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Introduction: Facial symmetry is prized for its association with health, genetic quality, and attractiveness, but minor asymmetries are common. Human asymmetry tends to favor the left side and is noticeable in various nose parts. However, the discrepancy in cartilage thickness between the nose's right and left sides remains understudied., Method: This cross-sectional study involved 60 patients undergoing primary open rhinoplasty. During routine rhinoplasty Procedure, upper and lower lateral cartilage strips were excised from each patient, yielding four tissue samples. Tissue thickness and width were measured using a microscope stage calibration slide. This approach systematically assessed left and right cartilage thickness differences in primary open rhinoplasty patients, offering insights into nasal asymmetry and potential surgical implications., Results: Out of 60 patients, 43 were female (72%) and 17 were male (28%). The mean thickness of upper lateral (UL) cartilage was 0.53 mm on the right and 0.54 mm on the left side (P value= 0.52). For lower lateral (LL) cartilage, the mean thickness was 0.50 mm on the right and 0.54 mm on the left side (P value < 0.001), indicating significant left-sided dominance. This dominance was consistent across both sexes., Conclusion: Our study highlights the significance of addressing subtle nasal cartilage asymmetries to improve postoperative symmetry. Modifying nasal cartilage microstructures during rhinoplasty can enhance both aesthetic and functional outcomes., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Facial and cranial asymmetry is common in bilateral vertebrates, particularly human beings. Through years of injecting fillers and performing face-lift operation on patients, we began to observe that more fillers were required on the right side to reach symmetry and also more loose skin and soft tissue was observed on the right side in the majority of patients (Fig. 5). Here, we conducted an analytical study to comprehensively measure human skulls in order to observe and quantify this difference., Methods: We collected forty-one natural skulls available from five medical schools of Tehran province in Iran. Standard photography was conducted from the front, lateral, and superior views. Measurements and statistics were completed using Image J software (National Institutes of Health) for exact comparison of fixed-point distances on the samples., Results: Comparison of right and left dimensions on the skulls revealed several fixed asymmetries. The most significant differences were measurements around the orbit. The distance between the upper orbit point and zygion (zy), zygion to sub-nasal, and orbital areas were significantly larger on the left side. Measuring the anterior gonion-pogonion distance showed a wider mandibular body on the left side. We did not find any considerable differences between any other left-sided and right-sided skull dimensions., Conclusions: Asymmetry of the face and body is a general rule in human anatomy, but correlation and consistency of this asymmetry between the left and right sides is a novel finding based on our measurements. Our findings showed that the orbit was significantly bigger in width, height, and surface area on the left side. We also quantified a narrower mandible on the right side. We hope these findings can be translated to aesthetic surgery practice to make the plastic surgeon and patient more familiar with the patient's specific anatomy in order to better predict, plan, and successfully implement aesthetic procedures such as injecting fillers or doing peri-orbital procedures., No Level Assigned: 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.

Background: Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, "bulbous pinch" LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen., Objectives: The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face., Methods: We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups., Results: There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally., Conclusion: Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60-70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration., Level of Evidence Iv: 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 .

Objective: The objective of this study was to analyse the failure mode of adhesive interfaces by comparing OCT and scanning electron microscope (SEM) analysis of class V restoration margins located on enamel and dentin., Materials and Methods: Three groups were tested that differed in the application of a 3-step etch-and-rinse adhesive system (OptiBond FL) prior to cavity filling with restorative composite resin (Clearfil AP-X). After tooth restoration and polishing, the samples were loaded in a fatigue machine, and adhesive interfaces were evaluated with OCT and SEM., Results: Important and complementary information could be obtained with OCT analysis in respect to how marginal defects can propagate inside the cavity, compromising the restoration's long-term performance. A self-etching effect was observed with OptiBond FL due to the presence of an acidic primer (GPDM) within its composition. Our results could show that areas of bonding and gaps coexisted within the same restoration., Conclusions: When marginal imperfections, or non-continuous margins, were detected by SEM, also imperfections beneath the surface could be observed at the tooth-restoration interface with OCT. Restoration loss occurred above the borderline of 50% of marginal gaps on enamel and dentin., Clinical Relevance: Marginal discrepancies of adhesive restorations can propagate inside the cavity and lead to restoration loss.

