Nasal Ala Research Articles

Effectiveness and Long-Acting of the Hyaluronic Acid Injected into the Nasolabial Fold Measured Through Magnetic Resonance Imaging.

MRI analyzed quantitatively the HA injected into the NLF subcutaneous fat to correlate the gel diffusion and degradation with the morphological changes of the NLF appearance for twelve months. Measurements of the gel diffusion and degradation were taken by MRI as parameters to assess the clinical efficacy and long-acting of the HA in NLF rejuvenation. HA was applied into the superficial compartment of the subcutaneous fat of twenty NLFs. Each NLF received three injection points, from the nasal ala toward the oral commissure, 1.0-1.5 cm distant from each other, according to the NLF length. A bolus injection technique without retrograde backflow applied per injection point 0.15-0.20 ml of HA for moderate. NLF and 0.20-0.25 ml for severe NLF. Patients were evaluated through MRI and clinically twenty-four hours, one month and twelve months after the HA application. MRI, in T2-weighted, displayed the gel as a dense, spindle-shaped nodule as pattern of the gel diffusion, measuring its largest longitudinal and transverse axes. Twenty-four hours after HA application the longitudinal axis measured 1.79 cm, after one month 2.33 cm and at month twelve 0.91 cm. The transverse axis measured 0.92 cm at 24 hours, 1.13 cm after one month and 0.47 cm at month twelve. Despite reduction in size and denseness of the spindle-shaped nodule, the small amount of gel presenting into the subcutaneous fat after twelve months of the application evidenced the HA efficacy and long-acting in NLF rejuvenation. 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 .

Alar facial sulcus and nasal ala reconstruction: a challenging anatomical area.

Background Most nasal cutaneous malignancies occur on the caudal third of the nose. Commonly, following resective surgery, the surgeon is requested to reconstruct the ala. Small skin defects of the nose may be left healing by secondary intention, although this may sometimes create an unpleasant scar. In the present paper we describe a 1-step reconstruction of the distal area of nasal ala, alar facial sulcus and cheek, with a segmented melolabial interpolated flap. Methods A 59-year-old man was operated for basal cell carcinoma involving the distal area of nasal ala and alar-cheek sulcus. The reconstruction was performed in 1-stage with a segmented melolabial interpolated flap used to reconstruct the anatomical missing subunits. Results Tumor-free margin was larger than the infiltrating region. No postoperative complications were observed. Conclusions The melolabial flap is a suitable option for the reconstruction of the nose, although the reconstruction of nasal ala is usually performed in 2-steps: the first one is performed to transfer the tissue and close the defect; the second, is performed to reshape the convexity of the ala and the concavity of the alar facial sulcus. In the present case, we do not perform a 2-steps reconstruction, we just reshaped the flap to perfectly fit the defect in 1-stage. The flap, supplied by collateral arteries from the facial and angular arteries, could be segmented for a better surgical outcome also during the harvesting stage if multiple anatomical subunits have to be reconstructed, with no need of a second surgical step that could be frustrating for the patient.

The Effectiveness of Preoperative Correction Techniques in Improving Nasal Deformity in Children With Unilateral Complete Cleft Lip and Palate.

