The Caudal Septum Pivot Technique for Short Nose Correction

The short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22–53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.

Choosing Appropriate Technique for Nasal Reconstruction in Challenging Cases of Panfacial Burn: Treatment Algorithm

The Nose is one of the most challenging facial parts to reconstruct. Its asymmetries, defects, or disharmonies are easily noticeable. The complex contours, highlights, shadows, and special shape of its subunits makes nasal reconstruction more difficult in panfacial burn than that of nonburned ones. This retrospective study conducted at Zare Hospital. Twenty-five panfacial burn cases with nasal defect were studied from 2010 to 2019. Profile photos were manipulated by Photoshop. Based on the difference between the burn-related shortened nasal length and the expected photoshopped one, severity of the short nose was detected, and strategy of the surgery determined. Ten out of 25 cases with normal nasal length and projection, or mild short nose with minimal alar rim, tip and/or columellar defect underwent nasal reconstruction with skin and/or composite graft. Nine patients with normal nasal length or mild to moderate short nose but moderate to severe alar defect underwent reconstruction with turndown flap plus skin and/or composite graft. Pre-expanded forehead flap (n=1) and delayed scarred or skin grafted forehead flap (n=5) were used for six patients with severe short nose defect. There are several procedural alternatives for reconstruction of burn-related mild to moderate nasal deformity. For severe and deep pan facial burn, delayed forehead flap seems safe with acceptable color and texture harmony. Our designed algorithm could potentially improve selection of proper nasal reconstruction techniques and assist novice surgeons.

The T- Graft to Control Nasal Length and Nasal Tip Position

The T-graft is a new tool in the armament of structural rhinoplasty. The graft makes it easy to create a well- balanced nasal framework both for beginners and more experienced rhinoplastic surgeons. Due to its multifunctional character the T-graft allows the surgeon to control nasal length as well as nasal tip projection and -rotation. The T-graft is indicated in many anatomical features like in patients with a short nose or heavy soft tissue envelope, but also in patients with under projection of the nasal tip, under- or over-rotation of the nasal tip and deviations of the caudal nasal septum.

MAKNA DENOTATIF DAN KONOTATIF HANA (HIDUNG) PADA CERPEN “HANA” KARYA AKUTAGAWA RYUNOSUKE

AbstrakPenelitian ini tentang makna denotatif dan konotatif hana (hidung) dalam cerpen “Hana” karya Akutagawa Ryunosukae. Tujuan penelitian ini untuk mengetahui makna hidung yang ditulis oleh Akutagawa baik dalam makna denotatif maupun konotatif. Metode penelitian ini adalah metode kualitatif. Teknik pengumpulan data menggunakan teknik baca dan catat. Hasil penelitian menunjukkan bahwa makna hidung dalam cerpen “Hana” yang dikembangkan oleh Akutagawa sebagai berikut: 1) Makna denotatif 身体 berarti fisik, terbagi dalam dua kelompok makna, yaitu 長い鼻 (hidung panjang), dan 短い鼻 (hidung pendek), 2) Makna konotatif 内心 (internal) terbagi dalam empat kelompok makna, yaitu苦しみ (penderitaan), がっかり(kekecewaan),幸せ (kebahagiaan), 動力 (usaha tokoh), 3) Makna konotatif 外心 (eksternal) yang terdiri atas tiga kelompok makna, yaitu 話 (pembicaraan), 妻 (istri), dan 嘲笑 (bahan ejekan). Berdasarkan hasil penelitian tersebut dapat disimpulkan bahwa kata hana (hidung) selain mengandung makna denotatif, kata hidung juga dikembangkan oleh Akutagawa dalam makna konotatif.Kata kunci: makna denotatif, makna konotatif, hana (hidung), cerpenABSTRACTThis research is about denotative and connotative meanings of hana (nose) in Akutagawa Ryunosuke’s short story entitled “Hana”. The purpose of this study is to find out the meanings of the word hana (nose )both denotatively and connotatively. The research method used in this study was qualitative one. The technigues used in collecting data were reading and taking notes. The results showed that the meanings of nose in Hana's short story developed by Akutagawa are as follows: 1)denotatively, 身体 means physical performace of nose which is divided into two categories, namely 長い鼻 (long nose), and 短い鼻 (short nose), 2)connonatively 内心 (internal) is segmented into three categories, such as 苦しみ (suffering)、がっかり(disappointment)、幸せ happiness), 3) 動力 (the character’s effort), 4) 外心 (external) which is classified into three group of meanings, those are 話 (talking material), 妻 (wife), and 嘲笑 (ridicule). Based on the result,, it can be concluded that the word hana (nose) in this short story not only has denotative meanings but also connotative ones.keywords: connotative meanings, denotative meanings, hana (nose), short story

