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Visual changes and intraorbital hemorrhage are the most dangerous complications of sinus surgery. The surgeon's appreciation of the high variability and intricate relationships of the posterior ethmoid and sphenoid sinuses is important. An understanding of the intraorbital anatomy and course of the optic nerve is a prerequisite to surgical planning. Preoperative studies should include not only coronal computed tomographic scans but axial projections. Magnetic resonance imaging scans with or without angiography may add information in some cases.

Objective To characterize the background and outcomes of tonsillectomy malpractice claims. Methods Review of 69 New York State insurance claims (Part I) and 87 national court trials (Part II) alleging injury after tonsillectomy. Results Part I. New York State insurance cases were most commonly discontinued (44%) or settled (42%) before trial. Compensations with a settlement or verdict were made in 48 percent of cases. Part II. Death or major injury occurred in 52 percent of insurance cases, with a mean award of $403,656 being made to plaintiffs. Of cases reaching trial, 60 percent of plaintiffs were compensated. Awards against anesthesiologists were more frequent and higher than against surgeons ($5 million vs $839,650). Death or major injury occurred in 52 percent of court cases, resulting in mean indemnity of $3.8 million. Most cases of death or major injury were attributable to airway complications. Conclusions Approximately half of both New York state claims and court cases involved death or devastating morbidity, mostly related to airway complications, resulting in large awards. Tonsillectomy is a source of uncommon but potentially high-dollar–value litigation exposure to the surgeon, often attributable to non-surgical complications.

Four cast iron lions guard the charming Lions footbridge crossing St. Petersburg's Griboedov Canal. The first author strolled across the bridge on an August evening in 1998 with a Russian friend, Polina. The experience presents a parable for concluding this volume:As we crossed the bridge in the dark, we barely avoided stepping into a gaping hole in the deck half way across. A person could easily fall through. I reacted as a typical American, immediately taking responsibility for doing something about the problem, looking for some board to place over the hole or a barrier to warn pedestrians or someone to report the hazard to who would address it promptly. Polina indicated that no Russian would make such a fuss, and she could think of no one to report the hazard to who would respond. As we stood discussing this problem before two of the guardian lions, a group of drunken soldiers began to cross the bridge from the far side, arm in arm, singing loudly. Sure enough, one slipped through the hole and, but for his comrades holding his arms, he would have plunged into the canal. Surely they will report it, I said, but Polina was doubtful. She saw little chance for some protective action to fix the bridge or even to warn passers-by to beware. We went on our way mindful of the problem left behind. Perhaps a month after my return to the U.S., I received an email from Polina that she had gone to the bridge and, to her surprise, it was fixed. “Perhaps,” she wrote, “there is hope for Russia after all.”

In the cold war era, perhaps there were no greater heroes of the Soviet Union than the as many as 700,000 firefighters, workers, and military personnel who fought the blazing fires at the Chernobyl nuclear reactor that burned out of control for months until smothered by a makeshift concrete structure, called the “sarcophagus” built to contain radioactive releases. Whether this sarcophagus will last as long as the Egyptian monuments, its name evokes has been a matter of grave continuing concern. And it is doubtful that its symbolism as a lasting evidence of 20th century life will be equally appreciated through the ages. But in April 26, 1986, northern Europe had been placed in dire peril by the catastrophic accident in the number 4 reactor at Chernobyl. Smoke pouring from the fires lofted high in the sky to carry radioactive contaminants eventually across the Northern Hemisphere. Some 100 million curies of radiation were released within 10 days of the initial explosion, comprising the word's worst civilian radiation release (Lawrence Livermore, 1999). And, the reactor threatened to unleash a nuclear explosion that would have dwarfed the effects of what already was the world's worst nuclear accident. The situation demanded extreme sacrifice (see also Zykova, this volume).