Unilateral complete cleft lip and palate (UCCLP) is associated with apparent nasal deformities before the cheilorrhaphy. The aim of this study was to determine whether preoperative correction techniques are effective in the treatment of nasal deformities in infant with unilateral UCCLP used by the systematic review and meta-analysis. We searched Medline, Cochrane Library, EMBASE, PubMed, and Chinese BioMedical Literature Database (CBM) until January 31, 2019, to identify studies that compared the effectiveness of preoperative correction techniques in the treatment of nasal deformities in infant with UCCLP. Two authors individually extracted the data and performed the quality assessments. The height of nasal columella, the width of the affected side nasal ala and the inclination of the nasal columella were evaluated. Seven articles were incorporated into the systematic review, and 5 (274 participants) in the meta-analysis according to the inclusion criteria. The preoperative correction could increase the height of nasal columella in children with UCCLP [SMD: 2.64 mm; 95% confidence intervals (CI); (1.35 mm, 3.94 mm); P < 0.0001]. Moreover, the preoperative correction resulted in reduced width of the affected side nasal ala [SMD: -5.14 mm; 95% CI; (-8.96 mm, -1.31 mm); P = 0.008]; However, the evidence was insufficient to determine a significant effect on the inclination of the nasal columella [SMD: -3.48 degrees; 95% CI; (-7.56 degrees, 0.59 degrees); P = 0.09]. Preoperative correction for children with UCCLP can increase the height of nasal columella, reduce the width of the affected side nasal ala, improve the nasal symmetry, and reduce nasal deformity, however, no significant effect could be observed for the inclination of the nasal columella.

同侧鼻翼及鼻前庭区非穿通性基底细胞癌一例

同侧鼻翼及鼻前庭区非穿通性基底细胞癌一例

Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

BackgroundHerpes zoster, also known as shingles, results from reactivation of the varicella-zoster virus. It commonly presents with burning pain and vesicular lesions with unilateral distribution and affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. The branches of the trigeminal nerves are affected in up to 20% of cases. Multidermatomal involvement of the trigeminal nerves has been only anecdotally described in immunocompetent subjects.Case presentationA 71-year-old previously healthy male presented with grouped vesicular and impetiginized lesions with crusts on the left half of the face of two-weeks duration. The lesions first developed on the left nasal tip and progressively worsened with unilateral appearance of vesicular lesions on the left forehead, face, ala nasi, nasal vestibulum and columella, as well as on the left side of hard and soft palate. The affected edematous erythematous areas corresponded to the distribution of the left ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve, including the infraorbital and nasopalatine nerves of the maxillary branch responsible for the oral cavity involvement. Viral DNA amplification by polymerase chain reaction confirmed the presence of Varicella zoster virus. The patient was started on oral valaciclovir with rapid recovery.ConclusionsAmong immunocompetent patients, herpes zoster is considered a self-limited localized infection. Our observation provides a rare but paradigmatic example of herpes zoster with involvement of both the ophthalmic and maxillary divisions of the trigeminal nerve in an immunocompetent patient. Immunocompetence status and age-specific screening should be warranted in case of atypical involvement and according to the patient’s history, while treatment with antiviral drugs should be rapidily initiated in patients at risk.

Cutaneous Plasmacytosis: A Pitfall For B and Plasma Cell Neoplasms

Abstract Introduction/Objective Cutaneous plasmacytosis (CP) is an uncommon condition typically affecting Asian males in the 3rd to 5th decades. It is thought to be a reactive process that classically presents with asymptomatic, red-brown, plaques and nodules on the face and neck. It has been associated with polyclonal hypergammaglobulinemia and systemic involvement. Histologically it is characterized by dense superficial and deep dermal infiltrates of mature plasma cells with polyclonal differentiation on in-situ hybridization (ISH). The differential diagnosis includes neoplastic plasma cell processes, characteristically with monoclonal plasma cell infiltrate, and mature B cell neoplasms with polyclonal plasma cell differentiation. Methods We report a case of a 69 year old Caucasian male who presented with asymptomatic, enlarging red-brown nodules on bilateral nasal ala. Histologic examination revealed dense, superficial plasma cell infiltrate, concerning for a plasma cell neoplasm. CD138 and Kappa/Lambda ISH demonstrated plasma cell polyclonality. Further workup ruled out infectious or systemic involvement and a plasma cell dyscrasia was ruled out by Hematology/Oncology. Results These findings supported the diagnosis of CP. Treatment with intralesional steroids showed initial improvement with regrowth of the nodules. To date, treatment with topical steroids and CO2 laser ablation are being considered. Conclusion CP is reported as type of pseudolymphoma, which is described as a reactive lymphoproliferation that histopathologically and/or clinically imitates cutaneous lymphoma. The pathogenesis is unknown, however, there are studies suggesting an association with increased interleukin-6, which is involved in the differentiation of B cells to mature plasma cells. The majority of patients with CP have a favorable prognosis. There has been variable success with both topical and intralesional treatment to include, cyclophosphamide, topical tacrolimus, prednisone, intralesional steroid therapy, topical psoralens combined with ultraviolet A exposure, and other chemotherapies. Familiarity with this rare entity is imperative to prevent misdiagnosis and overtreatment.

