Berke Ozucer

Endoscopic Transcanal Inlay Myringoplasty: Alternative Approach for Anterior Perforations.

M ost failures of myringoplasty during the repair of tympanic membrane perforations (TMPs) occur when the tear is located in the anterior half of the membrane. In describing the outcomes of 1040 myringoplasties, Nardone et al reported that anterior localization negatively affected operative success. If the entire perforation is not visible in a single field, either a postauricular approach must be used, or canalplasty must be performed to expose the entire perforation. Both alternatives are associated with longer operative times than that of myringoplasty, and the postoperative recovery period is longer. Various surgical approaches and techniques have been attempted to overcome the issues associated with anterior TMP repair. Here, we introduce an alternative approach for the closure of anterior TMPs up to 5.5 mm in diameter, and we present our clinical results.

Effect of Postrhinoplasty Taping on Postoperative Edema and Nasal Draping: A Randomized Clinical Trial

BACKGROUND Edema persists for months after rhinoplasty. Numerous modalities have been described to counteract postoperative edema. OBJECTIVE To evaluate the effect of postrhinoplasty taping (PRT) on nasal edema and nasal draping. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, 57 patients undergoing rhinoplasty at a tertiary reference center from August 1, 2014, to January 31, 2015, were assigned to a control group or to 2- or 4-week PRT groups. Baseline nasal thickness was measured with ultrasonography at the nasion, rhinion, supratip, and tip, and mean nasal skin thickness (MNST) was calculated. Participants in each group were categorized by the baseline MNST measurement from the lowest to greatest MNST; those in the upper half were categorized as having thick skin; those in the lower half, thin skin. The control group underwent no PRT after the removal of external packing. Patients in the 2- and 4-week PRT groups received additional taping during the allocated time. Data were collected from August 1, 2014, to June 31, 2015. Follow-up was completed on June 31, 2015, and data were analyzed from July 1 to August 1, 2015. MAIN OUTCOMES AND MEASURES Postoperative measurements of MNST were performed at the end of weeks 1, 3, and 5 and month 6. RESULTS Of the 57 total patients (33 male and 24 female patients; mean [SD] age, 30.0 [11.7] years), 17 were in the 2-week PRT group; 20, the 4-week PRT group; and 20, the control group. Compared with the control group, 4-week PRT had a significant effect on the supratip (P = .001). Comparisons of MNST with the control group revealed significant effects of 2-week (P = .02) and 4-week (P = .007) PRT. The effect on the tip was not significant (P = .052). Postrhinoplasty taping had no effect in thin-skinned patients. Comparison among thick-skinned patients revealed a significant effect on the MNST (P = .01) and the rhinion (P = .02) but not the tip (P = .06) and supratip (P = .07). CONCLUSIONS AND RELEVANCE Postrhinoplasty taping helps the skin envelope to compress to the underlying framework and decrease postoperative edema. The procedure can be used particularly in thick-skinned patients, in whom skin draping and nasal refinement is crucial to the surgical outcome. LEVEL OF EVIDENCE 1. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02626585.

Comments on “The Lateral Crural Rein Flap: A Novel Technique for Management of Tip Rotation in Primary Rhinoplasty”

We read with great enthusiasm the recent study of Kuran et al., entitled “The lateral crural rein flap: a novel technique for management of tip rotation in primary rhinoplasty.”1 Kuran et al. demonstrated that suturation of the …

Association of Autologous Costal Cartilage Harvesting Technique With Donor-Site Pain in Patients Undergoing Rhinoplasty

Importance Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting. Objective To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery. Design, Setting, and Participants Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical. Main Outcomes and Measures Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used. Results The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02). Conclusions and Relevance Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain. Level of Evidence 2.

Intraoperative Visual Documentation Using Smart Mobile Devices: A Simple Solution for Facial Plastic Surgeons.

Perioperative visual documentation is essential for facial plastic surgery. Before-and-after documentation with high standards is a routine of our daily practice,1,2 but intraoperative visual documentation (IVD) can be a hassle. Intraoperative visual documentation can be used as a useful addition to written operationnotes.3,4 Intraoperativevisual documentation is necessary not only for personal archiving and self-progress but also for sharing the surgical pearls through scientific meetings and literature. Practical and inexpensive ways of intraoperative photodocumentation have been described in the literature.5,6 Video documentation is another essential part of this process, and many professional systems are commercially available, but these require specific costly equipment, and unfortunately they are not a routine part of every facial plastic surgeon’s practice. An ideal IVD solution should be easy to set up, easy to control, enable stable and steady recording from various angles, should not interfere with the surgery, and be affordable. Smart mobile devices (SMDs) are readily available and provide high-definition (HD) photography (12 megapixels) and video recording (HD [1920 × 1080 and even 4K [3840 × 2160] video recording). Although footage recorded with these devices has been used for scientific purposes in the past,7 they are not suitable for intraoperative documentation purposes as is, mainly owing to particular shortcomings. These devices need to be held steadily by someone at a good recording angle. This is not always possible without interfering with the surgery, and can result in shaky and unsteady recordings that are poor in quality. Either the surgeon gets in the way, or the visual field or sterility and/or surgery is compromised. In addition, it is a hassle for the “sterile” surgical team to ensure ideal positioning of the camera and (start/pause) recording while operating. We wanted to share our simple and affordable IVD solution using SMDs (Video 1). A device holder and a Bluetooth remote shutter is required for this solution (Figure 1). Various device holders are commercially available under the name of “car mounts” and are available on the internet for less than

Dynamometric Analysis of Normative Auricular Stiffness and Comparison With Operated Prominent Ears.

