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Preservative dorsal hump surgery is an old approach that has revitalized recently. Preservation rhinoplasty aims to shape the existing structures instead of resection/reconstruction approaches. A thorough understanding of the applied anatomy of the nose is the backbone of preservative hump surgery. In preservative hump surgery keystone works as a joint, and by lowering this joint the hump is eliminated.

Background The tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society. Methods This is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation. Results Fifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant (P = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant (P < 0.01) Conclusion The study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation.

The nasal soft triangles are extremely vulnerable subunits of the nose that are prone to severe unaesthetic deformities. A technique to overcome these problems, comprising an effective simple modification of the shield graft, is presented. Using this technique, many existing soft triangle deformities, notches, and defects are easily restored. It may also be applied effectively in susceptible cases in order to avoid these complications. This article presents technical details and the cases of two patients treated with the technique, which indicate its potential utility.

Background Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections. Objectives This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections. Methods The authors searched PubMed/Medline and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet. Results The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as an insufficient volume or decreased volume by resorption, tip excess and supratip fillness, and mild displacement, more than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%. Conclusions Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Clinical expertise is essential to have a safe injection and to minimize the potential complications. Level of Evidence: 4

Cosmetic or functional concerns, especially for multiple operated noses, are always a challenge even for an experienced surgeon. Some authors distinguish the term “revision” rhinoplasty which is done by the same surgeon with “secondary” rhinoplasty which refers to more extensive surgeries. Regardless of the term used, this chapter aimed to mention the major and minor problems in multiple operated noses and define some surgical or nonsurgical solutions for such cases. Finally, the surgeon should recognize the objective problems, correlating them with subjective complaints, to suggest the possibilities of surgical intervention.

The use of botulinum toxin type A in facial cosmetics is extensively discussed in medical literature. Meanwhile, presence of many controversial issues and sometimes contradicting results precludes having unanimous guidelines in using this valuable remedy. Here, we have tried to discuss some of the challenging questions to find clinical solutions that are supported by evidence-based studies along with authors’ personal experience.

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.

Dental implant is currently the gold standard in the rehabilitation of missing teeth. Like all other surgeries, placement of implants may be accompanied by a wide range of minor to serious complications. These unwanted events may stem from any stage of implant therapy from the first consultation appointment up to several years after a seemingly successful treatment. Here, authors have tried to review a variety of complications which, in spite of their importance, are not sufficiently addressed elsewhere. Diagnosis, management, and prevention of each group of complications will be briefly discussed.

Dental implant therapy is currently considered the gold standard in restoring missing dentition. However, with the surge in dental implant placement over the past decade, the incidence of associated complications has also steadily increased in this period. To date, these complications have been extensively discussed in the literature. Complications can occur at any step in the implant process, including the preoperative planning phase, intraoperatively, or postoperatively (even many years after implant placement). In contrast to preoperative and postoperative complications, intraoperative complications usually occur unexpectedly and need to be dealt with in an urgent fashion. This chapter will review some of the significant complications that may arise during the surgical phase of implant placement. It will also focus on avoiding critical errors and discuss how to manage potential complications in a timely and efficient manner.

The purpose of this study was to evaluate four standard techniques for radix augmentation during primary rhinoplasty: Skoog, crushed septal cartilage, temporalis fascia, and crushed cartilage wrapped in temporalis fascia. The main criterion for a patient to be included in this study was the need for radix augmentation, which was determined through preoperative evaluations. All patients requiring total dorsal augmentation were excluded from the study. This study included 63 rhinoplasty patients who underwent radix augmentation. The Skoog technique was applied in 15 patients, crushed septal cartilage in 16, temporalis fascia in 17, and crushed cartilage wrapped in temporalis fascia in 15. In those undergoing the Skoog technique, sharp edges of graft were palpable in three patients and were even visible in one patient. In the crushed cartilage group, seven patients showed irregularities during the postoperative follow-up. The results of this study indicate that all four autologous grafts represent acceptable graft material for radix augmentation. The algorithm suggests using the easier techniques first and that secondary donor sites should be considered only when the ideal result is not achieved.