Weekly High-Dose Rate Brachytherapy Via Surface Applicator For Non-Melanoma Skin Cancers In The Elderly

Among patients treated with brachytherapy for non-melanoma skin cancers (NMSCs), including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), there exists a wide variety in dose, fractionation, and schedules employed. We retrospectively analyzed a hypofractionated regimen delivering 36 Gy in 6 weekly fractions to assess its safety and efficacy for the treatment of NMSCs in the elderly. All elderly (> 70 years old) patients treated in 2016 to 2019 with follow-up were included. In total, 46 patients with 63 NMSC lesions were treated using iridium-192 high-dose rate brachytherapy (HDR) delivered with custom molds containing catheters to encompass the tumor or tumor bed with a margin. The dose scheme employed was a weekly hypofractionated regimen of 36 Gy in 6 weekly fractions. Only 7 lesions (11.1%) underwent a more extensive excision than a biopsy. Acute and late toxicity were graded as per CTCAE version 5. Cosmesis was graded as “excellent” (similar to surrounding untreated skin), “good” (minimal changes), or “poor” (extensive telangiectasia, ulceration, or scar tissue). Kaplan-Meier curves were used to assess local control. Median age at treatment initiation was 85.8 years (range: 71.2-98.7), and 20 patients (43.5%) were female. Performance statuses ranged from 0 to 4 with 30.4% ECOG 0-1, 41.3% ECOG 2, and 28.3% ECOG 3-4. Median time from first treatment to last was 35 days (range: 28-70), and median follow-up was 8.6 months (range: 1.3-35.9). 35 lesions (55.6%) were BCC, and most lesions (81.0%) were located on the head and neck, including 20 on the nose (31.7%). All patients experienced acute toxicity with grade 1 occurring in 66.7%, grade 2 in 28.6%, and grade 3 in 4.8%. Lesions were not evaluated during follow-up in 5 cases (7.9%), and grade ≥ 2 late or persistent toxicity occurred in 12.1%. Overall cosmetic outcome was determined to be “excellent” or “good” following 54 treatments (93.1% of evaluable lesions). There was a higher incidence of “poor” cosmesis for lesions located on the lower extremities (33.3% vs. 3.8%, p = 0.049) and larger lesions (median: 11.8 vs. 5.1 cc, p = 0.031). Recurrence occurred in 3 lesions (4.8%) with 1 BCC on the bridge of the nose experiencing failure 8 months after completing treatment and 2 SCC lesions exhibiting persistent disease initially thought to be a poor cosmetic outcome, 1 on the nasal ala (confirmed at 6 months) and 1 on the scalp vertex (confirmed at 18 months). Estimated local control was 100% at 6 months, 94.5% at 12 months, and 88.2% at 24 months. Five patients (10.9%) have died since completing treatment, none due to disease progression. Our results suggest a hypofractionated regimen consisting of 36 Gy in 6 weekly fractions delivered with high-dose rate brachytherapy via surface applicator represents both a safe and an effective treatment of non-melanoma skin cancers in elderly patients.

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.

Trigeminal trophic syndrome : Late complication after herpes zoster infection with loss of ala nasi

This article presents the case of refractory facial ulcers with loss of ala nasi as arare differential diagnosis of chronic facial wounds. We diagnosed trigeminal trophic syndrome as alate complication of aherpes zoster infection. Education to avoid self-manipulation and an occlusive local therapy in combination with neuromodulating drug therapy are at the forefront of therapeutic measures. Further surgical plastic procedures can be used with restraint in therapy-resistant cases.

