation. MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive. We hereby present detailed clinicopathological findings. [ABSTRACT FROM AUTHOR]

Background The nasal septum plays an important role in nasal growth, but there have been few reports on the relationship between the septum and nasal growth. The authors investigated the relationship between septa and external noses using computed tomography during the growth period. Methods One hundred and ninety-eight patients under the age of 21 were enrolled in this study between 2008 and 2012. The authors evaluated a total of 9 measurement items (five for nasal bones and septa, and four for external noses). Results In the final age group, most measurement items were significantly larger in males than in females. However, there was no remarkable difference between male and female growth processes. Nasal bridge length and nasal height were significantly correlated with the nasal bone or septum in almost all age groups. The relative proportion of the cartilaginous septum decreased significantly with age, and was negatively correlated with the perpendicular plate in all age groups. Conclusions Nasal septa and external noses were both larger in males than in females at the beginning of the study period, although not significantly. The differences became significant throughout the study due to differential increases between the sexes during the monitored growth spurts. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Few reconstructive options are available for nasal defects measuring >2 cm. Staged procedures are often utilized for nasal defect reconstruction, but they are not feasible in some patients. Methods: Out of 92 patients operated upon for nasal skin lesions between 2009 and 2011, patients who received reconstructive surgery with a dorsal nasal flap, nasal skin lesions located in lower half of nose (≤5 mm from the alar rim), defect diameter ≥3 cm were included in this study. Results: Patients with nasal lesions larger than 3 cm who refused a staged procedure and were prone to compromised follow up underwent dorsal nasal flap reconstruction. Clear margins were obtained and no flap loss occurred. Minor complications occurred, such as flap dehiscence. Conclusion: The dorsal nasal flap can be effectively utilized for selected lesions as a surrogate for staged procedures that use various local flaps, such as the paramedian flap. [Copyright &y& Elsevier]

Abstract: Purpose: To study the possible morphologic changes in the nose after subnasal modified Le Fort I maxillary osteotomy to correct class III dentofacial deformities in patients with considered normal nasal morphology. Material and methods: Fifteen patients (7 males, 8 females) requiring maxillary advancement to treat class III dentofacial deformities were studied prospectively between January 2004 and January 2011. All the patients had an adequate projection of the nasal tip preoperatively preventing a conventional Le Fort I osteotomy. Patients received preoperatively (T1), 6 months after surgery (T2), and 12 months after the initial surgical procedure (T3) lateral cephalograms, CT-3D studies and clinical nose analysis to measure different morphologic variables including: the alar/nose base width, nasal tip protrusion and nasal bridge length using a digital sliding calliper directly on the soft-tissue surface of the face. Results: Mean age was 26.2 years, range 20–36 years. A significant advancement of the maxilla was noted postoperatively (mean 7.5 mm). After surgery the different anthropometric variables of the nasal region analysed had not suffered any significant variation. No significant differences were found when comparing T2 with T3 measures. No significant complications were found. Conclusion: The results indicated that maxillary advancement using a subnasal modified Le Fort I osteotomy can prevent undesirable soft tissue changes of the nose when anterior repositioning of the maxilla is indicated in patients with preoperatively normal nasal morphology. [Copyright &y& Elsevier]

