Incision Line Research Articles

Impact on Abdominal Skin Perfusion following Abdominoplasty.

Background:Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion.Methods:A standard abdominoplasty was performed in 16 patients. Dynamic infrared thermography (DIRT) using a mild and a stronger cold challenge was performed pre-, intra-, and postoperatively on day 1, 2, and in week 6. The abdomen was divided into Huger’s vascular zones. A two-tailed t test was used to evaluate differences in mean temperature between zones. Statistical significance was defined as P < 0.05.Results:Two patients suffered wound healing problems. Abdominal skin perfusion showed a hyperaemic state on day 1, day 2, and week 6, postoperatively. Hotspots in zones I and II had all disappeared at the end of surgery and on day 1, except in the cranial part of zone I. Hotspots reappeared in zones I and II during day 2. A statistically significant difference between zones I and II was seen on day 1 and 2, with zone II being cooler. This difference had disappeared in week 6 for the mild cold challenge but not for the stronger cold challenge.Conclusions:A standard abdominoplasty has a significant impact on abdominal skin perfusion. The skin perfusion is a dynamic process with a gradual improvement over time. The strongest effect was seen in zone II near the lower transverse incision line, where skin perfusion was the least. Such may contribute to impaired wound healing at this site.

The bikini incision anterior cemented total hip arthroplasty: Assessment of radiological and clinical outcomes - A mid-term review.

Introduction: There has been an increased interest in minimally invasive direct anterior approach total hip arthroplasty (THA) to provide greater patient satisfaction, improve pain relief, and reduce the duration of hospitalisation. A direct anterior approach hybrid cemented THA, utilising a bikini line incision, can be technically challenging. We aimed to undertake radiological analysis of femoral stem cementation, clinical outcomes, and component survivorship. Methods: Over a 5-year period, 215 primary elective bikini anterior THA conducted by a single surgeon were included. All procedures were performed using a cemented collarless polished stem. The operation was performed on a standard operating table. Patients undergoing posterior approach, revision procedures, and fractured neck of femurs were excluded. Post-operative radiographs were analysed for femoral cementation quality using the Barrack grading system. Harris hip scores (HHS) were determined at 6 weeks, 12 weeks, annually thereafter and the difference in HHS was noted. Results: In total, 215 anterior bikini THA (R = 101, L = 114) were performed in 199 patients (M = 89, F = 110) with a mean age of 77 and mean follow up of 2.9 years (range = 0.5–5). Radiographic analysis of femoral cementation showed 189 femoral stems (88%) were either Barrack A or B cementation grade, suggesting optimal cementation. Lucency in the cement-bone interface occurred mainly in Gruen Zone 1 (43%) and Zone 13(46.9%). At the most recent follow-up (mean 2.9 years), component survivorship was at 99.54% (stem). Significant improvement was noted in Harris hip scores at final follow-up (from 54 preoperatively to 92.7 at 2.9 years postoperatively). Conclusion: Our results suggest that a bikini incision direct anterior approach for total hip arthroplasty can be safely employed to perform cemented femoral stems on a standard operating table.

The Effect of Perioral Scan and Artificial Skin Markers on the Accuracy of Virtual Dentofacial Integration: Stereophotogrammetry Versus Smartphone Three-Dimensional Face-Scanning.

This study evaluated the effects of different matching methods on the accuracy of dentofacial integration in stereophotogrammetry and smartphone face-scanning systems. The integration was done (N = 30) with different matching areas (n = 10), including teeth image only (TO), perioral area without markers (PN) and with markers (PM). The positional accuracy of the integrated models was assessed by measuring the midline linear deviations and incisal line canting between the experimental groups and laser scanner-based reference standards. Kruskal–Wallis and Mann–Whitney U tests were used for statistical analyses (α = 0.05). The PM method exhibited the smallest linear deviations in both systems; while the highest deviations were found in the TO in stereophotogrammetry; and in PN in smartphone. For the incisal line canting; the canting degree was the lowest in the PM method; followed by that in the TO and the PN in both systems. Although stereophotogrammetry generally exhibited higher accuracy than the smartphone; the two systems demonstrated no significant difference when the perioral areas were used for matching. The use of perioral scans with markers enables accurate dentofacial image integration; however; cautions should be given on the accuracy of the perioral image obtained without the use of markers.

