Evolution and functional morphology of primate facial skulls

Both ontogenetically and phylogenetically the facial skull of primates consists of two components: the endocranial nasal capsule, and the exocranial membrane bones. The cartilaginous nasal capsule of the fetal period constitutes the framework for the nasal cavity, and it also functions as an expansive basis for the developing facial skull. In adult animals, its ossified parts form the fragile ethmoid bone. The structure of the nasal capsule is determined on the one hand by the spatial requirements of the orbits and of the nasal cavity (with respiratory and olfactory components), and on the other hand by the biomechanical properties of the chewing apparatus. The interaction of these heterogeneous factors results in complex, species-specific compromises. Primates are characterized by a gradual reduction of their olfactory system throughout evolution and by binocular vision. Their chewing apparatus shows constructional adaptations to a varying herbivorous diet. Viewed within a phylogenetic-systematic framework, primate evolution may be taken as a natural experiment that demonstrates the influence of various factors on a complex structural system such as the nasal and facial skeleton.     

Primary inherited defects in neutrophil function: etiology and treatment

A variety of materials have been employed in rhinoplasty for augmentation and reconstruction. While autogenous tissue remains the mainstay of nasal implants and are the clear choice for structural and augmentation grafting of the nasal tip, limited availability and unpredictable resorption or remodeling have made homologous and synthetic implants important considerations for dorsal augmentation grafting. This section discusses categories of graft materials, their physical properties, harvesting and preparation technique, and advantages and disadvantages. An algorithm for nasal implants for specific indications in support and augmentation is presented.     

Effect of glycosylated and non-glycosylated prolactin on the proliferation of normal human lymphocytes

Although rare tumors, chondromas will on occasion be encountered by the otolaryngologist in his routine daily practice. The authors describe a nasal myxochondroma in an 8-year-old child, which was removed satisfactorily surgically, with no signs of recurrence even after 4 years of follow-up. Because chondromas may also present as nasal polyps, the knowledge of cartilaginous tumors in the nose plays a pivotal role for a better approach to these patients.     

Nasal septum repair-plasty with pedicled flap technique in 126 patients--an analysis

BACKGROUND: The surgical closure of a nasal septal perforation is considered to be one of the most difficult procedures in nasal surgery with a relatively poor success rate. After a new surgical concept ("bipedicled-flap technique") was developed, a follow-up study was done in order to find out whether surgical results can be improved by means of this new method. PATIENTS AND METHOD: From 1988-1995 the bipedicled-flap technique was applied in 126 patients with nasal septal perforations (82 males, 44 females). In all patients the closure of the septal perforation was performed with an endonasal bilateral bipedicled-flap plasty and reconstruction of the cartilaginous defect with an autogenous cartilage graft from either the rib, the auricle, or from remnants of the septal cartilage. Postoperative results were evaluated in all patients. The follow-up period varied from a minimum of six months to a maximum of over seven years. RESULTS: The age peak was found in the third decade of life (females) and fifth decade (males), respectively. Most frequent preoperative symptoms were difficult nasal breathing, crusting and recurrent epistaxis. 65.8% of septal perforations were of iatrogenic origin. In 32 patients, the aetlology remained unknown. Six patients used silicone obturators preoperatively without getting any relief from complaints. In nine patients, surgical repair of the septal perforation had been attempted previously at another hospital. With the bipedicled-flap technique, primary closure was achieved in 118 patients (= 93.6%); revision surgery (same technique) was successfully performed in 2 patients, increasing the final success rate to 95.2%. Complications were rare and could always be managed easily. CONCLUSIONS: At present, the bipedicled-flap technique appears to be the most successful method for surgical repair of nasal septal perforations. The underlying principles responsible for the good success rate are: (1) the bilateral closure of the mucosal defects; and (2) the additional reconstruction of the cartilaginous septal defect with an autogenous cartilage graft only.     

