[Show abstract][Hide abstract] ABSTRACT: This is a systematic review of the available literature and our own personal experience regarding the optimal management of the rhinoplasty patient. The routine utilization of nasal splinting, casting and perioperative antibiotics is supported. The management of a number of common early complications is also discussed. Meticulous technique based on sound structural principles and coupled with preoperative planning and attention to wound care will result in a favorable outcome in most individuals undergoing rhinoplasty.
Southern medical journal 10/2008; 101(9):935-9. · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nasoseptal injuries have traditionally been treated via closed reduction. Historically, the high incidence of postreduction deformities has led some surgeons to consider alternative approaches to obtain superior results. Here we compare simple closed reduction versus primary open repair of the nasoseptal fracture.
This was a prospective study of 40 consecutive patients treated with simple closed reduction of their combined nasal bone and septal fracture versus 40 patients treated with closed reduction of their nasal bone fracture and open treatment of the septum. Group outcomes were then compared.
In the closed reduction group, 60% had significant postoperative septal deviation, whereas only 12.5% suffered from residual septal deformity in the open group. This resulted in a statistically significant reduction (p < .01) of patients requiring a second operation to formally address the septum.
By addressing the septum through an open approach, a statistically significant reduction in the number of patients requiring revision rhinoplasty was achieved.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 08/2008; 37(4):502-6. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe a simple technique for harvesting tragal cartilage and describe its use in rhinoplasty.
Rhinoplasties performed between January 2005 and June 2007 in which tragal cartilage grafts were utilized by the senior author (CSC) were reviewed to assess type of graft, preservation of tragal contour, and donor-site morbidity.
Tragal cartilage grafts were used in three primary and three secondary rhinoplasty patients. Postoperative follow-up ranged from six months to 12 months. Tragal cartilage was used as five alar contour grafts, one lateral crural onlay graft, one dorsal onlay graft, and one infratip lobule graft. Tragal cartilage was used to close the septal perforation of one patient. Tragal contour was preserved in all patients, and there were no complications noted with this procedure.
The tragus provides a simple, convenient alternative source of cartilage for rhinoplasty in graft-depleted patients.
Otolaryngology Head and Neck Surgery 03/2008; 138(2):166-9. · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of the study was to evaluate the accuracy by which computer-simulated rhinoplasty images reflect surgical results in 6-month postoperative photographs.
We performed a retrospective, objective evaluation of 5 features of the facial profile in the computer-simulated images and in the 6-month postoperative photographs of 36 rhinoplasty patients. Data recorded for the nasolabial angle, nasofrontal angle, columella tip angle, columella/infratip lobule ratio, and an established method of assessing tip projection were subjected to statistical analysis by 2-tailed t test and analysis of variance testing.
Simulated and actual measurements of columella tip angle were found to be significantly different (P = .021). The set of measurements taken from computer-simulated images at the nasolabial angle (P = .301), nasofrontal angle (P = .471), columellar/infratip lobule ratio (P = .402), and tip projection ratio (P = .547) were not statistically different from the respective measurements recorded from the 6-month follow-up images.
No significant difference was found between the measurements recorded from computer-simulated images and those recorded from 6-month postoperative photographs in 4 of the 5 features of the facial profile studied. The accuracy and predictive value of computer-simulated images is demonstrated and quantified for the first time.
American journal of otolaryngology 01/2008; 29(3):151-5. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the effect of multiple autoclave sterilization cycles on the integrity of titanium plates and screws used in craniofacial reconstruction.
Torque to fracture was evaluated for 36 titanium 6AL-4V (Ti 6/4) screws divided evenly into 3 groups and tested as machined (control), after 10 cycles of autoclaving or after 50 cycles of autoclaving. Sterilization was carried out by autoclaving for 15 minutes followed by 8 minutes of drying at 270 degrees to 272 degrees F. The maximum torque attained before fracture was recorded. Rotating beam specimens were crafted from single lots of Ti 6/4, commercially pure titanium grade 4 (CP4) and commercially pure titanium grade 2 (CP2), and then subjected to testing in a standard rotating beam device as machined (control), after 10 cycles of autoclaving or after 50 cycles of autoclaving. The cycles required to fracture the specimen at a given applied stress were recorded for each material and for the number of autoclavings carried out before testing.