A photographic evaluation of factors prevalent in Nepalese smile: A cross-sectional study

Aim: The aim of this study was to find out the prevalence of different characteristics of smile and to determine the level of normalcy based on the above. Materials and Methods: The standardized digital photographs of 529 participants were collected and transferred to personal computer in which the different characteristics of smile were visually inspected. Results: Smile with average upper lip position (54%) straight upper lip curvature in smile (46.9%), parallel incisal line to upper border of lower lip (51.8%) and incisal edges of maxillary dentition not touching to lower lip (62.4%) were most occurring characteristics with statistically significant prevalence of gingival and mucosal smiles amongst females. Conclusions: The study outlined few most occurring characteristics in smile of Nepalese population. The average upper lip position, straight upper lip curvature and parallel incisal line were some of the most prevalent characteristics in Nepalese smile. Keywords: Smile, Esthetics, Dentition, Nepalese.

Preoperative Versus Postoperative Scalp Block Combined With Incision Line Infiltration for Pain Control After Supratentorial Craniotomy.

Postoperative pain after craniotomy is a significant clinical problem that is sometimes underestimated, although moderate or severe pain in early postoperative period complicates up to 60% of cases. The purpose of this prospective randomized multicenter trial was to determine the optimal timing for selective scalp block in patients undergoing general anesthesia for supratentorial craniotomy. After ethics committee approval and informed consent, 56 adult patients were enrolled, and randomly assigned to receive a selective scalp block combined with incision line infiltration preoperatively or postoperatively. Postoperative pain at 24 hours after the procedure was recorded in all 56 enrolled patients. In patients assigned to receive a scalp block preoperatively, median VAS score at 24 hours after surgery was 0 (0 to 2), and in patients assigned to receive a scalp block postoperatively it was 0 (0 to 3) (P>0.05). There was no difference in severity of pain at 24, 12, 6, and 2 hours after surgery between the 2 study groups, but the amount of fentanyl administered intraoperatively was lower in patients assigned to the preoperative scalp block group (1.6±0.7 vs. 2.4±0.7 mkg/kg/h, P=0.01). This study confirms and extends available clinical evidence on the safety and efficacy of selective scalp blocks for the prevention of postoperative pain. Recorded data suggest that there is no difference in terms of occurrence and severity of postoperative pain regardless of whether the scalp block is performed preoperatively (after general anesthesia induction) or postoperatively (before extubation). Patients assigned to receive a scalp block combined with incision line infiltration preoperatively needed less intraoperative opioids than those assigned to postoperative scalp block.

A novel Lugol\u2019s iodine staining technique to visualize the upper margin of the surgical anal canal intraoperatively for Hirschsprung disease: a case series

BackgroundIn cases of Hirschsprung disease, complete and reproducible resection of the aganglionic bowel is ideal to achieve good postoperative bowel function. Reliable identification of the upper margin of the surgical anal canal, which is the squamous-columnar junction, is necessary during transanal pull-through. Here, we describe a novel staining technique using Lugol’s iodine stain to visualize the upper margin of the surgical anal canal.MethodsLugol’s iodine staining was performed in five patients with Hirschsprung disease treated using a single-stage laparoscopic transanal pull-through modified Swenson procedure. In two of these patients, endocytoscopic observation with ultra-high magnification was performed using methylene blue and crystal violet to mark the border of the squamous epithelium at 1 week before surgery. The alignment between the incisional line, which was revealed using Lugol’s iodine staining and endocytoscopic marking, was evaluated. Complications, including postoperative bowel dysfunction, were evaluated.ResultsIn all cases, Lugol’s iodine staining produced a well-demarcated line. The endocytoscopic marking of the upper margin of the surgical anal canal was aligned with the line revealed by Lugol’s iodine staining. There were no complications associated with the transanal pull-through procedure, including postoperative bowel dysfunction.ConclusionsLugol’s iodine staining could be a safe and practical method to visualize the upper margin of the surgical anal canal intraoperatively. This finding may be useful for surgeons to make a consistent removal of the aganglionic bowel during surgery for Hirschsprung disease.

