Dorsal Hump Research Articles

Discussion: Component Dorsal Hump Reduction: The Importance of Maintaining Dorsal Aesthetic Lines in Rhinoplasty

Chicago, Ill. Received for publication August 25, 2003. Peter McKinney, M.D., 1242 LSD, Chicago, Ill. 60610, [email protected]

Nose surgery: how to prevent a middle vault collapse--a review of 50 patients 3 to 21 years after surgery.

There is a conception, likely a misconception, that when performing a nasal osteotomy with a concomitant dorsal hump removal, the upper lateral cartilages are detached or damaged and, over the long-term, respiratory difficulties result because of a middle vault collapse or interference with the internal nasal valve. A follow-up of 50 patients between 3 and 21 years postoperatively provides evidence that this can be prevented. The vast majority (82 percent) reported they were breathing very well for an average of 6.5 years postoperatively. Of the authors' own 38 primary rhinoplasty patients, only two patients (5 percent) reported respiratory difficulties. The authors are unable to substantiate that either the osteotomy or the dorsal hump removal was responsible. Of the 12 patients who had their primary rhinoplasty performed elsewhere, six (50 percent) reported respiratory difficulties before the secondary rhinoplasty at this clinic. Furthermore, an appreciable improvement in breathing was reported by 66.7 percent of these patients after the secondary rhinoplasty. The authors conclude that their gentle proper surgical technique, combined with a good understanding of nasal physiology (with respect to the septum, inferior turbinates, and external and internal valves), allows them to perform a concomitant dorsal hump removal and osteotomy without interfering with nasal physiology.

Modification of the Skoog dorsal reduction for preservation of the middle nasal vault.

Preservation of the middle nasal vault has increasingly become a topic of interest and concern in rhinoplasty. Modification of the nasal dorsum with traditional techniques may create unfavorable cosmetic results and adverse functional sequelae due to collapse of the middle nasal vault. Nasal dorsal reduction invariably involves separating the upper lateral cartilage (ULC) attachments from the dorsal septum. A number of procedures are used to reestablish the width of the middle nasal vault and competence of the internal nasal valve. Spreader grafts are the most frequently used technique. Although these grafts reliably preserve the middle vault, dorsal irregularities may result. Alternative techniques, such as suture suspension of the ULCs to dorsal onlay grafts or direct suturing of the ULCs to the septum, may pose similar problems. We have found that a modification of the Skoog technique for dorsal hump reduction preserves both a favorable aesthetic contour of the middle nasal vault and proper function of the internal valve. This procedure involves removal of the osseocartilaginous dorsum en bloc. The nasal dorsum is further reduced; the removed portion of nasal dorsum is sculpted and then replaced anatomically. Once a favorable position is found for the native dorsal graft, the upper lateral cartilages are resuspended to the graft with suture fixation. The dorsal segment thus acts as a dorsal onlay spreader graft, reestablishing a natural dorsal contour and preserving the middle nasal vault. We can avoid osteotomies in patients with an appropriate preoperative width of their bony base while correcting the open roof with the replaced dorsal segment.

Migratory costs and contemporary evolution of reproductive allocation in male chinook salmon.

Energetically demanding migrations may impact the resources available for reproductive trait development and activity, and hence favour evolution of new investment strategies for remaining resources. We conducted a large-scale experiment to evaluate the proximate cost of migration on male reproductive investment in chinook salmon (Oncorhynchus tshawytscha) and contemporary evolution of reproductive allocation. Experimentally induced differences in migratory costs (17 km inland and 17 m elevation vs. 100 km and 430 m) influenced dorsal hump size and upper jaw length, two traits influencing male mating success that are developed during migration. Longer migration also reduced tissue energy reserves available for competition and length of breeding life. Corresponding shifts in the balance between natural and sexual selection appear to have been responsible for heritable population divergence in secondary sexual trait investment, in approximately 26 generations, following colonization of spawning sites with different migratory demands.

Management of the severe bulbous nasal tip using porous polyethylene alloimplants.

