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Expanded polytetrafluoroethylene (ePTFE), also known as Gore-Tex, is widely used as an implantable biomaterial in biomedical applications because of its favorable mechanical properties and biochemical inertness. However, infection and inflammation are two major complications with ePTFE implantations, because pathogenic bacteria can inhabit the microsized pores, without clearance by host immune cells, and the limited biocompatibility can induce foreign body reactions. To minimize these complications, we covalently grafted a biomembrane-mimic polymer, poly(2-methacryloyloxylethyl phosphorylcholine) (PMPC), by partial defluorination followed by UV-induced polymerization with cross-linkers on the ePTFE surface. PMPC grafting greatly reduced serum protein adsorption as well as fibroblast adhesion on the ePTFE surface. Moreover, the PMPC-grafted ePTFE surface exhibited a dramatic inhibition of the adhesion and growth of Staphylococcus aureus, a typical pathogenic bacterium in ePTFE implants, in the porous network. On the basis of an analysis of immune cells and inflammation-related factors, i.e., transforming growth factor-β (TGF-β) and myeloperoxidase (MPO), we confirmed that inflammation was efficiently alleviated in tissues around PMPC-grafted ePTFE plates implanted in the backs of rats. Covalent PMPC may be an effective strategy for promoting anti-inflammatory and antibacterial functions in ePTFE implants and to reduce side effects in biomedical applications of ePTFE.

IMPORTANCE: Studies comparing surgical results of rhinoplasty using autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are rare. OBJECTIVES: To compare the clinical results of major augmentation rhinoplasty using ACC vs IHCC and analyze the histologic properties of both types of cartilage. DESIGN, SETTING, AND PARTICIPANTS: A retrospective clinical study was conducted among patients who had undergone rhinoseptoplasty using ACC or IHCC from January 1, 2009, to December 31, 2014. Patients were followed up for more than 1 year after surgery and the histologic characteristics of ACC and IHCC were compared. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity, were evaluated by reviewing medical records and facial photographs. Patients’ subjective satisfaction with aesthetic and functional results was evaluated using a questionnaire. MAIN OUTCOMES AND MEASURES: The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity; patients’ subjective satisfaction with aesthetic and functional results’ objective evaluation of surgical outcomes, including symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result; and histologic structures. Objective evaluation of surgical outcomes was graded using the Objective Rhinoplasty Outcome Score, which assessed symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result. Histologic structures were evaluated using hematoxylin and eosin, Masson trichrome, Alcian blue, and Verhoeff elastic stains. RESULTS: A total of 63 patients (27 males and 36 females; mean [SD] age, 30.6 [9.5] years) had rhinoseptoplasty using ACC and 20 (9 males and 11 females; mean [SD] age, 35.4 [15.4] years) had rhinoseptoplasty using IHCC. Among observed complications, only notable resorption occurred more frequently in patients using IHCC (6 [30%]) than with ACC (2 [3%]) (P = .002). In subjective evaluations of aesthetic satisfaction, patients who received ACC showed significantly greater satisfaction (37 of 51 patients [73%] were very satisfied) than did those who received IHCC (6 of 20 [30%]) (P = .001). However, there was no between-group difference in subjective functional outcomes: 4 of 51 patients receiving ACC (8%) and 5 of 20 receiving IHCC (25%) were satisfied (P = .50) and 45 of 51 receiving ACC (88%) and 15 of 20 receiving IHCC (75%) were very satisfied (P = .15). Regarding objective aesthetic outcomes, all scores for both ACC and IHCC were more than 3.1 (between good and excellent). Histologic analyses showed larger, more evenly distributed, uniform chondrocytes and more collagens and proteoglycan contents in ACC than in IHCC. CONCLUSIONS AND RELEVANCE: Compared with patients receiving IHCC, those receiving ACC for rhinoseptoplasty showed superior aesthetic satisfaction; ACC also had less frequent notable resorption. Autologous costal cartilage also had better histologic properties than IHCC did, suggesting it as an ideal graft material with less chance of long-term resorption. LEVEL OF EVIDENCE: 3.

