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The African American nose has been broadly classified as ethnic yet it differs significantly in morphology from that of other ethnic groups with which it is categorized. The objectives of this study were to (1) establish an objective protocol for analysis of the African American female nose using anthropometric measurements, and (2) determine whether subjective subcategorization schemes are a reliable replacement for anthropometry. African American women (n = 107) between the ages of 18 and 30 years consented to participate in this study. Photographs and 14 standard anthropometric measurements were taken of the face and nasal region, including nose length, nose width, special upper face height, intercanthal distance, mouth width, nasal bridge inclination, nasal tip protrusion, ala thickness, nasal root width, nasal bridge length, tangential length of ala, length of columella, nasofrontal angle, and nasolabial angle. Nasal indices including nose width-nose height index, nasal tip protrusion-nose height index, and nasal tip protrusion-nasal width index were calculated. In addition, photographic analysis was performed to evaluate nostril shape, nasal base shape, and nasal dorsal height. Proportional relationships and subcategorization schemes were evaluated. A new method of nasal analysis for the African American woman uses the proportional relationships of the anthropometric measurements. Proportional relationships included a columellar to lobule ratio of 1.5:1, a nasolabial angle of 86 degrees, and an alar width to intercanthal distance ratio of 5:4. The nasal dorsal height classification scheme was the most reliable for subjective analysis. The degree of variability found within this group of young African American women is illustrated by the following indices and their respective ranges: nose width-nose height index mean, 79.7 (range, 57 to 102); nasal tip protrusion-nose height index mean, 33.8 (range, 23 to 46); and nasal tip protrusion-nose width index mean, 42.8 (range, 32 to 61). The guidelines provided are a baseline from which to begin analysis and evaluation.

Keloids are benign lesions that represent an exuberant collagen response to injury. These benign lesions are plagued with high recurrence rates. Multitudes of options are available for treatment of these lesions, which supports the theory that there is no superior treatment. A variety of treatment options are discussed.

Infection with the human immunodeficiency virus (HIV) is increasing in prevalence, and disease patterns are changing as patient survival lengthens. The purpose of this cross-sectional epidemiological study was to assess the prevalence and severity of self-reported symptoms of otolaryngologic disease in a group of patients attending a general HIV outpatient clinic (n = 203), and to compare the prevalence of self-reported symptoms with a sample of patients without HIV infection (n = 100). Of the HIV-infected patients, 65% of patients had AIDS, 35% were HIV-positive, and the median CD4 count was 135. Although only 11% of patients had seen an otolaryngologist in the prior 6 months, the majority of patients (66%) reported the presence of sinonasal disease during that time. Allergic rhinitis (80%) and sinusitis (54%) were the most commonly reported sinonasal symptoms, and 44% regularly used nasal or sinus medications. Sinonasal disease severity was significantly higher than the self-reported severity of mouth/throat disease (p = 0.01), ear disease (p = 0.03), and neck/salivary disease (p = 0.01). Although patients’ self-reported overall health status was associated (p = 0.02) with CD4 count, the severity of sinonasal symptoms was not associated (p = 0.93) with CD4 count. Similarly, sinonasal symptom severity did not differ between HIV-positive and AIDS patients (p = 0.45). In other words, sinonasal disease severity did not improve as general health status improved. In this series, sinonasal disease was the most significant otolaryngologic manifestation in HIV-positive and AIDS patients. A similar prevalence and severity of self-reported sinonasal symptoms was reported in the non-HIV-infected group of patients. These data may help guide resource allocation and policy decisions on research and treatment of HIV-infected patients.

Program Description: The modern otolaryngologist has had residency-based, and in many cases, advanced fellowship training in a wide spectrum of facial plastic and reconstructive procedures to correct congenital-, acquired-, and aging-related deformities. Due to advances in technologies, there has been an increase in the ability to offer patients a variety of effective and minimally invasive interventions in the office setting. Among these interventions, the use of injected botulinum toxin has become common in the treatment of rhytids, hyperfunctional lines, and facial dystonias. The treatment of skin and subcutaneous contour deformities is also a common challenge for which patients seek consultation. Although previously the materials used for correction were limited in number, there has now been an increasing number of widely used and newly introduced materials made available to the practitioner. The introduction of hyaluronic acid–based agents created a significant increase in acceptance and demand for f...

To determine the average facial proportions of the African American man and compare results with the neoclassical canons of facial proportions and the standard for the North American white man.Cross-sectional survey.Photographs and anthropometric measurements of the face were taken of 109 men of African American descent aged between 18 and 30 years, and results were compared with the neoclassical canons of the facial proportion and the averages of the anthropometric measurements for the North American white man. Proportional relationships were calculated based on the averages. Statistical analysis was performed.The neoclassical canons of facial proportion were not found to be applicable to most of the African American men who participated in the study. Of the 24 anthropometric measurements obtained, 21 were significantly different from the measurements of the North American white man (P.05). We present proportional relationships in our subjects.The face of the average African American man differs from the neoclassical canons of facial proportion and the averages of anthropometric measurements for the North American white man. The proportional relationships found in our subjects might serve as a template for facial analysis in this patient population.