Reliable outcomes in correction of the severely bulbous nasal tip remain elusive. Reduction and binding of the tip cartilages result in a partial external nasal valve collapse. If a concurrent dorsal hump reduction is accomplished and osteotomies are completed to close the open roof deformity, then a severe constriction of the external valve may result. This is best avoided by resection of the residual lower lateral cartilages and substitution with external valve batten implants. The tripod of nasal tip supports is then rigidly reconstituted. When autogenous graft materials are considered inadequate or undesirable, the surgeon may safely use porous polyethylene alloimplants to support the external nasal valve. A dependable surgical technique based on extensive experience with these materials is outlined.

On a new species of Potamocypris (Crustacea, Ostracoda) from Chalakkudy River, Kerala (India), with a checklist of the Potamocypris-species of the world

Potamocypris narayanani n.sp. is described from a riverine habitat in Kerala, India. The new species belongs to the 'Cyprilla' group in the genus because of the wide anterior and posterior flanges on the LV. It can be distinguished from its congeners belonging to this group by the large dorsal hump on the RV, which overlaps the LV. The value of some morphological characteristics at different taxonomic levels within the genus Potamocypris is discussed and the position of the Cyprilla- group within the genus is re-assessed. Potamocypris angularis Victor & Michael, 1975 is transferred to Plesiocypridopsis. A checklist of the species of Potamocypris of the world is added, together with subjective synonymies.

Consumption choice by bears feeding on salmon.

Consumption choice by brown (Ursus arctos) and black bears (U. americanus) feeding on salmon was recorded for over 20,000 bear-killed fish from 1994 to 1999 in Bristol Bay (sockeye salmon, Oncorhynchus nerka) and southeastern Alaska (pink, O. gorbuscha and chum salmon O. keta). These data revealed striking patterns of partial and selective consumption that varied with relative availability and attributes of the fish. As the availability of salmon decreased, bears consumed a larger proportion of each fish among both years and habitats. When availability was high (absolute number and density of salmon), bears consumed less biomass per captured fish, targeting energy-rich fish (those that had not spawned) or energy-rich body parts (eggs in females; brain in males). In contrast, individual fish were consumed to a much greater extent, regardless of sex or spawning status, in habitats or years of low salmon availability. The proportion of biomass consumed per fish was similar for males and females, when spawning status was statistically controlled, but bears targeted different body parts: the body flesh, brain and dorsal hump in males and the roe in females. Bears thus appeared to maximize energy intake by modifying the amount and body parts consumed, based on availability and attributes of spawning salmon.

The deviated nose

Steve H. Byrd, MD Peter McKinney, MD Jack P. Gunter, MD Ira D. Papel, MD Dr. Byrd: The first patient is a 28-year-old man who sustained a very typical nasal fracture on the right side at about the junction of the thick and thin portion of the nasal bone while playing basketball (Figure 1). He understands that his nose is deviated to the left, complains of a partially diminished airway on the right, and asks, “While you're at it, could you take that bump off my nose?” Dr. Gunter, how would you approach this patient? Dr. Gunter: It appears that the nasal base is a little wide. The one-sided fracture has deviated the nose to the left with collapse of the right upper lateral cartilage. On the lateral view, the nasal frontal angle is very shallow with a slight amount of increased tip projection and a small dorsal hump. Dr. Byrd: How would you explore this patient's aesthetic goals, and how would you go about achieving them? Dr. Gunter: I have large-scale patient photographs taken in the office over which I tape tracing paper. I draw on the photographs after getting feedback from the patient. I revise the drawing until I achieve what the patient would like. If I think it is reasonable, I explain that this will be the “goal” for the surgery, not exactly what the patient will look like. Although I usually employ an open approach, it really will not be necessary if I plan on doing a very small rasping of the dorsum, leaving the tip projection alone. I would do osteotomies on the right side while the septum remains deviated and see whether that corrects the curvature of the nose or just corrects the problem on the right. If the septum remains deviated, I would …

Selective predation by brown bears (Ursus arctos) foraging on spawning sockeye salmon (Oncorhynchus nerka)

