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Objective: Alar asymmetry in unilateral cleft lip (UCL) nasal deformity is a well-recognized clinical feature. However, there is a lack of comprehensive quantitative analysis of this asymmetry. This study compares the shape, volume, and axis rotation between the cleft and non-cleft ala in skeletally mature patients with UCL. Design: A retrospective comparative study utilizing three-dimensional rendered CT scans. Setting: Tertiary care pediatric institution. Patients, Participants: This study included 18 patients with UCL nasal deformity at skeletal maturity. Main Outcome Measure(s): Cleft and non-cleft side ala volume, surface area, and axis to the midsagittal plane. Results: The cleft-side ala was significantly lesser in volume by 27.3%, significantly lesser in surface area by 17.6%, and significantly greater in surface area to volume ratio by 14.6% than the non-cleft ala. The cleft-side ala was significantly greater by 43.1% horizontal axis to the midsagittal plane. In patients with primary rhinoplasty, the cleft-side ala had 28.0% less volume and 18.7% less surface area. In intermediate rhinoplasty, the cleft-side ala had 39.1% less volume and 23.5% less surface area than the non-cleft ala. Conclusions: Significant asymmetry exists between the cleft-side and non-cleft ala in patients with UCL. The cleft-side ala is significantly smaller in volume and surface area than the non-cleft ala. Additionally, the cleft-side ala demonstrates a significantly greater horizontal axis that contributes considerably to nasal asymmetry, supporting the need to restore a normal vertical axis to the clef-side ala. [ABSTRACT FROM AUTHOR]

Objective: This study used three-dimensional measurements to provide a nasolabial analysis of patients with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and controls across different races and ethnicities. Design: A retrospective comparative study. Setting: Tertiary care pediatric institution. Patients, Participants: The study included 90 patients with UCLP, 43 patients with BCLP, and 90 matched controls. Patients are separated as self-identified Caucasian, Hispanic, or African American. Main Outcome Measure(s): Nasal length, nasal protrusion, columellar height, columellar width, tip width, alar width, alar base width, nasolabial angle, upper lip length, philtrum length, nostril height, and nostril width. Results: All UCLP groups had significantly greater columella and tip widths and decreased nasolabial angles than controls. All BCLP groups had significantly greater columella width, tip width, nasolabial angle, and nostril widths. Upper lip length, philtrum length, and nostril height were significantly decreased in BCLP compared to controls. Across UCLP groups, African Americans had significantly decreased nasal protrusion and columella height and a significantly increased columella width compared to Caucasians and Hispanics. Alar and alar base widths were significantly different between all groups. Across BCLP groups, the Caucasian nostril width was significantly less than the African Americans. Conclusions: These findings suggest that when correcting nasolabial characteristics in patients with cleft lip, it is important to consider racial and ethnic differences to achieve a normal appearance. Specifically, goals for alar width, alar base width, nasal tip, and projection should be tailored to the patient's race and ethnicity. [ABSTRACT FROM AUTHOR]

Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis. [ABSTRACT FROM AUTHOR]

Binder's syndrome is a rare congenital deformity characterized by midface hypoplasia, particularly around the nasomaxillary area. Genetic etiology or developmental failure caused by prenatal exposure to teratological agents has been considered. In this article, we present 3 related rhesus monkeys born with orofacial deformities similar to those found in infants with the Binder phenotype. For the first time, a primate biomodel for this condition is presented. The clinical description and association with management and environmental factors are discussed. These findings reinforce the knowledge about the relationship between possible vitamin K metabolism interference and Binder's syndrome. [ABSTRACT FROM AUTHOR]

Objective: This study investigated various manifestations of nasal deformities in lesser-form cleft lips, including the minor-form, microform, and mini-microform, by photogrammetric comparison with incomplete cleft lips. Design: Retrospective study. Setting: Tertiary university-affiliated hospital. Participants: A total of 160 patients with unrepaired unilateral incomplete cleft lips ranging from lesser-form to two-thirds way clefts. Main Outcome Measures: The severity of nasal deformities was assessed by photogrammetric measurements of linear and angular variables. The symmetry ratio between the cleft and non-cleft sides was obtained by measuring various nasal parameters and comparing them among the different labial cleft groups. Results: The degree of nasal deformities increased with the extent of labial clefts among the 3 labial cleft groups (lesser-form, halfway, and two-thirds way clefts) in terms of alar base width ratio (1.102, 1.197, 1.309; P <.05), nostril width ratio (1.287, 1.387, 1.551; P <.05), and columellar angle (11.5, 14.45, 18.197; P <.05). Each parameter indicated lesser-form, halfway, and two-thirds way clefts, respectively. However, only the lateral lip height ratio (0.942, 0.851, 0.87; P <.05) and nostril width ratio (1.207, 1.35, 1.29; P <.05) significantly differed among the 3 subgroups. Each parameter indicated mini-microform, microform, and minor-form, respectively. Conclusions: The cleft nasal deformities in lesser-form cleft lip present comparable severities among its subtypes, which implies that the extent of the labial cleft is not correlated with nasal deformities. Each nose in the lesser form cleft should be individually assessed for primary rhinoplasty and requires tailored correction. [ABSTRACT FROM AUTHOR]

Proboscis lateralis is a rare craniofacial anomaly in which a rudimentary nasal appendage arises at the medial canthal area. The severity depends on organ involvement, including eyes, nose, cleft lip/palate, and/or concomitant intracranial anomalies. Here, we present a child with proboscis lateralis and associated trans-ethmoidal encephalocele. We suggest doing the preoperative CT and/or MRI to rule out associated intracranial anomalies and reliably preoperative planning tools. Moreover, we proposed an alternative nasal reconstructive technique using a composite graft from the proboscis mass at the same time as encephalocele repair with promising results. [ABSTRACT FROM AUTHOR]

Background: Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting. Methods: This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate. Results: There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed. Conclusion: The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis. [ABSTRACT FROM AUTHOR]