Alveolar Bone Graft Stabilization with Custom Maxillary Splints.

For secondary alveolar bone grafting in cleft patients, the success of bone graft take is dependent upon creating an ideal environment for both bony and soft tissue healing. This is particularly challenging in patients with existing fistulas, wide clefts, and bilateral alveolar clefts, where large soft tissue mobilization is required to get a tensionless repair, and micro-motion around the bone graft is significantly higher. Herein we describe our method for manufacture and placement of a custom postoperative maxillary splint following secondary alveolar bone grafting. Our splint encompasses the palate and alveolus to stabilize the maxillary arch and protect the incision lines during healing. We find our splint to be a useful adjunct to facilitate postoperative healing following secondary alveolar bone grafting.

Repair of Alar Defects Using the Alar Rotation Flap: Our Experience with 394 Patients.

The purpose of this study was for the authors to describe their patient selection, surgical technique, and results with the alar rotation flap for surgical defects of the nasal ala. The authors performed a retrospective analysis of all alar rotation flaps performed between June of 2006 and February of 2019. Three hundred ninety-four patients were identified, and follow-up encounters were reviewed to assess for complications and need for revision procedures. The alar rotation flap was performed on 394 patients over a 13-year period. The mean defect size was 9.3 ± 2.8 mm by 7.2 ± 2.3 mm. Three hundred nineteen patients (81 percent) were evaluated postoperatively, with a mean average duration of follow-up of 2.3 years (range, 6 days to 11.9 years). Complications included hemorrhagic crust along the incision line [n = 9 (3 percent)], flap edema [n = 7 (2 percent)], internal nasal valve dysfunction [n = 3 (1 percent)], depressed surgical scar [n = 2 (1 percent)], hematoma [n = 1 (0.5 percent)], and paresthesia [n = 1 (0.5 percent)]. The alar rotation flap is a reliable one-stage flap for small- to medium-size partial-thickness defects of the nasal ala that can produce topographic restoration with minimal risk of aesthetic or functional complication. Therapeutic, IV.

Image of gynecological operations on rubber models

The assimilation of the methods of production of gynecological operations presents some difficulties for students, due to the complexity of operations and the low availability of the field of vision. Drawings and drawings clarify the essence of the operation only in general terms, and even then not always, because the depiction and representation of complex shapes in one plane is not easy; in addition, during plastic operations, the incision line, the bloody surface stretched by tools, and the surface obtained after the imposition and tying of the seams have a completely different shape; if the drawings can understand several different moments of the operation, then with difficulty it is possible to show the very transition from one moment to another.

Large Pleomorphic Adenoma of the Submandibular Gland Causing Internal Jugular Vein Compression: Case Report

Pleomorphic adenoma is the most common benign tumor of the major salivary glands. It is generally asymptomatic; however, it may adversely affect surrounding structures when it becomes enlarged. In the submandibular gland in particular, the cervical blood vessels may be compressed or displaced by the tumor, and surgery to remove the tumor is associated with a higher risk. The purpose of this report is to describe how an enlarged pleomorphic adenoma in the submandibular gland may compress or displace cervical blood vessels, demonstrating that 3-D computed tomography angiography could be valuable for preoperative evaluation. This article describes a rare case of a 46-year-old man who had an internal jugular vein compression as a result of leaving untreated a large pleomorphic adenoma in the submandibular gland. Considering the anatomical location, salivary gland tumors arising in the submandibular gland may adversely affect the surrounding structures such as the trachea or cervical blood vessels when they grow larger. Preoperative evaluation of the positional relationship between the tumor and the surrounding structures is essential. 3-D computed tomography angiography was valuable for preoperative evaluation of the positional relationship between the tumor and the surrounding blood vessels. By confirming the compressed and displaced blood vessels with 3-D computed tomography angiography, the skin incision line can be designed to allow for successful separation of the tumor. This report suggests that 3-D computed tomography angiography could ensure a safe surgical approach for removal of large benign submandibular gland tumors, including pleomorphic adenomas.