RationaleInterleukin (IL)-33, a new member of the IL-1 family, is constitutively expressed in epithelial tissues and lymphoid organs and plays an important role in the pathogenesis of allergic disease. However, the role of IL-33 in chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear.ObjectiveTo investigate the role of IL-33 in the pathophysiology of CRSwNP.MethodsWe investigated IL-33 expression and its cellular origins in the nasal polyps (NPs) of human subjects by immunohistochemistry (IHC), quantitative reverse transcription PCR (qRT-PCR), and multiplex cytokine assays. Correlations between IL-33 expression and other inflammatory markers were also explored. To investigate the role of IL-33 in CRSwNP, anti-IL-33 antibody was used in a murine model of CRS.ResultsUncinate process tissues from control (19), CRSsNP (61), CRSwNP (69) and NP tissues (71) were used in this study. Increased expression of IL-33 mRNA and protein in patients with CRSwNP compared with controls was observed. The concentration of IL-33 protein in CRSwNP was positively correlated with the number of neutrophils and the expression of several Th1 and Th17 inflammatory markers, including interferon (IFN)-γ, IL-1β, tumour necrosis factor (TNF)-α, IL-17A, IL-22, and various markers for neutrophil recruitment. However, protein levels of IL-5 and quantity of eosinophils were inversely correlated with levels of IL-33. The expression of tissue inhibitor of metalloproteinase (TIMP)-1 was negatively correlated with IL-33 protein levels, while the expression of matrix metalloproteinase (MMP)-2 and MMP-9 was positively correlated with IL-33 protein levels. In animal studies, IL-33 expression was upregulated in the CRSwNP group compared with controls. Anti-IL-33 treatment reduced the thickness of oedematous mucosa, subepithelial collagen deposition, and infiltration of neutrophils, but infiltration of eosinophils was not reduced. This treatment also inhibited the expression of neutrophilic inflammatory cytokines, but not IL-4. In addition, the expression of intracellular adhesion molecule 1, vascular adhesion molecule 1 and CXCL-2 in the nasal mucosa was suppressed in mice treated with anti-IL-33 antibody.ConclusionsOur data suggest a role for IL-33 in the pathogenesis of CRSwNP via neutrophil recruitment. Therefore, anti-IL-33 may provide a new treatment strategy to target infiltrating neutrophils in CRSwNP.

IMPORTANCE: Combined rhinoplasty and septal perforation repair is a technically challenging procedure, and few studies have reported the outcomes. OBJECTIVE: To present the long-term surgical results of rhinoplasty with concurrent septal perforation repair. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study included 17 patients who underwent rhinoplasty with concurrent septal perforation repair at a tertiary academic medical center from March 2005, through March 2015. Patients had a mean postoperative follow-up duration of 50.9 months. The etiology of the deformity, presenting symptoms, perforation size, intraoperative surgical techniques, and complications were analyzed. Final follow-up was completed on March 31, 2015. MAIN OUTCOMES AND MEASURES: Postoperative subjective (telephone survey of patient satisfaction) and objective (Objective Rhinoplasty Outcome Score) patient satisfaction and endoscopic nasal cavity examination at the last follow-up. RESULTS: Among the 17 patients (14 men; 3 women; mean [SD] age, 40 [16] years), 12 (71%) had previously undergone septoplasty and/or septorhinoplasty, 4 (24%) had nasal trauma, and 1 (6%) had an unknown cause. The main aesthetic reasons for rhinoplasty were a saddle nose deformity (10 patients [59%]) and deviated nose related to a previous surgery or trauma (5 patients [29%]). The functional reasons for surgery included nasal obstruction (14 patients [82%]) crusting (2 patients [12%]), epistaxis (1 patient [6%]), and whistling (1 patient [6%]). The perforation size varied from 2 to 30 mm, with a mean of 14.3 mm. Surgery was performed through the open rhinoplasty approach. Perforations were first closed with an advancement flap in 6 patients, rotation flap in 6 patients, a combination of both in 4 patients, and a combination of advancement flap and free mucosal graft in 1 patient, with or without interposition grafts. Rhinoplasty was performed with various grafts, maneuvers, and septal reconstruction. Complete closure with symptom relief was achieved in 15 patients (88%). The mean objective score evaluating the rhinoplasty results was 3.4 (on a scale of 0-4, where 3.4 is good to excellent). No serious complications occurred after surgery. CONCLUSIONS AND RELEVANCE: Concurrent rhinoplasty and nasal septal perforation repair is a safe and effective option when necessary. The open rhinoplasty approach facilitated septal perforation closure, whereas septal perforation repair did not affect the surgical result of rhinoplasty. LEVEL OF EVIDENCE: 4.

