Oren Friedman

Current Trends in Otoplasty

Purpose of reviewWe present basic concepts and current trends in otoplasty, through a review of the recent literature. Recent findingsOver 200 otoplasty techniques have been described, yet most technical advances are minor modifications of techniques described 40–50 years ago. These techniques can be categorized as cartilage-cutting or cartilage-sparing techniques. Many approaches described today seem to combine elements of both. Recent retrospective analyses of several popular techniques show each to be effective and reliable, with low morbidity. Several technical updates and advances have also been described within the last few years. SummaryOtoplasty technique is constantly being modified and refined, with its basis in historically reliable techniques. The use of a graduated approach, combining elements of various techniques, is a common trend in otoplasty today.

Identification of congenital auricular deformities during newborn hearing screening allows for non-surgical correction: a Mayo Clinic pilot study.

OBJECTIVEnTo introduce a Mayo Clinic pilot study in which newborn hearing screeners are trained to identify congenital auricular deformities, allowing for non-surgical correction with a simple splint initiated in the immediate neonatal period.nnnMETHODSnNewborn hearing screeners received education on evaluation of congenital auricular deformities. Ten infants with 19 affected ears amenable to treatment with a simple splint were enrolled between June 15 and December 10, 2009. Splinting was initiated prior to the infants discharge from the hospital.nnnRESULTSnCongenital auricular deformities amenable to correction with splinting included cup ear, Stahls ear, and prominent ear. All ears were assessed by physical examination and photographic documentation prior to splinting and at follow-up visits. All exhibited improvement from the original deformity after 1-4 weeks of splinting. There were no instances of skin irritation or breakdown.nnnCONCLUSIONnSplinting therapy of congenital auricular deformities is very effective when initiated within the first 3 days of life while cartilage is quite malleable. Newborn hearing screening is performed within 24-48 h of birth and is an ideal opportunity to identify auricular deformities. This pilot study shows that early identification of auricular deformities by properly educated newborn hearing screeners is feasible, allowing for successful initiation of splinting therapy.

Functional support of the nasal tip.

Surgery of the nasal tip is among the most challenging aspects of rhinoplasty. Abnormalities of the nasal tip, whether primary or iatrogenic, have both functional and aesthetic consequences. This review focuses on the functional support of the nasal tip, surgical techniques commonly used to improve nasal tip support and function, and the effects of these techniques on the appearance of the nose.

Surgical Treatment of Nasal Obstruction in Rhinoplasty

The key to a successful septorhinoplasty includes an understanding of nasal anatomy and physiology. This allows the surgeon the ability to properly address both form and function during the operation. History and physical examination are paramount in diagnosing and subsequently treating the epicenter of obstruction, which is commonly found among the internal and external nasal valve, the septum, or the turbinates. Treatment of each of these areas is nuanced and multiple approaches are discussed to provide an understanding of the current surgical techniques that allow for excellent functional and cosmetic rhinoplasty results.

Update on injectables in the nose

Purpose of review The use of injectable fillers for nonsurgical rhinoplasty has increased tremendously over the past decade. This review describes the most commonly used fillers and their indications in the context of recent reports of both their successes and failures. Recent findings Hyaluronic acid and calcium hydroxylapatite are the two most commonly used fillers for injection. Recent studies have found that most injectable fillers are met with success and patient satisfaction, but vascular complications are still a serious problem of which physicians should be wary. Summary Injectable fillers should continue to be considered for patients on a case-by-case basis, but physicians should be knowledgeable of the various filler types, their indications, and injection technique to prevent serious complications.

Injectables in the Nose: Facts and Controversies

Nasal injectables and surface treatments alter the appearance of the nose both primarily and following nasal surgery. Fillers such as hyaluronic acids, calcium hydroxyapatite, and fat have a variety of advantages and disadvantages in eliminating small asymmetries postrhinoplasty. All nasal injectables have rare but severe ocular and cerebral ischemic complications. The injection of steroids following nasal reconstruction has a role in preventing supratip swelling and can improve the appearance of grafts to the nose. Resurfacing techniques reduce the appearance of autotransplanted grafts to the nose; there is little controversy about their benefit but surgeon preference for timing is varied.

