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The authors present a clinical report of deforming mucocutaneous leishmaniasis of the nose in a native American woman, left untreated for 25 years. The nose was reconstructed using the local tissue displaced as flaps, and using cartilage grafts taken from the nasal septum and the ear shell. To the best of the authors' knowledge, the literature offers just 1 report on a similar patient.

Purpose of Review: The review summarizes the basic concepts and recent updates on the management of saddle and short noses, with a particular focus on the selection of septal reconstruction techniques and dorsal augmentation material., Recent Findings: Different techniques have been reported for septal cartilage reconstruction, including various combinations of extended spreader and caudal septal extension grafts, as well as L-strut grafts. For dorsal augmentation, materials that help avoid costal cartilage warping including, diced costal cartilage with or without fascia, costal cartilage obtained by oblique cutting, diced conchal cartilage with perichondrial attachments, and lipofilling of the nasal dorsum have been reported., Summary: The article highlights the importance of rebuilding the septal cartilage support system by the proper use of costal cartilage and selection of an appropriate technique for the successful management of saddle and short noses. In addition, the importance of selecting suitable dorsal augmentation materials and other adjunctive maneuvers are emphasized.

Purpose of Review: The article reviews the current literature to provide an overview on contemporary reconstructive options for closure of Mohs defects of the nose that are 1.5 cm or less., Recent Findings: Although some of the techniques described in the literature are of historical importance only, others have undergone modification and metamorphosis to be broadly used in their contemporary form. Others are implemented in their original design, irrespective of relative age or multiple attempted adaptations. The increase in variable closure options available provides the surgeon with the ability to tailor reconstruction in such a way as to maximize form and function for the patient., Summary: Here we will provide an update on the core techniques in terms of subtle modifications, expanded applications, and examination of outcomes as well as newly described closure techniques that may fill a certain niche in nasal reconstruction.

Background: Although much has been published with regard to the columella assessed on the frontal and lateral views, a paucity of literature exists regarding the basal view of the columella. The objective of this study was to evaluate the spectrum of columella deformities and devise a working classification system based on underlying anatomy., Methods: A retrospective study was performed of 100 consecutive patients who presented for primary rhinoplasty. The preoperative basal view photographs for each patient were reviewed to determine whether they possessed ideal columellar aesthetics. Patients who had deformity of their columella were further scrutinized to determine the most likely underlying cause of the subsequent abnormality., Results: Of the 100 patient photographs assessed, only 16 (16 percent) were found to display ideal norms of the columella. The remaining 84 of 100 patients (84 percent) had some form of aesthetic abnormality and were further classified based on the most likely underlying cause. Type 1 deformities (caudal septum and/or spine) constituted 18 percent (18 of 100); type 2 (medial crura), 12 percent (12 of 100); type 3 (soft tissue), 6 percent (six of 100); and type 4 (combination), 48 percent (48 of 100)., Conclusions: Deformities may be classified according to the underlying cause, with combined deformity being the most common. Use of the herein discussed classification scheme will allow surgeons to approach this region in a comprehensive manner. Furthermore, use of such a system allows for a more standardized approach for surgical treatment.

Background: There have been relatively few articles in the English language on secondary Middle Eastern rhinoplasty. This article analyzes the cause and treatment of secondary Middle Eastern rhinoplasty., Methods: A prospective study of 40 consecutive female secondary Middle Eastern rhinoplasty patients was completed., Results: The majority of secondary rhinoplasty patients were older than 25 years. Half of the patients had undergone a single prior rhinoplasty and the other half had undergone multiple operations, ranging in number from two to five. A wide variety of surgical techniques was necessary because of the broad range of presenting deformities, patients' requests, and the author's preferred procedures., Conclusions: The principal reasons for secondary rhinoplasty in Middle Eastern patients were a failure to correct the original deformity and the presence of visible surgical stigmata. The persistent complaints were a poorly defined tip and a long, droopy nose. Surprisingly, most secondary rhinoplasty patients had thin skin (55 percent), which necessitated fascia or dermis grafts to conceal surgical stigmata. At the time of secondary surgery, there was an absence of structure in these noses as evidenced by the prior 0 percent insertion of spreader grafts and the 10 percent use of columellar struts in prior open cases. Also, there was little evidence of other structural grafts, including alar rim, alar battens, or lateral crural strut grafts. Insertion of structural support appears essential to control primary deformities and to repair secondary deformities.

Learning Objectives: After studying this article, the participant should: 1. Be familiar with subunits of the nose. 2. Understand various flaps used in nasal reconstruction. 3. Be able to choose a flap for the defect depending on its location, size, shape and orientation., Background: Management of small defects in nasal reconstruction can be quite challenging. Location, size, shape, and orientation of the defects are important factors in determining the method used in reconstruction., Methods: In this article, the authors retrospectively examined 300 cases where local flaps were used to reconstruct small nasal defects. The authors correlated the characteristics of those defects with the techniques used to reconstruct them., Results: The authors found that certain flaps were used predominantly in reconstruction of certain defects., Conclusions: The authors were able to develop a simple algorithm for management of small nasal defects that may prospectively aid the planning of reconstructive strategy in these cases.

