Krista L. Olson

Analysis of the African American female nose.

&NA; The African American nose has been broadly classified as ethnic yet it differs significantly in morphology from that of other ethnic groups with which it is categorized. The objectives of this study were to (1) establish an objective protocol for analysis of the African American female nose using anthropometric measurements, and (2) determine whether subjective subcategorization schemes are a reliable replacement for anthropometry. African American women (n = 107) between the ages of 18 and 30 years consented to participate in this study. Photographs and 14 standard anthropometric measurements were taken of the face and nasal region, including nose length, nose width, special upper face height, intercanthal distance, mouth width, nasal bridge inclination, nasal tip protrusion, ala thickness, nasal root width, nasal bridge length, tangential length of ala, length of columella, nasofrontal angle, and nasolabial angle. Nasal indices including nose width‐nose height index, nasal tip protrusion‐nose height index, and nasal tip protrusion‐nasal width index were calculated. In addition, photographic analysis was performed to evaluate nostril shape, nasal base shape, and nasal dorsal height. Proportional relationships and subcategorization schemes were evaluated. A new method of nasal analysis for the African American woman uses the proportional relationships of the anthropometric measurements. Proportional relationships included a columellar to lobule ratio of 1.5:1, a nasolabial angle of 86 degrees, and an alar width to intercanthal distance ratio of 5:4. The nasal dorsal height classification scheme was the most reliable for subjective analysis. The degree of variability found within this group of young African American women is illustrated by the following indices and their respective ranges: nose width‐nose height index mean, 79.7 (range, 57 to 102); nasal tip protrusion‐nose height index mean, 33.8 (range, 23 to 46); and nasal tip protrusion‐nose width index mean, 42.8 (range, 32 to 61). The guidelines provided are a baseline from which to begin analysis and evaluation. (Plast. Reconstr. Surg. 111: 620, 2003.)

The pedicled superficial temporalis fascial flap: A new method for reconstruction in otologic surgery

OBJECTIVES: Our goal was to describe a novel fascial flap of the temporal region and its use for reconstruction in otologic and neurotologic surgery. METHODS: The superficial temporalis fascia has an axial blood supply derived from the middle temporal artery and can be raised independently from the overlying temporoparietal fascia or the underlying deep temporalis fascia. This flap was used on 15 consecutive patients to solve a wide variety of reconstructive problems after otologic procedures. RESULTS: No additional morbidity was observed from the use of this flap. There were no complications related to the reconstruction. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. Follow-up ranges from 2 to 25 months. CONCLUSIONS: This fascial flap provides a wide surface area of tissue on a narrow-based pedicle capable of a wide arc of rotation. It provides thin, pliable tissue that can be adapted to the needs of various reconstructive otologic/neurotologic problems.

