Alar retraction: composite graft correction.
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Biomedical subjects
Publications and source records attributed to M E Tardy.
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Nasal tip surgery is a compromise, in which the surgeon gives away something to achieve something--a narrower, more defined, and stable tip component of the nose. Years of experience are required to thoroughly understand and master tip surgery techniques. While gaining this arduous but invaluable insight, emphasis should always be placed on conservation of tip anatomic structures and avoidance of radical excision and sacrifice of tip tissue. Compulsive long-term follow-up and evaluation of patients, both by frequent examination and review of standardized, uniform photographs, best facilitates the development of expertise in nasal tip surgical refinement.
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This paper deals with the long-term follow-up of cartilage autografts taken from various parts of the body to reconstruct areas of the nose, ear, trachea, eyelid, and other areas of the body which require augmentation, effacement, and long-term support. Our thesis will be that the cartilage autograft is the implant of choice in many of these areas, and that fate of autogenous cartilage is well known and should be given strong priority in facial grafting.
The midline forehead flap has been a preferred choice for nasal repair in our practice for over 20 years, with no significant complication ever having developed (Figs. 9 to 11). The abundance and length of tissue it provides is remarkable, given the inconspicuous defect remaining in the forehead area. Its use is economical of tissue, time, and expense to the patient. Most importantly, the midline flap provides superior aesthetic and reconstructive repair in a relatively short period of time without resorting to more complicated, and therefore more risky, flap designs.
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This report examines the various common congenital auricular deformities categorized under the broad heading of the "outstanding ear" and reviews briefly the major contributions to otoplasty surgery.
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Because of altered physical and psychological patterns, patients requesting rhinoplasty in midlife must be managed and treated with specific goals and limitations in mind. Subtle and conservative nasal appearance changes generally suit this category of patient best, avoiding a dramatic metamorphosis. When performed in conjunction with other age diminishing operative procedures, rhinoplasty plays a critical role in overall facial appearance improvement. By keeping in mind the principles and limitations discussed in this article, the surgeon can find exceeding satisfaction in performing conservative rhinoplasty in patients who find themselves in the middle stages of life.
Obtaining a photograph that provides genuine information entails strict uniformity and standardization. As noted throughout this discussion, this is best accomplished through use of a simple and consistent scheme for photography. To identify the aspects of the scheme that give optimal results it is wise to run several test rolls of film at various camera settings and to mark the camera accordingly. In this manner the same procedure is always followed. If all the foregoing criteria are met, the medical photograph will serve as an ideal clinical record, medicolegal record, teaching tool, and instrument for critical analysis of results. The following steps are recommended to ensure uniform medical photography: 1. One should use a 35 mm. single lens reflex camera body with a "grid" type of viewing screen. 2. A 90 to 105 mm. lens is used to avoid distortion and provide a comfortable patient to camera working distance. 3. An electronic spot flash (avoiding a ring flash except for deep cavity photographs) can be supplemented with an overhead "kicker" light. 4. A sky blue, nonglare background is ideal. 5. Kodachrome 25 film is recommended for most situations. 6. Careful positioning of the patient is critical. Observe the Frankfort plane horizontal. 7. One should avoid the pitfalls of photographic misrepresentation. 8. The key to successful uniform medical photography is consistency of equipment and positioning.
The majority of perforations of the nasal septum, regardless of etiology, create little more than an annoyance to the patient. Perforations commonly may be totally asymptomatic, discovered only on careful nasal examination. It is reasonable to assume, therefore, that only those septal defects creating important symptoms are deserving of repair and correction. Heavy crusting, recalcitrant bleeding and impending or actual loss of dorsal support are justifications for perforation closure. Textbooks and journals abound with suggested varieties of techniques of repair, testifying to the non-effectiveness of any one suitable approach. Local mucosal flaps, turbinate flaps, pedicle skin flaps, and free grafts of skin, dermis, perichondrium, cartilage, and fascia have all been employed with variable results. An inadequate blood supply and unfavorable scarred host bed commonly lead to failure of the above reconstruction methods. In the past five years a horizontal mucosal flap derived from the undersurface of the upper lip has proved reliable and expedient in septal perforation re-epithelialization and closure. The reconstructive procedure is not technically difficult and leads to minimal patient discomfort.