Background and Aim: Ectodermal dysplasia is a genetic condition that affects ectodermal derivatives such as skin, hair, nails, teeth and sweat glands. The disease is diagnosed at birth or in early childhood. Tooth developmental disorders are observed in different forms in these children. These disorders expose children to ridicule, which can lead to psychological problems; Therefore, the physical treatment of these children is very important, especially in the oral area. This report describes the appearance and dental treatments performed on a 6-year-old girl with ectodermal dysplasia. Case Report: A 6-year-old girl with no systemic disease complained of a history of being ridiculed by her peers. Lack of deciduous and permanent teeth and conical teeth were visible in this child. The child had reduced, thin hair, hypotonic lips, and a dry mouth. The bridge of the nose also seemed concaved. The baby's teeth had no caries or periodontal disease. The treatment plan for this child included a composite build-up of the conical anterior teeth and then the design of a removable partial denture to preserve the space of the missing teeth as well as their replacement. Conclusion: Removable prostheses are a suitable treatment option for children with ectodermal dysplasia. After the age of 18, surgical treatments for implant placement and then placement of implant-based prostheses can be considered. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of a single stage composite cleft septorhinoplasty procedure ("The Gujrat Technique") to correct the exaggerated cleft nose deformity after completion of nasal growth in an adult patient cohort. Methods: Adult patients with a residual unilateral cleft nasal deformity were deemed eligible for the proposed "Gujrat Technique". Over a 10-year period (2007–2017), 96 adult patients underwent this composite cleft septorhinoplasty as a single stage operation. Post-operative nasal symmetry evaluation was undertaken using the validated computer program 'SymNose'. Functional outcome and patient satisfaction were assessed using Nasal Obstruction Symptom Evaluation scale and Rhinoplasty Outcome Evaluation (ROE) questionnaires respectively. Various statistical analysis methods were used to validate the obtained results. Results: Due to poor compliance with follow-up, post-operative assessments were undertaken in only 32 patients. The single group study design using the non-parametric matching pairs Wilcoxon Sign test (p < 0.001) showed overall good to excellent functional and aesthetic outcomes and higher scores of the digital SymNose grading system. There was a significant improvement in ROE scores (from 26.4 ± 2.9 to 85.9 ± 4.7, p < 0.001). There were no major complications or revisions needed in our series. Conclusion: The individual components of "The Gujrat Technique" are not novel but their combination in this adult unilateral cleft rhinoplasty cohort has demonstrated a high patient satisfaction with its aesthetic appeal and functional versatility. In the background of limited resources and unpredictable patient follow up, the simplicity, reproducibility and cost effectiveness of this technique make it a practical reconstructive option. [ABSTRACT FROM AUTHOR]

Congenital absence of the nose or arhinia is an exceptionally rare craniofacial malformation, and the pathophysiology of the arhinia is still unknown. Most arhinia patients can have difficulties with breathing and feeding due to the absence of the nose, nasal cavities, and associated problems. A 38-day-old female patient was referred to our clinic with arhinia. Physical examination revealed the complete agenesis of nasal structures as the nasal bones and vestibulum nasi. The region of the absent nose was flat and firm at palpation. Congenital arhinia may occur with other associated malformations such as ocular, ear, palate, and gonadal. Therefore, it is recommended to evaluate computed tomography/magnetic resonance imaging in the postnatal period. Additionally, a radiological evaluation will help nasal reconstruction by documenting changes in nasal and maxillary anatomy over time. Due to the limited number of arhinia cases presented, the surgical management of this condition has not been standardized. We presented the pyramid-shaped cartilage grafts for the nasal framework and an expanded paramedian forehead flap for the skin coverage for reconstruction of arhinia. [ABSTRACT FROM AUTHOR]

Objective: This report describes a new observation of hyperglycemia in a child with Type 1 diabetes after off-label use of otic ciprofloxacin/dexamethasone drops in the nasal passage and reviews previous reports of adverse endocrine effects from intranasal corticosteroids in pediatric patients. Methods: We describe the clinical case and conducted a literature review of MEDLINE (PubMed) and EMBASE. Results: A 9-month-old female with a history of Type 1 diabetes who underwent unilateral choanal atresia repair was started on 1 week of ciprofloxacin 0.3%/dexamethasone 0.1% otic drops twice a day for choanal obstruction with granulation tissue. While the patient's airway patency improved, average daily blood glucose increases by 40 to 50 points were noted on the patient's continuous glucose monitor. The hyperglycemia resolved within 2 days after switching to mometasone furoate 0.05% spray. We also review 21 pediatric otolaryngology cases of iatrogenic Cushing's syndrome associated with on- and off-label use of topical steroid suspensions in the airway. Patients ranged from 3 months to 16 years in age and used doses of 50 μg/day to 2 mg/day. Conclusion: This is the first reported pediatric case of increased blood glucose levels associated with intranasal steroid suspensions, to the best of our knowledge. Counseling families on precise dose administration and potential endocrine disturbances is critical when prescribing these medications for off-label use in infants and small children, particularly among patients with underlying endocrine disorders such as diabetes. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to determine the anatomical variations of the sphenoid sinus and its adjacent critical structures using Cone-Beam Computed Tomography (CBCT). Methods: This cross-sectional study was conducted on CBCT scans of 67 females and 84 males between 18 to 67 years. Presence/ absence of intersphenoid septa, sphenoid sinus pneumatization and its type (conchal, presellar, sellar, and postsellar a and b), protrusion of the optic canal and carotid canal into the sphenoid sinus, optic canal and carotid canal dehiscence, and Anterior Clinoid Process (ACP) pneumatization was evaluated on CBCT scans, and their prevalence and correlation were calculated. Data were analyzed by the Chi-square test (alpha=0.05). Results:The prevalence of intersphenoid septa was 98.68%. Postsellar type a was the most common type of sphenoid sinus pneumatization with a prevalence of 41.3%. The prevalence of conchal, presellar, sellar and postsellar b types was 0, 11, 30, and 17.7%, respectively. The prevalence of optic canal and carotid canal protrusion into the sphenoid sinus was 50 and 52.7%, respectively. The prevalence of optic canal and carotid canal dehiscence was 48.3 and 40.3%, respectively. The prevalence of ACP pneumatization was 45%. Optic canal and carotid canal protrusion had a significant correlation with ACP pneumatization (p<0.001). Also, carotid canal and optic canal protrusion and dehiscence were significantly correlated with degree of sphenoid sinus pneumatization (p<0.001). Conclusion: Sphenoid sinus pneumatization significantly increases the likelihood of carotid canal, optic canal protrusion into the sphenoid sinus and their dehiscence, therefore, a preoperative 3D imaging is strongly recommended prior to trans-sphenoidal surgical procedures. [ABSTRACT FROM AUTHOR]

