Correction of the crooked nose

Correcting the crooked nose remains one of the most challenging problems in rhinoplasty. When faced with a twisted nose, rhinoplasty surgeons tend to be divided into those who perform an anatomic reconstruction and those who prefer camouflage techniques. Regardless of the approach used, the revision rate remains fairly high. An anatomic correction of the twisted nose through an open approach was performed. The septum was freed from the extrinsic forces of the deformed nasal bones and upper and lower lateral cartilages. The residual true septal injury was then evaluated. The septal deformity was addressed through quadrangular cartilage resection, repositioning of the caudal septum in the anatomic midline, and correction of the dorsal septal deformity with horizontal control sutures. The skeletal support was then reconstructed with the use of a spreader-extension graft on the concave side and a batten graft on the opposite side. The nasal tip was set relative to the dorsum by fixation to the extension grafts. Residual lateral crus deformities were corrected by a combination of lateral crural spanning sutures or alar spreader grafts. With this approach, straightening the crooked nose without compromising skeletal support or nasal aesthetics was successful.     

Comparative pharmacokinetics of paracetamol (acetaminophen) and its sulphate and glucuronide metabolites in desert camels and goats

Functional and aesthetic nasal surgery has been undergoing a process of fine-tuning. The surgical approaches lean toward greater conservation-particularly aesthetic- and functional selectivity. This has been made possible by improved diagnostic methods and pre-operative programming techniques such as computerized morphometry, computerized axial tomography, rhinosinus endoscopy, rhinomanometry, acoustic rhinometry and electromyography. Another important point in functional and aesthetic nasal surgery is that a) it can be divided into different techniques for each anatomo-functional sector considered and b) these can be used together in various combinations. Experience and the literature have underscored some issues which are most pertinent to the modern methodological viewpoint. The first large-scale controversy involves a comparison of open and closed techniques for access. The advantages and disadvantages of both techniques are described, although the disadvantages can be reduced to a minimum if the right indication is chosen. In the authors' opinion, the open technique should be reserved for general revision surgery, particularly in conjunction with difficult tips, labiopalatoschisis reconstruction, septal perforation and saddle nose. The second basic point involves how to deal with the perichondrium-periostium-mucosal flaps. The two main techniques for nasal skeletizing in rhinoseptoplasty include the extra-mucosal approach which is conservative and the trans-mucosal approach which is apparently more traumatic. Curiously, however, it is the latter technique which leads to fewer medium-long term complications. The nasal tip is the crux for the neophyte to rhinoseptoplasty. Through knowledge of the indications and the risks of the various techniques makes it possible to predict the result before-hand, although with certain margin of error. Indeed, this is one of the regions of the nose where errors reap the greatest damage. In this anatomical site, the use of conservative techniques is, therefore, strongly suggested. Finally, not only has research into the field of functional nasal surgery been unable to find concrete applications in humans (for obvious ethical reasons), it has likewise been unable to provide an answer to the question most rhinosurgeons pose: why do some patients still complain of difficulty breathing, even after successful surgery? It is our conviction that the problem is due to the fact that research into the endonasal receptors has not progressed.     

Site Characterization Model Using Artificial Neural Network and Kriging

In this paper, the problem of site characterization is treated as a task of function approximation of the large existing data from standard penetration tests (SPTs) in three-dimensional subsurface of Bangalore, India. More than 2,700 field SPT values (N) has been collected from 766 boreholes spread over an area of 220-km2 area in Bangalore, India. To get N corrected value (Nc), N values have been corrected for different parameters such as overburden stress, size of borehole, type of sampler, length of connected rod. In three-dimensional analysis, the function Nc = Nc(X,Y,Z), where X, Y, and Z are the coordinates of a point corresponds to Nc value, is to be approximated with which Nc value at any half-space point in Bangalore, India can be determined. An attempt has been made to develop artificial neural network (ANN) model using multilayer perceptrons that are trained with Levenberg-Marquardt back-propagation algorithm. Also, a geostatistical model based on ordinary kriging technique has been adopted. The knowledge of the semivariogram of the Nc values is used in the ordinary kriging method to predict the Nc values at any point in the subsurface of Bangalore, India where field measurements are not available. The results obtained show that ANN model is fairly accurate in predicting Nc values. In case of ordinary kriging, a new type of cross-validation analysis shows that it is a robust model for prediction of Nc values. A comparison between the ANN and geostatistical model demonstrates that the ANN model is superior to Geostatistical model in predicting Nc values in the subsurface of Bangalore, India.     