Oral and maxillofacial surgery (OMS) is a specialty of dentistry and medicine that includes the diagnosis and surgical and adjunctive treatment of diseases, injuries, and defects involving maxillofacial and contiguous head and neck regions. The present chapter aims to further introduce the origin and scope of OMS and discuss the most common procedures done on pregnant patients. While the obstetrician (OB-GYN) serves as the primary physician during pregnancy, there are a myriad of situations in which intervention of an oral and maxillofacial surgeon (OMFS) is beneficial and/or inevitable. These may range from prevention to acute, subacute, or chronic conditions in need of elective, semi-urgent, or urgent management. The authors have provided an overview of these scenarios with an emphasis on infection, trauma, and pathology. Close cooperation between the OMFS and the OB-GYN, and an understanding of each other’s role in the care of the pregnant female, seems crucial to optimal mother and fetus care.

Meningoencephlocele is a relatively rare deformity, usually characterized by penetration of brain or meningeal tissues through a defect in skull. This protruding tissue may affect facial structure and subtle to severe facial deformities may appear. Surgical treatments of these deformities are usually done by a team including a neurosurgeon and craniofacial surgeon. The conventional treatments includes several complicated operations to relocate herniating tissues, then correcting malformed facial structure. The nasal framework osteotomy, is an innovative approach that uses transfacial incisions to gain access to herniating tissue. Then, by completing the osteotomy around the nose, the entire nasal structure is lifted and transposed to it is original position. The authors believe that this technique may considerably reduce the complexity and risks of conventional approaches, while aesthetic demands are readily achieved at the same stage.

Purpose Perforation of the nasal septum is a frustrating problem frequently reported in the literature. Surprisingly, in most reports, iatrogenic perforation during septoplasty and electrocautery are the leading causes of this complication. This article presents the management of septal perforations and the indications for an extracorporeal approach. Materials and Methods Fourteen patients with septal perforations were referred for treatment. Treatment was chosen based on defect size. Flaps, extracorporeal repair, or no treatment was used as indicated. Results Two of 14 perforations were small and were repaired by local flaps, 5 cases were treated by extracorporeal repair, and the 7 remaining cases required no surgical procedure. Conclusions The extracorporeal technique, when indicated, can be used effectively for the repair of nasal septum perforations in selected cases.

Tapia syndrome is known as a rare complication of airway manipulation, which can occur after any type of surgery under endotracheal general anesthesia. This syndrome is characterized by neurologic deficits involving the hypoglossal (XII) and recurrent laryngeal branch of the vagal nerve (X) that result in the tongue muscle's unilateral paralysis associated with the vocal cord's unilateral palsy. This article describes the first case of Tapia syndrome, which occurred after repair of a fractured zygomatic complex. In this article, we discuss the diagnosis, possible causes, clinical manifestations, treatment methods, and preventive strategies as described in 10 case reports in the literature that have been attributed to manipulation of the airway.

Alloplastic mandibular reconstruction remains insufficiently predictable, with no systematic reviews to assess its scope and limitations.The PubMed, CINAHL, EMBASE, and Web of Science databases were searched for English study reports, published in the current century, of mere alloplastic surgical reconstruction of mandibular ablative defects.In 14 articles, there were 944 patients, with a median age of 58.7 years (interquartile range, 53.2 to 62 years); 58.7 percent (interquartile range, 66.7 to 78.6 percent) were male. Cases of squamous cell carcinoma per study constituted 93.5 percent (interquartile range, 81.5 to 100 percent). Defects were mostly lateral (Boyd classification) (60.5 percent; interquartile range, 56.2 to 62 percent) and received mostly conventional bridging plates (in 64.3 percent of the studies) and pedicled flaps (45.3 percent; interquartile range, 37.1 to 58.3 percent); 60.7 percent (interquartile range, 53.5 to 58.8 percent) received adjuvant therapy. At 32-month follow-up, the complication and failure rates were 40.1 percent (interquartile range, 26.7 to 58.6 percent) and 30.8 percent (interquartile range, 11.7 to 48.1 percent), respectively. The overall survival rate was 55 percent (interquartile range, 27.8 to 74 percent). Radiotherapy seemed to be a relative risk factor for complications (1.387; p = 0.014) and plate loss (1.585; p = 0.006). Crossing the midline seemed to be a relative risk factor for plate exposure (1.533; p = 0.000) and overall complications (1.385; p = 0.002).The results should be generalized cautiously. Alloplastic reconstructive surgery faces a remarkable lack of evidence. Relatively high complication and failure rates are areas of further concern.