How are identified instances of contamination addressed, assuming they have been identified and disclosed? The U.S. has evolved an activist ethos with regard to contamination – both in terms of identifying it and, in the case of identified contamination, taking some engineering action to remediate the hazard. In Chapter 13, A Grassroots Perspective on the Brownfields and Superfund Programs, veteran New Jersey grassroots leader Madelyn Hoffman offers a thorough review of the Superfund program that, since 1980s, has guided U.S. cleanup of sites identified as contaminated at a threshold demanding remediation. She provides a detailed overview of the process identifying the problem and for developing and comparing alternative approaches for remediation. Public involvement is integral to this process, as is the assessment of health risks for local populations. Hoffman also describes the more recent process of Brownfields remediation added as an adjunct to Superfund to more speedily return contaminated lands to productive use. If Superfund has been the subject of political opposition for its regulations, costs and for tying up property, Brownfields offers the political remedy by streamlining cleanup in order to foster reuse. The downside of this streamlined mitigation, however, as Hoffman stresses, may be the sacrifice in the quality of restoring the contaminated land, leading to future toxic exposures. Finally, throughout her discussion, Hoffman stresses the vital role of the grassroots network of organizations in the U.S. that “watchdog” local environments. Under the leadership of Lois Marie Gibbs, this grassroots network has become a force fighting for environmental cleanup and supporting newly discovered contaminated communities as they grapple with the attendant issues. In this view, it is the combination of laws and regulations and political will with an active level of citizen oversight and participation that makes the environmental cleanup process work.

Sustainability is a catch term for the different way of life required to counter the ills of the modern era. It encompasses new social and economic as well as ecological relationships. Sustainability theory is, by its nature, hopeful in envisioning an alternative corrective course of action. This volume deals with “the negative legacy problem” that confounds this optimism because we have so profoundly contaminated and altered the earth in lasting ways. Any effort to create a sustainable future will have to deal with this legacy. It is a huge and profound burden faced unevenly by people and non-humans today and that we have left for future generations (see Edelstein, 2006).

The City of New York was suddenly and deliberately attacked on September 11, 2001, killing thousands of people and leaving unbelievable destruction. Thirty-eight buildings and structures were destroyed or damaged, including seven buildings in the World Trade Center site completely leveled. Almost five years later, two very large contaminated buildings, Deutsche Bank at 130 Liberty Street and Fiterman Hall of Borough of Manhattan Community College, have yet to be cleaned up and demolished. Some 30 million square feet of commercial space was lost. Transportation was disrupted, including the loss of the World Trade Center PATH station, the 1/9 subway line and portions of Route 9A and Church Street. Cars were not allowed south of Canal Street for a week. For Americans this was a terrorist attack and a crime. It was a time for mourning losses and responding to disaster. There was the shock that something like this could happen. And there was more. The destruction of the WTC also posed competing environmental, economic and social threats.

In this chapter we explore some of the intriguing questions raised by contaminated communities. Is there a connection between exposure to environmental hazards and psychological distress? If yes, how best can it be measured? What kinds of psychological problems are aggravated by this kind of life stress? How do we know that victims are truly experiencing increased problems such as anxiety, depression and fears about their health?

The post-Cold War period allowed the U.S. nuclear legacy of ecocide to be declassified and made public. The policy of nuclear secrecy, evident in Russia (see Mironova et al., this volume), was not merely an eastern practice. Western nuclear releases were kept equally under wraps. In England, for example, the Windscale disaster was not fully disclosed until 1987.1 Likewise, releases from the Hanford Nuclear Reservation, in Washington State, and other U.S. nuclear sites were kept undercover until the same period. The irony was that Americans learned of many of the nuclear skeletons in their closet around the time that Russians learned of theirs (see Mironova et al., this volume). It would appear that glasnost was contagious.

What can we learn about cultures of contamination from our comparison of Russia and the United States? Three final chapters offer some perspective.

The Ural Mountain region is a remarkably beautiful landscape of forests and lakes. Here is the continental divide between Europe and Asia. One of the rivers originating here to eventually feed feeding the Artic Sea is the Techa river. But the verdant greenery that characterizes the region does not disclose the hidden dangers of plutonium and other radioactive materials either downstream or downwind of the Mayak Nuclear Complex. Major areas of the Techa river corridor and downwind areas were permanently evacuated after radioactive releases from the Mayak Nuclear Complex from the 1950s through the 1970s. Although acute and chronic water releases encompass this period, the so-called Kyshtim 57 accident, an air release from Mayak in 1957, was the word's worst nuclear accident until surpassed by Chernobyl (see Mironova et al. and Kutepova and Tsepilova, this volume). But what of the inhabitants who remain? In this chapter, we explore some of the psycho-social impacts of living in contaminated areas, drawing primarily upon interviews with residents of the region. In doing this, we give voice to their perspective and views on each other and life in this contaminated region.1

In a seminal essay, Mumford (1963) argued that society is forced to adapt to the demands of the technological systems it chooses. He distinguished between what he called “Authoritarian” and “Democratic” technics. Societies choosing the former path select technological and energy systems that are high risk and therefore demand authoritarian, centralized, secretive and closed social controls. In contrast, the second low-risk path allows for decentralized, open, participatory and democratic control. The two directions, and thus the resulting social forms, could not be more contradictory.1 Democratic technics, not Authoritarian, are necessary for a sustainable future.