Lateral proboscis is a rare congenital condition characterized by a cylindrical protuberance on the nasofrontal region accompanied by abnormal nasal development on the affected side. We aimed to describe the management of the lateral proboscis in staged repair. A 7-year-old girl came with a tube-like projection on the left medial canthal region and nasal agenesis on the ipsilateral side. She was diagnosed with lateral proboscis, left microphthalmia, lower eye lid coloboma, and asymmetry in the orbital region. The patient has undergone 3 major surgeries at our institution. The first surgery involved the deconstruction of the tube to form the left nasal body and nostril. The second operation involved trimming of the new nose form and the excision of the bony protrusion directly beneath the base of the pedicle through bifrontal craniotomy. The remaining bone defect was closed using a pericranial flap. The orbital floor was reconstructed using titanium mesh. The third operation involved nasal reconstruction using a costal cartilage graft to create a dorsal nasal and alar framework. The patient healed with no complications, had become less reserved and her grades improved significantly after the operation. Further appointments are being scheduled to evaluate growth distortion and the resulting facial asymmetry. Surgical correction will be planned thereafter to further reconstruct the facial features. Evaluation of patient is necessary to explore possible clinical outcomes and corresponding treatment options. Multidisciplinary management is highly recommended, involving plastic surgeons, neurosurgeons, ophthalmologists, pediatricians, and pediatric psychiatrists in order to improve patient's quality of life. [ABSTRACT FROM AUTHOR]

Atypical lipomatous tumor, also known as well-differentiated liposarcoma, is rare in the head and neck region. The primary and most effective option in the treatment of this malignancy with a good prognosis is excision with clean surgical margins. Therefore, it is important to distinguish this malignancy from lesions that require more aggressive treatment. In this article, we present the case of an atypical lipomatous tumor originating from the nasopharynx and almost completely obstructing the oropharynx in a 38-year-old male patient with chronic lymphocytic leukemia. To the best of our knowledge, this is the first report in the literature of an atypical lipomatous tumor case originating from the nasopharynx. [ABSTRACT FROM AUTHOR]

Objective: The study was designed to evaluate the effectiveness of the asymmetric dorsal preservation technique for correcting I-shaped crooked nose deformity (CND). Methods: Patients with I-shaped CND who underwent asymmetric dorsal preservation in the period from September 2020 to September 2021 were included in this retrospective study. The Rhinomanometry and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was used to assess the outcomes. Deviation angle (DA) measurements were used to evaluate the degree of crookedness. The results were recorded both preoperatively and 12 months postoperatively. Results: Twenty-three patients were included in the study. Total nasal airflow and long-side nasal airflow were significantly higher 12 months postoperatively (p=0.001 each). Total nasal resistance, long-side nasal resistance, SCHNOS scores and DA measurements were significantly lower 12 months postoperatively (p<0.001 each). Conclusion: Asymmetric dorsal preservation is a successful alternative technique for correcting I-shaped CND and achieving optimal aesthetic and functional outcomes. [ABSTRACT FROM AUTHOR]

Objective: Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty. Methods: We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022. Results: Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode’s formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient. Conclusion: The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP. [ABSTRACT FROM AUTHOR]

Congenital unilateral choanal atresia (CA) is not considered an emergent condition and should not cause respiratory distress in the newborn. Therefore, surgical repair of unilateral CA is usually delayed. This description of a newborn with congenital unilateral CA that caused significant respiratory distress, recurrent cyanotic episodes, and severe feeding difficulties highlights an exception to that rule. [ABSTRACT FROM AUTHOR]

Purpose : In this study, we present a modified technique for primary cleft lip repair with a rotation triangular flap from the cleft lateral side to reconstruct the nasal floor; and evaluate the outcome compared with traditional Millard repair. Methods : 40 patients with unilateral cleft lip were included in this research. The patients were divided into 2 groups; 17 patients treated with the Millard technique, and 23 patients treated with the newly modified technique. 14 measurement indexes were employed to evaluate the nose-lip morphology of postoperative patients with UCCL in standardized photographs preoperatively, postoperatively and 1-year follow-up. Results : For lip symmetry, statistical significance was detected in the measurements of the vertical philtral height ratio indicating that the newly modified technique resolve the shortage of lip height on the cleft side 1-year follow-up. (P <.05). In addition, statistical significance was detected in the 1-year postoperative columellar angle, alar width ratio, nostril width ratio, nostril height ratio, and nostril shape (cleft) (P <.05), showing more successful repair of the nose compared with the traditional repair. Conclusions : The modified unilateral cleft lip repair with rotation triangle flap from the cleft lateral side was beneficial in the correction of lip and nasal deformity in and had positive effects on labial symmetry. [ABSTRACT FROM AUTHOR]

Choanal atresia is the most common congenital anatomical abnormality of the nasal cavities, manifested with a clinical picture of neonatal respiratory distress. The treatment requires interdisciplinary management based mainly on tertiary referral centre experiences. However, there is a lack of high-quality evidence in the available literature. Recommendations were prepared based on a systematic review of the supporting literature: on a website survey addressed to the participating authors consisting of 28 questions and on five live meetings. The initial response to the recommendations was determined at their presentation at the sectional meeting of the section for otorhinolaryngology of the Slovenian Medical Association. Then, reactions from the professional public were accepted until the recommendations were presented at the Expert Council for Otorhinolaryngology of the Slovenian Medical Association. A systematic literature review identified eight systematic reviews or meta-analyses and four randomized controlled clinical trials. Thirty-four recommendations for diagnosis, treatment and postoperative management were consolidated. The paper presents the proposal and first Slovenian recommendations for treating patients with choanal atresia. They are based on foreign medical institutions' published literature and our clinical experience. They represent the basic requirements of diagnostics and may represent an essential guide in treatment. [ABSTRACT FROM AUTHOR]