Reduced nocturnal asthma by improved nasal breathing

The nose and not the mouth should be used for breathing as the nose has better air conditioning capacity. When air is inhaled through the mouth it may dry and cool the respiratory mucosa, which can lead to bronchoconstriction in sensitive patients with asthma. By dilating the nostrils you can increase nasal breathing in most subjects. The aim of this study was to investigate whether sleeping with dilated nostrils reduces nocturnal asthma. At the Asthma and Allergy Research Centre, Gothenburg, 15 out-patients with nocturnal asthma were selected. Every other night for 10 nights the test subjects slept with the nasal dilator Nozovent which has been shown to increase the nasal air-flow and decrease the need for mouthbreathing. Every morning the patients self-reported on a form whether they had woken with asthma during the night or if they had had to take asthma medication. When sleeping with the nasal dilator the patients woke up with asthma on 17 of 75 nights as compared with 32 of 75 when sleeping without the device (p < 0.01). Reduced nocturnal asthma was observed by 12 patients and less need for asthma medication at night by 7. None of the patients noted any side-effects due to the device. In conclusion, the easy-to-use and cheap medical device, Nozovent, which mechanically dilates the nostrils and improves nasal breathing, can reduce nocturnal asthma.     

Prediction of Surface Roughness in Turning of EN 353 Using Response Surface Methodology

In the present work, an attempt has been made to investigate the influence of cutting speed, feed, depth of cut and nose radius on surface roughness during wet turning of EN 353 steel using tungsten carbide inserts. Surface roughness prediction models in terms of speed, feed, depth of cut and nose radius is developed by using response surface methodology based on center composite rotatable design. A comparison of first order models with quadratic model was carried out on the basis of percentage mean absolute error and mean square error. The results clearly reveals that the predicted data using quadratic model is in close agreement to the experimental surface roughness values as compared to predicted data using first order model. In addition to this, it has been revealed that the speed is the main influencing factor affecting the surface roughness. The depth of cut has no significant influence on the roughness. Mathematical model for surface roughness shows that surface roughness decreases with increase in speed and nose radius, but increases with increase in feed. The percentage variation between the predicted and experimental values of the surface roughness during the confirmation experiments was found within 5 %. An attempt has also been made to obtain optimum cutting conditions for minimum surface roughness.     

Primary unilateral cleft nose correction: a 10-year follow-up

Primary nasal correction at the time of rotation-advancement of the lip has been rendered practical by developing a symmetrical nasal platform by presurgical orthodontics and a gingivoperiosteoplasty. The nasal correction involves unilateral columella lengthening, alar cartilage positioning, and alar base cinching to present a nose within normal limits. This is accomplished before the age of recall, and by avoiding retention of the nasal deformity through childhood, it by-passes the ridicule that invariably accompanies it.     

Magnesium and the transport system

For the purpose of studying the sex differences of the human face we collected five separate images, which consist of several parts of the face, from frontal view photographs of 48 male and 52 female college students. We traced outlines of their faces with simple lines (traced items), and made reproductions of the photographs of their eyes, mouth and nose by using a copying machine (reproduced items). The test subjects were 16 males and 8 females. They looked at parts of the face shown in each image, and categorized them individually by judging on their sex. Then, we calculated the percentages of correct judgments (percentage correct) for each image. By comparing the percentage correct between male and female we concluded that the sex of the subjects did not affect the results of their judgments. In the traced items the percentage correct for the face as a whole, which contained the outlines of the eyes, mouth, nose and the lower jaw, was 69%, but it decreased to 61% when the outline of the lower jaw was removed. Hence, the outline of the lower jaw apparently has a characteristic shape easily noticed by males. In the reproduced items the percentage correct was 65% for the eyes, 68% for the mouth and 58% for the nose. The mouth, therefore, has more distinguishing characteristics than the eyes or nose, especially with females. On the other hand, there is no correlation between the percentage correct for the eye, mouth and nose items. Hence, we concluded that the sexual specificity for the shape of the young Japanese face appears on their parts independently.     

