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A rhinoplasty operation can be described as a simple incision that often leads to multiple surgical procedures involving soft tissue, cartilage, and even bone. Success is often measured in the context of creating predictable and lasting results, but is ultimately determined by the understanding of anatomic and geometric relationships. Ali Sepehr, MD, and colleagues developed a novel mathematical model/simulator to aid in the treatment of cephalically orientated lateral cartilages in common nasal tip–defining maneuvers. The authors review their comparative findings with clear illustrations and a detailed discussion that offers a foundational understanding in the treatment of cephalically positioned lower lateral crura.
Head and neck reconstructive surgery has continued to evolve at an amazing pace since the introduction of microvascular free tissue transfer. Unfortunately, the postoperative complication remains a timeworn adversary to a successful surgery. Jose P. Zevallos, MD, and colleagues investigate the relationship of oxidative stress created by microvascular tissue transfer and the protective free radical scavenging capabilities of glutathione-S-transferase (GST). In a population of 107 patients, the authors identified the allelic variants of GST, which vary from normal to absent enzymatic function, and discovered that individuals with impaired oxidative recovery were at a significantly higher risk for postoperative complications. Details of the clinical findings, and the implications of preoperative genome analysis, are openly presented.
Secondary and reconstructive procedures of the nose and ear are particularly complex owing to limited supplies of native septal and auricular cartilage. With few viable alternatives, costal cartilage remains the preferred reservoir for surgeons despite the difficulty of grafts warping after placement. Allen Foulad, BS,and colleagues review their unique application of Nd:YAG laser technology in the stabilization of costal cartilage in a porcine model. The authors discuss their findings of accelerated shape change, and subsequent stabilization after a period of 30 minutes, in direct comparison to saline-immersed controls over 24 hours. The details of irradiation design, validation of cartilage cell viability, and cartilage thermal measurements are presented.
Surgery of the nose commonly involves the treatment of the nasal septum for functional and/or reconstructive purposes. As with any surgery, the unanticipated or undesired outcome may be the result of a unique or rare event. Curtis Gaball, MD, LCDR, and colleagues review a case of septal area of iatrogenic litheness (SAIL) in which the presence of a highly mobile septum, corresponding to a region of previously resected cartilage and bone, becomes a point of airway resistance and symptomatic obstruction as predicted by Bernoulli's theorem. The authors detail a computed tomography–based flow model, discuss general septal resection dimensions, and offer their therapeutic approach in treatment of SAIL.
Portrait of a Genoese Noblewoman by Sir Anthony Van Dyck (1599-1641)
This issue's Highlights were written by James M. Ridgway, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2010;12(6):370. doi:10.1001/archfacial.2010.79