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Shape, tip projection, and position can be controlled by the use of septal extension grafts (SEG). A retrospective cohort study of patients undergoing primary and secondary rhinoplasty was reviewed. The purpose of this study was to analyze maintenance of nasal length, dorsal length, and nasolabial angle postoperatively comparing different types of SEG using standardized photography and digital measurement. Two-hundred twenty-one patients undergoing rhinoplasty were included. There was a statistically significant change regarding the nasolabial angle during the time of follow-up decreasing from 97.53 to 95.30 degrees. No changes could be found in dorsal and nasal length. There was no significant difference among the techniques used to fixate the SEG. The nasolabial angle appeared to decrease from the position 2 weeks postoperatively without changes in the dorsal and nasal length. This means that the decrease in the nasolabial angle depends on the swelling effect and not on drooping of the tip confirming the reliability of SEG over time.

Background The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society. Methods A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel's recommendations were based on current evidence and expert opinions. The resulting report was circled in an iterative open e-mail process until consensus was obtained. Results Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures. Conclusion The implementation of the panel's recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.

BACKGROUND: Severe septal deformations require adequate treatment to restore shape and function using extracorporeal septoplasty. Because it has been criticized for being technically demanding to execute and has increased risk for aesthetic complications, the authors have developed two new suture techniques for refixation of the neoseptum. METHODS: A retrospective analysis of multisurgeon consecutive extracorporeal septoplasties performed from January of 2014 to December of 2014 was conducted at a single institution using the criss-cross or transcutaneous transosseous cerclage suture (group 1) compared with fixation at the upper lateral cartilages only (group 2). RESULTS: One hundred ten extracorporeal septoplasties were performed in 110 patients over 12 months. Group 1 consisted of 58 patients (53 percent), whether receiving the criss-cross [12 patients (21 percent)] or the transcutaneous transosseous cerclage suture [46 patients (79 percent)], and group 2 consisted of 52 patients (47 percent). The median follow-up was 11 months (range, 6 to 16 months). Operative revision because of complications at the dorsum or the keystone area had to be performed in no case in group 1 and in five cases (9.6 percent) in group 2, resulting in a statistically significant difference between the two groups (p = 0.0212). There were no complications such as bleeding or infection observed in any of the 110 cases. CONCLUSIONS: To facilitate and to reduce the complication rate after extracorporeal septoplasty, the authors have developed the criss-cross and transcutaneous transosseous cerclage suture to overcome the important and technically demanding reimplantation of the neoseptum. Thus, the authors believe that these new operative techniques are safe and reproducible procedures that may take a permanent place among extracorporeal septoplasty procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Reconstruction of the nose requires attention to form and function considering the size and localization of the defect with regard to the existing aesthetic subunits.1 Despite the availability of fundamental principles for nasal reconstruction, every nasal reconstruction requires a very individual, challenging, and time-consuming preoperative planning.2,3 For full-thickness defects, restoration of cover, framework, and lining has to be considered in the surgical plan. Besides the reconstruction of the 3-dimensional nasal structure, one has to maintain its aesthetic form and function. The paramedian forehead flap still represents the golden standard for cover; however, several surgical steps of thinning and refinements have to be included to achieve pleasant results.4,5 As foreign materials are associated with an increased risk of infection, the framework should be reconstructed with autogenous grafts from rib or ear cartilage,6 which have to be fixed firmly to guarantee stable projection and correct axial positioning of the nose. For lining composite skin grafts, skin and mucosa grafts, hingeover flaps, perinasal local flaps, folded or second forehead flaps, and free flaps7 are available.

Septoplasty is one of the most common surgery of ENT but even today the difficult septum still presents a great surgical problem. A severe septum deformity is usually due to an accident quite often in childhood. It is also seen in patients with malformation such as cleft lip and cleft palate deformity. It affects not only the nasal function, but also the aesthetic part of the nose. Severe septal deformities can not be corrected properly by the standard septoplasty techniques. Therefore in such cases an extracorporeal septoplasty is recommended. In this technique the whole septum is taken out, the bony and cartilaginous septum in one piece if possible, a new septal plate is reconstructed by different surgical techniques, followed by replantation and reconstruction of the cartilagenous dorsum. The first author kept on improving the safe septal fixation, rebuilding of cartilagenous dorsum and overall the extracorporeal septoplasty technique over the period of time and this technique with all its refinement can be recommended to all the surgeons dealing with this challenging noses.

