Abel-Jan Tasman

Control of tip rotation.

Rotating the nasal tip is an integral and challenging aspect of rhinoplasty. This article describes ways of measuring tip rotation, coming to an agreement with the patient regarding desired tip rotation and psychological implications of tip rotation. Based on the tripod theory of the nasal tip, various techniques for changing tip rotation and projection are detailed and illustrated with clinical cases. The authors review the literature and present their personal preferences.

A guide to the assessment and analysis of the rhinoplasty patient.

The science and art of facial analysis have made giant strides in the past 50 years. In addition to excellent technical knowledge about the anatomy of the region and the numerous surgical options available, the rhinoplasty surgeon must demonstrate meticulous care in the planning and execution of this difficult and demanding operation to minimize the real risks posed to the patient and to maximize the likelihood of a successful procedure and of obtaining the ultimate goal: the happy patient. Although imaging and computer analysis have provided a new technological dimension to this process, the surgeons clinical acumen, technical prowess, and communication skills remain paramount in their importance.

Nasolacrimal duct obstruction caused by lymphoproliferative infiltration in the course of chronic lymphocytic leukemia.

Background Endoscopic dacryocystorhinostomy (DCR) is the standard treatment of nasolacrimal duct obstruction. Only in rare cases, blockage may be caused by malignant tumors and even more exceptionally by lymphatic neoplasms so that biopsies are not routinely taken for diagnostic purposes. Methods A computerized retrieval system was used for this retrospective study to identify all patients with histologically documented lymphoproliferative infiltration in the lacrimal drainage system from 2001 to 2009. Results In four of 191 patients (2.1%), infiltration of the nasolacrimal sac mucosa with a small lymphocytic lymphoma (SLL)/chronic lymphatic leukemia (CLL) was found. Patients who develop symptoms like epiphora within the course of known CLL are highly suspicious for lymphoproliferative infiltration of the lacrimal drainage associated lymphoid tissue. Conclusion A proactive approach with ophthalmologic consultation and DCR should be followed in these patients to avoid dacryocystitis.

Eye tracker based study: Perception of faces with a cleft lip and nose deformity

AIM Quantification of visual attention directed towards cleft stigmata and its impact on the perception of selected personality traits. METHODS Forty observers were divided into two groups and their visual scan paths were recorded. Both groups observed a series of photographs displaying full frontal views of the faces of 18 adult patients with clefts, nine with residual cleft stigmata and nine with digitally-corrected stigmata (each patient only appeared once per series). Patients that appeared with residual stigmata in one series appeared digitally corrected in the other series and vice versa. Visual fixation times on the upper lip and nose were compared between the original and corrected photographs. Observers subsequently rated personality traits as perceived using visual analogue scales and the same photographs that they had observed in the series. RESULTS In faces depicting cleft stigmata observers spent more time looking at the oronasal region of interest, followed by the eyes (39.6%; SD 5.0 and 35.1%; SD 3.6, respectively, p = 0.0198). Observers spent more time looking at the cleft lip compared with the corrected lip (21.2%; SD 4.0 and 16.7%; SD 5.0, respectively, p = 0.006). The differences between questionnaire scores for faces with cleft stigmata compared with faces with corrected stigmata for withdrawn-sociable, discontent-content, lazy-assiduous, unimaginative-creative, unlikeable-likeable, and the sum of individual personality traits were not significant. CONCLUSION According to these findings, cleft lip and cleft nose have an attention-drawing potential with the cleft lip being the major attention drawing factor. These data do not provide supportive evidence for the notion reported in literature that patients with clefts are perceived as having negative personality traits.

Maxillofacial Fractures: Midface and Internal Orbit-Part I: Classification and Assessment.

Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all physicians treating facial trauma patients to understand the basic principles of injuries to the midface. Thus, this article aims to describe the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern.

Maxillofacial Fractures: Midface and Internal Orbit-Part II: Principles and Surgical Treatment.

Current clinical assessment and imaging techniques were described in part 1, and this article presents a systematic review of the surgical treatment principles in the management of midface and internal orbit fractures from initial care to definitive treatment, including illustrative case examples. New developments enabled limited surgical approaches by standardization of osteosynthesis principles regarding three-dimensional buttress reconstruction, by newly developed individualized implants such as titanium meshes and, especially for complex fracture patterns, by critical assessment of anatomical reconstruction through intraoperative endoscopy, as well as intra- and postoperative imaging. Resorbable soft tissue anchors can be used both for ligament and soft tissue resuspension to reduce ptosis effects in the cheeks and nasolabial area and to achieve facial aesthetics similar to those prior to the injury.