The ubiquitous goal of rhinoplasty is to make a natural-looking and attractive nose that blends harmoniously with the face. Rhinoplasty among Asians includes characteristics that distinguish the procedure from its white counterpart. Anatomic differences of the Asian nose coupled with differences in aesthetic standards demand they be approached in a unique way. In this article, peculiar aspects of Asian rhinoplasty are addressed with emphasis on surgical techniques used to obtain reliable results.

IMPORTANCE: Although autologous rib cartilage is a preferred source of graft material in rhinoplasty, rib cartilage for dorsal augmentation has been continuously criticized for its tendency to warp and for high donor-site morbidities. However, no meta-analysis or systemic review on complications associated with autologous rib cartilage use in rhinoplasty has been conducted. OBJECTIVE: To carry out a systematic review and a meta-analysis of available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty. DATA SOURCES: The studies reporting complications associated with the autologous rib cartilage use in rhinoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for sources published from 1946 through June 2013. STUDY SELECTION: The selected articles included clinical studies conducted with at least 10 patients and at least 1 postoperative long-term complication or donor-site morbidity in rhinoplasty. Excluded were nonhuman studies; review articles; case reports; abstracts; and reports of nasal reconstruction as indication for surgery, use of homologous rib cartilage, and diced or laminated methods. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model. MAIN OUTCOMES AND MEASURES: Number of patients; follow-up duration; and rates of complication, donor-site morbidity, and revision surgery. Also noted were study authors and year of publication. RESULTS: Ten studies involving a total 491 patients were identified. Mean follow-up across all studies was 33.3 months. In meta-analysis, the combined rates were 3.08% (95% confidence interval [CI], 0%-10.15%) for warping, 0.22% (95% CI, 0%-1.25%) for resorption, 0.56% (95% CI, 0%-2.61%) for infection, 0.39% (95% CI, 0%-1.97%) for displacement, 5.45% (95% CI, 0.68%-13.24%) for hypertrophic chest scarring, 0% (95% CI, 0%-0.32%) for pneumothorax, and 14.07% (95% CI, 6.19%-24.20%) for revision surgery. CONCLUSIONS AND RELEVANCE: The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon’s attention. Because a limited number of studies and patients were eligible, and consistent definitions of complications were lacking in this meta-analysis, future studies with a larger series of patients and objective outcome measurements are needed to obtain more reliable results. LEVEL OF EVIDENCE: 4.

IMPORTANCE Rib cartilage from the sixth, seventh, and eighth ribs offers a long cartilaginous curvature, making the material reliable for grafting. Calcification of cartilage causes unexpected absorption, difficult manipulation, and donor site morbidity. Most studies of calcification were performed in Western countries. OBJECTIVE To investigate the incidence, degree, and pattern of rib cartilage calcification in Asian patients. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of computed tomographic scans of the chest in 120 patients (60 male and 60 female). The incidence, degree, and pattern of cartilage calcification of the sixth through eighth ribs were noted. The patients were stratified into 6 age groups, and 20 patients (10 male and 10 female) were selected for each group. The degree of calcification was assessed as 0%, 1% to 25%, 26% to 50%, 51% to 75%, and 76% to 100%. Meaningful calcification was defined as 26% or greater. The pattern of calcification was classified as marginal, granular, and central. EXPOSURE Computed tomographic scans of the chest. MAIN OUTCOMES AND MEASURES Degree of calcification, presence of meaningful calcification, and calcification pattern. RESULTS Overall, 50.8% of cartilage was calcified, and female patients showed more frequent calcification than male patients (59.4% vs 42.2% [P < .001]). Calcification rates of the sixth and seventh rib cartilage were higher than those of the eighth rib cartilage in all age groups except teenagers, who had a similar rate for all 3 ribs. Calcification of the sixth and seventh rib cartilage significantly increased with age. A meaningful calcification rate was very low in males younger than 60 years, whereas the rate was relatively higher in females than males for all age groups. Males predominantly had the marginal type of calcification, whereas females predominantly had a granular type. The rate and pattern of calcification had no relationship to age. CONCLUSIONS AND RELEVANCE In Asian patients, males younger than 60 years show a very low incidence of calcification, whereas females 30 years or older show a relatively high incidence of meaningful calcification. Asian females also show a predominantly granular or central pattern of calcification that may hinder proper harvest and incision of the rib cartilage. These differences in the incidence and pattern of rib cartilage calcification need appropriate preoperative attention. LEVEL OF EVIDENCE NA