Usefulness of Ultrasonography in Diagnosis and Management of Tendon Injuries in Hand

Purpose: Tendon injuries in hand were one of the most frequent injuries caused by trauma. Although consequent tenorrhaphy is frequently conducted, in complete tendon rupture the location of retracted tendon stumps cannot be identified clearly, which causes difficulties in surgical management. Ultrasonography is known to be a fast, accurate, and cost-effective diagnostic method for tendon injury; therefore, the authors studied the usefulness of preoperative ultrasonography in diagnosis and management of tendon injuries in hand.Methods: Among the 34 patients who had hand tendon injuries and visited between January 2017 and March 2018, retrospective studies were conducted on six patients with unidentified tendon stumps. By identifying the location of the tendon injuries and ruptured tendon stumps through preoperative ultrasonography, the operation was conducted under a predetermined surgical plan. The authors compared the ultrasonography results and the surgical findings.Results: For diagnosis of the unidentified tendon injuries and location of ruptured tendon stumps, the ultrasonography results and the surgical findings were matched for all six patients. By prior planning of the operation incision line using the preoperative ultrasonography results, the length of the incision site was minimized without additional incision, and the operation time was shortened.Conclusion: For hand tendon injuries with unidentified tendon stumps, identifying the location of tendon stumps through preoperative ultrasonography is helpful for determining the incision range for the operation. Therefore, preoperative ultrasonography may be useful in the diagnosis and management of tendon injuries in hand.

Endometriosis cases that occurred at the incision site after cesarean section; Single-center experience

Objective: Endometriosis is the growth of functional endometrial gland and stroma outside the uterine cavity. Scar endometriosis is a very rare disease and is diagnosed by histopathologic examination. Endometriosis may be detected in the scar tissue after a previous gynecological operation. Scar endometriosis is a mass consisting of endometrial glands and stroma that may develop in the incision scar tissue or in the neighborhood after gynecologic procedures performed especially by cesarean section. We aimed to present the patients who had a history of gynecologic surgery, who presented with mass and/or pain complaints especially in the corner regions of the previous incision line, and underwent surgical excision and reported as endometriosis as a result of postoperative pathology.&#x0D; Materials and Methods: Patients who presented to the general surgery outpatient clinic between September 2018 and December 2019 with complaints of palpable mass, pain and swelling at the edge of the pfannenstiel incision were evaluated. The records of patients who underwent surgery with a preliminary diagnosis of endometriosis and reported as endometriosis as a result of pathology were reviewed retrospectively.&#x0D; Results: Surgical excision was performed in 14 patients with a preliminary diagnosis of endometriosis. The mean age of the patients was 29.5 (min: 18-max: 39 years). All patients had a history of cesarean section as a history of abdominal surgery. When the pathology results were examined, all the reports were endometriosis externa. In the pathology reports, the mean diameter of the lesion was 25x20x17mm (min: 10- max: 40).&#x0D; Result: Endometriosis should be considered in patients with a history of palpable mass and pain around the incision site in patients with a history of gynecologic surgery.

Revisiting the Direct Brow Lift in Patients With Facial Palsy: 4 Key Modifications.