Although there was a trend toward decreased strength and increased ability to fracture with increased number of autoclave cycles, this did not reach statistical significance. Torque to fracture testing for 7 mm Ti 6/4 screws showed no significant difference in the maximum torque reached before fracture between controls, those screws that had been autoclaved 10 times (P < .500 +/- 5.70) and those that had been autoclaved 50 times (P < .398 +/- 4.08). Rotating beam specimens of Ti 6/4, CP4, and CP2 showed no significant difference in cycles to fracture regardless of the number of sterilization cycles to which the material was subjected.
Repeated cycles of autoclaving had no significant effect on the integrity of titanium plates and screws routinely used in craniofacial surgery.
Journal of Oral and Maxillofacial Surgery 05/2007; 65(5):940-4. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The objective of this study is to review our favorable experience in performing rhinoplasty in aging patients.Methods: All patients aged 65 years or greater who underwent rhinoplasty, either esthetic or functional, by the senior author (Y.D.) from August 1997 to July 2005 with a minimum follow up of 1 year were retrospectively reviewed.Results: A total of 51 patients met the inclusion criteria and had complete records available for review. The average age was 69.5 years (range, 65–82 years) with 24 female and 27 male patients. All but two patients underwent open rhinoplasty. Eighteen procedures represented secondary rhinoplasties. Seven patients required auricular cartilage grafts, and 11 patients required costal cartilage grafts. One costal cartilage graft was aborted as a result of excessive calcification. All patients underwent columellar strut placement, 92% underwent internal valve grafts, and 80.4% underwent grafting of the external nasal valves. Nasal osteotomies were performed in only 23.5% of patients, all with the percutaneous technique. Revision surgery was necessary in only three (5.8%) patients, all of whom required grafting of the external valve (not performed primarily). In each of these cases, no significant external valve collapse was noted preoperatively. Premaxillary augmentation with diced or crushed cartilage grafts was performed in 81.8% (n = 18) of patients with an edentulous maxillary arch.Conclusions: Aging patients present unique technical challenges in rhinoplasty that warrant a comprehensive approach to restore internal and external valve competency and tip support. Consideration of prophylactic external valve grafts in addition to the routine use of internal valve grafts and columellar struts may help decrease the need for revision surgery in this patient population. Reasonable functional and esthetic outcomes can be expected in the aging patient.
The Laryngoscope 04/2007; 117(5):803 - 807. · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Liposuction of the lower face and neck regions is a time-honored technique associated with aesthetically pleasing long-term results in the majority of patients. The keys to achieving an excellent outcome remain, as always, appropriate patient selection and proper execution. Modern ideals tend to favor more natural, blended results rather than the skeletonized appearance noted often in the past. Particular attention in the preoperative assessment must be directed at evaluation of the position of the hyoid bone and submandibular glands as well as the patient’s overall body habitus. Concurrent rhytidectomy, neck lift or platysma plication may be required if significant skin laxity is present.
Operative Techniques in Otolaryngology-Head and Neck Surgery 01/2007; 18(3):261-266.
[Show abstract][Hide abstract] ABSTRACT: Age is the most significant factor contributing to the overall change in the appearance of an individual’s facial features over time. This gradual process of structural weakening of the face begins during the third decade and continues to worsen during the remainder of an individual’s lifetime. The purpose of the midface lift procedure is to reverse some of the central third changes seen early in the aging process. This can be accomplished through a variety of techniques that have been developed to date. However, whichever procedure is used, the ultimate goal is the same. The aim is to reposition the facial tissues in such a way as to return a more youthful and rested appearance to an individual’s face in lieu of introducing an “operated appearance” during the process. In this article, we cover three techniques that we use to address the midface, depending on the individual. These include the subciliary approach to the midface, the endoscopic approach to the midface, and the use of alloplastic contouring of the midface.
Operative Techniques in Otolaryngology-Head and Neck Surgery 01/2007; 18(3):217-232.
[Show abstract][Hide abstract] ABSTRACT: Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.
[Show abstract][Hide abstract] ABSTRACT: We present the case report of a 95-year-old white female with a cutaneous T-cell lymphoma (CTCL) of the upper eyelid. Due to her comorbid medical problems, multidisciplinary tumor board recommendation for treatment was surgical excision. She underwent excision with frontalis muscle flap and contralateral eyelid full thickness skin graft reconstruction. The patient has been symptom free for 3.5 years. A literature review of cutaneous CTCL isolated to the eyelid is included.