IMPORTANCE Using objective anthropometric measurement, this study reports the outcome of surgical correction of short-nose deformities in Asian patients. OBJECTIVE To present our experience in lengthening the short nose in Asians and report the surgical results. DESIGN, SETTING, AND PATIENTS In this retrospective review, we study the cases of 36 patients who underwent surgical correction of short-nose deformity. The effect of nasal lengthening was analyzed using anthropometric measurement, including nasion to tip-defining point (N-TDP), nasal tip projection (NTP), nasofrontal angle (NFA), and columellar-facial angle (CFA). EXPOSURES Surgical correction of short-nose deformity. MAIN OUTCOME MEASURES The preoperative and postoperative N-TDP, NTP, NFA, and CFA and patient satisfaction. RESULTS The mean postoperative follow-up duration was 29.8 months. The cause of the short nose was congenital in 18 cases and secondary to previous rhinoplasty in 18 cases. Septal tissue, conchal cartilage, costal cartilage, and conchal composite tissue were used as graft materials. The key procedures for lengthening included septal extension graft reinforced with extended spreader, dorsal onlay, and tip grafts. The N-TDP increased by 11.2%, and CFA decreased from 122.6° to 111.1°. The NFA changed from 148.9° to 148.5°. The NTP ratio, measured using the Goode method, decreased from 0.53 to 0.50. The increase of N-TDP was greater in patients undergoing the costal cartilage grafting procedure than in those who received septal or conchal cartilage. All patients were satisfied with the aesthetic results, and there were no serious complications. CONCLUSIONS AND RELEVANCE In Asians, the key maneuvers for lengthening were septal extension graft reinforced with extended spreader and dorsal onlay graft. Rib cartilage provided superior lengthening effect compared with other cartilage. LEVEL OF EVIDENCE 4.

Background We aimed to present our experience with and algorithm for septal perforation repair using advancement and rotation flaps.Methods A retrospective chart review was performed on 14 patients who underwent septal perforation repair. Etiology, perforation size, presenting symptoms, reconstruction methods, combined operation, surgical results, and complications were evaluated.Results The mean postoperative follow-up duration was 36 ± 18 months. Among 14 cases, 9 had previous septoplasty or septorhinoplasty and 5 cases suffered from nasal trauma. The perforation sizes varied from 5 to 27 mm, with a 14-mm average. Two cases had multiple perforations. The main symptoms included nasal obstruction, crusting, epistaxis, and whistling. Perforations were repaired using advancement flaps in seven cases or combination of advancement and rotation flaps in seven cases, with or without an interposition graft. Bilateral mucosal closure was accomplished in all cases. Conchal cartilage, remnant septal cartilage, or septal bone was used for an interposition graft. Nine patients had a concurrent rhinoplasty with septal perforation repair. At last follow-up, complete perforation closure was achieved in 12 cases (85.7%). Septal perforation recurred in 2 large perforation cases, which were repaired without interposition grafts. Nasal symptoms disappeared or improved in 13 cases (92.9%). There were no serious complications after surgery.Conclusion Combined use of intranasal advancement and rotation flaps is a safe and promising option for surgical repair of moderate to large septal perforation. Bilateral tension-free mucosal closure with an interposition graft is important for the surgical success.

Background Bilateral mucoperichondrial flap elevation is often needed to properly correct the septal deformity although it has been discouraged because of possible complications. This study investigated the effect of unilateral versus bilateral mucoperichondrial flap elevation on the morphological and histological changes of the septal cartilage in a rabbit model.Methods Eighteen mature New Zealand white rabbits were categorized into three groups (six animals for each) according to the procedures they received: unilateral mucoperichondrial flap elevation versus bilateral mucoperichondrial flap elevation versus no flap elevation. In each group, one-half of the animals were killed 3 months after the procedure and the other half were killed 6 months after the procedure. Thickness of cartilage was measured and histological changes of chondrocyte and extracellular matrix were evaluated using hematoxylin and eosin, Masson's trichrome, Alcian blue, and Verhoeff's elastic stains.Results There was no difference in changes of thickness of the cartilage among the three groups. Histological examination revealed that the chondrocyte numbers and dystrophic features as well as the ratio of chondroblast were not different among three groups. Masson's trichrome stain in the bilateral group showed lesser dense collagen fibers than the other groups. Alcian blue stain for proteoglycan documented that the peripheral zone showed lower expression in the bilateral group than the other groups. However, Verhoeff's elastic stain did not differ among the three groups.Conclusion Bilateral mucoperichondrial flap elevation of a rabbit model decreased deposition of collagen fibers and proteoglycan while maintaining the similar chondrocyte cellularity compared with the other groups.