The proper nasolabial angle is a determinant factor in achieving a pleasant result in esthetic rhinoplasty surgery. Nasal tip position depends on various interrelated elements. Its rotation should be analyzed by assessing the nasolabial angle. An increase in this angle results in an upward tilt of the base of the nose with a concomitant decrease in nasal length. Several methods have been advocated to improve this angle; unfortunately, these techniques have considerable limitations in modifying and stabilizing nasal tip rotation. The general principles for rotating the nasal tip include removing the factors that resist the rotation of the lower lateral cartilages, creating space to accommodate them, rotating the lower lateral cartilages into the desired position, and stabilizing the cartilages in the desired position. Resection of the cephalic margin of the lateral crura fulfills these goals. This report describes a straightforward and stable method that uses cephalic portions of the lower lateral crural cartilages as 2 flaps to suspend the nasal tip to the septum to modify and stabilize the nasolabial angle.

Lateral osteotomy is usually performed to narrow a wide nasal base, widen a narrow nasal base, straighten deviated nasal bones, or close an (iatrogenic) open roof deformity. Based on the approach used, nasal osteotomy can be classified as external or internal. Although nasal osteotomy is an essential part of cosmetic rhinoplasty, it can be very difficult for young surgeons to perform external osteotomy. This article focuses on external osteotomy and its essential concepts. In addition, a new splint-guide method is introduced, which can help young surgeons perform external osteotomy in a very safe and predictable manner.

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±3.5mm) in all cases postoperatively (P0.05); the increase was seen mostly in the lobule-to-base length (4.5±0.4mm), with a minimal change in lobule length (1.1±3.6mm). Preoperative and postoperative lobule lengths were not statistically different (P0.05). 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.

The nasal base is an important aspect of the nose with a complex anatomic architecture comprising a combination of cartilages, skin, connective tissues, and ligaments. Recent studies show that all nasal base deformities cannot be corrected by simple excision and suturing techniques. Alar release and medialization would be effective in some of these deformities. This article presents an overview of conventional concepts of alar base surgeries, which have remained unchanged over many years. Indications and limitations of each technique are discussed, followed by a more detailed description of alar release and medialization.

Lateral osteotomy is a controversial step in rhinoplasty, which is usually performed to narrow a wide nose, widen a narrow bony pyramid, straighten a deviated nose, or close an open roof deformity. The osteotomy is performed using several methods, although the internal continuous and external perforator are the main ways to perform the lateral osteotomy. Most other techniques are modifications of these basic methods. The purpose of this article is to review the essential concepts of nasal hump surgery and lateral osteotomy as used in cosmetic rhinoplasty.

The behavior of trigeminocardiac reflex (TCR) during maxillofacial surgeries has not yet been sufficiently studied and knowledge of its behavior is limited to some case reports. The present study aimed to assess the occurrence of TCR in bilateral sagittal split ramus osteotomy and to determine the possible effect of Gow-Gates block on its incidence.Twenty candidates for bilateral sagittal split ramus osteotomy (included were American Society of Anesthesiologists I Class III patients with a prognathism of 3 to 5 mm) were given routine general anesthesia after at least 12 hours of fasting. All patients received Gow-Gates mandibular nerve block on 1 random side (case ramus; the other side was used as the control) after induction of general anesthesia before surgery. Pulse rate was recorded at baseline, soft tissue cutting, bone cutting, sagittal splitting, setback manipulation, and recovery. Mean pulse rate values were compared statistically using t test for the 2 sides in patients.No statistically significant differences were found between the blocked and control sides except during ramus sagittal splitting and setback manipulation (P.0001), when a significantly decreased pulse rate was recorded for the control ramus compared with the blocked ramus.The present study provides further evidence for the complex neurophysiologic mechanism and probable prevention of peripheral TCR. The results of the present study should be further validated through future studies but already provide strong evidence that peripheral and central TCR may act differently based on slightly different pathways.

Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment.We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software.Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P.001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P.001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P.001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients.This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.

Trigeminocardiac reflex (TCR) is currently defined as a sudden bradycardia and decrease in mean arterial blood pressure by 20% during the manipulation of the branches of trigeminal nerve. TCR, especially during the last decade has been mostly studied in the course of neurosurgical procedures which are supposed to elicit the central subtype of TCR. Previously the well-known oculocardiac reflex was also considered as a subtype of TCR. Recently, surgeons dealing with the other branches of the fifth cranial nerve have become more interested in this reflex. Some noteworthy points have been published discussing new aspects of the trigeminocardiac reflex (TCR) in simple oral surgical procedures. Arakeri et al. have reviewed the similarities and differences between TCR, vasovagal response (VVR), and syncope. They have also explained a new possible pathway for the reflex during the simple extraction of upper first molars. The present paper aims to briefly discuss these recently presented points. Although the discussed concepts are noteworthy and consistent our preliminary results of our yet to be published studies, it seemed timely for us to discuss some possible shortcomings that may affect the results of such assessments.