Defining the Histologic Support Structures of the Nasal Ala and Soft Triangle: Toward Understanding the Cause of Iatrogenic Alar Retraction.

As rhinoplasty techniques have evolved to more extensive dissections, the incidence of iatrogenic deformities, such as alar rim retraction, has risen. Its mechanism is presently unknown. This study examined the microscopic anatomy of the nasal ala to define architectural support elements at the histologic level to determine why rhinoplasty dissection creates such deformities. Eight cadaveric noses were harvested and sectioned through the soft triangle and ala. Various tissue stains were performed. Slides were examined using light microscopy. Anatomical features pertaining to cartilage, skin, mucosa, elastic fibers, and muscle were documented. Four male and four female noses were sectioned. The median cadaver age was 64 years (range, 47 to 83 years). On Elastica van Gieson stain, distinct elastic fibers span from the vestibular lining to the caudal margin of the lower lateral cartilage, and from the caudal edge of the lower lateral cartilage to the external alar skin. In the nasal ala midsection, trichrome stains reveal that skeletal muscle is located far beyond the lower lateral cartilage, close to the free alar margin. The soft triangle shows a distinct microanatomical structure, with heavy longitudinal condensations of elastin. These histologic findings have not been previously reported. A distinct anatomical alar wall endoskeleton has been identified. It is obligatorily disrupted by specific rhinoplasty maneuvers when dissection is carried out over the lateral crura and into areas without cartilaginous support. This microanatomy may explain factors that contribute to postoperative alar wall retraction. Leaving this area undisturbed or performing adjunctive measures with rhinoplasty can provide structural support to the external valves, thus minimizing the risk of deformity.

CALCIFYING ODONTOGENIC CYST IN THE MAXILLA: A CASE REPORT

Calcifying odontogenic cyst (COC) is a rare, developmental odontogenic cyst that usually arises in the anterior region of the jaws. An 18-year-old, dark-skinned man was referred for evaluation of a painless, slow-growing swelling in the maxilla, extending from tooth #21 to tooth #25. Extraoral examination revealed slight elevation of the left nasal ala, producing discrete facial asymmetry. Computed tomography showed an expansive, unilocular hypodense lesion with small hyperdense foci, measuring approximately 3.0 cm in diameter. Under the diagnostic hypothesis of COC, an incisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by ameloblastoma-like epithelium, with focal accumulation of ghost cells. Calcifications within the ghost cells could also be observed. The definitive diagnosis was COC. The patient was referred for surgical treatment and remains under close follow-up. Calcifying odontogenic cyst (COC) is a rare, developmental odontogenic cyst that usually arises in the anterior region of the jaws. An 18-year-old, dark-skinned man was referred for evaluation of a painless, slow-growing swelling in the maxilla, extending from tooth #21 to tooth #25. Extraoral examination revealed slight elevation of the left nasal ala, producing discrete facial asymmetry. Computed tomography showed an expansive, unilocular hypodense lesion with small hyperdense foci, measuring approximately 3.0 cm in diameter. Under the diagnostic hypothesis of COC, an incisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by ameloblastoma-like epithelium, with focal accumulation of ghost cells. Calcifications within the ghost cells could also be observed. The definitive diagnosis was COC. The patient was referred for surgical treatment and remains under close follow-up.

Pilomatrical Carcinoma in a 70-Year-Old Hispanic Female

Pilomatrical carcinoma is a rare, locally aggressive malignancy of follicular matrix origin. It presents as a rapidly growing, flesh-colored, or blueish, exophytic nodule with tumor asymmetry and poor circumscription. Histological features of these tumors include dominant hyperchromatic basaloid cells with high mitotic rate and nuclear pleomorphism; along with anucleate matrical cells and central necrosis. Pilomatrical carcinomas demonstrate a high rate of recurrence and tendency to metastasize. The most described treatment is wide excision of the tumor with negative margins with or without adjuvant radiation therapy. We present the case of a 70-year-old female patient who presented to the office with a 3-year history of a growing, exophytic lesion on the right nasal ala. A biopsy of the lesion was obtained, and histologic examination was consistent with a diagnosis of pilomatrical carcinoma.

Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study.

ObjectivesThere is a need to develop a medical device which can accurately measure normal and abnormal nasal breathing which the patient can better understand in addition to being able to diagnose the cause for their nasal obstruction.The aim is to evaluate the accuracy of the nasal acoustic device (NAD) in diagnosing the common causes for nasal obstruction and diagnosing normal and abnormal (nasal obstruction) nasal breathing.MethodsThis pilot study recruited 27 patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS), and a deviated nasal septum (DNS) which represents the common causes for NO and 26 controls (with normal nasal breathing). Nasal breathing sounds were recorded by the NAD akin to two small stethoscopes placed over the left and right nasal ala. The novel outcome metrics for the NAD include inspiratory nasal acoustic score (INA) score, expiratory nasal acoustic (ENA) score and the inspiratory nasal obstruction balance index (NOBI). The change in acoustic score following decongestant is key in this diagnostic process.ResultsPre‐decongestant ENA score was used to detect the presence of nasal obstruction in patients compared to controls, with a sensitivity of 0.81 (95% CI: 0.66‐0.96) and a specificity of 0.77 (0.54‐1.00). Post‐decongestant percentage change in INA score was used to identify the presence of AR or CRS, with a sensitivity of 0.87 (0.69‐1.00) and specificity of 0.72 (0.55‐0.89) for AR; and a sensitivity of 0.92 (0.75‐1.00) and specificity of 0.69 (0.52‐0.86) for CRS. Post‐decongestant inspiratory NOBI was used to identify DNS, with a sensitivity of 0.77 (0.59‐0.95) and specificity of 0.94 (0.82‐1.00).ConclusionWe have demonstrated that the NAD can help distinguish between normal and abnormal nasal breathing and help diagnose AR, CRS, and DNS. Such a device has not been invented and could revolutionize COVID‐19 recovery telemedicine.Level of EvidenceDiagnostic accuracy study—Level III.

Facial Paralysis in a Babylonian Plaque.

A terra cotta plaque [LMU 2551] from the Neo-Babylonian period (c.629-539 BCE), housed in the museum of the Archaeology Center at Loyola Marymount University, Los Angeles, is a representation of right peripheral facial paralysis. Ancient representations of pathology are rare and often difficult to identify. This is particularly true of Assyrian-Babylonian cultures where, despite numerous surviving medical texts, artistic examples of disease are almost non-existent. Precise caliper measurements and archaeological analysis of LMU 2551 were used to confirm the authors' hypothesis. The facial distortions portrayed in LMU 2551 are not accidental. Measurements show a pronounced asymmetry of the lower face where the length from the mid-philtrum to the oral commissure and from the lateral edge of the ala nasi to the mid-ipsilateral nasolabial fold are twice as long in the left than in the right side. The left eye is closed, whereas the right is widely open. The described plaque is among the oldest representations of facial paralysis on record. It correlates with contemporary Babylonian texts describing neurological disorders but its function is unknown.

Presurgical Orthopedic Intervention Prior to Cleft Lip and Palate Repair: Nasoalveolar Molding Versus Passive Molding Appliance Therapy.