Abstract: Choanal atresia causes serious posterior nasal obstruction. This defect is the leading cause of nasal surgery in newborns, although its etiology is largely unknown. Data from the National Birth Defects Prevention Study, a population-based case–control study, were used to examine associations between maternal self-reports of exposures and occurrence of choanal atresia in their offspring. Overall, 117 case and 8350 control mothers with deliveries from 1997 through 2007 provided telephone interview reports of pre-pregnancy (one year before conception) and periconceptional (one month before through three months after conception) exposures. The exposures analyzed were pre-pregnancy dietary intake, pre-pregnancy and periconceptional caffeine consumption, and periconceptional cigarette smoking, alcohol drinking, and medication use. Independent associations between each exposure and all choanal atresia cases combined (n = 117) and isolated choanal atresia cases (those without additional unrelated major defects; n = 61) were examined. Odds ratios (ORs), both unadjusted (uORs) and adjusted (aORs) for potential confounders, and 95% confidence intervals (CIs) were estimated using unconditional logistic regression analysis. For all choanal atresia cases combined, positive associations were observed with maternal pre-pregnancy intake in the highest quartile for vitamin B-12 (aOR = 1.9; CI = 1.1,3.1), zinc (aOR = 1.7; CI = 1.0,3.1), and niacin (aOR = 1.8; CI = 1.0,3.1), and intake in the lowest quartile for methionine (aOR = 1.6; CI = 1.0,2.6) and vitamin D (aOR = 1.6; CI = 1.0,2.4) compared to intake in the two intermediate quartiles combined. Further, a positive association was observed with periconceptional use of thyroid medications (uOR = 2.6; CI = 1.0,6.3) compared to no use of such medications. Among isolated choanal atresia cases, negative associations were observed for pantothenic acid (aOR = 0.4; CI = 0.2,0.9) and fat (aOR = 0.5; 95% CI = 0.2,1.0) intake in the lowest quartile compared to that in the intermediate quartiles, and positive associations were observed for periconceptional cigarette smoking (aOR = 2.3; CI = 1.1,4.7) compared to no smoking and pre-pregnancy daily coffee intake of 3 or more cups (aOR = 2.5; CI = 1.1,5.6) compared to intake of less than 1 cup per day. The positive association for periconceptional exposure to thyroid medications also persisted for isolated choanal atresia cases (uOR = 4.0; CI = 1.1,11.2). Because of the large number of associations tested, these findings may be due to chance. Alternatively, they may contribute new hypotheses regarding the etiology of choanal atresia; thus, requiring replication in additional studies. [Copyright &y& Elsevier]

Abstract: Frontonasal dysplasia is an unusual congenital condition with a wide phenotypic range. Because of this, only a small number of cases and their management have been reported in the literature. The ideal surgical procedures to correct mild cases of frontonasal dysplasia, and the time to perform them, are still controversial. The case of a 9-month-old girl with a mild form of this condition (a congenital bifid nose and a duplicated frenulum), and its surgical management, is presented. The surgery achieved an early improvement of the patient's appearance and she had no complications. In the future, it is probable that she will need secondary rhinoplasty to aid in the projection of the tip and refine the shape of the nose. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the results of a transnasal endoscopic repair of congenital choanal atresia beginning by resection of the posterior portion of the vomer and ending by no stent. Methods: Seven patients with bilateral congenital choanal atresia aged ranging from 3 to 15days were operated upon between June 2009 and September 2011. This transnasal endoscopic approach allowed resection of the posterior portion of the vomer first then the atretic plates and part of the medial pterygoid plate if needed leaving no stent. Postoperative control included office fiberoptic nasal endoscopy. Results: Adequate functional nasal breathing was maintained in all patients during follow up of 11 to 23months. Apart from one case that complicated by palatal defect, no any other complications were detected. Conclusion: The described technique was proved to be very effective, allowing fast recovery, and one step surgery with early discharge from hospital using neither stents nor nasal packing. Good patency with no reduction in functional quality was also observed. [Copyright &y& Elsevier]