[Show abstract][Hide abstract] ABSTRACT: A sialoblastoma is a rare congenital epithelial tumor that arises in a major salivary gland. To our knowledge, only 24 cases of sialoblastoma have been previously reported in the English-language literature. We report a new case, that of a 15-month-old boy who presented with a submandibular mass. Surgical excision of the mass was undertaken. Intraoperatively, the mass appeared to be adjacent to the submandibular gland, but it had not invaded it. The mass was excised, and the submandibular gland was left in place. Pathology identified the tumor as a sialoblastoma. However, pathology also revealed that residual tumor was present at the surgical margin. The patient was returned to the operating room for excision of the left submandibular gland and the level I lymph nodes. Following revision surgery, the surgical margins were negative. The patient remained disease-free at the 1-year follow-up. Despite the need for revision surgery, this case provides support for the idea that surgery alone is sufficient for curative treatment.
[Show abstract][Hide abstract] ABSTRACT: T2-weighted fast-spin echo magnetic resonance imaging (MRI) can be an economically beneficial protocol for screening patients with asymmetric sensorineural hearing loss without other neurologic findings in a public hospital population.
The goal of this study was to determine if fast spin echo T2 MRI is similar to gadolinium-enhanced MRI in evaluating asymmetric sensorineural hearing loss in a county hospital population.
This was a retrospective chart review of all outpatients seen at a public hospital, comprising patients with no other cranial nerve findings who underwent gadolinium-enhanced MRI of the internal auditory canal and brain between January 2002 and September 2003. Patients with >15 dB difference in hearing at one frequency or 10 dB hearing difference at two frequencies underwent gadolinium-enhanced MRI scan with FSE T2 sequence as part of the examination protocol.
A total of 146 patients were identified who met all the inclusion criteria for the study. Of the 146 MRI scans performed, abnormalities were seen on 71 of them, the majority of which were inconsequential. No acoustic neuromas were identified in our study population. Cost savings of over 100,000 dollars would have been realized if only T2 FSE protocols had been used.
[Show abstract][Hide abstract] ABSTRACT: To review our experience with patients diagnosed with giant myxomas of the maxillofacial skeleton.
All patients undergoing excision of myxomas of the head and neck from September 1998 through September 2003 with a minimum follow-up of 1 year by the senior author (YD) were included in the study.
A retrospective chart review was conducted to select all patients who met the inclusion criteria. Clinical presentation, preoperative radiology findings, excisions performed, reconstruction, and follow-up were recorded and reported.
Four patients were identified who met the inclusion criteria. All underwent wide en bloc excision of the tumor with various reconstructions. Complete resection was achieved in each case, and no patients have had evidence of recurrence.
Giant myxomas of the maxillofacial skeleton have been reported to have significant rates of recurrence. Wide en bloc resection with appropriate reconstruction can result in excellent quality of life postoperatively and minimize the risk of recurrence. Lesser resections may not be appropriate especially in giant myxomas because of the potential morbidity that would be associated with a multifocal recurrence.
Otolaryngology Head and Neck Surgery 07/2006; 134(6):931-5. · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A congenital midline cervical cleft (CMCC) is a rare developmental abnormality with several common features of variable severity: a midline defect of anterior neck skin, a superior nipple-like skin projection, and a subcutaneous fibrous cord. Congenital midline cervical clefts have important functional and cosmetic implications as cicatrical contracture with subsequent deformity may result without early surgical intervention. Treatment involves excision of all abnormal tissue, and reconstruction with Z-plasty techniques is favored because linear closure results in hypertrophic scarring and recurrent contracture. Z-plasty allows broken-line closure, reorientation of the defect in the horizontal plane with re-creation of a cervicomental angle, and most importantly, a lengthening of the anterior neck skin that aids in preventing recurrent contracture. We present our experience managing a congenital cervical midline cleft in a 3-month-old patient and describe a simple technique for planning the ideal Z-plasty closure. No simple description for planning the ideal closure for this defect could be found in the otolaryngology literature.
International Journal of Pediatric Otorhinolaryngology 04/2006; 70(3):553-9. · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the identification of a kaposiform hemangioendothelioma (KH) in the oropharynx of a 3-year-old boy. This is a rare endothelial-derived spindle cell neoplasm affecting children and early adolescents with features common to capillary hemangioma and Kaposi sarcoma. Nine cases of head and neck KH have been reported, this being the first in the otolaryngology literature. Our patient underwent wide local excision and has remained tumor free for over 1 year. KH should be considered in the differential diagnosis of a vascular lesion demonstrating unexpected behavior from that of a hemangioma.
The Laryngoscope 11/2005; 115(10):1789-92. · 1.98 Impact Factor