The direct brow lift is a simple and popular technique, particularly in patients with brow ptosis secondary to facial palsy. It provides a high degree of control in determining the degree of brow elevation and shape achieved. However, it is arguably the least debated in terms of addressing some of its sequelae, namely the risks of a visible or indrawn scar and forehead paraesthesia. In this article, we report outcomes using four alternative principles to those outlined in current published literature. All patients undergoing a primary direct brow lift for brow ptosis secondary to facial palsy between January 2015 and December 2019 under a single surgeon (R.M.) were included in the study. The technical refinements of the procedure included a W-plasty type stealth skin incision, counter-bevelling of the upper and lower incision lines, skin excision in the subcutaneous plane only with minimal excision of fat and browpexy to the frontal periosteum through small linear puncture incisions in the frontalis. A total of 23 patients undergoing 24 direct brow lifts were included in the study. The mean follow-up was 1.3 years (range 0.5-3 years). No patients reported postoperative forehead paraesthesia or brow alopecia. One patient required a further temporal browlift 15 months later. Brow height was rated excellent (0-1.5 mm difference) in 71% of brows and good (1.6-4.9 mm difference) in 14% of brows. The average Manchester scar scale was 8.6/28. The technical modifications presented substantially reduce the rates of postoperative paraesthesia, whilst achieving satisfactory aesthetic outcomes.

Botulinum Toxin Type A Injection for Mammoplasty and Abdominoplasty Scar Management: A Split-Scar Double-Blinded Randomized Controlled Study.

Scars are inevitable results of surgical procedures, and prevention of them is still a major problem in the field of cosmetic surgery. Although various studies have been performed on botulinum toxin-A (BoNT-A) injection for the prevention of hypertrophic scars, the exact mechanism remains unclear. This prospective, double-blinded, randomized study was performed on 19 patients who underwent mammoplasty and abdominoplasty surgery in Razi Hospital from October 2018 to December 2019. Single session of treatment was performed, where XEOMIN was allocated to one half of the scar and 0.9% saline to the control half. 3 and 6months later, scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES). In total, 19 patients who completed the study were analyzed. mSBSES at the third month (Pvalue < 0.001; 3.34 ± 1.59 vs 1.5 ± 1.36) and the sixth month (Pvalue < 0.001; 4.89 ± 1.83 vs 2.39 ± 1.82) showed a significant difference between the treatment and control groups. In the subset analysis, there was significant difference between BoNT-A and control in all four items including width, height, color, and scar visibility at months 3 and 6, and the BoNT-A-treated sides had higher scores in all items. BoNT-A has a significant effect on scar prevention due to mammoplasty and abdominoplasty compared to placebo and results in decreased erythema, height, width and reduces incision line visibility. Moreover, its effect increases significantly over time from months 3 to 6. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Rapid Absorbable Sutures with Nonabsorbable Sutures in Closing Transcolumellar Incision in Septorhinoplasty: Short-term Outcomes.

Following open rhinoplasty, a postoperative scar at the columellar incision line is a common morbidity. The aim of this study is to compare absorbable and nonabsorbable suture materials which had been used for closing the transcolumellar incision, in the aspect of risk of postoperative infection, wound healing, postoperative columellar scar and patient satisfaction. A prospective, randomized, single-blind study was conducted between May 2017 and February 2018. Sixty-four rhinoplasty patients were randomly assigned to absorbable (n = 32) or nonabsorbable (n = 32) groups. The columellar incision was closed with 7 full-thickness skin sutures. Either nonabsorbable 6/0 polypropylene (Group 1) or absorbable 6/0 polyglytone 6211 (Group 2) sutures were placed at the columellar incisions. Polypropylene sutures were removed at the 7th postoperative day. A Mann-Whitney U test and Monte Carlo were used for statistical comparison. Photographs of the patients at the postoperative third month (Fig.2) were evaluated and scored in terms of scarring, pigmentation, notching, level differences in the incision area by two different otorhinolaryngologists who did not know the randomization. Suture removing discomfort was assessed with visual analogue scale scores. A satisfaction survey was filled out by all the patients completing their third month after the operation. According to the results of both otorhinolaryngologists, there was no significant difference between the two groups in terms of pigmentation, level difference, notching, overall appearance and total score (p = 0.920, p = 0.498, respectively). The mean score on the Wong-Baker scale was 3.19 ± 1.67 in group 1. In the Satisfaction Survey, the average score of the group 1 was 6.90 ± 3.24, while the mean score of the group 2 was 7.062 ± 2.77. There was no statistically significant difference between the two groups (p = 0.715). Suturing inverted V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to nonresorbable sutures as evaluated by patients and observers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Closed incision negative pressure wound therapy may decrease wound complications in major lower extremity amputations