Proboscis lateralis (PL) is a rare congenital craniofacial anomaly and it is represented by rudimentary, tube-like nasal structure measuring 2–3 centimetre (cm) length and generally attaches to medial canthal region. A 22-month-old male patient was referred to our clinic with a PL hanging from the right medial canthus and a coloboma on the medial third of the right lower eyelid. Physical examination revealed that the PL was 4 cm long and 1.5 cm in diameter. There was a blind cavity with dimple at its distal segment. The right side of the nose and the nasal airway was aplastic. Before surgical correction, neuroradiological evaluation should be performed to obtain the characteristics and relationship of the lesion with adjacent structures and associated anomalies Many reconstructive options have been described in the literature, however, these options are insufficient to obtain natural contour and define alar crease, especially. We described the laterally-based skin flap from the medial wall of the left heminose and adapted to the lateral edge of the de-epithelialized skin of PL for defining supra-alar crease. [ABSTRACT FROM AUTHOR]

Introduction: Nasal fracture is the most common fracture of the maxillofacial region, so surgeons’ and patients’ satisfaction after closed reduction from aesthetic and functional (including the effects of respiration and olfaction) perspective is important. The aim of this study was to evaluate the satisfaction of surgeons and patients with the appearance and function of the nose after closed reduction surgery during 6-12 months after surgery to improve the outcomes of this procedure. Materials & Methods: This descriptive-analytical and cross-sectional study was performed on 90 patients in Alzahra and Kashani hospitals of Isfahan during the years 1397-1398 who underwent a closed reduction of nasal fracture within 6-12 months after surgery. All patients and surgeons answered questions about aesthetic and functional outcomes and the need for septorhinoplasty after closed reduction. Pearson correlation coefficient, t-test and paired-sample t-test were used to analyze the data. P value less than 0.05 was considered as a significant level. Results: About 55% of patients were satisfied with the aesthetic outcome and 38.8% expressed they would consider further surgery to correct the residual nasal deformity. The mean score of surgeons’ satisfaction for nasal aesthetics and function was 3.74 and 3.50. Surgeons expressed that the patients’ requirement for septorhinoplasty is low to moderate. Conclusion: Satisfaction of the patient and the surgeon with the nasal closed reduction was in high-medium range. Also, according to both patients’ and surgeons’ opinions, requirement for septorhinoplasty surgery has a significant and direct relationship with aesthetic issues and also obstruction of the airway following a nasal bone fracture. [ABSTRACT FROM AUTHOR]

Introduction: Craniofacial clefts are rare congenital anomalies that might involve both soft tissue and skeletal components. The association of Tessier cleft number 3 and 4 with choanal atresia appears to be unusual and only few clinical cases have been reported in published literature. Objectives: Report a series of 13 cases of choanal atresia in patients with Tessier numbers 3 or 4 clefts and the literature review on this topic. Methods: A literature review was undertaken via PUBMED database before April 2020 addressing the association between Tessier numbers 3 or 4 clefts and choanal atresia. Retrospective chart review of patients diagnosed with both comorbidities at a tertiary hospital expertised in craniofacial anomalies. Results: Literature review yielded 10 studies describing the relationship between choanal atresia and Tessier 3 and 4 facial clefts. We identified 98 patients diagnosed with medial oro-ocular facial clefts (Tessier 3 and 4) and 119 with choanal atresia at our institution over a 20 years time period. Altogether, 13 individuals were diagnosed with both malformations, 3 patients with number 3 cleft, and 10 patients with number 4 cleft. It represents 13.26% of the cases. Conclusion: This study highlights the features of Tessier 3 and 4 facial clefts associated with choanal atresia. Although the publications regarding this association are very scarce, the authors present the largest series of cases of Tessier number 3 and 4 clefts with choanal atresia showing that association between these conditions could be not so unusual. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effects of concurrent inferior turbinectomy and balloon Eustachian tuboplasty on symptoms related to Eustachian tube dysfunction. Methods: This comparative case-control study prospectively enrolled 50 patients who underwent balloon Eustachian tuboplasty with inferior turbinectomy between September 2020 and March 2021. Retrospectively, an additional 50 patients who underwent balloon Eustachian tuboplasty without inferior turbinectomy between June 2019 and August 2020 were enrolled as the control group after frequency-matching by age and sex. The Eustachian Tube Dysfunction Questionnaire-7 and the nasal obstruction symptom evaluation scores were compared between the 2 groups. Results: The Eustachian Tube Dysfunction Questionnaire-7 scores significantly differed between patients who underwent a balloon Eustachian tuboplasty with inferior turbinectomy and those who underwent a balloon Eustachian tuboplasty without inferior turbinectomy (preoperative: 24.9 ± 5.91 vs. 25.3 ± 6.91 (P = .79); postoperative: 13.7 ± 4.75 vs. 17.2 ± 5.71 (P = .02)). The nasal obstruction symptom evaluation scores also significantly differed between patients who underwent a balloon Eustachian tuboplasty with inferior turbinectomy and those who underwent a balloon Eustachian tuboplasty without inferior turbinectomy (preoperative: 74 ± 13.45 vs. 77 ± 14.29, (P = .26); postoperative: 25.9 ± 4.7 vs. 75.9 ± 8.7 (P < .0001)). Conclusion: Concurrent balloon Eustachian tuboplasty with inferior turbinectomy is safe and can improve subjective Eustachian tube function in patients with nasal obstruction and Eustachian tube dysfunction. Moreover, it may be an optional technique for surgeons to ameliorate Eustachian tube dysfunction. [ABSTRACT FROM AUTHOR]

Choanal atresia is a developmental failure of the nasal cavity to connect with the nasopharynx. The cause is either unilateral or bilateral nasal obstruction. Bilateral choanal atresia is a very rare condition and diagnosed soon after birth because neonates are obligate nasal breathers. Delayed diagnosis can cause death due to respiratory distress. The objective of this study was to report bilateral choanal atresia in 5-year-old boy who survived by breathing through his mouth using a simple tool made by his parent. It was a very rare condition because the posterior nasal cavity was covered by medial wall malformations of both maxillary sinuses which fused with the posterior nasal septum. The surgery method for this patient was posterior septectomy with transnasal endoscopic to create a neochoanae. The post-operative patient could breathe normally through his nose. Six weeks later, the nasal endoscopic evaluation indicated the patient's patent neochoana. [ABSTRACT FROM AUTHOR]

