Technique for Reconstruction of Nasal Alar Defects in Asian Patients with a Modified Bilobed Nasolabial Flap

Introduction: The Oriental nose differs from the Caucasian nose in terms of size, subunit definition, texture, and thickness of the skin [1]. Zitelli’s bilobed flap enables aesthetic reconstruction in Caucasian noses but in smaller Oriental noses the outcomes are less desirable with nasal alar retraction commonly seen [2]. Hence, we describe a modification of Zitelli’s bilobed flap incorporating nasolabial skin for a single stage nasal reconstruction with reduced nasal alar retraction [3]. Methods: We modified the bilobed flap based on Zitelli’s bilobed flap and the aesthetic subunit principle, as modified for Orientals by Yotsuyanagi in 2000 [4]. The primary lobe was located between the defect and the cheek and the second lobe was located on the cheek, above the nasolabial fold. The modification of the bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect edge from the flap’s pivot point, and the width of the primary lobe was equal to the width of the defect. The length of the secondary lobe was 130% of the length of the distal defect edge to the flap’s pivot point, and the width of the secondary lobe was two-thirds the width of the primary lobe. Results: Satisfactory alar reconstruction was achieved from the viewpoint of the patient and surgeon. There was good nasal contour and appropriate symmetry of the nasal tip with reduced nasal alar retraction. Conclusion: The modification of Zitelli’s bilobed flap to have a longer primary lobe and include nasolabial skin, results in reduced nasal alar retraction.

A New Species of Ligophorus (Monogenea: Dactylogyridae) from the gills of the Flathead Mullet Mugil cephalus (Teleostei: Mugilidae) from Mexico

A new monogenean species, Ligophorus yucatanensis n. sp. from the gills of the flathead mullet Mugil cephalus from the Yucatan Peninsula, Mexico, is described. The new species can be differentiated from all other species of Ligophorus by the morphology of the accessory piece of the copulatory organ. Its main lobe is cylindrical, tunnelled expanded distally, slightly bowed with a characteristic membranous opening at level of medial bifurcation of the accessory piece, forming a thick-walled bulbshaped expansion that ends in a round labium. The secondary lobe is spatulate, straight, and shorter than the main lobe. In addition, the new species can be distinguished from other species by the morphology of the haptoral ventral bar, and the distal end of the vaginal duct. Furthermore the ventral anchors are shorter than those of all other species of Ligophorus reported in the Gulf of Mexico and Caribbean Sea. In addition, the zoogeographical records of Ligophorus spp. on the M. cephalus species complex are briefly reviewed and updated.

STUDIES ON THE PATHOGENESIS OF EXPERIMENTAL PNEUMOCOCCUS PNEUMONIA IN THE DOG

A study has been made of the mode of origin of the secondary lesions occurring spontaneously during the course of experimental pneumococcus pneumonia in the dog. It was observed that the primary lesions of dogs exhibiting interlobar spread contained much more edema fluid than did those in which the inflammatory process remained confined to a single lobe. Furthermore, the sequence of spread from lobe to lobe in relation to the anatomical arrangement of the bronchi and the prone position of the animal was such as to suggest that secondary lobe involvement arose as a result of edematous pneumonic exudate flowing into the more dependent bronchial openings. Experiments were undertaken to determine whether pneumococci are constantly being distributed throughout the lung in the experimental disease in varying degree yet produce secondary foci of consolidation only if the microorganisms reach the terminal airways and are retained there through some interference with the normal eliminatory mechanism. Attempts to produce secondary lesions in dogs with non-spreading single lobe involvement, by means of plugging a terminal bronchus of a normal lobe with starch paste or mucin were largely unsuccessful. In only three out of 19 instances did a lesion develop at the site of obstruction. An investigation was then made of the distribution of pneumococci in the lungs of dogs at the height of the pneumonia. In dogs with single lobe lesions pneumococci were recovered from the lesion itself but not from any other part of the peripheral lung tissue, whereas in animals showing spread to other lobes pneumococci were found to be distributed widely throughout the lung in both the apparently normal and the involved lobes. Some of the microscopic sections of the uninvolved parts of the lungs of dogs with metastatic lesions revealed small masses of pneumococcus-containing exudate in the smaller bronchi and terminal airways of otherwise normal tissue. This finding, in conjunction with the detection of beginning inflammatory changes in other areas normal in the gross, would seem to provide direct evidence of the manner in which pneumococci are transferred from the initial lesion to other lobes and highly presumptive evidence for the mode of origin of the secondary lesions.