Summary: Background: Although many articles have investigated the optimal method for the primary correction of nasal deformities during unilateral cleft lip repair, residual nasal deformities often remain. Such residual deformities are commonly corrected around the age of 5. We have started performing two-stage nasal repair operations for unilateral cleft lip patients. During the first stage, the nasal floor is elevated, and the alar base is brought into the correct position by muscle reconstruction during primary lip repair. During the second stage, the slanting nasal apex and drooping alar rim are corrected at pre-school age. This article describes the methods and results of second-stage open rhinoplasty. Methods: Open rhinoplasty is performed. The conchal cartilage is harvested and used as a strut to strengthen and extend the septum. The lower lateral cartilages are sutured to the grafted cartilage and fixed in the correct position. The operative results of 38 patients were evaluated photogrammetrically. The nasal height, nostril height and the columella angle on a basilar view of the nose were measured. Results: In most patients, the nose was refined and became less distorted. Poorly projecting nasal tips and drooping alar rims were corrected. The reformed configuration was relatively well maintained for many years. Photogrammetric analysis demonstrated increases in both the nasal height to nasal width ratio and the nostril height to nostril width ratio, and improvement of the columella angle. Conclusion: Performing open rhinoplasty using conchal cartilage during childhood effectively improves unilateral cleft-lip nasal deformities. [Copyright &y& Elsevier]

Abstract: Objective: To test the hypothesis that there is no long-term stability of soft tissue changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Setting and sample: Oral Health Sciences Centre at PGIMER, Chandigarh; 15 consecutively treated adult subjects in the age range of 17–34 years with cleft lip and palate who underwent advancement of maxilla by distraction osteogenesis. Materials and methods: Lateral cephalograms recorded prior to distraction, at the end of distraction, 6-months after distraction and at least 2-years after maxillary distraction of 15 subjects (M =8, F =7) in the age range of 17–34 years with complete cleft lip and palate were used for the evaluation of treatment outcome and long-term stability of the soft-tissue changes. Results: The soft tissue profile, total soft tissue profile and nasolabial angle were improved significantly after immediate (P <0.001), 6-months (P <0.01) and 2-years (P <0.01) of maxillary distraction. Forward movement of the nasal tip and nasal base were increased significantly (P <0.001). The length and thickness of the upper lip was improved after various time intervals of maxillary distraction osteogenesis (P <0.01). Approximately 25% of the changes following maxillary distraction were relapsed during first 6-months of post-distraction follow-up period. Conclusions: Distraction osteogenesis of the maxilla improved the soft tissue profile by increasing the prominence of nose, moving the upper lip forward and normalizing the nasolabial angle. Approximately 75% of the changes were remained stable at the end of 2-years of follow-up of maxillary distraction osteogenesis. [Copyright &y& Elsevier]

Summary: Introduction: Nasal deformities secondary to incomplete cleft lip are often underestimated in terms of their severity with resultant sub-optimal treatment. Constant refinements have led to the evolution of different surgical techniques in our institution for the treatment of these deformities. This study compared three different techniques in achieving nasal asymmetry for patients with unilateral incomplete cleft lip. Methods: Sixty-six patients who had primary correction of incomplete cleft lip nasal deformities at the age of 3 months were reviewed later at the age of 5 or 6. The patients were divided into three groups as according to the surgical treatment received: Group I (n =21) underwent a closed rhinoplasty with cartilage dissection and repositioning through lip incisions; Group II (n =25) underwent a semi-open rhinoplasty technique with cartilage dissection through bilateral rim incisions; and Group III (n =20) received a semi-open rhinoplasty technique through a Tajima incision on the cleft side and a rim incision on the contralateral side. Using photo-analysis, a total of seven measurements were obtained comparing the cleft side with the non-cleft sides, including bilateral nostril height, nostril width, height-to-width ratio, medial dome height, nasal sill height, nostril area, nasolabial angle and nostril axis. Results: All the patients benefitted from primary correction of their incomplete cleft lip and nasal deformities. In addition, Group III patients achieved superior results over Groups I and II in terms of nostril height ratio and nostril axis (p <0.005). Conclusion: Primary correction of the nasal deformity is an important component of surgery at the time of lip correction. Our results indicated that a semi-open rhinoplasty technique accompanied by the Tajima incision provides the best overall nasal symmetry. [Copyright &y& Elsevier]