Airway Management in Facial Trauma Patients.

Airway management in craniofacial trauma patients is a challenge for an anesthetist. Treating these patients requires a close interdisciplinary communication and cooperation. Maintaining the airway and oxygenation of the patient is the initial challenge in craniofacial trauma patients. The management of the difficult airway is facilitated and patients safety improved by following one of several published difficult airway algorithms. We describe the St. Gallen difficult airway algorithm for the management of difficult airway in general and the airway in facial trauma patients in particular. Whenever possible, the airway should be secured in a conscious and spontaneously breathing patient. It is important to be familiar with different techniques and to change the approach after two unsuccessful attempts with one technique. Once the airway is established, all available preventive measures should be used to avoid losing the airway. A tracheotomy has its place in a significant number of patients in whom an immediate postoperative or a delayed extubation appears unfeasible.

Management of the Prominent Ear

This article incorporates the opinions and preferred surgical options in managing patients of 3 prominent facial plastic surgeons who have large otoplasty practices. Six different questions covering the management of prominent ears are answered by the 3 practitioners. Nonsurgical options for the treatment of prominent ears are discussed. The role of cartilage-cutting and cartilage-sparing techniques as well as individual preferred otoplasty techniques are thoroughly covered. Postoperative management of these patients is presented by the individual surgeons.

Dorsal Augmentation-Diced Cartilage Techniques: The Diced Cartilage Glue Graft

Abstract The quest for the ideal method for augmenting the nasal dorsum continues to be a matter of debate, with both most surgeons and patients preferring autologous tissue. This article reviews the current use of diced cartilage for nasal augmentation, emphasizing the diced cartilage in fibrin glue (DCG) graft. It offers the first collation of unfavorable outcomes and complications of the DCG graft seen in a series of 108 patients treated at the authors institution. The DCG graft continues to be a versatile graft that is stable over time and combines unique features. It has proved to be particularly well suited for segmental augmentations of the dorsum. Resorption of the graft has been rare and infrequent unfavorable outcomes have all been amenable to successful minor surgical revisions.

Glued Diced Cartilage Graft for Augmentation Rhinoplasty

Glued Diced Cartilage Graft for Augmentation Rhinoplasty To the Editor We have recently come across the article “Diced cartilage augmentation: early experience with the Tasman technique” by Baker1 in your journal, and congratulate him on his early results. We have had extensive use with using autologous fibrin glue and diced cartilage grafts in augmentation rhinoplasty as described in our article published in 2011.2 Our article, which included 68 patients from 2005 to 2008, is the first and the largest in the literature describing the use of autologous fibrin glue with diced cartilage grafts for dorsal nasal augmentation, which was recognized and cited in his article. We started using this technique after routinely noting inflammatory reactions to the dorsal nasal skin and poor retention of the diced cartilage grafts when wrapped with oxidized regenerated cellulose (Surgicel; Ethicon Inc). Using autologous fibrin glue, there is decreased inflammation and no longer a barrier to cartilage revascularization, which likely leads to better retention of the cartilage grafts. The introduction of the diced cartilage construct via an open or closed approach is easily performed by a syringe with only the end cut off with a handheld battery-operative ophthalmological cautery. This allows the entire syringe to be placed beneath the dorsal nasal skin with the cartilage construct. As the body of the syringe is slowly withdrawn, the plunger is pushed forward, thereby, leaving the diced cartilage construct on the nasal dorsum. With an obliquely cut syringe as the author describes, we am not surprised at his limitation with the closed (endonasal) approach since the cartilage graft would fall out or become dislodged during its insertion. It was very interesting that credit for the use of our technique for augmentation rhinoplasty was given an eponym, the “Tasman technique,” following a presentation in 2011, a month after our article was published online in PubMed.3 We have been sharing our results with this concept since 2008, when it was first presented at the Rhinoplasty Society Annual Meeting,4 and at the International Society of Aesthetic Plastic Surgeons (ISAPS) annual meeting the same year.5 In fact, our presentation won the award for the Best Presentation at the ISAPS meeting in Melbourne, Australia, in 2008. All of which occurred well before Tasman’s series of patient beginning in 2009.6 The problem with eponyms is the proper credit may not be given to the individual, or (more commonly) group of people, who may have contributed to a particular notion or concept. Currently, it appears that our group was the first to describe this technique in the literature, despite when it may have been heard by another. For this reason, a more fitting eponym would be the “Yuksel technique” or the “Baylor technique”, based on the time it was described. However, eponyms do not accurately describe the technique, and for the scientific and medical community, it would best to refer to this technique as a “glued diced cartilage graft” in the future.