The asymmetric nose is challenging for even the most experienced rhinoplasty surgeons. It has often been referred to as the crooked, twisted, and deviated nose and describes any nose that has deviation of the nasal dorsum and pyramid from the facial midline. This article summarizes the senior author's (SPM) approach and application of structural and preservation concepts to correct the underlying causes of the crooked nose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Our study aimed to evaluate a stepwise treatment of class III malocclusion accompanied with flat nasal deformity, using orthodontics, orthognathic surgery, and rhinoplasty, as well as stability during long-term follow-up. In total, 27 patients with nasomaxillary hypoplasia and skeletal class III malocclusion were enrolled in this study. All patients had accepted orthodontic and orthognathic surgery, followed by rhinoplasty with costal cartilage as the second surgical procedure. Clinical results were evaluated by radiography, medical photography, questionnaire, and cephalometric analysis. All patients were satisfied with the surgical results and no serious complications occurred. During the follow-up, the patients showed well-corrected midface contour and nasal projection, and stable occlusion. The costal cartilage grafts were well fixed, without obvious absorption deformation. Lateral cephalometric analysis and overlay results showed that the postoperative point A had advanced approximately 5.20 ± 1.43 mm and the SNA angle had increased by approximately 5.59 ± 2.86°. Soft-tissue measurements showed a 14.22 ± 6.56° decrease in the facial lobe, while the nasolabial angle had increased by 16.83 ± 6.65° postoperatively. The results suggested that stepwise orthodontic-orthognathic surgery and rhinoplasty produce a predictable and stable result in long-term follow-up., Competing Interests: Declaration of competing interest None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. None of the authors has any conflicts of interest., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Tip refinement procedures are still controversial in secondary unilateral cleft rhinoplasty. The aim of this study was to assess whether the septal extension graft improved nasal and tip deformity and achieved a normal profile with clinical and three-dimensional morphometric analyses., Methods: A consecutive series of 194 skeletally mature patients with unilateral cleft were included and analyzed. All had undergone secondary open rhinoplasty, performed by a single surgeon, with the use of the septal extension graft between 2013 and 2021. Clinical data were collected, and three-dimensional morphometric measurements were performed. An age-, sex-, and ethnicity-matched normal group was included for comparisons., Results: The authors' standard procedures included open approach combining reverse-U incision, septal extension graft, dorsal augmentation, lip revision, and vermilion augmentation. The postoperative outcome showed significantly increased numerical values (nasal bridge length, nasal height, nasal tip projection, nasal dorsum angle, columellar angle, columellar-lobule angle, nostril height ratio, nasal surface area, nasal volume) and decreased numerical values (alar width, tip/middle deviation, nasal tip angle, labial-columellar angle) compared with the preoperative morphology. The postoperative measurement showed significantly higher numerical values (nasal protrusion, tip/middle deviation, nasal dorsum angle) and lower numerical values (columellar-lobule angle, nostril height ratio, alar width ratio) compared with the control group., Conclusions: This study revealed that the authors' secondary cleft rhinoplasty significantly improved the underprojected, up-rotated, deviated, and poorly defined tip and short nasal bridge deformities. The technique could result in the nose of the patients with cleft lip nasal deformity being closer to that of the normative profile., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Objective: This is a cross sectional study aimed to asses novel semi objectve compter assisted method to asses the symmetry amog unilateral cleft lip patients., Design: using Standard inferior view nose photos that were uploaded to Digimizer© Version 4.6.1 (2005-2016 MedCalc Software) Image Analysis, symmetry percentage was calculated and compared between cleft and non-cleft neonates. This method was compared to two subjective methods of rating symmetry., Setting: This a cross sectional pilot study performed in the Univresity Medical Center using standard inferior views of unilateral cleft patients which were compared to non-cleft neonates., Patients: Photographs of 71 neonates with unilateral complete and incomplete cleft lip and 30 neonates without facial cleft, which were born at the university medical center, Beer Sheba, Israel, were analyzed in a standard manner to determine nasal symmetry., Main Measures: the novel method proposed produced a nominal value for percentage of symmetry., Results: Using Pearson's correlation test we found intra-rater reliability of 91.2% (p < 0.001) and Inter-rater reliability of 82.9% (p < 0.001). The analysis correlated with the surgeons subjective scores in both the numerical ranking method at 73% (p < 0.001) and 72.6% (p < 0.001) and the Ordinal ranking method at 87.6% (p < 0.001) and 77.7% (p < 0.001). The ability of the method to discriminate healthy from Cleft Lip patients overall was 92.3% With high sensitivity and specificity., Conclusions: This method accurately distinguishes healthy patients from cleft lip patients. We have achieved High levels of inter and intra-rater reliability. Significant correlations were found between our semiobjective method and the subjective scores., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The existing literature is conflicted on whether nasal deviation is primarily attributable to trauma or the result of asymmetric facial development., Objectives: The aim of this study was to establish the prevalence of nasal trauma and facial asymmetry in patients undergoing rhinoplasty, and to determine if a correlation exists between the laterality of facial asymmetry and nasal deviation., Methods: A retrospective review was undertaken of patients who had undergone primary rhinoplasty with the senior author over a 12-month period. Patient charts were reviewed and clinical photographs were analyzed., Results: In total, 144 patients underwent rhinoplasty over the study period; 68 patients underwent revision rhinoplasty and were excluded. Of the 76 patients who underwent primary rhinoplasty, 9% reported prior nasal trauma, 68% had deviated nasal bones, 46% had deviated nasal tips, 70% had asymmetric midfaces, and 36% had deviated chins. In patients without prior trauma history, nasal bones were most commonly deviated towards the side of midface hypoplasia (53%, P = .008). The nasal tip was most commonly deviated contralateral to the side of septal deviation (59%, P = .001). There was no association between nasal bone and chin deviation. Nasal tip deviation was not associated with midface hypoplasia or chin deviation., Conclusions: Nasal deviation is primarily driven by asymmetric facial growth rather than being the result of nasal trauma., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Standardized and reliable medical photographs are crucial for preoperative and postoperative comparisons and academic communication in the medical field. There is limited research on photographic techniques in patients with cleft lip. Deformities of the lip and nose in patients with cleft lip are not only associated with morphological abnormalities but also with abnormalities of muscle function., Methods: Considering the morphology and function of the lips and nose in cleft lip patients, the study captured the deformity of cleft lip patients in 6 positions: frontal view, 45 degrees left-right tilted side view, 90 degrees left-right tilted side view, and basal view, and in 5 facial expressions: tightly closed lips, slightly open mouth, smiling, teeth bared, and pout., Results: In 6 different positions and 5 different expressions, we took pictures of lip and nasal deformities covering most of the common deformities in patients with cleft lip, such as white lip scarring, interruption of continuity of vermillion border, lip prolapse, asymmetric corners of the mouth, collapsed ala nasi, loss of the nasal base and deviated nasal septum., Conclusions: This paper suggests a set of effective, easy-to-follow, and precise photographic protocols to assist cleft lip surgeons in capturing suitable and informative, high-quality 2D digital photographs., Level of Evidence: Level-V., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