Repairing Angle of the Mandible Fractures With a Strut Plate

IMPORTANCE Despite multiple fixation techniques, the optimal method of repairing mandibular angle fractures remains controversial. OBJECTIVE To evaluate the outcomes when using a 3-dimensional, curved strut plate in repair of angle of the mandible fractures. DESIGN Retrospective cohort study. SETTING Level I trauma center at an academic institution in Harris County, Texas. PARTICIPANTS Patients with diagnostic codes involving angle of the mandible fractures that were repaired by the otolaryngology-head and neck surgery service from February 1, 2006, through February 28, 2011. EXPOSURE Open reduction internal fixation using either a 3-dimensional curved strut plate or any other type of repair technique for angle of the mandible fractures. MAIN OUTCOMES AND MEASURES Complication rates, postoperative complaints, and operative characteristics. RESULTS Ninety patients underwent qualifying procedures during the study period. A total of 68 fractures (76%) were repaired using the 3-dimensional curved strut plate and 22 (24%) were repaired using other methods. The revision surgery rate was 10% for the strut plate group (7 patients) and 14% for the non-strut plate group (3 patients), with no significant differences in rates of infection (3 [4%] vs 2 [9%]), dehiscence (4 [6%] vs 2 [9%]), malunion (1 [1%] vs 2 [9%]), nonunion (3 [4%] vs 0), hardware failure (1 [1%] vs 1 [5%]), malocclusion (2 [3%] vs 2 [9%]), and injury to the inferior alveolar nerve (1 [1%] vs 1 [5%]). The most common postoperative complaints were pain (13 [19%] vs 6 [27%]), followed by numbness (5 [7%] vs 2 [9%]), trismus (4 [6%] vs 3 [14%]), edema (3 [4%] vs 3 [14%]), and bite deformity (2 [3%] vs 2 [9%]), with a mean (range) follow-up time of 54.7 (2-355) days for the strut plate group vs 46.8 (8-308) days for the non-strut plate group. CONCLUSIONS AND RELEVANCE The 3-dimensional curved strut plate is an effective treatment modality for angle fractures, with comparable infection rates, low incidence of alveolar nerve injury, and trends for decreased length of operation, complications, and infections compared with other techniques.

A novel technique to repair moderate-sized nasoseptal perforations.

OBJECTIVES To describe a novel technique for closure of moderate-sized nasoseptal perforations and to review the current literature on various techniques for closure of nasoseptal perforations. DESIGN Retrospective review. SETTING Academic research. PATIENTS We performed a retrospective review of a successful novel technique that has been used at a facial plastic and reconstructive surgery practice for closure of nasoseptal perforations during 3 years (January 1, 2008, to January 1, 2011). MAIN OUTCOME MEASURES Medical records were reviewed to identify patient characteristics, symptoms, causes of nasoseptal perforations, and outcomes, including patient satisfaction and rate of recurrent nasoseptal perforation. RESULTS During 3 years at our institution, 7 patients were identified with nasoseptal perforations that had been closed using bilateral mucosal advancement flaps (one inferiorly based flap advanced from the floor of the nose and another superiorly based flap advanced from the lateral nasal wall). The nasoseptal perforations ranged from 0.6 to 1.6 cm. Most patients had excellent outcomes, with resolution of symptoms and no recurrence. CONCLUSIONS Nasoseptal perforations have traditionally been closed using 2 superiorly based flaps or 2 inferiorly based flaps. We present a novel technique combining both flaps for closure of moderate-sized nasoseptal perforations. This procedure decreases the risk for recurrence of the perforation, necrosis of the flaps, and development of a new perforation.

Nasal gout presenting as nasal obstruction

IMPORTANCE We describe a case of nasal gout presenting as nasal obstruction, a rare etiology for a common presentation. OBSERVATIONS We report a single case of a 56-year-old man with history of multiple nasal traumas, obstructive sleep apnea, referred for nasal obstruction and congestion, having failed attempts at medical management. He had severe septal deviation, elements of external and internal nasal valve collapse, and a nasal dorsal mass suspicious for gouty tophus. He was brought to the operating room for septorhinoplasty through an open incision with nasal tip reconstruction, which exposed a 4 × 3-cm mass on the nasal dorsum, extending to the tip, supertip, and into the septal plane at the level of the upper lateral cartilages. Final pathologic findings revealed gouty tophus. He has done well since, and breathing and sleep are significantly improved. CONCLUSIONS AND RELEVANCE This case demonstrates a rare etiology for nasal obstruction that may complicate the workup, evaluation, and management of such a patient. It highlights the ways in which a rare diagnosis adds complexity to the workup and management of a patient with nasal obstruction, and serves as an important reminder about rarer pathologies that can present in an everyday clinic.