Outcomes research examines the delivery of medical care from the patient's perspective, using unique instruments and methodologies. Outcome studies can measure the effectiveness of treatments or interventions in individual patients or in large populations, using prospective observational research designs. The steps in performing outcomes research are as follows: identify and define the disease or procedure of interest, create a staging system for disease severity, identify important co-morbid conditions, choose or design an outcomes instrument to measure treatment outcomes, and design a study to assess outcomes prospectively. Although there is currently a dearth of outcomes instruments available for use in facial plastic and reconstructive surgery, some new instruments are being developed, and even using existing tools outcomes research should prove to be a valuable research tool for facial plastic surgeons to demonstrate improved quality of life and functional status in their patients.

When performing septorhinoplasty, deviated segments of septal cartilage can be straightened using cartilage or bone as splinting grafts. In some cases, autologous material is not available without an additional surgical procedure to harvest cartilage or bone. It is possible that resorbable plates can be used to splint and straighten deviated cartilage. Experience using bioresorbable rigid fixation devices on cartilage has been limited.To examine early histopathologic changes of rabbit ear cartilage and adjacent soft tissue following implantation with bioresorbable plates.Nonrandomized, placebo-controlled trial.Twelve adult New Zealand white rabbits.Ten adult New Zealand white rabbits (20 ears) underwent stenting of intact ear cartilage with LactoSorb plates (Lorenz, Jacksonville, Fla). Rabbits were killed 28 days after implantation, and the soft tissue, plates, and cartilage were harvested and prepared for histological examination. As controls, 2 rabbits (4 ears) underwent dissection and closure without stenting.Six rabbits experienced superficial skin breakdown on the ventral surface of the ear caused by excessive wound tension of the implant. The cartilage-plate interface and the surrounding soft tissues stenting the dorsal side of the ear remained free of inflammation or necrosis for all animals. Simple elevation of the perichondrium revealed no differences in the appearance of the cartilage between the control and test rabbits.Resorbable plates have no deleterious effects on cartilage during the first month of implantation. While short-term studies have documented the safety and efficacy of using bioresorbable plates, further studies are recommended.

Over the past 15 years, grafts have been used with increasing frequency during rhinoplasty procedures as the transition has been made from reductive rhinoplasty to augmentation or restructuring rhinoplasty. There are a number of grafting materials available, including autogenous materials (bone, cartilage), homograft materials (rib cartilage, dermis), and a wide variety of synthetic or alloplastic materials. With regard to the autogenous materials, cartilage has been the mainstay for augmentation in rhinoplasty. Bone is used infrequently because it often yields unsatisfactory results in the aesthetic appearance of the nose, and has problems with graft resorption. I will therefore not discuss bone herein. This article focuses on the differences between autogenous cartilage implants and synthetic materials, in particular expanded PTFE (Gore-tex; WL Gore & Associates Inc, Flagstaff, Ariz). Certainly, there is no argument that autogenous grafts, in particular cartilaginous grafts, are superior as a grafting material in rhinoplasty for a variety of reasons. Cartilaginous grafts are considered the criterion standard by many authors. The more debatable issue is in the case where substantial dorsal augmentation is required: is autologous material preferable to synthetic? Arguments to both support and refute the notion that autologous cartilage is superior will be presented here. Overall, the ideal implant should have biocompatible physical properties. It should retain constant shape and volume and be nonresorbable. Removal should be easy, and migration should not be a problem. As well, the implant should be easily modified and molded, readily available, and cost-effective. On a microscopic level, there should be no inflammatory response, and there should be resistance to infection. The tissue should not degrade, transmit disease, or act as a carcinogen. These characteristics apply to implants throughout the body. Another desirable characteristic with respect to the nose is that in the area of thin skin over the upper dorsum, the implant should be easily camouflaged. These issues as they pertain to both the autogenous and synthetic graft will be addressed and conclusions offered. While comparison of the aesthetic results is impossible and has not been evaluated in a series, patient satisfaction and revision rates will be emphasized. The wide variety of synthetic materials that have been used for the purpose of rhinoplasty is an indication of the need for a perfect alloplastic implant. Through the years, numerous synthetic materials have had relatively high complication rates. I will address only 2 synthetic implants that continue to be used frequently: silicone and expanded PTFE. Silicone is widely used in rhinoplasty for the Asian patient, and the issues relative to this procedure will be addressed. Expanded PTFE has been gaining in popularity over the past 10 years, and results after long-term follow-up will be assessed. PRO