ObjectiveWound complications after major lower extremity amputations (LEAs) are a cause of significant morbidity in vascular surgery patients. Recent publications have demonstrated the efficacy of the closed incision negative pressure dressing at preventing surgical site infections (SSIs); however, there are few data on its use in major LEAs. This study sought to assess if closed incision negative pressure wound therapy (NPWT) would decrease the risk of complications as compared with a standard dressing in patients with peripheral vascular disease undergoing major LEA. MethodsFifty-four consecutive patient limbs with a history of peripheral arterial disease underwent below-knee or above-knee amputations. This was a retrospective review of a prospectively maintained database from January 2018 to December 2019, and it included 23 amputations in the NPWT group and 31 amputations in the standard dressing group. NPWT using the PREVENA system was applied intraoperatively at the discretion of the operating surgeon and removed 5 to 7 days postoperatively. The standard group received a nonadherent dressing with an overlying compression dressing. Amputation incisions were assessed and wound complications were recorded. Student's t-test and two-sample proportion z-test were used for statistical analysis. A P value of less than .05 was considered statistically significant. ResultsFor comorbidities, there was a higher incidence of tobacco use in the NPWT as compared with the standard group (44% vs 13%; P = .011), as well as trends toward increased prior amputations, anemia, hyperlipidemia, and chronic obstructive pulmonary disorder in the NPWT group. For risk factors, there were more dirty wounds in the NPWT as compared with the standard group (52% vs 26%; P = .046). For outcomes, there were fewer wound complications in the NPWT as compared with the standard group (13% vs 39%; P = .037). The types of wound-related complications in the NPWT group included one wound dehiscence with a deep SSI, one superficial SSI, and one incision line necrosis. In the standard group, there were four wound dehiscences with deep SSI, three superficial SSIs, four incision line necroses, and one stump hematoma. The rates of perioperative mortality and amputation revision did not differ significantly between the NPWT and the standard groups (3% vs 4% and 4.3% vs 10%, respectively). ConclusionsClosed incision NPWT may decrease the incidence of wound complications in vascular patients undergoing major LEA. This held true even among a population that was potentially at higher risk. This therapy may be considered for use in lower extremity major amputations.

Application of digital positioning guide plate in extraction of impacted supernumerary teeth

To explore the application of digital positioning guide plate in extraction of impacted supernumerary teeth and evaluate its clinical efficacy. From March to August, 2019, 30 patients with labial impacted supernumerary teeth treated in the Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University were enrolled in this study. Fifteen of the patients were treated with digital positioning guide plate to remove the impacted supernumerary teeth (test group). According to the CBCT data and the dentition model of the patients, the positioning guide plate was positioned by avoiding the important anatomical structure with the tooth-bone surface as the support to design the soft tissue incision line and bone tissue exposure range. The other 15 patients who were treated without the use of the guide plate for operation served as the control group. The design time, tooth searching time, operation time and complications were compared between the two groups. The positioning guide plate was well attached during the operation and allowed quick location of the supernumerary teeth while helping to expose the supernumerary teeth and avoid the damage of the adjacent important anatomical structures. The pre-operative design time was 50 ± 5 min in the test group and 0 min in the control group. The average time of tooth finding in the test group was 5±2 min, as compared with 10±3 min in the control group (t=15.40, P &lt; 0.01); the average time of operation was significantly shorter in the test group than in the control group (25±4 min vs 45±6 min; t=35.50, P &lt; 0.01). No intraoperative complications occurred in the test group, and slight deviation occurred in one case in the control group. The application of digital positioning guide plate in extraction of embedded supernumerary teeth can significantly shorten the time of tooth finding, reduce the difficulty of operation, and improve the quality of operation.

Minimally invasive techniques in rhinoplasty.