Abstract: Orthognathic surgery is a recognised way of correcting dentofacial deformities and it is common practice to treat problems that affect the chin simultaneously, while deferring or not treating nasal deformities. There is inadequate published information about the prevalence of nasal deformities in such patients, and our aim was to remedy this. We retrospectively studied 75 patients with dentofacial deformities to find out if there was an association between nasal and dentofacial abnormalities. Forty-six of the 75 patients (61%) had mild to prominent cosmetic nasal problems, of whom 27 had deformities of the nasal bridge, 22 of the lobule of the nasal tip, 20 of nasal width, 14 in the width of the alar base, and 11 of the columella; 8 presented with deviation of the nose, and 6 with abnormal nasal length. Skeletal classes II and III had only slightly varied emphasis on nasal deformities. In comparison 14 patients (19%) had problems with the chin that required, or had already had, genioplasty. We also studied 9 patients who had had corrective bimaxillary surgery with simultaneous rhinoplasty. We set no formal questionnaire, but all patients expressed satisfaction with the postoperative results. [Copyright &y& Elsevier]

Abstract: Abnormality of the structures of the nasal cavity has featured little in palaeopathology. Here we present a possible case of concha bullosa, the abnormal pneumatisation of the middle turbinate. Differential diagnosis for concha bullosa, and the potential importance of this condition in earlier populations are discussed. [Copyright &y& Elsevier]

Summary: Alveolar bone graft is considered conducive to tooth eruption and maxilla stability in unilateral cleft patients, but its contribution to nasal symmetry is still under discussion. To explore the detailed effects of alveolar bone graft on nasal symmetry and its role in rhinoplasty, 90 mixed-dentition complete unilateral cleft lip and palate patients were studied and categorised according to the operation they underwent during the mixed dentition period (bone graft, secondary rhinoplasty or bone graft and rhinoplasty combined). Standardised frontal and submental oblique photographs were taken before and after surgery, and objective measurements for the evaluation of nasal symmetry were devised. Measurement reliability was examined with the intraclass correlation coefficient. Intra- and inter-group comparisons were performed to explore the effect of bone graft on nasal symmetry and its role in rhinoplasty. The intraclass correlation coefficient values were >0.84. Preoperative inter-group analysis yielded satisfactory comparability. Among the bone-graft-only patients, seven of 10 measurements demonstrated significant differences, five indicated enhanced symmetry and two indicated compromised symmetry. For the rhinoplasty-only patients, all measurements revealed significant improvement. Compared with the patients who underwent rhinoplasty only, those who underwent combined bone graft and rhinoplasty were superior in nasal-base elevation only. The photogrammetric strategy appeared reliable for evaluation of nasal symmetry. Most of the effects imposed by alveolar bone graft on nasal symmetry were localised to the alar base and would be camouflaged by rhinoplasty. Considering the limited benefit in symmetry and the potential risk of more complications, overextended dissection during mixed dentition bone graft may be unnecessary. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to describe the clinical and three-dimensional (3D) outcomes following secondary correction of bilateral cleft lip and nose by reverse-U incision, nasal tip cartilage graft, and medial-upward advancement of bilateral nasolabial components with vestibular expansion with a free mucosal graft. Patients and methods: Secondary correction of the bilateral cleft lip and nose deformity was performed on 11 patients with complete bilateral cleft lip, alveolus and palate (BCLP). In four patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotating into the columella base was included to elongate the columella length. Pre- and postoperative nasal forms were recorded using photos and 3D data taken serially. Results: The nasal forms and lateral profiles were improved in all patients postoperatively. The pre- and postoperative 3D colour images demonstrated satisfactorily elongated columella length, symmetrically increased nasal tip projection, and enlarged alar groove. No serious complications were observed postoperatively. Conclusions: Our secondary correction technique of the bilateral cleft lip and nose will provide successful results producing an adequate nasal tip projection and alar forms without damaging the upper lip tissue in patients with BCLP. [Copyright &y& Elsevier]