Selective predation by and predation rates of brown bears (Ursus arctos) foraging on spawning sockeye salmon (Oncorhynchus nerka) in a small shallow creek in the Wood River lake system near Bristol Bay, Alaska, were quantified during 1986 and 1990–1992. Bears killed a high proportion of spawning salmon when few salmon entered the creek (92% of 505 fish) and a much smaller proportion when the spawning population reached a historical high (16% of 15 631 fish). Selective predation on salmon that differed in length, sex, and spawning condition was measured by tagging salmon at the mouth of the creek immediately prior to upstream migration and then recovering dead tagged fish during daily surveys of the entire creek. The relative frequencies of large, medium-sized, and small salmon killed by bears indicated that the risk of predation was more than 150% greater for large than for small salmon. A higher proportion of the male salmon population was killed and a greater proportion of male bodies were consumed than female salmon. Selectivity for male salmon increased as the spawning season progressed, possibly because male salmon weakened earlier and lived longer in a weakened state than female salmon. Male salmon were attacked mostly along the dorsal hump area, whereas female salmon tended to be attacked along the abdomen, where eggs could be exposed. Bears selectively killed female salmon prior to spawning during 1 of the 3 years, but only 6.1–7.8% of the female spawning populations were killed prior to spawning. These data support the hypothesis that selective predation by bears may influence the body morphology of spawning salmon.

AN AESTHETIC DORSUM: The CATS Graft*

A Joseph resection of the dorsal hump permanently alters the nasal dorsum from a fused smooth cap into three individual components with an open roof. In those patients in whom infracture is unwise or in whom the septum is severely twisted or the skin is very thin and likely to show irregularities, reconstruction of the cap is done with a cartilaginous dorsal graft that has been sanded thin.

Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty.

Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. The factors involved in nasal tip support are numerous; however, the role of the anterior septum versus the lower lateral cartilages has been debated in the literature. The purpose of this study was to quantitate, using fresh cadavers, the critical elements for nasal tip support with open versus closed rhinoplasty techniques. Multiple nasal manipulations, including cephalic trim, cephalic trim and interruption of the lower lateral cartilages, dorsal hump resection (1 to 4 mm), submucous resection of the septum, and complete septal removal, were performed using fresh cadaver heads and using both the open and closed rhinoplasty approach. Changes in nasal tip support were recorded. In comparing similar procedures, the mean loss of tip projection for the open approach was 3.43 mm versus 1.98 mm for the closed approach (p < 0.001). There was a significantly larger loss of tip projection in open versus closed procedures for cephalic trim, cephalic trim and interruption of the lower lateral cartilages, and cephalic trim with interruption of the lower lateral cartilages and septum removal (p < 0.001, 0.001, and 0.001, respectively). We attributed the differences between the open and closed approaches to the increases in ligamentous disruption and skin undermining that occur when using the open approach. Septum manipulation in general resulted in larger losses in tip support in both the open and closed approach. We conclude that the open approach for rhinoplasty results in a significantly increased loss of tip projection when compared with the closed technique due to the larger disruption of ligamentous support. Contrary to previous data, septal manipulation resulted in significant losses of tip projection, most likely secondary to lowering the nasal septal angle, and this effect may be more significant in closed rhinoplasty. The apparent clinical implications are that active measures, such as columellar struts and/or suture techniques for adding or maintaining nasal tip support during rhinoplasty, are indicated, especially when using the open approach and when any anterior septal alteration is performed using the open or endonasal approach.

Valvular incompetence is most likely cause of postrhinoplasty airway problems

Mark B. Constantian, MD, Nashua, NH , is a board-certified plastic surgeon and an ASAPS member. I believe that most of the obstructions I treat after rhinoplasty have inadvertently been caused by the surgery. In the process of removing a dorsal hump or refining a tip, the surgeon can easily create an internal or external valvular incompetence or both. If you reduce the height of the dorsum with or without fractures, you will lose the primary support to the anterior edges of the upper lateral cartilages, so that they collapse medially. When the surgeon has resected too much upper lateral cartilage or failed to recognize a lower lateral cartilage malposition or cephalic rotation and removed too much lateral crus, it is almost certain that the patient will come back and say, “Now I don't breathe as well as I did before.” That's when the surgeon frequently will …

Neural spine elongation in dinosaurs: sailbacks or buffalo-backs?