To present criteria of minimally invasive surgery, which include minimal and hidden incision lines, reduced injury to tissue and application of endoscopic techniques, when feasible; to analyze techniques in rhinoplasty for their minimally invasive character - in light of recent publications; and to discuss the techniques that best meet the criteria of minimally invasive surgery. The nose consists of about 60 percent soft tissue and 40 percent skeletal elements. Surgery causes injury to both tissue types through various mechanisms, including mechanical traction, separation, incision, heat, desiccation, and others. Multiple aspects including extent of approach and degree of tissue undermining determine the minimally invasive character of techniques and maneuvers in rhinoplasty. A single incision endonasal approach, the subperichondrial and subperiosteal septal plane, the supraperichondrial plane over the cartilaginous dorsum, the subperiosteal plane over the bony dorsum, limited dorsal undermining with endoscopic visualization when feasible, conventional straight lateral osteotomy or percutaneous curved lateral osteotomy; percutaneous transverse osteotomy; conventional straight paramedian osteotomy; piezo and drill paramedian ostectomy; dorsal uncapping osteotomy; conventional rasp gross dorsal contouring; piezo or drill fine dorsal contouring; (cartilaginous) middle vault 'let down'; and minimal access subperiosteal turbinate bone resection were found to best fulfil the criteria of minimally invasive surgery. A classification system for the degree of minimally invasiveness of rhinoplasty techniques is proposed as a basis for discussion.

Versatility of the Berger-Tenenhaus Approach for Mandibular Fractures.

Mandibular fractures between the angle and condyle can be difficult to access and treat. The authors sought to evaluate a small transcutaneous incision between the marginal mandibular and buccal nerve branches (Berger-Tenenhaus incision) to treat these fractures. Ten cadaveric hemi-faces were dissected. Surrounding facial nerve branches were identified and measured in relation to the discussed incision. Our clinical experience with the approach for mandibular angle, ramus, subcondylar, and condylar fractures was reviewed. Operative technique and postoperative outcomes were examined. The incision is located in a safe interval between neighboring facial nerve branches. Marginal mandibular nerve branches maintained a consistent distance beneath the incision along its length (median distances of 0.95-cm (SD ± 0.5), 1.05-cm (SD ± 0.5), and 1.00-cm (SD ± 0.8) posterior to anterior, respectively). Buccal nerve branches increased in distance and ascended away from the incision line (median distances of 0.75-cm (SD ± 0.9), 1.4-cm (SD ± 0.8), and 1.45-cm (SD ± 0.9) respectively posterior to anterior). No nerves were injured. In our clinical experience, all postoperative patients (n = 9) have had successful fracture reduction with restoration of occlusion, intact facial nerve function and an acceptable cosmetic result. The Berger-Tenenhaus incision can safely and efficiently be used to treat difficult to access mandible fractures between the angle and condyle. VI.

Change in Incisional Design in Primary Unilateral Cleft Lip Repair Under General Anesthesia.

Nasolabial features of infants with unilateral cleft lip (UCL) are different when they are under general anesthesia for lip repair compared to when they are awake. This study aimed to investigate changes in the incisional design of cheiloplasty according to patient position and anesthesia: upright and awake versus supine and under general anesthesia. Three-dimensional images of 20 infants with UCL were randomly selected. Two different incisional designs were drawn on the images captured while the infants were awake. Those incisional designs were anthropometrically compared to the designs drawn on the images captured while the infants were under general anesthesia. Under general anesthesia, vermillion height of both the medial and lateral sides of the cleft became significantly greater. In the rotation-advancement design, the incisional line of the rotation flap on the medial lip element became significantly shorter under general anesthesia, whereas the advancement flap on the lateral lip element was not significantly altered. In an anatomical subunit approximation, both lengths of the philtral ridge on the noncleft side and incisional line along the philtral ridge on the cleft side became significantly shorter under general anesthesia, but these alterations did not affect the calculation of the width of the small triangular flap on the lateral lip element. These changes in nasolabial features after general anesthesia may cause surgical error, which result in secondary cleft lip deformities. However, because these changes varied among infants, preoperative planning using three-dimensional facial images of infants who are awake may be able to avoid surgical error.