Abstract: Background: Cleft-lip nasal deformity alters patient’s self-image, as well as posing unique challenges for the rhinoplastic surgeon. Objectives: The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient’s self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients’ age; (3) patients’ gender; and (4) panel perceptions. Methods: Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient’s subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P ≤0.05 and <0.05 for single- and two-tailed tests of hypothesis, respectively. Results: The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings (P >0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics (P =0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients’ age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction. Conclusions: Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient’s self-assessment seems unreliable to be used as an outcome measure. [Copyright &y& Elsevier]

Summary: Emphasis of secondary repair for unilateral cleft-lip has been placed on correction of the cleft-lip nasal deformity by translocation of the alar cartilage with its attached vestibular lining into a normal position, thereby establishing the normal vault and shape of the cartilage. We have managed cleft-lip deformities employing a modified reverse-U method. We present our modified technique and the obtained results. Eighty-nine patients with unilateral cleft-lip nasal deformity underwent surgical repair between 1998 and 2007 by one surgeon. These patients were divided into two groups based on their previous operative histories. Group A comprised 52 patients who underwent primary cheiloplasty using a modified Tajima technique. No other surgery had been performed prior to our modified reverse-U method in these cases. Group B consisted of 37 patients receiving the primary operation and/or more than one rhinoplasty at another hospital before our method was employed. The ages of our patients at the time of the secondary operation ranged from 4 to 40 years (average, 8.1 years; 4.2 years in group A and 13.4 years in group B). The follow-up period ranged from 2 to 11 years (average 7.2 years). For objective evaluation, points on the nasal dome and alar crease were measured on patient photographs. The results were retrospectively distinguished to three levels by total point score: Excellent, Good and Fair. Excellent or Good results were obtained in 74 cases, while 15 had Fair results. Eighty-one percent of all cases maintained acceptable results without relapse. Fair results were attributed to an unclear alar crease or relapse. In conclusion, rigid fixation and release of nasal cartilage are very important. We believe our modified reverse-U method to be very useful for achieving symmetry of the unilateral cleft-lip nose in the long term. [ABSTRACT FROM AUTHOR]

Summary: The current report describes a case of a 16-year-old girl with a rare combination of nasal dysmorphology, anonychia and brachydactyly of hands and feet. The combination of hand and nasal malformations suggested a type B brachydactyly. Genetic investigation, however, revealed Cooks syndrome with unexplained facial dysmorphology. Concerning her cosmetic complaints, options for surgical treatment were discussed. It was decided to treat only the nasal deformity by open rhinoplasty, leaving the nail deformities undisturbed. [ABSTRACT FROM AUTHOR]

Abstract: Over the last three decades bilateral cleft lip and nose repair has been characterised by a trend towards more detailed reconstruction of the nasolabial muscles together with simultaneous correction of the deformity. An understanding of the true nature of the nasal deformity in bilateral cleft lip and palate (BCLP) has gradually emerged, and has inspired new approaches to their repair. This article discusses recent trends and controversies in primary cheilorhinoplasty for BCLP. [Copyright &y& Elsevier]

Summary: Background: A new classification system for dorsal humps in Korean patients with nasal dorsum deformities was designed. Patients were treated based on these classifications, and their treatment outcomes were assessed. Methods: A total of 164 patients, who underwent rhinoplasty for correction of convex nasal dorsum deformities, were analysed. Convex dorsum deformities were classified based on anthropometric measurement, nasal length, hump length and tip projection. The three classifications were generalised hump, isolated hump and relative hump because of a low tip. Postoperative photographs were analysed to assess hump reduction outcomes. Results: Generalised hump was the most common deformity, occurring in 88 (53.7%) patients; an isolated hump was observed in 67 (40.9%) patients and a relative hump, with a low tip, was observed in nine (5.5%) patients. Successful surgical outcomes were achieved in 65.9% of generalised hump cases and 80.6% of isolated hump cases (p =0.014). Of the fair or poor outcomes, 89.6% were attributable to hump undercorrection. Conclusion: Our classification system could help surgeons tailor management of convex nasal dorsum deformities. The present study showed that the milder the deformity, the better was the outcome. It was also found that excessive conservation in hump reduction was the main factor predictive of unsatisfactory outcome. [Copyright &y& Elsevier]