Several dinosaurs, notablyOuranosaurusandSpinosaurus,have vertebral columns marked by prominent arrays of elongated neural spines. Using pelycosaurian sailbacks likeDimetrodonas analogies, popular orthodoxy holds that the tall spines served as supporting struts for dorsal sails of purported thermoregulatory function, especially heat dissipation in tropical climates. It is argued here that the neural spines ofOuranosaurus, Spinosaurus,and several other long-spined dinosaurs favor bison-like humps rather than sails: 1) in functional morphology and relative elongation they are dissimilar to pelycosaur spines but homoplastically converge on the spines of high-withered ungulates; 2) the usefulness of a sail in thermoregulation has been exaggerated—in large tetrapods it would have been fairly efficient as a thermal amplifier but ineffective as a radiator; hence large sail-bearing dinosaurs in open tropical climates are improbable; 3) the insulation properties of humps favor gigantothermy, the most likely thermobiological model for large dinosaurs.Dinosaur humps are probable adaptations for: 1) energy storage, maintenance of gigantothermy, and heat-shielding in unshaded habitats; 2) long-distance migration from feeding to nesting grounds across terrains of variable productivity; and 3) lipid conservation for production of large clutches of eggs at the nesting site. Because sacral, caudal, or dorsal humps were relatively common traits among certain groups, the fashionably anorexic image of many large dinosaurs must be emended.

Morphology and infraciliature of some soil ciliates (Protozoa, Ciliophora) from continental Antarctica, with notes on the morphogenesis of Sterkiella histriomuscorum

AbstractThe morphology of seven soil ciliate species from continental Antarctica was investigated using live observation and protargol impregnation. Observations on two populations of Protospathidium serpens corroborate the view that this species usually has a single, more-or-less nodular, macronucleus distinguishing it from P. muscicola, which possesses 10–30 nodules. The Antarctic specimens of Protospathidium terricola differ inconspicuously from the type population in that they are slightly larger, have fewer ciliary rows (17 vs 21), and the fragments of the circumoral kinety are less distinctly separated from each other. Spathidium seppelti nov. spec, resembles 5. bavariense, but has 100–200 macronuclear nodules and a conical depression in the dorsal third of the oral bulge. Odontochlamys wisconsinensis nov. comb, (basionym: Chilodonella wisconsinensis Kahl, 1931) has four right field kineties and an oral basket consisting of 14 rods; the dorsal brush is near the anterior margin and usually consists of four cilia. The Antarctic population of Pseudochilodonopsis mutabilis possesses a regular dorsal hump and only 12–14 (about 15 in Austrian type population) phary ngeal rods. Oxytricha opisthomuscorum has six dorsal kineties with long cilia and a buccal cirrus near the anterior end of the paroral membrane. The Antarctic specimens of Sterkiella histriomuscorum have fïve transverse cirri. Their morphogenesis differs slightly from that of a population having four transverse cirri in that the daughter's anlagen are more distinctly separated and some temporal sequences are different.

Rhinoplasty with Advancing Age: Characteristics and Management

The aging nose presents several unique challenges to diagnosis and management. Although classically it presents as a drooping nasal tip secondary to loss of tip support with a relative dorsal hump, there are associated changes in the nasal skin, bony architecture, and airway that mandate consideration. Methods of correction emphasize restoration of tip support with nondestructive suture techniques. Use of osteotomies is minimized. Airway patency is improved or maintained by restoring the internal nasal valve, often with dorsal spreader grafts. Finally, special consideration is given to the patients' unique expectations and motivation. Rhinoplasty in the patient with advancing age is a rewarding operative procedure if one follows the guidelines delineated here to optimize the functional and aesthetic results.

Aesthetic and technical aspects of nasal osteotomies

Osteotomies of the nose including the lateral nasal bones, dorsal hump, and anterior nasal spine, are reviewed.The author shares his indications and techniques for these procedures. Some of the salient points made include the following: (1) In general lateral osteotomies are overdone. When in doubt, they should not be done or deferred. By maintaining the upper third of the nose on the larger side, one keeps the tip portion of the nose small by comparison. Because the tip is the hardest part of the nose to make smaller, it is best to adjust the upper half of the nose to the limiting width of the lower half of the nose. (2) There seems to be a tendency to underdo the medial osteotomy, causing some noses to have narrow nasal bone bases but broad dorsal components. (3) There are a number of sculpturing considerations for osteotomies. Nasal bones should be thought of in four separate sections: the base, where it is often broad; the dorsal aspect of the nasal bones, where it may be broad; the cephalic portion; and the caudal portion. Consideration of reduction of the nasal bones should take into account which combination of the four portions of the nasal bones need to be reduced. (4) Lateral osteotomy from the buccal-sulcus approach is an outstanding method of controlling the width of the nasal bones. It eliminates one more incision from the nose. It allows any blood that accumulates to exit from the mouth rather than by the nose, and thereby minimizes nasal bleeding. (5) The open approach is not an indication for osteotomies, but it does allow one to see the extent of the medial osteotomy. In some cases it can help establish what is causing the nasal bones to not come together properly.