The claustrum (Cl) is a subcortical structure located in the basolateral telencephalon of the mammalian brain. It has been a subject of inquiry since the mid-nineteenth century. The Cl can be identified in a number of species, and appears as a phylogenetically related nucleus in Insectivores, Prosimians and Marsupials. Ontogenetic investigations have been the subject of much debate over the years. There are three hypotheses for claustral development. To date, the "hybrid theory" has garnered the most support. Pathological conditions specifically associated with the Cl, while few in number, are of interest from a functional perspective. Several cases of claustral agenesis have been reported. The implications of these clinical reports are discussed. Claustral neuroanatomy at the light-microscopic and electron-microscopic level is reviewed. The morphology of the claustral neuron consists of several types, which roughly corresponds to the neuron's location within distinct claustral subdivisions. The interconnectivity of the Cl with the cerebral cortex is rather complex and reflective of complex functional interrelationships. Several researchers have investigated the angioarchitecture of the Cl. It appears that vessels permeating the insula also vascularize the Cl. Literature investigating the neurotransmitters and overall chemical neuroanatomy of the Cl is extensive. These studies clearly demonstrate that the Cl is richly innervated with a wide and diverse array of neurotransmitters and neuromodulators. Lesion, stimulation and recording experiments demonstrate that the functional and physiologic capacity of the Cl is quite robust. A recurring theme of claustral function appears to be its involvement in sensorimotor integration. This may be expected of the Cl, given the degree ofheterotopic, heterosensory convergence and its interconnectivity with the key subcortical nuclei and sensory cortical areas. The Cl remains a poorly understood and under investigated nucleus. Therefore, a review of the world literature through 1986 prior to the advent of the "molecular revolution" is presented. This diverse and extensive body of knowledge is reviewed in the areas ofphylogeny, ontogeny, pathology, angioarchitecture, cytochemistry, anatomy and physiology. Theories of possible claustral function are also noted. It is hoped that this work will stimulate research scientists to further investigate the functional interrelationships of the Cl as well as to aim with far greater precision and accuracy towards a deeper understanding of its raison d'etre. The recent efforts in neurosciences by Sir Francis Crick and Christof Koch implicating the Cl in visual consciousness, is an important step in understanding just what its functions could encompass. Efforts in molecular neurosciences will be indispensable for a mechanistic understanding of these functions. Currently research efforts are underway from many perspectives. In considering the past scientific literature on the Cl, it is interesting to regard that this once obscure brain structure, may serve as a model system for the study of one of the most interesting and complex brain functions-consciousness.

We report the first observation of a charm-strange meson D(+)(sJ)(2632) at a mass of 2632.5+/-1.7 MeV/c(2) in data from SELEX, the charm hadro-production experiment E781 at Fermilab. This state is seen in two decay modes, D(+)(s)eta and D0K+. In the D(+)(s)eta decay mode we observe a peak with 101 events over a combinatoric background of 54.9 events at a mass of 2635.4+/-3.3 MeV/c(2). There is a corresponding peak of 21 events over a background of 6.9 at 2631.5+/-2.0 MeV/c(2) in the decay mode D0K+. The decay width of this state is17 MeV/c(2) at 90% confidence level. The relative branching ratio Gamma(D0K+)/Gamma(D(+)(s)eta) is 0.14+/-0.06. The mechanism that keeps this state narrow is unclear. Its decay pattern is also unusual, being dominated by the D(+)(s)eta decay mode.

Pion virtual compton scattering (VCS) via the reaction pi(-)e-->pi(-)egamma was observed in the Fermilab E781 SELEX experiment. SELEX used a 600 GeV/c pi(-) beam incident on target atomic electrons, detecting the incident pi(-) and the final state pi(-), electron and gamma. Theoretical predictions based on chiral perturbation theory are incorporated into a Monte Carlo simulation of the experiment and are compared to the data. The number of reconstructed events (=9) and their distribution with respect to the kinematic variables (for the kinematic region studied) are in reasonable accord with the predictions. The corresponding pi(-) VCS experimental cross section is sigma=38.8+/-13 nb, in agreement with the theoretical expectation of sigma=34.7 nb.

