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The saddle nose and short nose deformities are challenging surgical problems characterized by significant architectural deficiencies of the nasal framework. These defects produce cosmetic and functional nasal problems. Reconstructive techniques and augmentation materials are reviewed. Case examples illustrate the authors currently preferred techniques.
The aim of this study is to assess the risk of contamination by Salmonella Typhimurium of pigs by nose-to-nose contact or the airborne route. Thirty twelve-week-old SPF pigs were divided into 4 groups housed in 4 different rooms: the first room contained Salmonella-free control pigs (n = 4), the second room had 10(3) CFU S. Typhimurium inoculated pigs (n = 5) and non-inoculated "contact" pigs (n = 4), the third room had pigs (n = 8) receiving potentially contaminated air from the following room through a hole (4 pigs housed in the pen situated near the hole and 4 pigs in the pen at the opposite side of the room), and the fourth room had pigs (n = 5) inoculated with 10(6) CFU Salmonella Typhimurium and also non inoculated "contact" pigs (n = 4). The "contact" and the inoculated pigs were housed in adjacent pens allowing nose-to-nose contact. The 5 pigs orally inoculated with 10(6) CFU S. Typhimurium were bacteriologically and serologically positive 1 week later and their environment was contaminated as early as 1 day pi. The faecal samples of 4 nose-to-nose contact pigs were bacteriologically positive and one of them was seropositive 5 weeks pi before the pigs were commingled. The 8 pigs housed in the third room received S. Typhimurium by an active airflow coming from the contaminated room (1000 m3/hour). Their faecal samples remained negative until 8 weeks pi but the environmental swabs taken in the room close to the airinlet were contaminated 2 days pi and positive swabs were found elsewhere in the room 5 weeks pi. Two seropositive pigs were encountered 8 weeks pi in the pen situated near the hole. Only one among the 5 pigs inoculated with 10(3) CFU had bacteriologically positive faeces 1-week pi and the 4 pigs kept in nose-to-nose contact with them remained negative. A dose of 10(3) CFU was too small to induce persistent excretion and to stimulate a humoral immune response. However, the dose of 10(6) CFU induced contamination of nose-to-nose contact pigs and contamination of the environment by airflow.
BACKGROUND: The 3-dimensionally complex interplay of soft tissue, cartilaginous, and bony elements makes the mastery of nasal anatomy difficult. Conventional methods of learning nasal anatomy exist, but they often involve a steep learning curve. Computerized models and virtual reality applications have been used to facilitate teaching in a number of other complex anatomical regions, such as the human temporal bone and pelvic floor. We present a 3-dimensional (3-D) virtual reality model of the human nose. METHODS: Human cadaveric axial cross-sectional (0.33-mm cuts) photographic data of the head and neck were used. With 460 digitized images, individual structures were traced and programmed to create a computerized polygonal model of the nose. Further refinements to this model were made using a number of specialized computer programs. This 3-D computer model of the nose was then programmed to operate as a virtual reality model. RESULTS: Anatomically correct 3-D model of the nose was produced. High-resolution images of the "virtual nose" demonstrate the nasal septum, lower lateral cartilages, middle vault, bony dorsum, and other structural details of the nose. Also, the model can be combined with a separate virtual reality model of the face and its skin cover as well as the skull. The user can manipulate the model in space, examine 3-D anatomical relationships, and fade superficial structures to reveal deeper ones. CONCLUSIONS: The virtual nose is a 3-D virtual reality model of the nose that is accurate and easy to use. It can be run on a personal computer or in a specialized virtual reality environment. It can serve as an effective teaching tool. As the first virtual reality model of the nose, it establishes a virtual reality platform from which future applications can be launched.
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Most of the nitric oxide (NO) in expiratory air is produced by the nose and its accessory sinuses, and nasal allergies related to NO have been often reported. In the present study, we postulated that nose bleeds may be somehow related to reactive oxygen species. The expression of NO synthase (NOS) by the nasal mucosa was evaluated using the RT-PCR method, and the concentration of NO in air expired through the nose was measured. The activity of superoxide dismutase, which scavenges superoxide anions, was also evaluated. The genetic expression of iNOS was observed in the nasal mucosa, and a significantly lower level of expression was noted in subjects with a nosebleed, compared to that of the controls. This result was interpreted as indicating a decrease in NO levels as a result of the nosebleed, leading to an elevation in blood pressure. Transient elevations in blood pressure caused by oxidative stress may lead to the rupture of nasal vessels if hypertension preexists. Serum levels of superoxide dismutase increased significantly in subjects with nose bleeds. This finding might be related to the activity of the superoxide anion, which is released in large amounts during nose bleeds. Serum superoxide dismutase levels increase in response to the high concentration of superoxide anions. The concentration of NO in air expired through the nose was significantly lower in subjects with nose bleeds, compared to that of the control subjects. We suggest that NO production decreases in subjects experiencing nose bleeds and that this reduction is induced by preexisting hypertension and injury from reactive oxygen species, contributing to the resulting nose bleed.