Objective. The present study aimed to assess the occurrence of trigeminocardiac reflex (TCR) during Le Fort I osteotomies. Study design. This case-crossover study included 25 Le Fort I osteotomy candidates without systemically compromising conditions. Mean arterial blood pressure and pulse rate values were recorded before downfracture (DF) (MABP1, PR1), during DF (MABP2, PR2), and after DF (MABP3, PR3). The data were analyzed using repeated measure ANOVA tests (alpha = 0.05). Results. PR1 and PR3 were significantly higher than PR2 (P < .001). MABP2 value was significantly lower compared with MABP1 and MABP3 values (P < .001). PR2 and MABP2 showed a mean decrease of 6.5% and 9.7% compared with PR1 and MABP1, respectively. Conclusion. Different values have been suggested for TCR. Considering the limitations, the present study may suggest a revision of the values or descriptions for TCR, at least in maxillofacial Le Fort I osteotomy. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 178-181)

Purpose Augmentation of a deficient nasal dorsum remains a challenge in rhinoplasty. Different methods and materials have been described in the literature. The purpose of this study was to present the authors' experiences using a composite graft consisting of conchal cartilage and retroauricular fascia for dorsal augmentation. Materials and Methods Patients with moderate to severe dorsal deficiencies were included in this study. The postauricular sulcus was used to gain access to the auricular cartilage and the retroauricular fascia. If the dorsal deficiency was moderate, then 1 layer of conchal cartilage was used. In more severe deficiencies, the cartilage pieces were superimposed, and a multilayer conchal graft was used. To fix the cartilage segments to each other, 6-0 polydioxanone (PDS) suture was used. Then, the cartilage segment was fixed to the retroauricular fascia with 6-0 PDS suture. The nasal dorsum was undermined carefully to create adequate space for chondrofascial graft placement. After performing required maneuvers for solving the functional disorders, tip plasty, and the lateral nasal wall osteotomy, the prepared chondrofascial graft was placed in the dorsal pocket. Results Fourteen patients (5 men and 9 women) participated in this study. The average follow-up duration was 25.4 months (range, 16 to 42 months). The patients' age ranged from 14 to 54 years (average, 25.9 yr). Follow-up showed no cases of infection, hematoma, major graft resorption, asymmetric graft resorption, and displacement of grafts. No postoperative scars were visible at the donor sites. Mild to moderate ecchymosis occurred at the donor sites in 8 patients, which were solved after 10 days without any complications. In 3 male patients, slight graft resorption was noted. The esthetic results were not compromised in these patients, and revision surgery was not performed. Conclusion This small series of cases with relatively adequate follow-up showed that a composite graft consisting of conchal cartilage and retroauricular fascia is a reliable technique for nasal dorsal augmentation in patients with moderate to severe dorsal deficiency.

Many methods and techniques have been proposed for the assessment of the nasal valve, most requiring special equipment. Furthermore the main focus has been on the internal valve, while the role of the external nasal valve (ENV) has usually been underestimated. An index to assess ENV is presented herein. Two photographs of the basal view of the nose are taken, one in the resting position and the other after deep inspiration. These two life-size views are used to calculate the External Nasal Valve Efficacy Index (ENVE Index). Using simple software, the surface area of the nostril in the resting view (A) and breathing view (B) is measured. The ENVE Index is calculated by dividing the deep inspiration surface area by the resting surface area (B/A). The clinical indications for the use of the ENVE Index include rhinoplasty treatment planning, postoperative evaluation to assess the effects of surgery with regard to improvement or deterioration of the airway, and orthognathic surgery and the planning of appropriate postoperative care (such as elastic or intermaxillary fixation) according to the airway patency. The ENVE Index is a relatively simple, reproducible, and documentable test. This index can help the surgeon to make better decisions during treatment planning and postoperative care.

Achieving adequate pulpal anesthesia in mandibular teeth is always a challenge. Supplementary injections and using drugs in combination are some methods implemented to overcome this hurdle. In this randomized clinical trial, use of meperidine in conjunction with lidocaine in intraligamentary injection did not exhibit significant improvement in anesthesia.