Given a lack of a comprehensive classification for the frontoethmoidal encephalomeningocele (FEEM), clinical, photographic, and computed tomography (CT) data of 23 nonoperated patients were reviewed. Extracranial pathological findings of interest included herniation masses, facial deformities, and frontonasal bone morphology. Intracranial pathological findings of interest included morphology of the anterior cranial floor and brain malformations. Stereographic software processed data from a new-generation CT scanner into three-dimensional pictures that revealed some interesting morphological findings not often appreciated (eg, herniation mass without underlying external bone defect; mass at location far from external bone defect ["sequestrated cephalocele"]; new type of external bone defect characterized by a combination of nasoethmoidal and naso-orbital defects; correlation between mass, external bone defect, and exit pathway of herniation). Given these observations plus current knowledge available in the medical literature, a new classification system was developed that covers phenotypes and severity of the disease. The "FEEM classification" is an alphanumeric system based on facial deformities, external bone defect, exit pathway of herniation, and malformation of brain. It was tested in 42 patients for usability and validity. When combined with a newly designed "FEEM diagram," relevant pathological findings can be recorded in an objective manner so that diagnosis becomes more precise and uniform and comparison of outcome is possible. It also emphasizes the fact that FEEM has a range of manifestations governed by dynamic interaction between structural defects and herniation. Each clinical entity is a final result of its own disease course (stable, progressive, or regressive FEEM), with a varying degree of communication between the external mass and the central nervous system.

The conventional designation of septal pathology is a deviated septum, and the common treatment of choice is submucous resection of the septum. These limited generic terms leave the surgery open to frequent failure and render the education of this topic suboptimal. During 1224 septal surgeries, we have observed six different categories of septal deviation requiring different surgical treatments. A study was conducted to investigate the frequency of different classes of septal deviation and to develop guidelines for a more successful surgical correction of each category. Ninety-three consecutive patients who underwent septoplasty were carefully evaluated for the type of septal deformity, age, gender, history of trauma, and previous septal surgery. The surgical technique was reviewed for each category of the septal deformity. Of the 93 patients, 71 were women and 22 were men. Ages ranged from 13 to 76, with an average age of 31.5. Most patients exhibited a "septal tilt" deformity (40 percent; 37 of 93) or a C-shape anteroposterior deviation (32 percent; 30 of 93). The other deformities were C-shape cephalocaudal (4 percent; 4 of 93), S-shape anteroposterior (9 percent; 8 of 93), S-shape cephalocaudal (1 percent; 1 of 93), or localized deviations or large spurs (14 percent; 13 of 93). Each of the six categories of septal deviation requires specific management. If a single procedure is selected for all of the septal deformities, disappointing results may ensue.

Nostril stenosis is an infrequent finding that often has an iatrogenic cause. It is a very difficult problem to resolve and usually requires several months of prosthetic support in order to counteract the recurrence of internal scarring and shrinking. We present a 4-year-old child with a monolateral iatrogenic nostril stenosis. A satisfactory and stable correction was obtained using a "piercing" flap taken from the labial vestibule. The use of a nasal stent (not placed immediately and worn only at night) was necessary for only 2 months. This technique has a number of advantages: the absence of external scars, little or no tendency to recurrence due to the absence of contraction provided by the well-vascularized flap tissue, and the ease and rapidity of the surgical procedure.

A new approach for creating an anatomically aesthetic nasal tip is presented. It is based on extensive cadaver dissections which demonstrate that a convex domal segment plus a sharp domal segment-lateral crural drop-off are key determinants of a refined tip. This configuration can be achieved with sutures in a manner similar to creating the anthelical curl in an otoplasty. Two operative variations are presented. One achieves tip refinement with a limited increase in projection, while the other provides maximum projection. Currently, the technique is of value in bilateral cleft lip noses, posttraumatic deformities, certain secondary cases, and very selected primary aesthetic cases where tip refinement and projection are limited.

Functional problems and deformities of the eyes have become a major concern in the surgical treatment of ortital hypertelorism and craniofacial dysostosis, as experience with skeletal relocation for these disorders has been gained. Comprehensive preoperative and postoperative study and measurements of the bony orbits, the globes, the lids, the canthi, and the nose are necessary for the evaluation of present techniques and the design of alternative procedures. Some of the deformities of the blepharo-canthal complex are part of the congenital malformation. Other distortions, seen only postoperatively, are secondary to specific surgical maneuvers. Awareness of these primary and secondary factors has led to better soft tissue reconstruction at the time of the bony orbital translocations or the craniofacial disjunction. We describe the techniques which we have found especially useful in avoiding and correcting these postoperative blepharocanthal deformities.