Interventional Drug-Induced Sleep Endoscopy: A novel technique to guide surgical planning for obstructive sleep apnea

STUDY OBJECTIVE One of the challenges of surgery for obstructive sleep apnea (OSA) is identifying the correct surgical site for each patient. The objective of this study was to use drug-induced sleep endoscopy (DISE) and nasopharyngeal tube (NPT) placement to determine the effect of eliminating palatal collapse on the obstruction seen on other segments of the upper airway. METHODS Forty-one OSA patients were enrolled in this prospective study. All patients had a polysomnogram followed by DISE. DISE findings were recorded and compared with and without placement of a NPT. Obstruction was graded with a scale that incorporates location, severity, and interval of obstruction. RESULTS Most patients (83%) demonstrated multilevel obstruction on initial DISE. With the nasopharyngeal airway in place, many patients with multilevel obstruction had at least a partial improvement (74%) and some a complete resolution (35%) of collapse (p < 0.05). Reduction in collapse was observed at the lateral walls (86%), epiglottis (55%), and tongue base (50%). NPT placement did not significantly alter upper airway morphology of patients with incomplete palatal obstruction or mild OSA. CONCLUSIONS To our knowledge, this is the first study to evaluate the effect of soft palatal stenting on downstream pharyngeal obstruction during DISE. Our study provides evidence that reducing soft palatal collapse can reduce negative pharyngeal pressure and thereby alleviate other sites of upper airway obstruction. Taken together, these findings provide a means to identify appropriate candidates for isolated palatal surgery and better direct a minimally invasive approach to the surgical management of OSA.

Frequency of sinus disease in normal subjects and patients with benign paroxysmal positional vertigo.

Background/Aims: To determine if patients with benign paroxysmal positional vertigo (BPPV) have a higher frequency of rhinosinusitis than people with normal vestibular function. Methods: The subjects were 52 patients with BPPV and 46 normal people. Every subject had a sinus CT scan, a blood draw for IgE and a rhinologic examination by an otolaryngologist. Results: The frequency of rhinosinusitis based on physician diagnosis was 49% and based on CT scan findings 59%. This difference approached significance (p = 0.08). The observed frequency of rhinosinusitis was higher than predicted by survey data about the southern US region. The data trended toward higher prevalence of rhinosinusitis (by physician diagnosis) in the BPPV patients versus controls (58 vs. 39%, p = 0.06). Conclusion: BPPV patients have a higher frequency of sinus disease compared to people with normal vestibular systems, perhaps due to age differences, but physiologic factors may also be involved. The higher frequency of rhinosinusitis in this geographical area than reported rates based on survey data raises concerns about the usefulness of questionnaire data for estimating population prevalence.

A Novel Technique in Repair of Moderate-sized Nasal Septal Perforations

Objective: 1) Describe a novel technique which has been successful in closure of moderate-sized nasal septal perforations. 2) Review the current literature on various techniques that have been previously described for closure of nasal septal perforations. Method: Retrospective review of a successful technique used at our institution for closure of septal perforations over a 5-year span (2006-2010) at a facial plastic surgery practice. Charts were reviewed to find patient characteristics, symptoms, etiologies of perforation, and outcomes, including patient satisfaction and rate of recurrent perforation. Results: Over the past 5 years at our institution, 12 patients were identified with nasal septal perforations, which were closed using bilateral mucosal advancement flaps: one inferiorly-based flap advanced from the floor of the nose and another superiorly-based flap advanced from the lateral nasal wall and upper lateral cartilage. The size of the perforations ranged from 0.6 cm to 1.6 cm. The majority of patients had excellent outcomes with resolution of symptoms and a low rate of recurrence. Conclusion: Nasal septal perforations have been approached traditionally with 2 superiorly based or 2 inferiorly based flaps. We present a technique with a combination of both flaps for closure of a moderate-size perforation. This decreases the risk of recurrence of the perforation, flap necrosis, and development of a new perforation.

Use of reconstructed sagittal computed tomography images to plan middle cranial fossa surgery

Objective To facilitate planning in temporal bone surgery for the middle cranial fossa approach by using sagittal reconstructed temporal bone computed tomography images.