Summary: Purpose: A definitive correction of nasal deformity is best performed by creating symmetry and addressing the nostril/tip/columella complex, which is more easily handled by direct vision. The main objective is to evaluate the nasal changes along with function and also to evaluate the satisfaction outcome of the patients following secondary rhinoplasty. Methods: Ten patients who were admitted to our unit for secondary rhinoplasty procedure involving the cleft lip–palate defects associated with nasal deformities were considered for the study. All the patients were evaluated pre- and postoperatively for aesthetics and function along with patient satisfaction and perception. Results: All the operated cases of cleft nasal deformity had a significant improvement in the facial aesthetics and function postoperatively. Clinical evaluation revealed that the post-nasal changes were significant with no nasal obstruction. Statistically, the results were significant (p <0.05). Conclusion: Although our sample is small, this study would assist in some preliminary conclusions. From our present study, in the view of a distinct deformity of the internal and external nose associated with cleft lip/nose/palate in adolescents or adults, septal rhinoplasty or rhinoplasty alone provides good aesthetics and functional results. [Copyright &y& Elsevier]

This study examined the effects of infrared beak treatment (IR-BT) and hot blade beak trimming (HB-BT) on beak length and production in laying hen pullets. Seventy-two 1-d-old birds were randomly assigned to the HB-BT, IR-BT, or control group. Birds were pair housed by treatment, and beak images and production indices were obtained posttreatment at fixed intervals for 10 wk. Immediately after treatment, HB-BT beaks were shorter than control or IRBT beaks (P < 0.01), whereas control and IR-BT beaks remained comparable in length until the onset of tissue degeneration and erosion of the IR-BT beaks at 1 to 2 wk posttreatment. At wk 2 posttreatment, beaks were longest in control birds, intermediate in IR-BT birds, and shortest in HB-BT birds (P < 0.01). Thereafter, an increase in beak length in all treatments was observed over time (P < 0.01), but HB-BT beaks had the greatest regrowth. The beak length of birds in the HB-BT group was similar to that of birds in the IR-BT group from wk 3 to 8, and then grew longer at wk 9 and 10 posttreatment (P < 0.01). The effects of treatments on BW emerged at d 5 posttreatment. The BW of birds in the HB-BT group was suppressed up to and including wk 9 posttreatment compared with that of control birds (P < 0.05) and was significantly lower than that of birds in the IR-BT group between 2 and 4 wk posttreatment (P < 0.05). Birds in the IR-BT group did not differ from control birds after wk 3 posttreatment (P < 0.05). By the final week of the study, differences in BW across treatments were no longer apparent (P > 0.05). For the most part, feed intake was higher in control birds, intermediate in birds in the IR-BT group, and lowest in birds in the HB-BT group until wk 9 posttreatment (P < 0.05). Similarly, feed waste was generally higher in control birds and least in birds in the HBBT group (P < 0.05). The IR-BT treatment appeared to be more effective at inhibiting beak regrowth, with a less pronounced effect on feed intake than the HB-BT treatment in laying hen pullets. [ABSTRACT FROM AUTHOR]

