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THE PROBLEMS that arise in the narrowing of the wide nose can be illustrated by a presentation of Joseph's1classic operation as found in his book: NARROWING OF THE BONY NASAL FRAMEWORK (RHINOSYSPASIS) This procedure is often necessary in conjunction with hump removal, because following the excision of a considerable hump the nose will be too wide if its lateral dimensions are left unchanged. The operation consists in the cutting of the upper maxilla along the dotted line, shown in Figure 1, and the shifting of the bony lateral wall toward the midline. This I accomplish intranasally (without external scarring) in the following manner: I introduce into one of the nostrils a straight double-edged knife and advance it into the lateral recess of the vestibule, directly beneath the nasolabial fold, to a depth which will permit the point to lie on the outer aspect of the upper maxilla. This

REPORT OF CASE B. J. P., a girl aged 11 years, was first seen by me on July 10, 1935. There was a swelling in the left cheek, extending into the lower eyelid and obliterating the upper part of the nasolabial fold. The girl's color was strikingly white. The history given was that following scarlet fever in March 1935 there was a discharge from the left side of the nose, associated with a swelling in the left cheek. After about a month of unsuccessful local and general treatment, a naso-antral window operation was performed. The discharge and swelling continued, and a peculiar musty odor of the breath developed, with fever. Physical examination revealed nothing of consequence except a daily temperature of 101 F. The Wassermann reaction of the blood was negative. A biopsy made at the time of the operation was reported as showing granulation tissue only. When I first

Case report-1: Sabarna, a female baby of fifteen months old was admitted in Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with the complaints of deviation of the angle of mouth to right side and inability to close the left eye for five days. Systemic examination revealed an incision scar mark on the left mastoid region. Facial asymmetry as evidenced by smooth forehead, absence of nasolabial fold, drooping of the angle of mouth and nonclosure of eyelid on left side. She was mildly pale, mild hepatomegaly, no lymphadenopathy, bone pain or bleeding manifestation. Physical, hematological and histopathological investigations the features were suggestive of facial nerve palsy due to granulocytic sarcoma (GS) with acute myeloid leukemia (AML). Following second day of chemotherapy her vital signs suddenly deteriorated and succumbed probably due to the leukostasis or intracranial hemorrhage. Case report-2: Chayon, another nine month old female baby was admitted in the same unit with the history of fever, proptosis of both eye balls, deviation of the angle of mouth to the right side and unable to close the left eye for one month. Physical examination revealed facial asymmetry with the features of left sided facial nerve palsy along with proptosis of eyeballs. She was moderately pale, moderate hepatosplenomegaly, no bleeding manifestation or bone pain. Physical, hematological and cerebrospinal fluid (CSF) examination the features were suggestive of facial nerve palsy due to leukemic cell infiltration with AML. Following induction and consolidation the baby is on continuation phase with regular follow up for last 9 month having significant improvement of her facial nerve palsy along with hematological remission. DOI: 10.3329/jbcps.v28i1.4646 J Bangladesh Coll Phys Surg 2010; 28: 53-58

Neurofibromatosis type 1 is a rare disease which can manifest itself by the development of plexiform neurofibromatosis, with craniofacial deformities. In this paper, we propose special consideration in excision nasolabial fold mass to help lifting procedures in neurofibromatosis patients. We are reporting two case, both presented with von Recklinghausen’s disease, a 21 years old male patient with neurofibromatosis in his right hemifacial for which he had been operated on five times previously at other center, and a 24 years old male with neurofibromatosis in his left hemifacial. After several stages of reconstruction which started with nasolabial fold mass excision, the result was satisfactory, by using the multiple stage repair, it was done until the end result is similar to anatomical form. The mass debulking procedures for these patients, which started with Nasolabial Fold mass excisison are continued with durable lifting procedures. This method gives results a satisfactory lifting procedure.

The statement made by von Mikulicz in 1884 is still valid today: “Probably no other defect on the face is as small or as hard to reconstruct as that of the cutaneous septum of the nose.” Total defect of the columella can occur as a result of syphilis, trauma, and tumor resection. Reconstruction is done by using parts of the upper lip, the neighboring cheeks or the forehead, or by means of small tubed pedicle flaps from the upper arm or by means of free grafts from the ear.

In paralysis of the facial nerve, the temporal muscle and its fascia can be used for supporting the drooped tissues of the face. For this the muscle is connected to the face by loops of fascia lata, and it can then straighten the deviated mouth and columella nasi and support them in the normal position. The nasolabial fold is often reformed, and a small amount of movement may be produced by the muscle which is controlled by the fifth cranial nerve. Patients are grateful also for the improved control of the mouth, which permits them to smoke, whistle and eat and drink in public. The procedure does not disturb the patient much, does not impair the functions of other nerves or leave visible facial scars. Five or six days' hospitalization is recommended, with an additional week of outpatient care. Worth while improvement is usually noted at once. INDICATIONS FOR OPERATIVE

A total of 43 cases of metastatic basal cell epithelioma are recorded in the literature. An additional case of basal cell epithelioma of the nasolabial fold with metastases to bone and a fatal outcome is presented.

INITIALLY machanical assistance, and presently full control of respiration, has been accepted as fundamental in the therapy of respiratory failure. The primary requirement is a patent airway of adequate size. An oral or nasal pharyngeal airway and mouth to mouth resuscitation may be adequate for short-term assistance, but this is esthetically displeasing and on occasion may result in transmission of infection. The recent case report of cutaneous tuberculosis of the nasolabial fold, secondary to mouth to mouth resuscitation in the Bellevue Hospital emergency room, attests to this.1The use of any of the resuscitator bags or a mechanical respirator is certainly preferable if available. These bags are nominal in cost and should be available on all wards, intensive care units, and emergency rooms. Prior to using a pharyngeal airway, the oral pharynx should be cleared of any foreign material, ie, vomitus, the head extended, and the jaw-tongue assembly pulled