Investigation of protein folding by mass spectrometry

Bone repair by regeneration as we know it continues to undergo changes, with advances approaching that may change our treatment of patients with craniofacial deformities and skeletal defects. Perhaps by the turn of the century, patients born with asymmetric deformities due to lack of growth will be treated early in life by skeletal stretching, and then later in life by skeletal distraction that is followed by use of accelerating factors to assist the healing processes. All of these available modalities are part of the regeneration of new bone formation. The future of such changes is very interesting, and our ability to help our patients will be maximized. We may even look back 25 years from now at bone grafting and find it to be obsolete and crude. It is hoped that with the new modalities being developed, we will not deviate from the use of a bone grafting procedure, which is the workhorse of the craniofacial surgeon. Bone grafting is used by all surgeons working on the craniofacial skeleton despite the problems of unpredictability of healing and an inability to calculate what percentage of the original graft will survive. The transplantation issue will be solved. The problems with donor site morbidity will continue. The use of inorganic bone substitutes will continue to have its limitation, particularly in type II wounds, which we as plastic surgeons see in the craniofacial region. As we redefine our approach to skeletal repair, we may look back and find solutions to some of the major problems we have had. The rapid stretch of soft tissue after facial advancement or structural alteration that is accompanied by a relapse due to the elastic recoil of the soft tissue could be eliminated by gradual distraction. The bone will undergo better functional adaptation when it has a gradual change in structure based on adjustment and molding in a gradual fashion. The problem of donor site morbidity and a prediction formula for bone could be resolved with new bone formation in situ by mineralization of the area under repair. Bone healing enhancers are here to stay and their clinical application will produce a far-reaching better final outcome (Fig. 11).     

Use of laser irradiation in the surgical treatment of pulmonary echinococcosis

Unilateral disturbance of nasal respiration was modeled in albino rats. All animals developed deformations of the skull in the sagittal and transversal planes. The pathogenesis of deformations is connected with neurotrophic disorders and injury to the nasal cartilaginous structures responsible for the skull growth.     

Cartilaginous disorders of the chest

Cartilaginous disorders of the thorax can arise in the parenchyma, airways, chest wall, and axial skeleton. At radiography, pulmonary hamartoma is characterized by "popcorn" calcification or fat density, either of which is diagnostic. Bronchiectasis is best demonstrated at high-resolution computed tomography (CT) and has a "tramline" or "signet ring" appearance. Tracheopathia osteochondroplastica appears at CT as multiple sessile submucosal nodules with or without calcification along the cartilaginous portion of the trachea. In relapsing polychondritis, the trachea and mainstem bronchi have diffuse or focal thickening with luminal narrowing at radiography. Costochondritis of the chest wall has become more prevalent with increased intravenous drug abuse and may be demonstrated at CT as soft-tissue swelling along with underlying cartilaginous fragmentation and bone destruction. Enchondromas are expansile and may display a calcified cartilaginous matrix at radiography. In osteochondroma, the thickness of the cartilaginous cap determines the likelihood of malignant degeneration. At radiography, chondroblastomas have a round contour, sharp margins, and cortical scalloping, whereas chondrosarcomas are large masses with indistinct margins, cortical breakthrough, and soft-tissue extension. By identifying either a process affecting a cartilage-containing structure or a cartilaginous matrix within a lesion, the chest radiologist may be able to narrow the list of differential diagnostic possibilities substantially.     

Value of scaphal graft in secondary rhinoplasties

The scaphal cartilaginous area is a most suitable anatomic site for cartilaginous graft harvesting. These grafts allow reconstruction of a flat dorsum, or a rounded dome, or alar cartilages or can be used for an extended tip graft. In some cases, both scaphes may be harvested. Raising of the grafts does not leave any sequelae when performed correctly. We have an experience of 20 cases. The main advantage of this graft is its flatness, which makes it ideal for the nasal dorsum. It has to be tailored, moderately crushed and included in a collagen "surgicel" in order to break the shape memory, slightly curved at its borders. We have used scaphal autografts in 15 cases of secondary rhinoplasties, 2 cases of cleft lip repair and in 3 cases of tertiary rhinoplasties. They solved most problems of missing cartilage, when minor defects had to be treated. These grafts will not solve major tissue defects which must be repaired by bone autografts, mostly iliac bone harvesting in our experience. The results of scaphal autografts are stable after 5 years. Resorption is moderate when the graft is correctly inserted, in an extramucosal pocket. The aesthetic result is maintained with a mean follow up of 2 years for 15 cases. The scaphal area of the ear therefore appears to be a favorable donor site for secondary, nose repair; it is easy to harvest, with inconspicuous morbidity and allows the raising of a good, flat and sculpturable material for cartilaginous nose replacement. Achieves the objectives of ore informed patients asking for artistic perfection.     

Nose deformation as a result of birth injury

The authors have compared the frequency of occurrence of nasal septum deformation in two groups of newborns, using the simplest testing methods for: 1. newborns born by spontaneous labor (254 newborns), 2. newborns born by caesarean section (52 newborns). The deformation from the central position of the nose were found in 2 newborns from group 2 (3.9%) and in as many as 50 newborns from group 1 (approx. 20%) providing the evidence that most deformations occur as a result of birth injury (during labor). 32 deformations (26 in the cartilaginous section of the nasal septum and 6 in the osseous section) have been tested repeatedly in the third or fourth week of life. 19 out of 26 deformations of the cartilaginous section of the nasal septum (73%) have been repositioned automatically. All deformations in the osseous section detected after birth were also analyzed physically in the third or fourth week of life.     

