Ashlin J. Alexander

Cephalic Positioning of the Lateral Crura: Implications for Nasal Tip-plasty

OBJECTIVE To apply a mathematical model to determine the relative effectiveness of various tip-plasty maneuvers while the lateral crura are in cephalic position compared with orthotopic position. METHODS A Matlab (MathWorks, Natick, Massachusetts) computer program, called the Tip-Plasty Simulator, was developed to model the medial and lateral crura of the tripod concept in order to estimate the change in projection, rotation, and nasal length yielded by changes in crural length. The following rhinoplasty techniques were modeled in the software program: columellar strut graft/tongue-in-groove, lateral crural steal, lateral crural overlay, medial/intermediate crural overlay, hinge release with alar strut graft, and lateral crural repositioning. RESULTS Using the Tip-Plasty Simulator, the directionality of the change in projection, rotation, and nasal length produced by the various tip-plasty maneuvers, as shown by our mathematical model, is largely the same as that expected and observed clinically. Notably, cephalically positioned lateral crura affected the results of the rhinoplasty maneuvers studied. CONCLUSIONS By demonstrating a difference in the magnitude of change resulting from various rhinoplasty maneuvers, the results of this study enhance the ability of the rhinoplasty surgeon to predict the effects of various tip-plasty maneuvers, given the variable range in alar cartilage orientation that he or she is likely to encounter.

Arguing the Ethics of Facial Transplantation

While 7 face transplants have been performed around the world, to date, there remains debate regarding the validity of this procedure. We submit that performing a facial transplant-in the appropriately selected patient-is technically defensible and ethically sound. By outlining the technical and ethical boundaries of the debate, responding to the key arguments against the procedure, and describing its motivations and potential benefits, we state our justification of facial transplantation.

Head and neck multidisciplinary team meetings: Effect on patient management.

The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management.

Quantifying fibrosis in head and neck cancer treatment: An overview

Fibrosis is a common late complication of radiotherapy and/or surgical treatment for head and neck cancers. Fibrosis is difficult to quantify and formal methods of measure are not well recognized. The purpose of this review was to summarize the methods available to quantify neck fibrosis.

The increasing prevalence of clindamycin resistance in Staphylococcus aureus isolates in children with head and neck abscesses

OBJECTIVE To retrospectively review trends in clindamycin resistance among Staphylococcus aureus head and neck abscesses between January 2000 and June 2008. METHODS Between January 2000 and June 2008, inpatient and out-patient S aureus isolates were reviewed for antibiotic susceptibility. In particular, cultures from 153 abscesses in the head and neck region were assessed for clindamycin and methicillin resistance patterns. RESULTS Annual clindamycin resistance rates for all S aureus isolates, and specifically for S aureus head and neck abscesses, revealed concerning levels of clindamycin and methicillin resistance. After 2002, the mean clindamycin resistance rate in head and neck abscesses was approximately 27%. The number of new cases of methicillin-resistant S aureus per year increased from four cases in 2000 to 44 cases in 2007. CONCLUSION Antibiotic resistance should be considered following failed empirical therapy of head and neck abscesses with clindamycin.

Evolution in nasal tip contouring techniques: a 10-year evaluation and analysis.

question was asked regarding the area of medicine the students were interested in. Having such a question may have offered more information about those who responded compared with those who did not decide to participate. However, if such a question was asked, it could also induce biased assumptions about the respondents. Another difficulty we encountered was the time of the year in which the survey was distributed. More schools and students may have agreed to participate in the survey if it had been distributed earlier in the school year. Last, it should be stated that using different terms for the various specialists mentioned in the study would have most likely led to different results. For example, if the title “facial plastic surgeon” or “otolaryngologist–head and neck surgeon” was used alone instead of being combined, it can be assumed that the responses would have been different than those we received. The title “facial plastic/ENT surgeon” was originally used in the study by Rosenthal et al, and we decided to include this title as well in an effort to provide continuity for comparing our results with those of previous studies. In conclusion, this study suggests that medical students view multiple specialists as qualified to perform aesthetic and reconstructive facial surgery. Most importantly, this study suggests that the facial plastic and reconstructive surgeon is perceived as most qualified to perform multiple aesthetic and reconstructive facial procedures when being compared to other specialists. In order for the facial plastic and reconstructive surgeon to maintain its positive perception among medical students it is important for otolaryngology– head and neck programs to incorporate facial plastic and reconstructive surgery education into their medical student curriculums. The plastic surgery literature has demonstrated positive results from similar endeavors. Vallino and Brown and Kim et al demonstrated that exposure to plastic surgery in medical school increased the overall knowledge and the breadth of the specialty. The same idea could be applied to otolaryngology–head and neck surgery programs across the country by incorporating facial plastic and reconstructive surgery education within their medical student rotation curriculums.

The risks and the identification of ingested button batteries in the esophagus: a child safety issue.

Ingestion of foreign bodies is a common problem in children; frequently, the swallowed foreign body will become lodged in the upper esophagus causing distress to the child. Although coins are the most frequently ingested foreign body, they are very similar in shape and appearance to a button battery. Button batteries can be very difficult to distinguish from coins to the untrained eye. In contrast to a coin, a button battery lodged in the upper aerodigestive tract poses a significant health risk due to potential for esophageal burn and perforation and delays in diagnosis may lead to potentially fatal complications or long-term esophageal stenosis. Therefore, when that foreign body is a battery, correct and early identification is critical. The child must be referred urgently for removal because of the high risk of caustic damage and perforation. The current method of differentiation on plain x-rayVthe ‘‘double density,’’ where a radioluscent halo is seen on AP views; or ‘‘lateral step’’ where a notch is seen on the lateral neck viewVis not as easy to identify with the untrained eye as is suggested in the literature. If misdiagnosed as a coin, referral may be delayed with potentially fatal consequences.

Reconstructive Options for the Face

Non-melanoma skin cancer (NMSC) is the most common form of cancer worldwide. In 2008, approximately 430,000 cases of NMSC were diagnosed in Australia; of these, 296,000 were basal cell carcinoma (BCC) and 138,000 were squamous cell carcinoma (SCC) [1, 2]. Whereas many treatment options exist, the mainstay of management is surgical excision with adequate margins, followed by reconstruction. The functional and aesthetic consequences of surgery of the face, more than that of any other part of the body, can be dramatic. Therefore, the reconstructive surgeon must apply a thorough and thoughtful approach to the repair of facial defects. While a full analysis of the topic is outside the scope of this chapter, an overview of the general concepts and techniques used to address the various subunits of the face are discussed.