The authors present the senior author's experience and evolution of techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty.

OBJECTIVES To present the aesthetic and functional outcomes of nasal alar reconstruction in Asian patients and to propose a working surgical algorithm. METHODS Seventeen patients underwent nasal alar reconstruction at a university-based facial plastic surgery practice from March 1, 1998, through February 28, 2010. The male-female ratio was 10:7, with a median age of 59 years (range, 34-78 years), and the mean follow-up duration was 64 months. RESULTS The defect was mostly caused by basal cell carcinoma resection (14 of 17 [82%]), followed by the resection of squamous cell carcinoma, trauma, and excision of a previous scar. The mean defect size was 1.71 cm (range, 1-4 cm). The full-thickness defects were noted for 8 patients, whereas 9 had partial-thickness defects. The choice of reconstruction method was primarily based on the size and depth of the surgical defect. Most of the defects 1 to 2 cm in diameter needed nasolabial flaps (10 of 17 [59%]), whereas full-thickness defects larger than 2 cm needed forehead flaps (3 of 17 [18%]) to reconstruct the external defect. Smaller defects less than 1 cm were reconstructed with composite grafts (2 of 17 [12%]), a bilobed flap (1 of 17 [6%]), or primary closure (1 of 17 [6%]). Seven of 8 full-thickness defects had the internal nasal lining reconstructed using a septal mucoperichondrial flap, and 1 case was reconstructed using a cutaneous turn-in flap. Reinforcement cartilage graft was used in 8 patients. No flap failure occurred except in 1 case, in which necrosis of the internal lining flap caused contraction of the external flap with resultant alar rim elevation. An elevation of the alar margin and alar groove blunting occurred in 3 cases. No functional problems emerged. Subjective surgical outcome on a 4-point satisfaction scale revealed that 5 patients (29%) were much satisfied, 10 patients (59%) were satisfied, 1 patient (6%) was fairly satisfied, and 1 patient (6%) was dissatisfied. CONCLUSIONS The choice of reconstruction method of nasal alar defect in Asian patients depends primarily on the size and depth of the defect. Staged local flaps, use of cartilage reinforcement grafts, and internal lining reconstruction using septal mucoperichondrial flaps are key elements for achieving optimal aesthetic and functional results.

OBJECTIVE To evaluate the usefulness of septal batten grafts to correct cartilaginous septal deformities in endonasal septoplasty. DESIGN Retrospective study. SETTING University medical center. PATIENTS Of 430 patients who underwent endonasal septoplasties from January 2006 to January 2011, 30 received septal batten grafts and were enrolled in the study. Twenty-eight patients were male and 2 were female. MAIN OUTCOME MEASURES Thirty consecutive patients received septal batten grafts and were followed up for more than 6 months. Patterns of septal deformity, materials used for batten graft, surgical results, symptom improvement, findings of acoustic rhinometry, and surgical complications were investigated. RESULTS Among the 30 patients, 5 were revision cases. Most of the deformities were characterized as moderate to severe degrees of curved or angulated deviations of the cartilaginous septum. The batten graft was performed with either septal cartilage (n = 21) or bony septum (n = 9). A straight septum was achieved in 90% of all procedures. Subjective symptoms of nasal obstruction were improved in all patients, as evaluated by the Nasal Obstruction Symptom Evaluation scale. Acoustic rhinometry revealed that after surgery the mean minimal cross-sectional area changed from 0.33 cm2 to 0.42 cm2 (P = .02) and the nasal volume from 4.71 mL to 6.28 mL (P = .02). There were no major complications, eg, septal perforation or saddle nose, and no revision surgery was needed. CONCLUSION Endonasal septal batten graft is a safe, useful, and effective technique to straighten moderate to severe septal cartilage deformities that are otherwise not correctable via conventional septoplasty techniques.