Abstract: Zimmermann–Laband syndrome is a rare disorder characterized by gingival fibromatosis, abnormalities of the nose and/or ears, absence and/or hyperplasia of the nails or terminal phalanges of the hands and feet, hyperextensibility of joints, hepatosplenomegaly, mild hirsutism and mental retardation. The syndromic characteristics of Zimmermann–Laband syndrome are highly variable and complicated. This paper described a patient with Zimmermann–Laband syndrome with new manifestations and discusses the possible underlying genetic mechanisms. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this retrospective study was to correlate the width of the cleft lip with the severity of the nasal deformity in unilateral cleft lip and palate (UCLP) patients before primary lip repair. Preoperative impression casts were made. Measurements were taken of the width of the cleft lip (CW), nose (NW), and nasal floor (NFW), alar base height (ABH), columella length (CL), nasal length (NL) and nasal tip protrusion (NTP). The ratio of the non-cleft side (NFW) to the cleft side (NFWR), the ratio of the non-cleft side (ABH) to the cleft side (ABHR), and the ratio of the cleft side (CL) to the non-cleft side (CLR) were calculated. The average NW, NL and CW were higher in the group with complete clefts. There was a negative linear relationship between CW and NFWR, and a positive linear relationship between CW and ABHR in the complete group. In the incomplete group, negative correlations were obtained between CW and NFWR and between CW and ABHR. These findings show that there are correlations between CW and the transverse and vertical imbalance of nose in both groups but not between CW and anteroposterior imbalance of nose. [ABSTRACT FROM AUTHOR]

Summary: Background: Nasal frame grafting has been widely used in nasal reconstruction; however, a stable nasal frame with satisfactory functional and aesthetic results is hard to achieve in total nasal reconstruction. In this study, we devised a technique to create an individually designed anchor-shaped nasal frame composed of an L-strut and two C-battens, and applied it in the total nasal reconstruction procedure to achieve satisfactory functional and aesthetic results. Method: In a 9-year period, 17 patients with total nasal defect were treated with autogenous costal grafting utilising forehead flap as the covering. The techniques of the individualised design of the anchor-shaped nasal frame were applied to fit the facial features. All cases were followed for at least 18 months, and outcomes were evaluated separately by the patients and plastic surgeons in terms of aesthetics, stability and function. Results: Satisfactory results were achieved in most of the cases after the operation. More than 82.4% of the patients in this series were assessed as satisfactory by both groups in the aesthetics survey; more than 76.5% in the stability survey; and more than 64.7% in the function survey. Complications included flap hyperpigmentation (one case), flap-skin paleness (one case), L-strut distortion (three cases) and stuffiness of the nostrils (one case) as well as minor brow elevation of the donor side (five cases). Conclusions: The procedure of applying individually designed anchor-shaped nasal frame with forehead flap technique has obvious advantages for restoration of distinct and delicate subunits, stable nasal structure and good nasal function. [Copyright &y& Elsevier]

Summary: Background: Alar cartilage malposition is an anatomical variation. Axis of the lateral crus lies cephalically and can be parallel to the cephalic septum. The characterised findings of the malposition are broad and bulbous nasal tip, abnormal lateral crural axes, long alar creases that extend to the nostril rims, alar wall hollows, frequent nostril deformities and associated external valvular incompetence. This article presents a new technique for the repositioning of the lateral crus in this article. Methods: Open rhinoplasty was conducted. A cartilage Z plasty was performed on the lateral crus of the alar cartilage to treat for malposition. The 14 women and 8 men included in the study had an average age of 27 years (range, 18–46 years). The average follow-up period was 12 months (range, 4–20 months). Results: Alar cartilage malposition was successfully corrected in patients with aesthetic and functional improvements. Conclusions: Cartilage Z plasty can effectively correct alar cartilage malposition. Advantages of this technique can be listed as follows: it does not require extra graft material and protects the lateral crural complex; it does not disrupt movements of the alar muscles and can also serve to adjust projection of the nasal tip. [Copyright &y& Elsevier]