Computational parallels between the biological olfactory pathway and its analogue 'the electronic nose': Part II. Sensor-based machine olfaction

Over the last fifteen years, we have witnessed a rapid expansion in the development of artificial odour sensing systems, or so called 'electronic nose' systems. Whilst the power of this approach to flavour has undoubtedly been demonstrated by its recent application to various complex odours, it will be argued that the original research programme, aimed at developing a comparative model of the biological olfactory pathway, has degenerated into an attempt to obtain an ad hoc workable system, based around readily available sensor and pattern recognition (PARC) technologies. At the time, the first 'model' nose system reflected the limited understanding of sensory information processing carried out within the biological olfactory pathway. We are now presented with an opportunity to evaluate and re-assess the architecture for an electronic nose, in view of the recent advances in understanding the key processing principals exploited by the olfactory bulb and cortex in the identification and characterisation of molecular stimuli. In Part II of this paper, we examine the parallels that exist between the biological olfactory system and the electronic nose. It is shown that the two systems share many similarities in their architectures and other properties, such as odour delivery, nonspecific sensor/receptor response, sensor/receptor preprocessing and content addressable memory (CAM) function. Of particular importance, both systems need to overcome similar operating problems, such as sensor/receptor drift, degeneration and poisoning, limited sensor/receptor sensitivity, discrimination of odour quality invariant of intensity and also the identification of particular odour components within a mixture of background odours. Finally, a number of opportunities for improving the biological plausibility of electronic nose systems are suggested that may yield an improvement in performance.     

Headaches associated with nasal obstruction due to deviated nasal septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressurelike in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

Rhinotillexomania: psychiatric disorder or habit?

BACKGROUND: Conditions once considered bad habits are now recognized as psychiatric disorders (trichotillomania, onychopagia). We hypothesized that nose picking is another such "habit," a common benign practice in most adults but a time-consuming, socially compromising, or physically harmful condition (rhinotillexomania) in some. METHODS: We developed the Rhinotillexomania Questionnaire, mailed it to 1000 randomly selected adult residents of Dane County, Wisconsin, and requested anonymous responses. The returned questionnaires were analyzed according to age, sex, marital status, living arrangement, and educational level. Nose picking was characterized according to time involved, level of distress, location, attitudes toward self and others regarding the practice, technique, methods of disposal, reasons, complications, and associated habits and psychiatric disorders. RESULTS: Two hundred fifty-four subjects responded. Ninety-one percent were current nose pickers although only 75% felt "almost everyone does it"; 1.2% picked at least every hour. For 2 subjects (0.8%), nose picking caused moderate to marked interferences with daily functioning. Two subjects spent between 15 and 30 minutes and 1 over 2 hours a day picking their nose. For 2 others, perforation of the nasal septum was a complication. Associated "habits" included picking cuticles (25%), picking at skin (20%), biting fingernails (18%), and pulling out hair (6%). CONCLUSION: This first population survey of nose picking suggests that it is an almost universal practice in adults but one that should not be considered pathologic for most. For some, however, the condition may meet criteria for a disorder-rhinotillexomania.     

Numerical/Experimental Correlation of a Plasma Wind Tunnel Test on a UHTC-Made Nose Cap of a Reentry Vehicle

The nose cap demonstrator named Nose_2 has been tested for the second time in the plasma wind tunnel (PWT) facility which is part of the sharp hot structure (SHS) technology project, focused on the assessment of the applicability of ultrahigh temperature ceramics (UHTC) to the fabrication of high performance vehicles and SHS for reusable launch vehicles. In this paper the FEM based thermal analyses, carried out for the rebuilding of this PWT test, are presented. Experimental data measured in the PWT have been compared with numerical ones in order to validate the FEM model and to help in interpreting the experimental test itself. The knowledge on the physical phenomenon under investigation has been greatly improved, thanks to the synergy between numerical and experimental activities. In particular, a qualitative study of the modeling of the tip-dome interface has been performed in order to estimate the thermal contact resistance that heat flux encounters in passing through the demonstrator. The correlation between numerical and experimental temperature curves has been found to be satisfactory for both internal and surface temperature distribution, and the FEM model was found reliable in reproducing the thermal behavior of the nose cap.     