The trigeminocardiac reflex (TCR) is a well-known brain stem reflex that appears first in neurosurgical skull-base surgery. More and more craniomaxillofacial skull-base operations also are known to exhibit the reflex. This chapter discusses the appearance of the TCR in craniomaxillofacial surgeries.

Purpose While performing a lateral nasal wall osteotomy during a rhinoplasty, an intentional fracture is produced and the fractured segments are medialized to narrow a wide nasal base. The purpose of this study was to investigate the effect of size, shape, and extension of the external nasal splint on the osteotomy, brow lines, and long-term results of rhinoplasty. Materials and Methods The authors designed a randomized prospective clinical trial. The study population was composed entirely of patients who were voluntarily referred to the authors' department from May 2012 to May 2013. They were randomly divided into 2 equal groups. The primary predictor variable was splint type. For group 1, the external splint was extended beyond the osteotomy lines laterally and covered the overlying skin of the frontal process of the maxillary bone. For group 2, the external splint was trimmed above the osteotomy lines. The primary outcome variables were the levels of satisfaction with the dorsal esthetic lines, brow lines, and distinct osteotomy lines at 12 months after the operation. Demographic variables were gender and age. Mann-Whitney U test, χ 2 test, and t test were used to analyze the data. Results with a P value less than .05 were considered significant. Results Forty healthy patients (American Society of Anesthesiologists status I and II; 18 men and 22 women; age range, 19 to 41 yr; mean, 31.4 yr) were selected. Although the level of satisfaction with the dorsal esthetic lines was higher in group 2, it was not significantly different from group 1 ( P > .05). The levels of satisfaction with the brow lines and the distinct osteotomy lines were significantly higher in group 2 ( P Conclusion The results of this study showed that when a nasal splint is extended beyond the frontal process of the maxilla rather than the base of the nasal bones, positioning of the bones and long-term results are unpredictable.

Nasolabial angle (NLA) and nasal tip projection (NTP) play an important role in aesthetic nose surgery. Little deviations can determine success and failure. The goal of this study was to analyze the immediate effect of different steps of open rhinoplasty on NLA and NTP. In this prospective single-blind study, 50 consecutive rhinoplasty cases were considered. The study consisted of 38 women and 12 men. The mean age was 28 years, ranging from 17 to 37 years. A standard life-size photograph was taken in each step of a classic open rhinoplasty during surgery. Nasolabial angle and NTP were measured and analyzed. Nasolabial angle: average increase after skeletonization (2.26 degrees), strut insertion (4 degrees), and tip spanning (0.17 degrees), whereas cephalic resection caused a decrease (1.9 degrees). Nasal tip projection: average increase after skeletonization (0.1 mm), strut insertion (0.31 mm), and tip spanning (0.84 mm), whereas cephalic resection caused a decrease (0.53 mm). Whereas strut insertion caused the highest mean increase in NLA, tip spanning was the most effective regarding change of NTP. Expectably cephalic resection was associated with decrease in NLA and NTP.

Resection of cancer often involves the excision of underlying hard tissue, and some procedures in aesthetic rhinoplasty can be used in reconstructive nasal surgery to increase the margin of safety while still achieving an acceptable aesthetic and functional outcome. We have used techniques from aesthetic rhinoplasty to shape the nasal framework. Osteotomy and formation of the tip were used in 17 patients with defects (ranging from 1 to 3.5 cm in size) from the nasal root to the tip of the nose. After the underlying bony or cartilaginous framework, or both, had been removed, the resulting open roof deformity had to be corrected by osteotomy of the bony nasal wall and the tip shaped by excision and suturing, including insertion of the tip graft and columellar strut graft. After this, and narrowing of the nose, the defect was smaller and could be closed with local tissue without tension. There were no deformities in the contour, and patency of the airway was maintained. Patients were satisfied with both the aesthetic and functional results. Although the margin of safety was increased, shaping the nasal framework reduced the size of the defect, which allowed tension-free closure with a local flap. The operation requires a thorough knowledge of procedures used in aesthetic rhinoplasty.