This paper presents the findings of an observational study involving 38 patients to evaluate the application of a surgical technique utilizing an autologous costal cartilage scaffold for correcting nasal tip and alar asymmetry in unilateral cleft lip-nasal deformity. Nasal septum extension spreader grafts (SEG) and warped alar batten grafts, both made from autologous costal cartilage, were utilized in open rhinoplasty procedures. The warped alar batten graft was fixed to the caudal end of the SEG, with the lower lateral cartilage on the cleft side suspended to the free part of the newly created warped alar batten graft to lift the collapsed nasal alar further. Measurements of nasal tip height, nostril height, and the intersection angle of the nasal sill and alar (α) were taken before and after surgery, comparing the ratios between the normal and cleft sides. Patients were followed up for 2.5 to 5.5 years, with all cases showing successful healing and no complications. Postoperative improvements in nasal tip and nostril asymmetries were significant, with statistically significant changes observed in nasal tip height, nostril height, and the intersection angle of nasal sill and alar (α) ( P <0.05). The combined use of SEG and warped alar batten graft, both crafted from autologous costal cartilage, effectively corrected nasal tip and alar asymmetry in adult cleft lip nasal deformity cases., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Purpose: The aim of the present study was to objectively and subjectively compare the preoperative and postoperative aesthetic and functional outcomes of the correction of crooked noses using a suture technique we call "nasal axis lateralization suture (NALS)"., Method: A total of 36 patients who had preoperative and postoperative photographs taken and who completed the Rhinoplasty Outcome Evaluation (ROE) questionnaire were included in the study., Results: Crooked noses were divided into two groups: C-shaped (17 patients) and I-shaped (19 patients). The preoperative and postoperative nasal axis angles were 145.3 ± 11.9 and 178.5 ± 3.3, respectively, in C-shaped nasal deviation. In I-shaped nasal deviation, on the other hand, the preoperative nasal axis angle was 8.8 ± 2.8, while the postoperative nasal axis angle was 1.4 ± 2.4. In terms of the ideal axis percentage before and after surgery, a significant difference was found between the C-shaped and I-shaped nasal deviation patient groups (p < 0.05). While there was a significant improvement in both groups in the evaluation based on the ROE questionnaire, satisfaction was much higher in the C-shaped nasal deviation group. In both groups, the ROE values of functional and aesthetic outcomes were significantly different compared to the preoperative values of both groups (p < 0.005)., Conclusion: NALS can be used as an alternative technique to correct both I-shaped and C-shaped nasal axis deviations., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Johanson-Blizzard syndrome (JBS) is an autosomal recessive disorder. We established an induced pluripotent stem cell (iPSC) line from peripheral blood mononuclear cells of a 2-year-old boy with Johanson-Blizzard syndrome carrying a compound heterozygous mutation of c.3167C>G (p.S1056X) and c.1911 + 14C>G(splicing) in the UBR1 gene. This iPSC line was free of exogenous gene, expressed stemness markers, exhibited differentiation potential, had normal karyotype and harbored the same mutations found in the patient. The iPSC cellline can serve as a disease model in drug development and novel personalized therapies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Trichorhinophalangeal syndrome (TRPS) is a genetic disorder caused by point mutations or deletions in the gene-encoding transcription factor TRPS1. TRPS patients display a range of skeletal dysplasias, including reduced jaw size, short stature, and a cone-shaped digit epiphysis. Certain TRPS patients experience early onset coxarthrosis that leads to a devastating drop in their daily activities. The etiologies of congenital skeletal abnormalities of TRPS were revealed through the analysis of Trps1 mutant mouse strains. However, early postnatal lethality in Trps1 knockout mice has hampered the study of postnatal TRPS pathology. Here, through epigenomic analysis we identified two previously uncharacterized candidate gene regulatory regions in the first intron of Trps1. We deleted these regions, either individually or simultaneously, and examined their effects on skeletal morphogenesis. Animals that were deleted individually for either region displayed only modest phenotypes. In contrast, the Trps1Δint/Δint mouse strain with simultaneous deletion of both genomic regions exhibit postnatal growth retardation. This strain displayed delayed secondary ossification center formation in the long bones and misshaped hip joint development that resulted in acetabular dysplasia. Reducing one allele of the Trps1 gene in Trps1Δint mice resulted in medial patellar dislocation that has been observed in some patients with TRPS. Our novel Trps1 hypomorphic strain recapitulates many postnatal pathologies observed in human TRPS patients, thus positioning this strain as a useful animal model to study postnatal TRPS pathogenesis. Our observations also suggest that Trps1 gene expression is regulated through several regulatory elements, thus guaranteeing robust expression maintenance in skeletal cells., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: Capsular contracture is a rare but serious complication of silicone implant-based augmentation rhinoplasty. When severe, the contracture can affect all layers of the nose, causing significant scarring and disfigurement. There is currently no standardized method of evaluating contracted noses and a paucity of literature on the treatment of severe contracture. Therefore, this study aimed to establish a comprehensive grading system and treatment approach for patients with nasal contracture secondary to silicone implant-based rhinoplasty., Methods: We conducted a retrospective analysis on patients who presented with nasal contracture from 2012 to 2021. All preoperative photographs were evaluated by two plastic surgeons, twice at 1-month intervals. The proposed grading system comprised: normal (grade I), mild contracture with detectable implant (grade II), moderate contracture with skin thinning (grade III), severe contracture with short nose deformity (grade IV), and destructive contracture with scarring of the dorsal skin (grade Va), or columella deficiency (grade Vb). Inter- and intraobserver agreement was assessed using the kappa value to determine the reliability of the system., Results: Based on 87 patients, interobserver agreement was substantial for both evaluation time points (k = 0.701 and 0.723). Intraobserver agreement was excellent for evaluator 1 (k = 0.822) and substantial for evaluator 2 (k = 0.699)., Conclusions: Using this grading system, we propose a graduated treatment algorithm for contracted noses. Most notable is our use of radial forearm free or forehead flaps to reconstruct the columella in grade Vb patients. By combining reconstructive and aesthetic principles, this treatment approach provides an effective and elegant solution for the management of the severely contracted nose., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Summary: Columellar base deviation is a common and challenging deformity in patients with unilateral cleft lip. Debate continues on its surgical correction without sufficient studies to establish effective management. This article presents the authors' experience in correcting the columellar base deviation with the muscle-driven method in primary lip repair. The key is to perform extensive muscle dissection and reconstruction. In the medial lip segment, muscle dissection is performed subcutaneously up to the contralateral nostril floor for effective lengthening and rotation. In the lateral lip segment, muscle dissection is executed in both submucosal and subcutaneous planes, and muscle component is extensively separated from the lip skin and buccal mucosa. The lateral muscle flap is advanced and reattached to the contralateral nostril floor and columellar base using a subcutaneous sustaining suture. Cinching suture between columellar base and alar base is performed. These 2 sutures help centralize and overcorrect the columellar base. Bilateral muscle components are reoriented and approximated in a Z-plasty format for lengthening of the lip. The patients were followed up for at least 3 years. Quantitative measurements of deviation in columellar base angulation were taken and revealed 55.8 ± 2.6 degrees (before nasoalveolar molding), 29.6 ± 1.7 degrees (after nasoalveolar molding), and 2.8 ± 0.4 degrees (postoperative follow-up), respectively. The muscle-driven method represents a safe and effective technique to correct columellar base deviation in patients with unilateral cleft lip., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Meier-Gorlin syndrome (MGORS) is an autosomal recessive disorder characterized by short stature, microtia, and patellar hypoplasia, and is caused by pathogenic variants of cellular factors involved in the initiation of DNA replication. We previously reported that biallelic variants in GINS3 leading to amino acid changes at position 24 (p.Asp24) cause MGORS. Here, we describe the phenotype of a new individual homozygous for the Asp24Asn variant. We also report the clinical characteristics of an individual harboring a novel homozygous GINS3 variant (Ile25Phe) and features suggestive of MGORS. Modification of the corresponding residue in yeast Psf3 (Val9Phe) compromised S phase progression compared to a humanized Psf3 Val9Ile variant. Expression of Psf3 Val9Phe in yeast also caused sensitivity to elevated temperature and the replicative stress-inducing drug hydroxyurea, confirming partial loss of function of this variant in vivo and allowing us to upgrade the classification of this variant. Taken together, these data validate the critical importance of the GINS DNA replication complex in the molecular etiology of MGORS., (© 2024 The Authors. Clinical Genetics published by John Wiley & Sons Ltd.)