Nasal sill augmentation in adult incomplete cleft lip nose deformity using superiorly based turn over orbicularis oris muscle flap: an anatomic approach

Adult incomplete cleft lip nose deformity is not uncommon in India. Poverty, ignorance, and parental neglect account for its late presentation. Besides the classical features of cleft lip nose deformity, the constant findings observed in this patient population have been a widened and depressed nasal sill. This is attributable to the sparse, hypoplastic, and abnormally orientated orbicularis oris muscle in the region of the sill. Failure to restore the nasal sill symmetry by suitably augmenting the sill frequently leads to unsatisfactory and asymmetric results. However, in the literature, satisfactory restoration of the nasal sill has not been given the importance it deserves while performing cleft lip rhinoplasty. We present a method of augmenting the depressed nasal sill in cases of adult incomplete nose deformity using a superiorly based orbicularis oris muscle flap, which is harvested from the soft tissues between the apex of the cleft and the nostril sill. Following de-epithelialization of the overlying skin, the exposed muscle is raised as a superiorly based flap after dissecting it from the underlying mucosa. It is folded, turned over, and tucked into the nasal sill base and anchored to the anterior nasal spine to give the desired augmentation. Satisfactory results have been obtained in 18 cases of nasal deformity associated with incomplete cleft lip. In our opinion, this technique offers a simple and effective method of augmenting the depressed sill by utilizing locally available tissues and without the need for procuring autologous tissue from distant sites.     

Structural Equation Models for Interchangeable Dyads: Being the Same Makes a Difference.

Structural equation modeling (SEM) offers a flexible method for studying the patterns of interdependence in partners' behavior, which lie at the heart of interactions and relationships. Although SEM has been applied to the study of distinguishable dyads, in which partners are distinguishable by type, such as male and female, it has rarely been applied to the study of interchangeable dyads, such as male-male or female-female pairs. The authors integrate a wide range of dyadic interdependence models--including actor-partner interdependence models, mutual-influence models, and common-fate or dyadic personality models--into an SEM framework for use with interchangeable dyads. The authors also address the use of latent variables at both the dyadic and individual levels, whereby substantive relationships in these models can be corrected for errors of measurement. Furthermore, the authors discuss the conceptual underpinnings of dyadic models and give examples of their application. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatigue hardening in annealed and deformed aluminum and copper

Fatigue hardening in 2024 aluminum and in OFHC copper has been investigated by measuring the hysteresis-loop width at zero stress as a function of the number of tension-compression cycles with a constant stress amplitude. Prior to cycling, the specimens were either annealed, elongated, or twisted. For the annealed and the preelongated specimens, the loop width is shown to decay with the number of cycles as a second-order process, and for the pretwisted specimens, as a first-order process. This behavior can be accounted for by reasonable assumptions regarding the dislocation movements involved.     

Reconstruction of a short nose by full-thickness tissue transfer with osteotomy

A severely shortened nose secondary to fracture of the middle third of the face was reconstructed by full-thickness tissue transfer with osteotomy. A nasalis musculocutaneous island flap, including the scar located in the nasal dorsum, was harvested for the lining. It was elevated based on the lateral nasal artery. The donor site defect of the flap and the covering defect were reconstructed with a forehead flap. The platform and framework of the nose were corrected with an en bloc osteotomy of the nasal bone, including the piriform aperture with a vascularized calvarial bone graft. Satisfactory and stable results were obtained in one stage along with the restoration of the relationships between the nose and the surrounding structures.     

Revision rhinoplasty for monographs in facial plastic surgery contemporary rhinoplasty

Revision rhinoplasty represents the amalgamation of years of knowledge, judgment, technique, communication, self-critique, and patient selection. The surgeon's ego, economics, or personality should not persuade or dissuade him or her from undertaking revision rhinoplasty. This decision should be made after critical evaluation of his/her skills at technical execution, and communicating with the patient, as well as the patient's perception and expectations. If any concern exists, delay. Re-evaluation and referral become prudent. These patients may already be angry. They are obviously dissatisfied with their results and have frequently had attempts at revision by the previous surgeon. All these factors complicate the psychological aspects of an already difficult task. One other realization is the fact that this now becomes your result if it is the revision of a colleague's surgery. When comfortable with all of these factors, revision rhinoplasty can then be undertaken. The need for revision may be subtle or grotesque and can result from a multitude of factors: unrecognized deformities at the primary surgery; misunderstood consequences of technique; poor technique; unfavorable healing; postsurgical injury; the inevitable need for revision surgery in a difficult nose; and poor aesthetic judgment. Revision of one's own results is emotionally more difficult, but functionally and technically easier. A complete understanding of the primary surgery, access to the initial photographs, and a rapport with a patient who is willing to return are all helpful in achieving a satisfactory result. In approaching the correction of postoperative deformities, it is important to have an understanding of the anatomic abnormality as well as the aesthetic deformity. Recognizing the anatomic cause of the postsurgical deformity is more relevant to their avoidance and to the maturation of the surgeon than to their correction and the desired aesthetic result except when functional abnormalities exist and need correction. Ultimately it is the deformity that needs to be corrected, and this may or may not require the restoration of anatomic normalcy.     