We observe a signal for the doubly charmed baryon Xi(+)(cc) in the charged decay mode Xi(+)(cc)--Lambda(+)(c)K-pi(+) in data from SELEX, the charm hadroproduction experiment at Fermilab. We observe an excess of 15.9 events over an expected background of 6.1+/-0.5 events, a statistical significance of 6.3sigma. The observed mass of this state is 3519+/-1 MeV/c(2). The Gaussian mass width of this state is 3 MeV/c(2), consistent with resolution; its lifetime is less than 33 fs at 90% confidence.

We report precise measurement of the Ds meson lifetime. The data were taken by the SELEX experiment (E781) spectrometer using 600 GeV/c Sigma-, pi- and p beams. The measurement has been done using 918 reconstructed Ds. The lifetime of the Ds is measured to be 472.5 +- 17.2 +- 6.6 fs, using K*(892)0K+- and phi pi+- decay modes. The lifetime ratio of Ds to D0 is 1.145+-0.049., Comment: 5 pages, 2 figures submitted to Phys. Lett. B

We report new precision measurements of the lifetimes of the Lambda(+)(c) and D0 from SELEX, the charm hadroproduction experiment at Fermilab. Based upon 1630 Lambda(+)(c) and 10 210 D0 decays we observe lifetimes of tau[Lambda(+)(c)] = 198.1+/-7.0+/-5.6 fs and tau[D0] = 407.9+/-6.0+/-4.3 fs.

The abundant glands situated in the lamina propria of the human anterior middle nasal turbinate were complex tubules that consist of serous, seromucous, and mucous cells, either singly or in combination. Serous granules were homogeneously dense, but could have a small lighter core. Seromucous granules had a dense rim and a large compartment of appreciably lighter density. Gradation between serous and seromucous granules made precise identification of these secretory cell types difficult. Mucous cells were of conventional morphology. The secretory tubules, which possessed a complement of myoepithelial cells, gradually transformed into ducts or the changeover was relatively sudden. The ductular portions of the tubules consisted either of tall prismatic cells or of shorter columnar cells, both of which lacked secretory granules, but had many mitochondria in their supranuclear cytoplasm. In many cases the ducts, for most of their length, consisted of secretory cells. These glands clearly participate in the elaboration of the glycoconjugate coat that serves to protect the nasal mucosa and keeps it from drying out.

Cyclooxygenase (COX) catalyzes the formation of prostaglandins (PG) from arachidonic acid. A large body of evidence has accumulated to suggest that COX-2, the inducible form of COX, is important in carcinogenesis. In this study, we determined whether (1) COX-2 was overexpressed in squamous cell carcinoma of the head and neck (HNSCC) and whether (2) retinoids, a class of chemopreventive agents, blocked epidermal growth factor (EGF)-mediated activation of COX-2 expression. Levels of COX-2 mRNA were determined in 15 cases of HNSCC and 10 cases of normal oral mucosa. Nearly a 100-fold increase in amounts of COX-2 mRNA was detected in HNSCC. By immunoblot analysis, COX-2 protein was detected in 6 of 6 cases of HNSCC but was undetectable in normal mucosa. Because retinoids protect against oral cavity cancer, we investigated whether retinoids could suppress EGF-mediated induction of COX-2 in cultured oral squamous carcinoma cells. Treatment with EGF led to increased levels of COX-2 mRNA, COX-2 protein, and synthesis of PG. These effects were suppressed by a variety of retinoids. Based on the results of this study, it will be important to establish whether newly developed selective COX-2 inhibitors are useful in preventing or treating HNSCC. Moreover, the anticancer properties of retinoids may be due, in part, to inhibition of COX-2 expression. Combining a retinoid with a selective COX-2 inhibitor may be more effective than either agent alone in preventing cancer of the upper aerodigestive tract.