Summary: Reconstruction of cutaneous nasal defects is often a challenging problem with multiple solutions. Many factors must be considered when deciding on the appropriate reconstructive procedure, including optimally matching donor site skin to the original recipient site skin. To the best of our knowledge no objective study has been undertaken to examine which areas best match the histological features of skin from various nasal cosmetic subunits. We have undertaken a descriptive histological analysis of skin from 25 facial and nasal aesthetic subunits from four male Caucasian cadavers, aged 65–88. The three variables looked at were epidermal thickness, dermal thickness and density of pilosebaceous subunits. Our findings have been plotted on photographs of the face to provide visual maps of facial histological features by cosmetic subunit. Our results show that histologically, the best matched skin for reconstructing a given nasal defect is likely to come from an adjacent nasal subunit. Looking at distant donor sites, the helical root, helical rim and pre-auricular area are closest to nasal skin in terms of dermal thickness. In terms of density of pilosebaceous units, the helical root, pre-auricular area and lateral forehead are the three areas best matched to nasal skin. [Copyright &y& Elsevier]

Summary: Purpose: The application of rhinoplasty in the treatment of traumatic nasal deformity remains one of the most challenging problems for surgeons. Not only is the skeletal structure severely deformed, but the soft tissue may also be disfigured by a previous injury. Although autogenous bone and cartilage have been the primary choice for nasal reconstruction, synthetic material is desirable for various reasons. This article presents our experiences in the reconstruction of traumatic nasal deformity by using porous polyethylene (Mdepor®) implant in Orientals. Materials and methods: From May 1998 to January 2005, 32 patients, including 15 males and 17 females, underwent augmentation rhinoplasty for the correction of traumatic nasal deformity. Of these, 30 patients had experienced associated midfacial bone fractures. The surgical procedures employed consisted of the open-tip approach that was followed by implant carving, placement and fixation. Twenty patients received lateral nasal osteotomies, and septoplasty procedures were performed in nine patients, simultaneously. External taping was done, and nostril tampons were placed postoperatively and left in situ for 3 days. The outcome was assessed by an independent investigator and the patients themselves. Results: The patients were, on average, 22 years old at the time of reconstruction and were followed up for an average period of 25.4 months. The interval from injury to the rhinoplasty procedure was 304 days, on average. The average length of dorsal grafts was 44.9mm. The overall aesthetic-improvement rate was 90.6%, and the patient-satisfaction rate was 84.4%. There were three complications, including an implant-tip exposure and two implant infections. Conclusion: A porous polyethylene (Medpor®) implant is an effective alternative to autograft for correction of traumatic nasal deformity in Orientals to achieve a pleasing appearance of the nose without donor-site morbidity. A meticulous execution of concomitant procedures and impregnation of the implant by submerging it in an antibiotics solution prior to use were helpful in decreasing the complications. [Copyright &y& Elsevier]

Summary: Background and objective: The classic forehead flaps, which are designed vertically, two-staged and exteriorised pedicled peninsular flaps, are still a reconstructive option for nasal and periorbital defects. However, some drawbacks such as conspicuous donor-site scar, multi-staged procedure, rather short pedicle, hairy appearance (in narrow foreheads), and inability to use the forehead flap when the donor site is involved are often encountered during surgery. To avoid these issues, three unusual designs of the forehead flap are presented, and also a new algorithm is proposed to guide surgeons in their solutions. Materials and methods: Nineteen patients (10 women and nine men) were managed with 21 forehead flaps to restore the nasal, medial canthal and frontal defects caused by skin tumours. The flaps were applied as interpolation island, V–Y island, and transverse peninsular designs in 12, four and three patients, respectively. All donor sites were closed primarily except one, where a split thickness skin graft was used. Results: The average follow-up was 14 months. All flaps survived (totally) but in one partial necrosis developed. Aesthetic and functional recoveries were acceptable in all patients. Conclusions: Based on the algorithm presented, the forehead flaps with their superb anatomic characteristics including rich vascular supply and pliable skin can be safely used in either classic or extraordinary fashion for small to medium sized defects of the nasoorbital and frontal regions. [Copyright &y& Elsevier]