Head & face medicine 9(1), 41 (2013). doi:10.1186/1746-160X-9-41, Published by BioMed Central, London

Autologous fat grafting is one of the most demanded facial cosmetic procedures. Fat reservoirs are usually available in large amounts in most patients. The procedure of fat grafting may be repeated several times without any considerable complications. Facial tissues readily accept autologous fat without any fear of immune reaction or carcinogenicity. It is a popular technique that may be used in maxillofacial esthetic surgery. This procedure may be done as an isolated procedure or as an adjunct to any facial esthetic operation such as face lifting to enhance the final esthetic outcome. The main drawback of this procedure is possibility of resorption and unpredictable results of the augmentation; however it is generally believed that prognosis of fat grafting is directly related to proper case selection and meticulous surgical technique. This chapter provides an overview of current concepts and key points in fat harvesting, refinement and injection that may potentially lead to long-lasting, predictable results. Common compli‐ cations are discussed, and effort is made to explain ways to avoid these events and to solve the problems when they happen.

Pain in the throat after extubation is one of the most common complaints after maxillofacial operations under general anaesthesia. We have evaluated the amount of pain after extubation when we controlled the pressure in the endotracheal cuff during operation by analysing the records of 43 patients who had maxillofacial operations under general anaesthesia. In the study group (n = 20) the cuff pressure of the endotracheal tube was adjusted using a pressure gauge at the beginning of intubation and every hour during operation. In the control group (n = 23), an experienced anaesthetist adjusted the pressure only at the beginning of the operation by palpating the pilot balloon. Throat pain was evaluated 1, 6, and 24 h postoperatively on a visual analogue scale (VAS), and the pain scores in the control and study groups postoperatively was 5.3 (1.1) compared with 3.9 (1.5) (p = 0.002); 4.5 (1.3) compared with 3.1 (1.5) (p = 0.002); and 1.9 (1.1) compared with 1.6 (1.2) (p = 0.4), respectively. The differences between the two groups at 1 h and 6 h postoperatively were significant, but that at 24 h was not. Control of the cuff pressure of the endotracheal tube with a gauge at the beginning of the operation, and adjustment of the pressure during operation, can reduce postoperative complications such as throat pain.

Septal deviation presents a considerable challenge in septorhinoplasty because it leads to functional and esthetic problems. This deformity may displace the nasal tip, disturb nasal valve patency, and affect the final outcomes of septorhinoplasty. This report describes an innovative technique that can be used in patients with C-shaped deviation of the septum in a cephalocaudal direction. Because the procedure is similar to carpentering, it was named a "carpenter spreader graft." In this technique, the deviated dorsal cartilage is separated and displaced to a new straightened position.

Background: Lip augmentation is a very common cosmetic procedure. A wide variety of materials have been used to enhance and contour the lips, including alloplastic and autogenous substances. Objectives: The authors describe their experience with augmentation of the upper lip using an autologous graft from the temporalis fascia. Methods: Patients were enrolled prospectively. Upper-lip projection and vermilion show were measured preoperatively and 6 months postoperatively for 19 patients who were candidates for lip augmentation with temporalis fascia. Results: Six months postoperatively, the mean values for upper-lip projection and lip vermilion were significantly greater than preoperative measurements. Conclusions: Augmentation of the upper lip with temporalis fascia appears to be safe and effective. Larger patient series, longer follow-up, and comparative studies are needed to corroborate these preliminary results. Level of Evidence: 4 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

PURPOSE This study aims to review the authors' experience with the lower lateral crura (LLC) transposition flap in an attempt to highlight its advantages, indications, and limitations. MATERIALS AND METHODS A retrospective study of 37 rhinoplasties (29 primary cases, 7 secondary cases, and 1 tertiary case) was performed. In all of these, an LLC transposition flap was used by inserting the cephalic portion of the LLCs into a subperichondrial pocket between the medial aspect of the remaining rim strip and the vestibular skin, based on the posterior pedicle. RESULTS The most prevalent symptom among our patients was nasal external valve dysfunction. Concavity of the LLCs was very common. The LLC transposition flap can correct the LLC deformities with a high rate of patient satisfaction and no need for revision operations. CONCLUSIONS The LLC transposition flap can overcome the common irregularities of the LLCs and could be applied to primary and secondary rhinoplasties, as well as ethnic noses.

Fasciae are known reservoirs of ideal graft material. The temporalis and mastoid fasciae are 2 of the most important graft reservoirs used by plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons. The temporalis fascia is harvested predominantly by plastic surgeons, whereas otolaryngologists often prefer the mastoid fascia. In either case, graft harvesting might be accompanied by donor-site complications, such as hair loss, bleeding, hematoma, and scar formation, which can limit its application. To gain access to the temporal and mastoid fasciae simultaneously, the authors combined conventional techniques to develop a modified single-approach incision line that would minimize most donor-site complications.