Nasoalveolar molding (NAM) is a widely used presurgical orthopedic device, despite disputes over its effectiveness. This study compares the outcomes after cleft lip and nose repair in patients who received NAM versus those who underwent passive alveolar molding with lip taping. A retrospective review of patients with complete unilateral cleft lip and palate who received either NAM (n = 16) or passive molding (n = 10) treatments was conducted. Alveolar gap width was measured on maxillary casts until time of palatoplasty. Nasolabial symmetry was assessed by examining anthropometric ratios on post-operative three-dimensional photographs. Burden of care was evaluated by analyzing the number of patient appointments attended, treatment costs, and caregiver satisfaction surveys. No statistically significant difference existed in alveolar gap at time of initial appointment or palatoplasty, however the gap was smaller in the NAM cohort at time of lip and nose repair. No statistically significant difference existed in postsurgical heminasal width, nostril width, nostril height, labial height or nasal ala projection asymmetry between the NAM and the passive molding cohort. Patients in the NAM group attended more dental appointments and incurred higher treatment costs compared to the passive molding group. Caregivers reported high satisfaction with treatment outcomes in both cohorts. There were no differences between NAM and passive molding regarding postsurgical nasolabial appearance and patient satisfaction. Both treatments narrow the alveolar gap. However, NAM places a higher burden of care on families.

Accuracy Evaluation of a Three‐Dimensional Model Generated from Patient‐Specific Monocular Video Data for Maxillofacial Prosthetic Rehabilitation: A Pilot Study

To evaluate if the combination of a monoscopic photogrammetry technique and smartphone-recorded monocular video data could be appropriately applied to maxillofacial prosthesis fabrication. Smartphone video and laser scanning data were recorded for five healthy volunteers (24.1± 0.7 years). Three-dimensional (3D) facial models were generated using photogrammetry software and a laser scanner. Smartphone-recorded video data were used to generate a photogrammetric 3D model. The videos were recorded at two resolutions: 1080 × 1920 (high resolution) and 720 × 1280 pixels (low resolution). The lengths of five nasal component parts (nose height, nasal dorsum length, nasal column length, nasal ala length, and nose breadth) were compared in the photogrammetric 3D models (as the test model) and the laser scanned 3D models (as the validation model) using reverse engineering software. There was a significant difference in the nasal dorsum length between the test model and the validation model (high resolution; 95% confidence interval, 2.05-5.07, Low resolution; confidence interval, 2.19-5.69). In contrast to the nasal dorsum length, there were no significant differences in nose height, nose breadth, nasal ala length, and nasal column length. Using smartphone-recorded video data and a photogrammetry technique may be a promising technique to apply in the maxillofacial prosthetic rehabilitation workflow.

Three-dimensional assessment of nasal changes after maxillary advancement with impaction using stereophotogrammetry.

ObjectiveTo evaluate the changes in the nose in three dimensions after Le Fort I osteotomy in patients with skeletal Class III malocclusion.MethodsThe subjects were 40 adult patients (20 females and 20 males; mean age, 20.3 ± 3.0 years; range, 17.0 to 31.1 years) who underwent one-piece Le Fort I osteotomy with maxillary advancement and impaction treatment for maxillary hypoplasia. The mean maxillary advancement was 4.56 ± 1.34 mm, and the mean maxillary impaction was 2.03 ± 1.04 mm. Stereophotogrammetry was used to acquire three-dimensional images before and at least 6 months after surgery.ResultsAlare (Al) and alare curvature (Ac) points had moved vertically and antero-laterally postoperatively. A significant increase was observed in the nasal ala width and alar base width, and no changes were noted in the columellar length, nasolabial angle, and nasal area. There was a significant relationship between maxillary impaction and nasal ala width and horizontal and sagittal positions of the bilateral Al and Ac. The only relationship found was between maxillary advancement and postoperative sagittal location of the subnasale and pronasale.ConclusionsNasal soft tissues were highly affected by the vertical movement of the maxilla; however, the soft tissue responses were individual-dependent.

Office-Based Forehead Flaps: A Safe and Reliable Reconstructive Option.