Spectrum of cartilage grafting in cutaneous reconstructive surgery

BACKGROUND: The use of cartilage grafts in cutaneous reconstructive surgery is becoming increasingly common among dermatologic surgeons. OBJECTIVE: Our purpose was to describe the indications, technical application, results, and complications associated with cartilage grafting in cutaneous reconstructive surgery. METHODS: The spectrum of cartilage grafting is reviewed, and illustrative examples are provided. RESULTS: A well-planned application of cartilage grafts in cutaneous reconstructive surgery can provide exceptional results, permitting restoration of impaired anatomic free margins as well as maintenance of the functional patency of key anatomic structures such as the nasal valve. CONCLUSION: Cartilage grafting in cutaneous reconstructive surgery is an important method to ensure optimal reconstructive outcomes. Dermatologists involved in reconstructive surgery will experience improved results through the application of these techniques.     

Upper lateral splay graft

Middle vault collapse narrows the internal nasal valve and impairs airflow through the nose. Loss of structural integrity of the upper lateral cartilaginous vault, the cause of the middle vault collapse, is classically corrected by inserting anterior spreader grafts, resulting in variable success. The desire to reconstruct the natural "T" of the upper lateral and septal cartilages culminated in the development of the upper lateral splay graft. The splay graft spans the dorsal septum but is deep to the left and right upper lateral cartilages. The intrinsic spring in the splay graft elevates each upper lateral cartilage with the septum as the fulcrum, thus correcting the middle vault collapse and opening the internal valve. The procedure, a physiologic substitute for the device "Breathe Right" applied externally, has been performed on nine patients and proved to be a prodigious functional boon to all of them. The powerful splay effect, however, can result in excessive widening of the caudal portion of the dorsum with imprudent use of the technique. Two case reports illustrate the subjective and objective improvement that was shared in all but one patient. Excess widening in one patient resulted in a suboptimal aesthetic improvement, although the functional objectives were met. Identification of suitable patients, preoperative assessment, choice of cartilage donor site, and the surgical technique are discussed. Improved internal valve function, predictability, and reliability are some of the distinct advantages of using a splay graft.     

Aesthetic rhinoplasty with maximum preservation of alar cartilages: experience with 52 consecutive cases

Historically, rhinoplasty has been conceptualized mainly as an excisional and reductional operation of the nasal framework; however, there is growing evidence showing that conservatism in terms of preserving as much skeleton as possible makes the final results more predictable and more physiologic. On the basis of this point of view and using modifications of Tebbetts' technique, a prospective study of 52 patients presenting for primary open rhinoplasty was made. In all the cases, the cephalic portion of the lateral crus was preserved, and the procedure was designed basically to create a better anatomy from an aesthetic point of view. The results were evaluated aesthetically and by cephalometry, and patients showed improvement; native crura preservation was maximized. This report suggests more prospective studies need to be conducted to demonstrate the efficacy of these surgical variations on the average patient.     

Case report. Dental Class I and skeletal Class III with unilateral right crossbite

Different forms of bone grafting materials are alluded to in this paper. Autogenous graft is superior to other bone grafting materials but is many times not available or the patient is not willing to utilize cranial or iliac crest bone. Allografts, Xenografts and bone substitute materials are the most widely used today in dentistry and especially those patients wishing to use dental implants as abutment support. The technique discussed utilizing surgical tissue design, tissue closure over the graft material and the tissue barrier can be used to produce a successful final result using a graft material of choice. It is quite certain that in the near future, the use of bone graft enhancement materials (bone morphogenic protein-like substances) will be used to enhance a quicker result. It is anticipated that growth factors, stimulating factors, bone morphogenetic proteins, and osteogenetic proteins will cause a bone graft to vascularize, solidify, incorporate, and function optimally in a shorter period of time. These materials will reduce the disability time and enhance the outcome of bone grafting in the dental profession. It is also anticipated that advanced tissue surgical techniques will give better vascularization to the new graft. The described technique is predictable and should give the operator the desired result.     