The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.
The infinitely many possible isothermal dynamics based on Nose and Nose-Hoover methods are investigated. Their properties and criteria for selecting different isothermal dynamics determined by various scaling functions of the thermostat s variable involved in the generalized Nose Hamiltonian [J. Jellinek and R. S. Berry, Phys. Rev. A 38, 3069 (1988)] are tested with molecular dynamics simulations, and examined analytically. It is shown that time scaling is related to the scaling of the momenta. It is demonstrated that, for practical realizations, the entire generalization of the Nose-Hoover method reduces to only two momentum scaling functions h and u, with a function v defining the "potential energy" of the thermostat. The most general form of the generalized Nose-Hoover (GNH) equations of motion is established. It enables correct calculations of both static and dynamic equilibrium quantities. GNH equations with h=s(alpha), u=s(vartheta), and v approximately lns are studied in detail. With such a choice of the functions the extended Nose-Hoover (ENH) equations are expected to produce more chaotic phase-space dynamics than the NH equations. This is illustrated by thermalization of a one dimensional harmonic oscillator. For a system away from equilibrium the ENH thermostat is not able to provide dynamics consistent with the target temperature, and, thus, the GNH approach reduces to the original Nose-Hoover thermostat. A simple modification of the ENH equations is proposed which makes the ENH thermostat also applicable to nonequilibrium states.
This research tests the relative ability of body size factors and sex to explain variation in nose volume and to explain metabolic measures during rest and moderate exercise in 50 young adults. It uses standard anthropometric measures plus two new measures of nose morphology (nose/face angle and nose volume) and evaluates body composition with a device for air displacement plethysmography. Standard physiological measures were obtained in nose-only and mouth-only breathing conditions with subjects at rest and using moderate exercise. A factor representing linear and bulk measures of body size and a factor representing lean body mass explain subjects' variation in nose volume, resting volume of oxygen consumed (VO2), and resting ventilation volume (VV) better than subject's sex does. By contrast, during exercise, sex explains VO2 and VV better than do body size factors, probably because hormone-mediated muscularity in males produced greater work output. Nose breathing was found to be more energetically efficient in most but not all subjects, but additional research is needed to explore this finding further. Qualitative comparisons between modes of breathing and the application of this research protocol to studies of climate-related patterns of nasal variation are discussed.
The crooked nose deformity and the saddle nose deformity represent two of the most challenging complications of nasal trauma. Optimal management requires careful preoperative analysis and thoughtful surgical planning. The surgeon must make the mental and philosophical commitment to address the difficult cosmetic components and the functional problems related to these deformities. Because these conditions result from disruptions of the nasal septum, their surgical correction mandates use of techniques that modify the septum, and they might require reconstruction of the sacrosanct dorsal-caudal strut. By understanding the three-dimensional anatomy of this L-shaped strut, how its relationship to the other structural components of the nose determines external nasal contour, and the techniques available to stabilize this structure into an optimal position, the surgeon can correct these difficult cosmetic problems effectively while maintaining the overall structural and functional integrity of the nose.
Nasal augmentation is a highly popular technique used among Asian patients to change the characteristic flat Asian nose to a more prominent nose. The extent of augmentation is determined by the aesthetic desires of the patient, and the method of augmentation is provided by the surgeon, who takes into account the technical limitations of his or her preferred technique and the proposed surgical result. Although a silicone prosthesis is the most common implant used to improve the nasal appearance, the author prefers an autogenous approach with the olecranon bone used as a dorsal implant and conchal cartilages used to improve nasal tip projection because of the long-term stable results. A series of 31 cases over 15 years is reviewed. The technique varies little from that described for saddle nose by Hodgkinson in 1992 [5]. The procedure is a variation of the ulnar donor site originally described by Antia et al. [1].
The contracted nose is a unique entity that follows primary rhinoplasty in the Asian patient. The proposed reasons for this complication are capsular contraction from a silicone nasal implant, pressure necrosis of the lower lateral cartilage resulting from the nasal implant, and infection after alloplastic implantation. The two principal anatomic constituents that must be addressed at the time of secondary rhinoplasty are the lower lateral cartilages and the skin envelope. The lower lateral cartilages should be derotated, projected, and transfixed with an extended spreader graft. Additional onlay grafting may be required to provide greater nasal tip derotation and projection. A transcolumellar incision situated at the columellar-labial angle permits undermining of the upper lip skin to release tension on the incision. If the nasal tip retraction is severe, then the skin envelope may be insufficient to provide coverage to the new cartilaginous framework. In this case, a paramedian forehead flap is recommended to provide adequate tissue coverage. Correction of alar-columellar disparity should be undertaken with composite grafting only after 6 months have transpired to gauge the ultimate relation between the alae and columella. Infection that arises after correction of the contracted nose can be devastating. It should be treated aggressively, but tailored to the severity of the infection. Wound tension along the columella may predispose to skin necrosis and consequent cartilage exposure, which should be managed in turn with prostaglandin emollients to accelerate wound healing and to prevent infection.