15. Bluetooth remote shutters are also available for less than

Surgical Approach to the Thick Nasolabial Folds, Jowls and Heavy Neck—How to Approach and Suspend the Facial Ligaments

10. In total, this setup costs less than

Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty: Precision Profileplasty

25. Connecting the SMD to the operative lights with a “vacuumed mobile device holder” ensures stabilization and ease of recording from various angles (Figure 2). It works in a fashion similar to that of professional cameras embedded to operative light handles that record bird’s eye views. When the Bluetooth remote shutter is paired to the mobile device, it works as a shutter in photography mode, and when the device is in video recording mode, clicking the button will start or stop recording. The small remote shutter can be inserted in a sterile nylon bag for the control of the surgical team. A sterile handle attached to the operative lights will enable the surgeon to easily control the positioning and angle of the camera as required. This solution enables both intraoperative photography and video recording. The easy setup (it takes <2 minutes) makes it practical to use, and the only requirement is the presence of operating theater lights. Easy synchronization/backup of IVD footage using the cloud system is another pro of this solution. This setup may be useful for facial plastic surgeons looking for an affordable and practical IVD system. Surgical techniques, interesting and new surgical cases, and unsuspected findings can be documented with this approach. Although there are more professional systems that provide superior results, this is a simple solution that makes use of the technology readily available in facial plastic surgeons’ pockets. Video at jamafacialplasticsurgery.com

Olfactory Dysfunction Associated With Neuro-Behçet Disease

Aim:Stiffness of the auricular cartilage is the main determining factor for the choice of operative technique of the prominent ear deformity. The aim of this study is to evaluate the stiffness of normal appearing ears objectively and quantitatively, compare the results with the operated prominent ear patients, and present prospective short-term dynamometric evaluation of the operated prominent ear patients. Patients and Methods:A total of 190 volunteers without ear deformities were recruited and 9 age groups were formed: group (5–9), group (10–14), group (15–19), group (20–24), group (25–29), group (30–34), group (35–39), group (40–49), and group (50+). Total 28 ears (14 patients) with otoplasty were included in the study as group (operated 5–9) and group (operated 10–14). In addition, 3 patients with prominent ear deformity were prospectively followed for dynamometric changes that occur with otoplasty operation. The auriculocephalic angle (ACA) was measured once and auricle to scalp distance was measured at 4 different standardized levels. Ear stiffness was measured on each ear individually at 4 different points over the antihelix using digital computer-aided dynamometry. Each ear was compared in terms of ACA, distance, and dynamometric values. Findings:Dynamometric values tend to increase with age, which increase and peak around 35 years of age and declines after 40 years of age. Measurements of the first 2 age groups were statistically different compared with the other groups. Postoperative dynamometric measurements (DNM) of group (operated 5–9) were similar with normative values of group (5–9) and postoperative satisfaction visual analogue scale (VAS) score was 92.8%. Postoperative DNM of group (operated 10–14) were higher compared with normative values of group (10–14) for each different measuring level and the postoperative satisfaction VAS score was 75.3. A total of 3 patients with prominent ears had lower dynamometric values preoperatively; these values approached closer to normative values of their age group postoperatively. Conclusions:Results show that auricular cartilage stiffens and malleability decreases with increased age. This stiffness peaks in the 35–39 age group and declines after 40 years of age. Dynamometric values increase, at all levels, suggesting increased cartilage stiffness is related to age. In the scope of these results, cartilage sparing techniques are more suitable for 5 to 14 years of age and cartilage-cutting techniques are more suitable for older patients.

Current updates in nasal bone reshaping.

Abstract Patients with thick skin typically present with a redundant, baggy, lax skin envelope together with prominent nasolabial folds, jowls, and a heavy neck. Durable and natural‐appearing rejuvenation is not possible unless the deformities are addressed adequately and harmoniously in these patients. Traditional superficial musculoaponeurotic system techniques do not include surgical release of the zygomatic cutaneous ligaments and repositioning of descendent malar fat pad, and may lead to an unbalanced, unnatural appearance and the lateral sweep phenomenon. Additional attempts to improve unopposed nasolabial folds such as fat grafting to malar region are more likely to result with a “stuffed” look, far from a natural and rejuvenated appearance, and must therefore be avoided. The facelift techniques including true release of the anchoring ligaments of the midface and allowing adequate repositioning of saggy tissues are ideal for these patients to obtain harmonious, natural result. Despite the extensive dissections, maximal release, and maximal lateral pull, additional maneuvers, e.g., platysmaplasty, subplatysmal fat removal, or partial resection of submandibular glands may be required for satisfying result in patients with heavy neck. In this article, the authors outline the relevant anatomy of the facial retaining ligaments and their implications to surgical management of patients with heavy skin are discussed.