Unusual three-dimensional bite mark evidence in a homicide case

A comparison has been made between bite marks observed on the nose of a female homicide victim and the configuration of the dental structures of a male suspect. The victim's bite marks showed a number of demonstrable characteristics which could be reproduced by models of the dentition of the suspect. Special peculiarities within and between individual teeth, together with the upper and lower jaw relationship, were demonstrably consistent with the bite mark patterns on the victim's nose. Detailed examination of the scientific evidence led the dental investigators to the conclusion that there was a positive match between the suspect's dentition and the bite mark on the decedent's nose. The dental investigation and subsequent dental testimony were prime factors leading to the defendant's conviction of manslaughter in the first case in California involving the major use of bite mark evidence.     

A Model for Precipitation Kinetics in Vanadium Microalloyed Steel

Small dispersoid particles inhibit recrystallization which is critical in controlling the grain structure of many high strength low alloy steels. A general kinetic model has been developed to predict precipitation of V(C, N) in vanadium microalloyed steels with a series of carbon and nitrogen contents. The solubility product and driving force of carbonitrides precipitated in austenite as well as the interfacial energy and other parameters can be evaluated to predict Nucleation rates-Temperature (NrT) and Precipitation-Time-Temperature (PTT) diagram. By using stress relaxation tests and fitting with Avrami equation, it is possible to draw PTT diagrams. The predictions of the model coincide with results of experimental investigation on V(C, N) precipitation in austenite. The nose temperature is around 850 ℃ obtained by experiment which is different from the prediction of the model and the difference is 30 ℃, and nitrogen has more effect on the shape of "C" curve of PTT diagram than carbon that makes "C" curve move leftward significantly.     

Cold Modelling of Slag Splashing in LD Furnace by Oxygen Lance with Twisted Nozzle Tip

The effects of a conventional lance tip with 4 normal nozzles and a lance tip with 4 twisted nozzles on slag splashing were investigated. A cold model for LD converters, Jiuquan Iron & Steel Co., was established and the amount of slag splashed onto the model walls was measured in the cold modelling experiments. The results from the experiments show that at low top gas flow rate the amount of slag splashing for the tip with twisted nozzles is less than that for the conventional tip, whereas at high top gas flow rate the amount of slag splashing for the nozzle twisted lance is greater than that for the conventional lance. For the nozzle twisted lance tip, slag splashing rates increase with increase in slag amount, lance height and top gas flow rate and the maximum amount of slag splashing for the tip with twisted nozzles can be obtained under the process parameters of 47.6 Nm³/h gas flow rate, 12% slag amount and 247 mm lance height. More slag droplets can be directed onto the cone with a nozzle twisted lance tip than with a normal lance tip at high top gas flow rate.     

Simultaneous construction of an internal and external nose in an infant with arhinia

We report on the simultaneous construction of an internal and external nose in an infant born with arhinia. The indication for this very early reconstruction was due to respiratory distress and the associated feeding problems. It was possible to create two nasal cavities separated by a septum and to form an external nose from pre-expanded skin and a secondary arm flap for the tip supported by a frontal bone flap with intrinsic growth potential and auricular cartilage grafts for the tip. The 4-year-old child has excellent function of the nose with an acceptable appearance. Her psychological development is normal. Respiratory distress and associated feeding problems necessitated the use of oropharyngeal and orogastric tubes in a female infant born without a nose (arhinia). Over a period of many weeks, with attempts to remove the tube resulting in aspiration, we decided to create a functional nasal airway and an external nose simultaneously at this early stage. At the age of 20 weeks, two nasal cavities were created by using a buccal sulcus incision and connected to the existing nasopharynx and partially lined with split skin grafts. An external nose was created using the expanded midfacial skin and supporting it, an osteoperiosteal flap from the frontal bone. Later, a Tagliacozzi flap had to be added for the nasal tip. The newly constructed nose functions well and appears to aid favorably in the normal psychosocial development of the now 4-year-old girl.