Introduction: Asymmetric facial skeletal growth is a common finding in the rhinoplasty patient population. This common abnormality affects all facial components, including the upper lateral cartilages (ULCs). The asymmetric growth also may produce uneven thickness, consistency, curvature, and elastic recoil of the ULC. Ignoring this asymmetry may have a marked impact on the outcome of any rhinoplasty operation, especially in the management of crooked noses., Materials and Methods: The files of 89 consecutive rhinoplasty patients who underwent surgery by a single surgeon were reviewed for deformities of the middle vault and to tabulate the procedures performed in each individual case., Results: Of the 89 rhinoplasty cases, 72 (81 %) had asymmetric ULCs. Approximately 30 % (27/89) of the cases had a straight septum with asymmetric ULCs which required appropriate correction., Conclusions: Awareness of an asymmetric ULC in a crooked nose and an attempt to correct this condition in addition to straightening of the septum is key to decreasing postoperative residual or recurrent mid-vault deviation., Level of Evidence Iv: 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 .

Background: In certain cases of endoscopic forehead lift without muscle resection, patients were incidentally noted to develop weakness or loss of their ability to frown during the postoperative period despite intact musculature. This finding suggested the possibility of decreasing frown strength using the disinsertion of the relevant muscles. This finding persuaded the authors to try to eliminate or decrease the sensory problems resulting from open or endoscopic frowning muscle resection by disinserting these muscles. We therefore sought to determine the efficacy of a brow/forehead lift that involved disinsertion rather than muscle resection., Methods: From September 2004 through December 2006, 22 endoscopic forehead lifts (20 females and 2 males) were performed using the conventional corrugator muscle resection technique (group 1). From January 2007 through October 2009, 43 patients (38 females and 5 males) underwent endoscopic forehead lift with a muscle-preserving technique (group 2). In both groups, small scalp incisions were made, and an endoscope was used to elevate the brows and forehead to perform glabellar and forehead muscle resection in group 1 and disinsertion of the frowning muscles in group 2. The skin of the forehead was then reanchored to a more superior location using sutures attached to deep temporal fascia as well as outer table screws and skin staples., Results: Aesthetically pleasing eyebrow and forehead with reduced power in the frowning muscles were achieved in the majority of patients in both groups. A significant decrease in the depth of vertical and horizontal glabellar creases was obtained in these patients. In group 1, 19 of 22 patients completely lost the ability to frown and 3 patients (13.6%) suffered permanent sensory loss. In group 2, 33 of 43 patients lost their ability to frown but only 2 cases (4.5%) developed minimal unilateral forehead partial sensory deficit after a 12-month follow-up period., Conclusion: Disinsertion of the corrugator supercilli, procerus, or orbicularis oculi muscles can decrease contractility with less chance of damaging nearby or intermingled sensory nerves than offered by resection.

Background: We reviewed the radiologic features of 15 patients with orbital metastases originating from breast cancer., Methods: This was a retrospective consecutive case series. Fifteen consecutive patients with orbital metastases originating from breast carcinoma were identified between March 1997 and September 2008. A retrospective chart review was carried out, and the radiologic findings were reviewed., Results: The metastases were preseptal in 53%, intraconal in 60%, and both intraconal and extraconal in 33%. Lacrimal gland enlargement was noted in 33%, episcleral space involvement in 33%, bone involvement in 13%, and globe dystopia in 53%. The extraocular muscles were involved in 87%; in 60%, two or more muscles were involved. The medial and lateral rectus muscles were affected in 53% and 47%, respectively, and the inferior and superior rectus muscles in 33%. In 47% one or more radiologic features had not been noted by the radiologist, and in 20% the findings were misinterpreted as an"orbital pseudotumor.", Conclusion: Orbital metastases originating from breast cancer may present heterogeneously. Orbital imaging most commonly shows unilateral and multifocal involvement of multiple extraocular muscles and intraconal and preseptal areas by an irregular lesion.