The aim of the paper is to report our experience of 60 ear reconstructions to correct the microtia with surgical technique. Autogenous rib cartilage was used to reconstruct the affected ear. Cartilage resorption was found in 10% of the cases, distortion and fusion of pinna in 20% of the cases and infection was found around 8% of the cases. Most of the patients were satisfied with the final result.

Oxidative stress, i.e., excessive production of oxygen free radicals and reactive oxygen species, leads to lipid peroxidation and to formation of reactive aldehydes which act as second messengers of free radicals. It has previously been shown that oxidative stress may be involved in the transcriptional regulation of cytomegalovirus (CMV) immediate early promoter, involved in viral reactivation from latency. In the current study we used a plasmid containing the yellow fluorescent protein (YFP) gene under the control of CMV-1 promoter to monitor the influence of hydrogen peroxide and reactive aldehydes, 4-hydroxy-2-nonenal (HNE) and acrolein, on CMV-1 promoter activation in human embryonic kidney cells (HEK293). While acrolein was ineffective, hydrogen peroxide slightly (50 %) stimulated the CMV promoter. In contrast, HNE had a strong, up to 3-fold, enhancing effect on the CMV-1 promoter within four as well as after 24h of treatment. The most effective was the treatment with 24 microM HNE. This effect of HNE suggests that stressful conditions associated with lipid peroxidation could lead to CMV activation.

Nasal reconstruction occupies a special position in facial plastic surgery because of the complex three-dimensional surface of the nose, the varying thickness of the skin covering it, its varying types of scaffolding ranging from rigid bone to flexible cartilage, and its inner epithelial lining. Burget and Menick have written a seminal text on functionally and esthetically superior nasal reconstruction (1). Other authors have described particular reconstructive techniques that can be used advantageously to repair defects at certain special sites. There are, as yet, no controlled studies on the quality of nasal reconstruction. The defects are too varied, and the reconstructions, though always based on the same basic principles, allow a great deal of room for creativity on the plastic surgeon’s part. This is an important characteristic of plastic surgery in general that makes it difficult to consider the types of therapy under discussion from the point of view of "evidence-based medicine." Inadequate results are not infrequently seen, particularly with more complex types of nasal reconstruction. Such experiences have motivated the authors to describe in this article, for the general medical public, the types of results that are attainable. In a later issue of the Deutsches Arzteblatt International, another article will appear on the subject of reconstructive surgery of the face, head, and neck.

Bahman Guyuron . Rhinoplasty. Philadelphia, PA: Saunders, 2012. ISBN-10: 1416037519 ![][1] Bahman Guyuron is recognized throughout the world for his superb lectures and expertise in rhinoplasty surgery. Every live presentation is insightful, beautifully illustrated, and often includes original techniques that are validated by impressive clinical results, usually with long-term follow-up. For many years, his colleagues have awaited a publication summarizing his personal philosophy and surgical techniques developed during the past 31 years. Rhinoplasty is that text. Rhinoplasty is divided into 21 chapters, each clearly structured and ending with a “textbox” that summarizes the essential points. Each chapter begins with an outline of the contents both for the text and the specific video content, which means that information is easily found. Next, there is a list of 10 to 20 basic principles followed by a description of each technical step, with a list of the different surgical options. Instead of the more common inclusion of DVDs, this book is … [1]: /embed/graphic-1.gif

Rhinomanometry can still be considered as the standard technique for the objective assessment of the ven- tilatory function of the nose. Reliable technical requirements are given by fast digital sensors and modern information technology. However, the xyimaging of the pressure-flow relation typically shows loops as a sign of hysteresis, with the need for resolution of the breath in four phases. The three pillars of 4-phase rhinomanometry (4PR) are the replacement of estimations by measurements, the introduc- tion of parameters related to the subjective sensing of obstruction, and the graphical information regarding the disturbed function of the nasal valve. In a meta-analysis of 36,563 clinical measurements, we analyze the errors of the ''classic'' parameters (flow in 150 Pa) and reject the further use of these parameters as obsolete, because they correspond to an inaccurate estimation rather than proper measurement. In a pre-study of 1580 measurements, the logarithmic effective resistance (Reff) was found to have the highest correlation with values obtained from a visual analog scale. Next, we classify the inspiratory effective resistance in 20,069 measurements without treatment and 16,494 mea- surements after decongestion with xylometazoline 0.1 % spray in 20 % percentiles. The gradation of obstruction delivers not only ''normal'' values but also indications for the severity of the obstruction in adult Caucasian noses. Adoption of the distribution for the growing nose and analysis of the total nasal resistance is addressed, and typical findings of nasal valve phenomena are outlined.