Deformation behavior of skeletal composites under mechanical loading

The deformation behavior of ceramic-metal composites with a bulk-linked metal skeleton made of highly porous cellular nickel and a stainless wire mesh is examined. It is established that samples of skeletal ceramics remain intact after all types of destructive tests and show high plasticity and strain and fracture energies. A technique is developed for producing ceramics with a bulk-linked metal skeleton by filling a highly porous framework with a ceramic powder and subsequent pressing and sintering of the composite. The technique is tested for two types of skeletal ceramics: structural ceramics such as pyroceramics-highly porous cellular nickel and bioceramics such as hydroxyapatite-highly porous stainless wire skeleton. The hydroxyapatite-based composite has lower bending strength and shock bending energy but higher plasticity and nondestructability than the pyroceramics-based composite. __________ Translated from Poroshkovaya Metallurgiya, Vol. 46, No. 7–8 (456), pp. 82–90, 2007.     

The use of radiographs to evaluate shoulder pain in the ED

There is general agreement that the delivery of topical nasal medication by sprays is suboptimal. This study examines the distribution of spray to the anterior end of the middle turbinate as a guide to the distribution to the middle meatus by means of an endoscopic photographic comparison using dyed aqueous nasal spray. The technique was found to be reproducible. The effect of vigorously inhaling whilst spraying was studied by means of a randomized crossover trial and was found to have no significant effect. This technique could be used in conjunction with other means of assessing intranasal distribution when assessing improved topical nasal drug delivery systems.     

Alveolar bone grafting in unilateral complete cleft lip and palate patients

Autogenous bone graft of an alveolar cleft area has the following advantages: (1) assistance in the closure of buccoalveolar oronasal fistula; (2) provision of bony support for unerupted teeth and teeth adjacent to the cleft; (3) formation of a continuous alveolar ridge to facilitate orthodontic correction of malocclusion; (4) supporting the nostril floor and alar base to improve nasal aesthetics. It has been well accepted in most craniofacial centers as routine procedure in cleft lip and palate rehabilitation. A new surgical technique for alveolar bone grafting has been introduced to the Chang Gung Craniofacial Center since July 1991. It provided a good exposure of the alveolar cleft, primary closure of the fistula and adequate volume of bone graft. A review of 27 consecutive alveolar bone grafting procedures performed in unilateral cleft lip and palate patients from July 1991 to June 1992 was presented. Patients have been followed up for at least 6 months. The alveolar bone graft was evaluated clinically and radiologically at one week, six months and one year after the surgery. The preliminary results indicated that the new surgical technique produced less chance of recurrent fistula, good postoperative gingival height, and improvement of nasal aesthetics. Based on the results of this new study we strongly advocate the use of this new surgical technique.     

Growth of the nasal septum in the Snell strain of hypopituitary dwarf mouse

The literature relating to experimental investigation of growth of the nasal septum has been reviewed in detail. A total of 156 skulls from the Snell hypopituitary mouse, six controls and six dwarfs at each age group were radiographed in lateral view to enable measurement of the different components of the nasal septum. By 80 days of age, the snout of the nasal septum in the Snell strain of mice was 56 per cent the size of the snout in normal mice (n = 12, t = 8.07, P = 0.0005). It is concluded that the Snell strain of mouse is an example of a specific genetic defect causing severe growth retardation of cartilaginous tissues, particularly the nasal complex.     

Lisuride treatment of Alzheimer''s disease. A preliminary placebo-controlled clinical trial of safety and therapeutic efficacy

The approach to nasal bone classic corrective rhinoplasty is an almost-blind technique, where the results depends on feeling by the surgeon's hand. To overcome these drawbacks, endoscopic-assisted corrective rhinoplasty and septoplasty were performed for 16 cases of deviated noses between January 1995 and May 1997. The average follow-up period was 18 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection, and septal deviation. The postoperative courses were satisfactory in most cases, with few complications. Compared with 28 cases of classic rhinoplasty, the patient satisfaction rate was high (87.5% in endoscopic-assisted rhinoplasty, 71.4% in classic rhinoplasty), and the complication and revision rate was low (0% in endoscopic-assisted rhinoplasty, 14.3 and 7.1% in classic rhinoplasty). But extra time (about 40 min) and greater expense were required for endoscopic-assisted rhinoplasty. It appeared to us that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum, the cause of the deformity, and the immediate effect of the corrective measures used. The use of an endoscope in corrective rhinoplasty for deviated noses provides an expanded field of vision, direct manipulation of lesions, and better aesthetic and functional results.     

Glandular cells in vaginal smears from posthysterectomy patients

Relapsing polychondritis (RP) is a rare disease characterized by recurrent inflammation and destruction of the cartilaginous structures. Tracheobronchial chondritis is a dreaded complication of RP. We wish to report a case of RP of the trachea and bronchi which was treated with nasal continuous positive airway pressure.