Background: In most references to the nasal anatomy, the shape of the lower lateral cartilage (LLC) is described as a two-dimensional structure. However, the authors have found different forms of LLC in at least 40% of their open rhinoplasty cases during the past 20 years. This cartilage was found to have a three-dimensional hemispheric appearance and to be connected to the upper lateral cartilage (ULC) at the scroll area by an inward limb of this hemisphere. This inward limb may have an important role in producing asymmetry and flare of the nostril., Methods: The LLC of 286 patients was evaluated during open rhinoplasty over a 2-year period, with a focus mainly on the shape of this structure, especially at the LLC-ULC junction (scroll area)., Results: A dome-shaped appearance of the LLC was noted in 40.9% of cases, and 11.5% of cases had bilateral LLC variation. This different anatomic form was seen mostly in patients with a strong bulbous nasal tip, although it was observed less frequently also in patients with narrow nasal tips., Conclusion: At least one-third of the LLCs analyzed had a medial wall in addition to the lateral wall, which significantly increased the flare and recoil force of this structure. This makes this cartilage more redundant to reshaping procedures (straightening). Thus, special attention must sometimes be paid to this common anatomic variation to produce symmetric nostrils and to obtain a more aesthetically acceptable alar tip.

We report a case of bilateral lacrimal gland involvement as the first sign of Waldenstrom's macroglobulinaemia in a patient with sarcoidosis. Histological analysis of an incisional biopsy revealed a lymphoplasmocytic lymphoma consistent with Waldenstrom's macroglobulinaemia. No noncaseating granulomas were encountered. Systemic treatment was initiated and resulted in complete resolution of the lesions. In a patient with a systemic disease, such as sarcoidosis, and lacrimal gland involvement, a biopsy of the lacrimal gland mass should be taken to make a correct diagnosis and start appropriate treatment.

Background: Nomograms are efficient tools to improve the predictability of refractive procedures by using statistical methods to analyze pre- and postoperative refractive data. The purpose of this work was to analyze the clinical relevance and limitations of nomograms in a case series., Methods: Computer simulations based on the known unpredictability for refractive outcomes were performed for three different distribution functions of the preoperative refractions. In addition, the clinical applicability was investigated in three different cohorts that underwent laser in situ keratomileusis (LASIK)., Results: The use of individual nomograms significantly improves the predictability of the refractive outcome. However, theoretical investigation demonstrates that a homogeneous data distribution within cohorts is a key factor for predictable nomogram calculations. Outliers within the cohorts are not integrated into the nomogram calculation due to the mathematical model used., Conclusions: Nomograms are helpful for improving refractive outcomes. However, they are currently limited to approximately 90% within +/-0.5 D.

Although of benign nature and slowly progressive, paranasal sinus mucoceles may, depending on their localization, cause a multitude of ophthalmological symptoms due to compression and displacement of adjacent tissue. Here we report the unusual case of a patient suffering from a progressively growing giant mucocele that developed years after ENT surgery and that was neglected for almost 2 decades despite massive symptoms. This case report demonstrates the importance of including mucoceles of the paranasal sinuses into the differential diagnosis of unilateral or bilateral proptosis.

Are observations on ultraviolet (UV)- and visible light-induced ocular changes in animals relevant for human pathology? Different conclusions are drawn by different groups, depending on their perspective: while in the epidemiologist's view the evidence for those lesions is mostly limited or insufficient, laboratory scientists continually extend observations on radiation damage in animals. Consequently, there are diverging views on the necessity and specifications for eye protection. In this review, problems of epidemiological surveys and observations in humans and animal studies are discussed, and natural and artificial protection of the eye is outlined. The human and animal eye has an inherent potential for photochemical lesions due to chromophores including the visual pigments that are present at birth. Lifelong light exposure gives rise to additional absorbing molecules. With decreasing wavelengths of the electromagnetic spectrum the number of absorbing molecules rises; therefore, the likelihood of a photochemical reaction grows. As the spectral energy is augmented, more damage will occur. In our view, the knowledge gained from laboratory studies is a significant component of the total evidence from different fields-epidemiology, clinical observations, model studies and theoretical calculations-that UV radiation and short-wavelength visible light can cause acute and chronic changes in ocular structures. Such changes may comprise irreversible damage. Following recently issued recommendations of the major visual health organizations in the United States, protection against UV and blue light should be incorporated into the spectrum of safety considerations for sunglasses.