Contamination became a widely recognized facet of modern reality in the 1970s after such events as the discovery of buried hazardous wastes at Love Canal in Niagara Falls, New York and the spread of dioxin following an explosion at a pharmaceutical plant in Seveso, Italy. In these instances, reflecting chronic and acute cases of contamination, residents were relocated and permanent ‘dead zones’ were created on the landscape. Based upon such events, contamination emerged as the prototypical ‘new species of trouble,’ challenging modernity and forcing the transition toward a new postmodern society.1 Here it is argued that an understanding of this transition can be drawn from the experience of pollution’s victims. Using observations derived from empirical studies of the contamination experience, it is possible to confirm the largely European sociological representation of postmodernity, as depicted by Ulrich Beck’s theory of the ‘risk society.’2 At the same time, limits to the risk-society formulation also become apparent.

We report the first observation of the Cabibbo-suppressed charm baryon decay Ξ_{c}^{+}→pK^{-}π^{+}. We observe 150±22±5 events for the signal. The data were accumulated using the SELEX spectrometer during the 1996-1997 fixed target run at Fermilab, chiefly from a 600 GeV/c Σ^{-} beam. The branching fractions of the decay relative to the Cabibbo-favored Ξ_{c}^{+}→Σ^{+}K^{-}π^{+} and Ξ_{c}^{+}→Ξ^{-}π^{+}π^{+} are measured to be B(Ξ_{c}^{+}→pK^{-}π^{+})/B(Ξ_{c}^{+}→Σ^{+}K^{-}π^{+})=0.22±0.06±0.03 and B(Ξ_{c}^{+}→pK^{-}π^{+})/B(Ξ_{c}^{+}→Ξ^{-}π^{+}π^{+})=0.20±0.04±0.02, respectively.

Background Migration is common among youth in Africa and is connected to life transitions. Migration has also long been associated with increased risk of being HIV-infected. Although this association has been observed in multiple studies, the temporal order between infection and migration is often unclear. This investigation uses unique cohort data from Rakai, Uganda to test whether recent in-migration places youth at a higher risk of HIV acquisition. Methods We used data from the Rakai Community Cohort Study, 1999–2011. Respondents included were aged 15–24, sexually experienced and initially HIV negative (n = 9365). Migration and HIV status were assessed at each annual survey round. Poisson regression with robust standard errors was used to estimate age-adjusted incidence rate ratios (aIRR) of HIV acquisition among in-migrants versus non-migrants, by geographic origin and reason for migration. Additional adjustment for characteristics assessed at follow-up was explored. Results In young men, HIV incidence in recent in-migrants (14.3 per 1000 person-years (py)) was 2 times greater than non-migrants (6.6 per 1000 py) (aIRR = 2.04; 95% confidence interval (CI): 1.07–3.92). In young women, incidence among in-migrants (12.6 per 1000 py) was similar to non-migrants (11.5 per 1000 py) (aIRR = 1.07; CI: 0.74–1.55). Associations were not affected by geographic origin. Men who had migrated for marriage were at particularly high risk (141 per 1000 py) compared to non-migrants (aIRR = 17.16; CI: 3.15–93.35). However, this was uncommon ( 19. Women who had migrated for work were at increased risk (30.3 per 1000 py) compared to non-migrants (aIRR = 2.59; CI: 1.41–4.76). IRRs were relatively unchanged with adjustment for marital status, number of partners in last 12 months or sexual concurrency. Conclusion Recent in-migration is associated with increased HIV risk in young Ugandan men. Among young women, the increase in HIV risk may be specific to migration for work.

Educational objectives: To explain the differences in the nose and sinuses on the basis of age and development, to outline methods of evaluation and diagnosis in the very young and the geriatric population, and to formulate a new decision tree for therapy of the young child to the elderly with nasal and sinus disease.

The cytokertatins in respiratory epithelial cells (REC) of human nasal polyps and turbinates were analyzed by immunohistochemistry. Cytokeratin 19 (CK19) was present in all REC, CK5 and 14 were expressed primarily in basal cells, and CK7, 8, and 18 were found in suprabasal cells. Differences in cytoplasmic locations were also apparent among the individual cytokeratins. CK13 was not detected in any REC of these tissues. The results indicate the profile of cytokeratins in REC of human nasal polyps and turbinates is essentially identical to that of REC in the more distal respiratory tract.