Forehead flaps are one of the workhorse flaps for nasal reconstruction, especially for large defects involving the nasal tip, ala, or multiple nasal subunits. Forehead flaps are often performed on older patients who have accompanying comorbidities and who may be at higher risk for anesthetic complications. The aim of this retrospective study was to compare the safety and success of forehead flap nasal reconstruction in 2 different clinical settings: those performed under local anesthesia in an office-based procedure room, compared with those performed in the operating room under either general anesthesia or intravenous sedation. A retrospective chart review was performed on all patients who underwent forehead flap reconstruction between the years of 2011 and 2018 by the senior author. Patient demographics, operative details, and postoperative complications were recorded and analyzed. Patients were followed for 1 year postoperatively or until the end of the study period. Patients were excluded if they had an accompanying unrelated cosmetic procedures performed during first-stage forehead flap reconstruction. A total of 96 forehead flaps were performed, 35 of which (36.5%) were done in an office-based procedure room using local anesthesia only. Patient ages ranged from 45 to 92 years, with an average age of 71.9 years. The majority of flaps (n = 81, 85.3%) were divided at the second-stage procedure. There was no statistically significant difference in time elapsed between first- and second-stage procedures between groups (procedure room: 22.6 days; operating room: 23.8 days). There were 13 total postoperative complications (13.5%), but there was no statistically significant difference in complication rate between groups (office-based: 3 complications, 8.6%; operating room: 10 complications, 16.4%). Our data suggest that forehead flap reconstruction can be done safely with acceptable postoperative results when performed under local anesthesia in an office-based outpatient setting.

Facial Landmark Reconstruction with a Combination of Local Flaps: A Novel Technique for Landmark Destruction.

Various methods of landmark reconstruction have been discussed in medical literature, but few describe defects involving the rim of the landmark. For landmark malposition, such as eyelid ectropion, borders are abnormally elongated by scar contracture. The reconstruction should thus restore both the cutaneous defect and the anatomical structure. We suggest the combination of local flaps via end-to-end connection and transposition for facial landmark reconstruction. Ten patients who had facial landmark malpositions caused by scar contractions, and 5 patients who had landmark defects, were successfully treated using this combination flap technique. Among the 15 patients, landmark malposition repairs of the nasal ala, nasal columella, eyelid margin, Cupid's bow, and eyebrow were performed. Most flaps survived without complications; one procedure resulted in the cutaneous tip developing necrosis, which was successfully healed within 2 weeks of conservative treatment. The landmark was reconstructed with aesthetics in mind, and no subsequent scar contracture was observed. After a 6- to 14-month follow-up period, successful landmark reconstruction had been achieved in all 15 patients via a single-stage procedure. A combination of local flaps is a viable option for facial landmark reconstruction in selected patients having landmark rim destruction.

Prevention of Nasal Ala Pressure Injuries With Use of Hydroactive Dressings in Patients With Nasotracheal Intubation of Orthognathic Surgery: A Randomized Controlled Trial.

To compare a hydroactive dressing to an adhesive tape standard of care in the prevention of nasal ala pressure injuries associated with nasotracheal intubation during orthognathic surgery. Randomized controlled trial. The study took place in a tertiary hospital of stomatology in China. Patients undergoing general anesthesia with nasotracheal intubation during orthognathic surgical procedures were invited to participate. Participants were divided into 2 groups: in the experimental group, a hydroactive dressing was applied to the nasal ala before the surgical procedures; the control group received standard prevention with a type of tape. Skin assessments were performed on the wards up to 72 hours after the procedures. Demographic information and potential contributing factors associated the development of nasal ala pressure injuries were collected from patients' electronic medical records. Pressure injury development was staged using National Pressure Injury Advisory staging guidelines. Pressure injury incidence was compared between groups using the χ test and odds ratio. The sample comprised 450 participants, 225 in each group. The incidence of nasal ala pressure injuries development was 14.222% and 4.444% in the 2 groups, respectively (P = .000). The odds ratio was 3.565 (95% confidence interval, 1.707-7.443). The study findings indicate that the incidence of pressure injuries of nasal ala skin protected by hydroactive dressings was lower than the standard preventive method. Hydroactive dressings should be considered as a prevention method to reduce device-related skin injuries associated with nasotracheal intubation.