Cornelia De Lange Syndrome in Iraq

Background: Cornelia de Lange syndrome is a rare syndrome of highly variable phenotype making a spectrum ranging from classic syndrome with many cardinal features to mild condition few cardinal features. Typically patients with classic syndrome had growth and mental retardation and distinctive facial dysmorphism including thick (bushy) and / or long eyebrows commonly with synophrys, short nose with depressed or concave nasal bridge and/or upturned nasal tip , long or smooth or indistinct philtrum, thin upper lip vermilion and/or downturned corners of mouth, and low set ears. The diagnosis of the syndrome is clinical. Ocular abnormalities that can be associated with Cornelia de Lang syndrome squint, nystagmus, refractive errors, and ptosis. Materials and methods: The occurrence of Cornelia de Lange syndrome has not been reported or well-documented. The first four Iraqi patients (Three boys and one girl) with Cornelia de Lange syndrome are described. The relevant literatures were reviewed with aim of determining the early documentation of the syndrome in the medical literatures. Results: All the patients were sporadic cases and had growth retardation, severe mental retardation with significant developmental delay, thick eye brows with some degree of synophrys, short nose with depressed or concave nasal bridge, and low set ears. All the patients had normal karyotype. One male patient had all of the classical features including long smooth and indistinct philtrum, thin upper lip vermilion, and downturned corners of mouth. The second male patient had a concave nasal bridge that becomes more obvious during crying, nystagmus and bilateral convergent squint. The third boy had milder dysmorphic features. The fourth patient was a girl who was the second of a twin. She had severe growth retardation and was hypotonic with poor head control. She also had bilateral convergent squint, refractive error, and reduction in visual acuity. Conclusion: The first four Iraqi patients with Cornelia de Lang syndrome are reported.

The Possibilities of Multislice computed Tomography in nasal Anthropometry

Background. Nasal anthropometry is an important aspect of maxillofacial and plastic surgery especially in the preoperative stage of rhinoplasty. Multislice computed tomography (MSCT) permits to assess quantitative the variant nasal anatomy using measuring.Aims: to determine the possibilities of MSCT-anthropometry in nasal configuration grade.Materials and methods. We performed a proand retrospective analysis of MSCT data of maxillofacial region of 50 patients (aged 35 ± 10.7 years old) with changes of nasal height and width and 35 women (32.9 ± 8.4 years old) with normal nasal configuration. The variant anatomy consists in long nose (n = 16), short nose (n = 17), wide nose (n = 17). The nasal height was measured from the nasal root (nasion) to the nasal base (subnasion), the nasal width is the distance between the most lateral aspects of the alae nasi. Besides, the nasal index was calculated. The descriptive statistics of obtained data were presented by mean and standard deviation (SD), also the multiple regression analysis was used. Values of p = 0.005 were considered statistically significant.Results. The results showed that the average nasal height in patients with normal configuration is 51.9 ± 2.63 mm, with short nose – 45.2 ± 1.36 mm, with long nose – 60.3 ± 1.28 mm. The mean nasal widths are 34.9 ± 1.88 mm in normal configuration, 38.8±3.57 in wide nose. The nasal indexes were calculated, their features were detected. These obtained results correlate with anthropometric data of different studies.Conclusions. MSCT-anthropometry is an objective imaging method of variant nasal anatomy that could provide improving quality of diagnostics of patients seeking rhinoplasty and choose a surgical approach.