Objective: To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery., Design: Descriptive clinical study with one group, prospective., Setting: Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam., Patients: 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery., Interventions: Interventions include PNAM and cheiloplasty by modified Millard technique., Main Outcome Measures: Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance., Results: After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm)., Conclusion: Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Supernumerary Nostril, also called triple nostrils or accessory nostril, is a rare congenital nasal malformation.Case Presentation: We report one conceal case of supernumerary nostril in a 19-years-old men which is misdiagnosed to a simple small nasal skin pit. Ordinary surgical excision led to recurrent infection of the lesion postoperatively, and was eventually required secondary surgery and the lesion was finally confirmed by pathological biopsy as a trinasal nostrils.Conclusions: Through this case, we stress the essential role in differential diagnosis, confirming the diagnosis and seeking for better solutions. Level of Evidence V. [ABSTRACT FROM AUTHOR]

Aim: The term frontonasal dysplasia (FND) represents a spectrum of anomalies and its genetics have not been well defined. Recently, the critical role of the aristaless-like homeobox (ALX) gene family on the craniofacial development has been discovered. In the present study, we aimed to propose a systematic surgical treatment plan for the ALX -related FNDs according to the genotypic classification as well as demonstrating their clinical characteristics to help surgeons diagnose the underlying pathology accurately. Design: Single-institution retrospective. Setting: Tertiary health care. Patients and Methods: Eighty-nine FND cases were evaluated. Eight of them had ALX1 -related FND3, 3 had ALX3 -related FND1, and 2 had ALX4 -related FND2. Phenotype characteristics of ALX -related FNDs were evaluated, and relevant surgical interventions were assessed. Results: The ALX1 -related FND3 phenotype is striking due to the involvement of the eyes in addition to the presence of hypertelorism, facial clefts, and nasal deformities. A widened philtrum and prominent philtral columns are remarkable features of the ALX3 -related FND1, whereas the ALX4 -related FND2 has more severe deformities: severe hypertelorism, brachycephaly, large parietal bone defects, broad nasal dorsum, and alopecia. Facial bipartition, box osteotomies, eyelid coloboma repair, cleft lip and palate repair, nasal reconstruction, and fronto-orbital advancement can be performed in ALX -related FNDs based on the characteristics of each subtype. Conclusions: This genetic classification system will help surgeon diagnose patients with FND with unique features and draw a roadmap for their treatment with a better surgical perspective. [ABSTRACT FROM AUTHOR]

Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and airway. We report our novel multistaged reconstructive approach and literature review. Nasal methyl methacrylate prosthesis was created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 with cannulization was utilized for midface advancement and airway formation. External framework was reconstructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. Patient was pleased with the aesthetics and had safe decannulation with the ability to breathe through the nose and airway. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of postoperative nasal stenting in preserving nasal shape and preventing nostril stenosis in cleft rhinoplasty, and to develop a classification system for postoperative nasal stents., Design: Systematic review., Methods: Electronic and manual searches of scientific literature were conducted from 3 databases (PubMed, SCOPUS, OVID). Primary evidence that described postoperative nasal stenting in cleft rhinoplasty were included. Exclusion criteria included secondary evidence, non-English articles, and studies focusing on preoperative nasal stents., Patients and Participants: Patients with cleft lip/nose of any type were included., Main Outcome Measure(s): Role in preservation of nasal shape & symmetry, role in prevention of nostril stenosis, complications with the use of postoperative nasal stent., Results: Of the 13 articles, 9 papers described the preservation of nasal shape with nasal stents and three studies with a control group showed improved symmetry score. No studies evaluated the prevention of nostril stenosis; however, 2 studies reported improvement of nostril stenosis in secondary cleft rhinoplasty. The results of the included studies had significant heterogeneity. Nasal stents were classified into five types: Type I-spare parts assembled, Type II-prefabricated commercial, Type IIIa-patient specific 3D-printed static, Type IIIb-patient specific dynamic, and Type IV-internal absorbable. Total complications were 6.0%, including irritation (0.9%), infection (0.3%), and stent loss (4.6%)., Conclusion: Despite the lack of consensus with postoperative nasal stents, this review suggests its safety and role in preserving shape and improving stenosis. Our classification system highlights variability and the need for better quality studies to determine the efficacy of nasal stents., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Rhinoscleroma is a rare endemic disease in low socioeconomic settings characterized by nasal growth, nasal blockage, and epistaxis. The causative organism is not an usual nasal commensal, and diagnosis is often delayed. Characteristic Mikulicz cells should be visualized microscopically for definitive diagnosis. We present our experience of rhinoscleroma with unusual presentation of severe headache and orbital mass in three patients over an 11-year period in the pathology laboratory of a tertiary hospital. [ABSTRACT FROM AUTHOR]

Introduction: The basis of dorsal preservation rhinoplasty goes back to the late 19th and the early 20th centuries. In that era, pioneers such as Drs. Goodale, Lothrop, and Cottle were prominent surgeons who reported on this technique. Currently, there has been a renewed interest of this technique that stems from the nasal anatomy and an interest in less destructive techniques. In this review, we discuss examples of the contributions of those surgeons, which represent some of the earliest experiences in this field. Methods: We reviewed several journals from the late 19th and early 20th centuries as detailed in the references section. We collected the related publications on closed reduction techniques performed by Drs. Goodale, Lothrop, and Cottle. Results: The publications on closed reduction techniques by Drs. Goodale, Lothrop, and Cottle described similar thought processes and techniques comparable to current dorsal preservation rhinoplasty techniques. The thought processes of these 3 renowned rhinoplasty surgeons appear to be very much relevant today. Conclusions: Although there has been recent resurgence in dorsal preservation rhinoplasty techniques due to anatomical and functional aspects of the nose, the basis of dorsal preservation rhinoplasty goes far back to more than 100 years ago. [ABSTRACT FROM AUTHOR]

Trichorhinophalangeal syndrome (TRPS) is an autosomal dominant genetic malformation disorder which is best characterized by both its craniofacial and skeletal abnormalities. The purpose of this paper is to identify the various orthopedic manifestations and management in patients with TRPS. A systematic search of PubMed, Ovid MEDLINE, and Cochrane Library was conducted. They were each individually searched for primary articles yielding information on the orthopedic manifestations and management of patients with TRPS. The goals and results of each of the included studies were described. Data regarding the demographics, orthopedic condition, treatment strategy, and outcomes were extracted and analyzed. 221 unique articles were retrieved, with 13 articles being included in the study. 26 patients with TRPS were identified. Trials of conservative management were reported for 14 patients, and surgical intervention was pursued for 8 patients. The mean age for surgery was 14.1 years. The most common orthopedic manifestations of TRPS are clinodactyly, Perthes-like changes, and coxa magna. Early identification and maintenance of TRPS is important for being able to monitor musculoskeletal health of the patients in order to prevent detrimental outcomes. Additional high-quality research is required regarding the orthopedic manifestations and treatment of this patient population., Competing Interests: There are no other conflicts of interest or financial disclosures to report., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Objective: This study used three-dimensional measurements to provide a nasolabial analysis of patients with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and controls across different races and ethnicities., Design: A retrospective comparative study., Setting: Tertiary care pediatric institution., Patients, Participants: The study included 90 patients with UCLP, 43 patients with BCLP, and 90 matched controls. Patients are separated as self-identified Caucasian, Hispanic, or African American., Main Outcome Measure(s): Nasal length, nasal protrusion, columellar height, columellar width, tip width, alar width, alar base width, nasolabial angle, upper lip length, philtrum length, nostril height, and nostril width., Results: All UCLP groups had significantly greater columella and tip widths and decreased nasolabial angles than controls. All BCLP groups had significantly greater columella width, tip width, nasolabial angle, and nostril widths. Upper lip length, philtrum length, and nostril height were significantly decreased in BCLP compared to controls. Across UCLP groups, African Americans had significantly decreased nasal protrusion and columella height and a significantly increased columella width compared to Caucasians and Hispanics. Alar and alar base widths were significantly different between all groups. Across BCLP groups, the Caucasian nostril width was significantly less than the African Americans., Conclusions: These findings suggest that when correcting nasolabial characteristics in patients with cleft lip, it is important to consider racial and ethnic differences to achieve a normal appearance. Specifically, goals for alar width, alar base width, nasal tip, and projection should be tailored to the patient's race and ethnicity., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Alar asymmetry in unilateral cleft lip (UCL) nasal deformity is a well-recognized clinical feature. However, there is a lack of comprehensive quantitative analysis of this asymmetry. This study compares the shape, volume, and axis rotation between the cleft and non-cleft ala in skeletally mature patients with UCL., Design: A retrospective comparative study utilizing three-dimensional rendered CT scans., Setting: Tertiary care pediatric institution., Patients, Participants: This study included 18 patients with UCL nasal deformity at skeletal maturity., Main Outcome Measure(s): Cleft and non-cleft side ala volume, surface area, and axis to the midsagittal plane., Results: The cleft-side ala was significantly lesser in volume by 27.3%, significantly lesser in surface area by 17.6%, and significantly greater in surface area to volume ratio by 14.6% than the non-cleft ala. The cleft-side ala was significantly greater by 43.1% horizontal axis to the midsagittal plane. In patients with primary rhinoplasty, the cleft-side ala had 28.0% less volume and 18.7% less surface area. In intermediate rhinoplasty, the cleft-side ala had 39.1% less volume and 23.5% less surface area than the non-cleft ala., Conclusions: Significant asymmetry exists between the cleft-side and non-cleft ala in patients with UCL. The cleft-side ala is significantly smaller in volume and surface area than the non-cleft ala. Additionally, the cleft-side ala demonstrates a significantly greater horizontal axis that contributes considerably to nasal asymmetry, supporting the need to restore a normal vertical axis to the clef-side ala., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.