Background This study was designed to evaluate the necessity of postoperative nasal packing and to find factors relevant in determining if nasal packing was required after endoscopic sinus surgery (ESS).Methods From January 2007 through June 2007, 64 consecutive patients who underwent ESS were evaluated. The decision whether or not to perform nasal packing depended on the surgeon's judgment of the bleeding after surgery. Demographic characteristics, medical history, disease extent, surgical procedures, and subjective and objective amount of intraoperative bleeding were analyzed. Postoperative symptoms and endoscopic findings were evaluated also.Results Forty-eight (75%) of the 64 patients included in this study did not have nasal packing after ESS. One patient from the no-packing group needed nasal packing postoperatively because of persistent nasal bleeding. Symptom scores of nasal obstruction and postnasal drip on the 1st postoperative day were lower in the no-packing group. In unilateral ESS cases, subjectively estimated blood loss and mucosal inflammation scores were lower in the no-packing group. It was observed that preoperative steroid use was more frequent in the packing group. All other parameters did not show significant differences between the two groups.Conclusion Nasal packing can be safely used less frequently to help the patients experience less discomfort after ESS. The need for nasal packing after ESS can be decided by judicious estimation of bleeding during and after the surgery.

Background The aim of this study was to evaluate the incidence of and possible risk factors for residual diplopia after surgical repair of pure blowout fracture (BOF) of the orbit.Methods Sixty-three patients with pure orbital BOFs who had preoperative symptomatic diplopia were investigated. In each patient, the relationship of residual diplopia and the following factors were analyzed: (1) timing of surgery, (2) presence of enophthalmos, (3) site of fracture, (4) type of fracture, (5) extraocular muscle swelling, and (6) surgical method.Results Fifty-five (87.3%) of 63 patients experienced improvement in diplopia and 8 (12.7%) patients had residual symptomatic diplopia after surgery. Of the six factors, only swelling of extraocular muscle on computed tomography (CT) scan was significant for the development of residual diplopia after surgery (p < 0.01).Conclusion In pure BOF of the orbit, patients who have swelling of the extraocular muscles on CT scan are more likely to have residual postoperative diplopia.

OBJECTIVE To investigate the validity of the sixth edition of the American Joint Committee on Cancer (AJCC) staging system for sinonasal squamous cell carcinoma. DESIGN A 15-year retrospective case series review. SETTING Multicenter study from tertiary care facilities. PATIENTS Data from 113 patients diagnosed as having and treated for sinonasal squamous cell carcinoma from September 1988 through August 2003 were retrieved. Ninety patients followed up for at least 12 months were included in the study. MAIN OUTCOME MEASURES The TNM staging system and survival rates were analyzed using the Kaplan-Meier method to determine the mean, disease-free, and 5-year survival statistics. The effect of tumor stage on overall survival was assessed with stages defined by the fifth and sixth editions of the AJCC staging systems. RESULTS The overall 5-year survival rate was 59.5%. According to the sixth edition, the survival rates of patients with stages III, IVA, and IVB tumors showed a significant difference (P = .002). In 32 cases, the stages were changed in accordance with the criteria in the sixth edition. The group in which the stage changed from III (fifth edition) to IVA (sixth edition) showed a worse survival rate than the group in which the stage did not change, although the difference was statistically insignificant. The 5-year disease-free survival rates of the group in which the stage did not change and of the group in which the stage changed from III (fifth edition) to IVA (sixth edition) were 64% and 34%, respectively (P = .08). Local recurrence was more frequently observed in the group in which the stage changed from III (fifth edition) to IVA (sixth edition). CONCLUSION The new AJCC staging system seems to be more accurate in predicting the survival rates for patients with advanced but surgically resectable sinonasal squamous cell carcinoma (stage IVA).Arch Otolaryngol Head Neck Surg. 2007;133:131-134 --

Background The authors present surgical results of 64 Asian patients with deviated nose and introduce important key maneuvers used in the surgery.Methods Sixty-four consecutive patients who underwent corrective rhinoplasty because of a deviated nose were analyzed retrospectively. Approaches and techniques used for the surgery, surgical results, and complications were evaluated. A questionnaire was used to evaluate each patient's functional and esthetic satisfaction. Preoperative and postoperative standardized photographs of the face were evaluated to judge objectively the esthetic outcomes of the surgery.Results An endonasal approach was used in 44 patients and an open approach was used in 20 patients. Five important key maneuvers to correct the deviation were noted, in the order of frequency: septoplasty, osteotomy, spreader graft, turbinoplasty, and camouflage graft. Additional procedures included augmentation of the dorsum, tip surgery, and hump removal. On a 5-point box scale of 0–4, the patients scored their satisfaction on functional improvements as 3.2 ± 0.79 and their esthetic satisfaction as 3.0 ± 0.8. The objective evaluation of the appearance showed complete correction in 84.4%, a minimally visible deviation in 10.9%, and a residual deviation but less than before surgery in 4.7%. Aside from residual deviations, complications included a slight depression of the middorsum after spreader graft and a malpositioning of the dorsal cartilage graft.Conclusion Deviated nose in Asians can be managed successfully by combining key maneuvers that correct specific anatomic abnormalities. Many of these key maneuvers require modifications that take into account the race-specific characteristics of the Asian nose.