Anatomic Evaluation of the Vertical Face-lift in Cadavers

IMPORTANCEnThis study investigates how different orientations of tension vectors affect the amount of soft-tissue lift in specific cervicofacial regions.nnnOBJECTIVESnTo compare differences in cosmetic neck and face changes generated by 3 different face-lift techniques, to quantify the amount of lift across different points on the face, and to quantify changes in platysmal dehiscence in each of 3 standard superficial musculoaponeurotic system plication face-lift techniques applied to fresh-frozen cadaver heads.nnnDESIGN, SETTING, AND PARTICIPANTSnTen cadaver heads in an academic tertiary care center.nnnINTERVENTION(S)nThree different superficial musculoaponeurotic system plication rhytidectomy procedures were conducted in the following sequence: (1) vertical tension vector plication (vertical lift), (2) superolateral tension vector plication (superolateral lift), and (3) superolateral tension vector plication combined with midline platysmal plication (superolateral lift with platysmal plication).nnnMAIN OUTCOMES AND MEASURESnAfter completion of each technique, the amount of lift at 4 standard key points was measured and recorded, and differences in lift at the key points were analyzed.nnnRESULTSnVertical lift was associated with greater total lift than superolateral lift alone or superolateral lift with platysmal plication (P < .001 for both). Platysmal dehiscence increased from baseline measurements after superolateral lift and decreased after vertical lift (P = .002 for both).nnnCONCLUSIONS AND RELEVANCEnOur findings establish how different orientations of tension vectors applied during face-lift surgery achieve different structural changes to various key points across the face. This study helps the face-lift surgeon and student understand the underlying structural anatomic changes associated with different face-lift techniques, which ultimately result in different cosmetic outcomes.nnnLEVEL OF EVIDENCEnNA.

The Conchal Cartilage Butterfly Graft.

Nasal obstruction due to weakening of the nasal sidewall is a very common patient complaint. The conchal cartilage butterfly graft is a proven technique for the correction of nasal valve collapse. It allows for excellent functional results, and with experience and attention to technical detail, it may also provide excellent cosmetic results. While this procedure is most useful for restoring form and function in cases of secondary rhinoplasty following the reduction of nasal support structures, we have found it to be a very powerful and satisfying technique in primary rhinoplasty as well. This article aims to describe the butterfly graft, discuss its history, and detail the technical considerations which we have found useful.

Surgical repair of nasal septal perforations: an update.

Purpose of reviewNasal septal perforations can have a substantial impact on patients nasal breathing and subsequent quality of life. Various surgical techniques have previously been described for the repair of these perforations. In this review, we examine the most recent literature evaluating surgical techniques for the repair of nasal septal perforations. Recent findingsTwenty-seven studies evaluating 646 patients were included. None of these studies compared different surgical techniques. Four major categories of surgical techniques are described: multilayer, single layer, patch, and resection. Within these broad categories there is much heterogeneity in both the individual surgical technique and material used for reconstruction. However, the overall closure rate in all studies evaluated was 88%. SummaryThe diversity in surgical techniques demonstrated in this review would indicate that surgeons are not satisfied with the current surgical approaches for the repair of nasal septal perforations. However, the overall closure rates presented in this review are very favorable. Future comparative studies are needed to better evaluate these techniques.

Cutaneous Squamous Cell Carcinoma of the Head and Neck: Management of the Parotid and Neck

Although the metastatic rate of cutaneous squamous cell carcinoma (SCC) is low, detailed examination for the presence of micro- and macrometastasis of lymph nodes is crucial in avoiding the devastating outcomes and in planning appropriate treatment. Cutaneous SCC of the head and neck can spread to parotid lymph nodes, cervical lymph nodes, or both, depending on the location of the primary tumor. Therefore, clinical and radiologic evaluation of the parotid and neck should be performed in patients with cutaneous SCC. Optimal treatment of metastatic cutaneous SCC of the head and neck should consist of complete surgical resection with adjuvant radiotherapy.