In some bats, a noseleaf is thought to help focus echolocation calls emitted through the nostrils. I studied the ontogenetic mode of the rhinarial cartilages and the associated facial muscles to assess how these rhinarial infrastructures interact with the noseleaf, and the inferred function of such a rhinarial complex. This study focuses on developmental stages of Hipposideros diadema and Lavia frons. Based on new data on these two rhinolophoids and a review of former studies concerning rhinopomatids, rhinolophoids and phyllostomids, the functional and phylogenetic implications of the rhinarial complex among leaf-nosed Microchiroptera are evaluated by the current study. Nasal emitting forms evolved several times independently in the Microchiroptera and share various features, irrespective of their phylogenetic position: the nostrils lie dorsally; the noseleaf has a well-developed horseshoe-shaped plate; the cartilago cupularis bears a large processus cupularis; M(iv) is extended on the lateral plate of the processus alaris superior. The unique similarities of the ontogenetic process of the nasal 'resonators' support the assumption that the rhinolophids + megadermatids and rhinopomatids may represent a natural group. In some features, the rhinolophids + megadermatids differ significantly from the phyllostomids. The noseleaf has a median flap and anterior-facing pockets. The processus alaris superior is half-tube-shaped or included in the lateral wall of the cupula nasi anterior. The cartilago accessoria and the attendant musculature perform an important function for supporting and moving the noseleaf. Similar emission of the echolocation pulses but alternative constructional designs of the external nose structures suggest that a separate history of rhinolophoids and phyllostomids might account for these differences.
In this second part of a diptych on cleft lip and nose, the nose deformity is analysed. The lip/nose adhesion and the growth guidance plate are as important for the functional primary rhinoplasty as for the definitive lip repair.
The star-nosed mole (Condylura cristata) has a snout surrounded by 22 fleshy and mobile appendages. This unusual structure is not an olfactory organ, as might be assumed from its location, nor is it used to manipulate objects as might be guessed from its appearance. Rather, the star is devoted to the sense of touch, and for this purpose the appendages are covered with thousands of small mechanoreceptive Eimer's organs. Recent behavioral studies find that the star acts much like a tactile eye, having a small behavioral focus, or "fovea" at the center--used for detailed explorations of objects of interest. The peripheral and central nervous systems of the mole reflect these behavioral specializations, such that the small behavioral focus on the nose is more densely innervated in the periphery, and has a greatly enlarged representation in the somatosensory cortex. This somatosensory representation of the tactile fovea is not correlated with anatomical parameters (innervation density) as found in other species, but rather is highly correlated with patterns of behavior. The many surprising parallels between the somatosensory system of the mole, and the visual systems of other mammals, suggest a convergent and perhaps common organization for highly developed sensory systems.
PURPOSE: To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seats (A(ntcs) and B(ntcs)) on penile hemodynamics and perineal compressive forces in subjects who cycle in a stationary bicycle. MATERIALS AND METHODS: Subjects underwent cavernosal artery peak systolic velocity (CAPSV) measurements after intracavernosal injection of vasoactive agents while supine, sitting upright on an examination table, straddling a saddle, sitting on a seat, and again supine. Mean perineal compression pressures recorded while straddling the saddles were compared with those while sitting upright. RESULTS: No differences were found in right and left CAPSV values while supine, sitting upright on an examination table, sitting on a seat, and supine again. Right/left CAPSV (cm/second) values straddling A(ns) and saddle B(ns) (0.7 +/- 2.9/1.5 +/- 6.2 and 0/0, respectively) were significantly lower than values obtained while sitting on A(ntcs) and B(ntcs) (25.6 +/- 13.4/23.8 +/- 12.0 and 17.3 +/- 6.4/18.3 +/- 6.5, respectively) (P < 0.001). Mean perineal compression pressures (mm Hg) on A(ns) and saddle B(ns) (315.2 +/- 39 and 387.9 +/- 64.3, respectively) were significantly higher than values obtained while sitting upright on an examination table (47.6 +/- 5.2 and 46.0 +/- 8.1, respectively) (P < 0.001). CONCLUSIONS: We have identified an objective test to assess if an individual bicycle rider, sitting on a certain shape of bicycle saddle or seat generates sufficient compressive forces at the perineal-saddle interface to obstruct cavernosal arterial inflow. This study also demonstrated that straddling bicycle saddles with nose extensions is associated with perineum-saddle interface compressive pressures that exceed systolic perfusion pressures, significantly diminishing penile hemodynamics.
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