Background A retrospective multicenter study examined the safety of Gore-Tex as a nasal implant in rhinoplasty.Methods This study involved 853 patients (656 primary surgeries and 197 secondary surgeries) who had undergone rhinoplasty and used Gore-Tex either at the dorsum or at the nasal tip. Data were extracted from the medical records by surgeons and entered on a standard form. Data included the information about the demographics and history of the patient, method and results of surgery, complications, follow-up, and various factors believed to predispose to complications.Results The average follow-up period was 18 months. Overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases; 2.1%) followed by two cases of seroma and one case of persistent nasal swelling. Among the 21 suffering complications, 19 patients (91%) needed graft removal. Nine cases of infection developed in primary surgeries (1.4%) and nine cases developed in secondary surgeries (4.6%), which represented a statistically higher complication rate in those undergoing secondary surgery (p = 0.0062). Infections developed within 1 month in five cases and nine cases developed infection >6 months postoperatively. Other complications including esthetic problems were identified in 16 cases (1.9%).Conclusion Gore-Tex should be used judiciously in rhinoplasty because of a 2.1% infection rate, a risk that is higher still after secondary surgery; moreover, once infected, Gore-Tex implants usually require removal.

Although the action of cetirizine dihydrochloride (cetirizine), a potent histamine H1 receptor antagonist, has been well known, its effect on the cytokine profiles in the nasal immune inductive site has not been elucidated yet. We studied the effect of cetirizine on the cytokine profiles in the nasal-associated lymphoid tissue (NALT), which is a principal mucosal lymphoid tissue of the respiratory tract in rodents. Two different doses of cetirizine were given intraorally for 5 days before the nasal challenge of ovalbumin in sensitized mice. The sensitized group was given normal saline instead of cetirizine, and the nonsensitized group had no sensitization or medication. The cytokine gene expressions in the NALT taken from the mice were investigated with real-time quantitative reverse-transcription polymerase chain reaction. The effect of cetirizine on the allergic symptom score, histamine threshold, and the eosinophil count in the nasal septal mucosa were examined also. Compared with the normal mice, the sensitized mice showed significantly increased levels of interleukin (IL)-4 and IL-5 gene expression although the increase of interferon (INF)-γ gene expression was not significant. In the cetirizine groups, the levels of expression of IL-4, IL-5, and INF-γ in the NALT were significantly decreased compared with the sensitized group. The cetirizine groups also showed decreased allergic symptom score, histamine threshold, and eosinophil count in the nasal septal mucosa compared with the sensitized group. In conclusion, cetirizine reduced the levels of expression of IL-4, IL-5, and INF-γ in the NALT of ovalbumin-sensitized mice. Cetirizine also reduced the acute allergic symptom, histamine sensitivity, and eosinophil count in the nasal septal mucosa.

Purpose:This article describes the endonasal endoscopic reduction (EER) of blowout fractures (BOFs) of the medial orbital walls and reports the clinical results. Patients and Methods:Sixteen patients who underwent EER for a BOF of the medial orbital wall were analyzed. The surgical indications for treatment were diplopia, limitation of eye movements, and significant enophthalmos. They were followed-up for at least 3 months after the surgery. Surgical techniques, surgical results, and postoperative complications were reviewed. Results:There were no significant intraoperative or postoperative complications. Fourteen patients showed complete resolution of symptoms after the surgery. One patient, who had persistent diplopia and remaining enophthalmos, underwent medial wall reconstruction with a Medpor surgical implant (Porex Surgical Inc, College Park, GA) by a transorbital approach. Another patient, who had residual enophthalmos, had correction of enophthalmos after insertion of a Medpor implant. Both patients are now symptom-free. Conclusion:The results indicate that EER is a safe and effective technique for the treatment of BOFs of the medial orbital wall. © 2000 American Association of Oral and Maxillofacial Surgeons.