Endoscopic instruments have revolutionized surgical diagnosis and treatment. Recently, a high resolution microfiberoptic endoscope has been developed that has vast potential for otologic use. This microfiberoptic endoscope was used in cadaver and human studies to visualize the middle ear cavity. The technique used involved placing a 1.0-mm or smaller microfiberoptic scope into the middle ear via a tympanic membrane perforation, through a myringotomy tube or up the eustachian tube. Using the scope, the mesotympanum and hypotympanum can be well visualized. Similarly, the round window, oval window, ossicular chain, and related structures can be clearly demonstrated and recorded photographically. This technique has great potential to enhance diagnosis without open surgery.

The efficacy and safety of a once-a-day antibiotic in the treatment of sinusitis was studied. Two randomly assigned groups were treated with either once-a-day cefixime, a third generation cephalosporin, or amoxicillin three times a day. One hundred and fourteen patients were evaluated with antral punctures, microbiologic evaluation, and radiographic studies. Cultures revealed 40% gram-negative organisms, 48% gram-positive, and 12% anaerobes. The most common bacteria were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus and viridans group streptococci. Ninety-four percent of the cefixime group were cured compared with 96% of the amoxicillin group. Staphylococcus resistance was a problem in both groups, necessitating an occasional change to amoxicillin-clavulanate potassium in the amoxicillin group. Once-a-day antibiotics offer the potential for improved compliance in the treatment of sinusitis. Cefixime offers an additional benefit of covering beta-lactamase producing strains of bacteria which are increasing in incidence and resistant to many penicillins.

One hundred twelve patients (116 ears) were treated for recurrent and residual cholesteatoma. A retrospective review revealed that 66% had undergone canal wall down mastoidectomy at the previous surgery. The surgical procedure at revision was selected on the basis of an intraoperative assessment of the extent of disease, and clinical prediction of eustachian tube function. The average period of follow-up was 3.4 years. Revision surgery was successful in providing the patient with a safe, dry ear in 105 (91%) of 116 cases. Surgical principles and hearing results are presented.

Procainamide, a widely used antiarrythmic, causes DNA hypomethylation in the human T cell line Jurkat, but the mechanism is unknown. We report that procainamide inhibits the DNA methyltransferase catalyzed transfer of methyl groups from S-adenosylmethionine to DNA, but has no effect on other known regulators of DNA methylation. Our results suggest that procainamide could inhibit cellular DNA methylation by inhibiting DNA methyltransferase activity.

The surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. Forty cases (41 ears) of labyrinthine fistulas were reviewed. This represented 10% of our total series of cholesteatomas in adults and children (426 ears). Clinical presentation, extent of disease, results of fistula testing and audiometric studies, and radiographic findings were analyzed. A canal wall-down procedure was performed in all but one patient. Generally an attempt was made to completely remove the cholesteatoma, to graft the fistulous area, and to reconstruct the middle ear mechanism in one stage. The matrix was preserved in patients with large fistulas where the involved ear was the only hearing one, when the matrix was adherent to the underlying optic duct, and in selected elderly persons. Long-term followup did not reveal a significant difference in hearing, degree of vertigo, or incidence of recidivism when those patients in whom the matrix was removed were compared with those in whom the matrix was preserved. The importance of recognizing the presence of a labyrinthine fistula preoperatively is stressed, along with the need to be prepared for an unexpected fistula. Operative management is described.

Complete medical interviews and physical exams were performed on two stimulated patients by a class of medicine interns. These interviews and examinations were videotaped and were then scored using a rating scale developed by the authors. This system of videotaping and rating complete interviews and physical examinations is called the The Northwestern Evaluation & Training System (NETS). Selected findings are presented and discussed. It is shown how the NETS can be used for educational feedback to the individual student and for quality assurance feedback to training programs regarding the effectiveness of their instruction in interview and physical examination skills.

David R. Edelstein, MD, New York, NY , is a board-certified otolaryngologist. In my experience, there are many causes of postrhinoplasty airway problems that do not involve valvular obstruction. For example, there may be mucosal problems. In fact, if you examine a patient within the first year after rhinoplasty, I believe most of the problems are mucosal. After a year, the problem is more likely to be structural support, of which the valve is a part. Remember that the valve is a three-dimensional space, so the septum is actually part of what I call the valve area, as well as the interior part of the inferior turbinate. The floor of the nose is prone to scarring and manipulation, both of which can decrease the size of the anterior space. Again, three-dimensionally, there are multiple airflow patterns for lamina flow through the nose. If the surgeon doesn't look closely, it's easy to overlook areas of obstruction. When examining a patient complaining of postrhinoplasty obstruction, I want to look three-dimensionally …