The effects of body size and sexual dimorphism on the reproductive behaviour of sockeye salmon, Oncorhynchus nerka

Abstract. Factors associated with the evolution of sexual dimorphism in sockeye salmon were examined by relating individual behavioural correlates of reproductive success with morphological measurements in both sexes. Adult salmon were captured, measured and tagged, then released and observed in Iliamna Lake, Alaska. Males were generally larger than females (447 versus 428 mm) and had larger dorsal humps and more elongated jaws for their length. Indices of male reproductive success varied considerably among individuals (e.g. 0-12 observations in dominant status). Male social status was positively associated with both length and dorsal hump size, independent of length. All resident females completed spawning and only nine of 82 had their nests dug up by other females. However, size-related variation in spawning-site location was observed; larger females tended to spawn in shallower water than did smaller females. Thus reproductive success apparently varied much more in males than in females. Consistent with the theory regarding the evolution of sexual dimorphism, the greater variability in male reproduction was directly associated with the greater average size and exaggerated shape of males.

Radix Grafting to Maintain Dorsal Height

Over the past 25 years, the trend for rhinoplasty has been toward higher dorsums. This emphasis on the more aesthetically prominent nose has led to examination of augmenting the radix to achieve this higher dorsum. Traditionally, augmentation of the radix has been limited to those cases where the radix is disproportionately low. While it is true that augmentation due to low radix disproportion is the major criterion for radix grafts, radix augmentation may benefit many patients who do not fit into that category. It is well known that the dorsum will rise after lateral osteotomies and nasal bone infracture. Without reduction this can create a hump. Integrity of the dorsal projection achieved with the infracture can be maintained by implementation of the radix graft procedure which overcomes the appearance of a dorsal hump. A retrospective review of 52 patients who underwent radix grafting was performed. Some were augmented due to low radix disproportion and some were augmented to maintain the aesthetic line of the higher dorsal projection. This review examined the following criteria: type of cartilage graft used; cartilage morselization; cartilage tiering, complications; and, revisions of radix graft implants. This study examines the use of radix grafting in those instances where a high profile cannot be otherwise achieved. A broader utility of radix grafting is encouraged to maintain dorsal height in aesthetic rhinoplasty.

The Larva and Pupa ofApatania praevolansMorse (Trichoptera: Limnephilidae), with a key to described Larvae of North American species ofApatania

The larva and pupa of Apatania praevolans Morse are described and compared with those known of other North American species. The dorsal and lateral humps on abdominal segment I of the larva of A. praevolans are absent; the tergite on abdominal segment IX is triangular and bears two long setae. These two characters of A. praevolans can be used to distinguish the larva of this species from those of other described species. On each caudal process of the pupa, there are two subapical setae, one long and one short. A key to known Nearctic larvae of Apatania species is provided.

Distribution, structure and importance of the cephalic dorsal hump, a new sensory organ in calanoid copepods

The occurrence, external morphology and internal ultrastructure of a cephalic integumental organ in calanoid copepods were studied, using the specimens from the Pacific, Indian and Atlantic Oceans. This organ is located on the dorsoanterior surface of the cephalosome, and a name, cephalic dorsal hump (CDH) is proposed. Externally, it usually has two pores, anterior and apical, a dorsal plate, and a thin cuticle along the sides. CDH is found only in the male of Calanidae, Megacalanidae, Mecynoceridae and Paracalanidae, and showed some variation between species or species groups both in size and shape. Transmission electron microscopy (TEM) on the specimens from Sagami Bay, Central Japan, revealed that the CDH of Paracalanus parvus and Calanus sinicus consists of two dermal glands and a receptor, which is assumed to be chemosensory. A comparison of the distributions of CDH and prehensile fifth legs of male calanoid copepods suggests that it plays an important role in mate recognition.