To our knowledge, the spare roof technique (SRT) is the first technique that is based on a complete skeletonization/preservation of the upper lateral cartilages. This technique is used to keep the natural roof of the nose's middle third, while dehumping and/or correcting the crooked septum. From January 2014 till March 2015, a total of 40 rhinoplasties were performed through the SRT: 28 reduction rhinoplasties, 6 complex crooked noses (with extracorporeal septoplasty), and 6 mixed cases. The SRT is an excellent middle third technique. The natural roof was kept and fitted the accurate new position in almost all cases with no surgical complexity. It is an easy technique with many applications and it is also very useful in the classical humpectomy of the Caucasian nose and correction of the crooked nose.

ObjectiveTo describe the average values of the nasal anthropometric measurements of Caucasian Mediterranean patients seeking rhinoplasty and evaluate the major nasal deformities.DesignProspective, observational and cross‐sectional study.SettingCentro Hospitalar do Porto.ParticipantsA 100 Caucasian Mediterranean patients seeking rhinoplasty.OutcomesStandardized photography was used to obtain nasal anthropometric measurements and to evaluate the major nasal defects. Data regarding age, gender, skin type and Fitzpatrick scale were also collected.ResultsThere was a statistically significant difference in the means values of palpebral fissure, intercanthal width, upper lip height, nasal root width, morphological nose width, nose height, nasal tip projection and nasofrontal–hump and nasofrontal–supratip angles between females and males. The major nasal deformity was dorsal hump (78.0%), followed by rinomegalia (53.0%) and boxy bulbous tip (47.0%).ConclusionThe present study shows statistically significant gender differences between anthropometric nasal measurements and the mean values are greater than standard values obtained on general population. This might be one of the reasons why Caucasian Mediterranean patients seek aesthetical rhinoplasty. On both genders, dorsal hump, rinomegalia and boxy bulbous tip were the major nasal defects. This emphasize the importance of rhinoplasty techniques designed to reconstruct nasal dorsum and nasal tip on Caucasian Mediterranean patients. To the best of our knowledge, our study is the first study of digital anthropometric nasal analysis and evaluation of major nasal defects specifically in Caucasian Mediterranean patients who applied for rhinoplasty. With this results, we provide a reference material for the evaluation of the Caucasian and Mediterranean patient when planning a cosmetic nasal surgery.

Objectives:The biologic behavior of the adenoid cystic carcinoma (ACC) and the factors predicting outcome for these tumors are still poorly understood. Our objective is to analyze the predicting factors and the value of different treatment possibilities, since none sole treatment has been standardized. Methods: A retrospective analysis of the epidemiologic, clinical and histologic aspects of ACC, as well as treatment options and other prognostic factors of all the cases of ACC of the head and neck treated at this Institution were analyzed. From 1974 until 2011, 152 patients were diagnosed with ACC and treated at the Portuguese Institute of Oncology (Porto Centre). Main outcome measures: overall survival, local recurrence and distant metastasis were calculated by the Kaplan-Meier method. Factors predictive of outcome were identified by univariate and multivariate analysis. Results: The mean age at diagnosis was 55.8 years (range, 19 -83 years). Incidence was higher in the female population, with a female to male ratio of 1.7:1 respectively. The primary tumor location was hard palate and submandibular region in 56 cases, 28 in each location (24.6%), parotid gland (17 cases, 14.9%) and oral cavity excluding palate (16 cases, 14%).Distributions according to T stage were: T1 (29.8%); T2 (30.7%); T3 (17.5%); T4 (22%). The overall 1-year, 5-year and 10-year survival for all patients were 94.6%, 60.5%, 41.6%, respectively. Conclusions: Univariate survival analysis revealed that age older than 60 years (p = 0.002), solid histologic subtype (p = 0.042), advanced clinical stage (p < 0.001) and the presence of perineural invasion (p = 0.036) were correlated with a poor survival. Multivariate analysis confirmed that age and advanced clinical stage were worst independent predicators of overall survival as well as perineural invasion for local recurrence and distant metastasis. In our analysis, radiotherapy did not have a relevant impact on survival, except in cases of solid histologic subtype. To analyze distant metastatic capacity, long term follow-up was necessary, since distant metastasis way occurs even after 10 years, which has the case with 4 patients.

Myringotomy with the insertion of ventilation tubes is the most frequent surgical procedure performed in children, and the appearance of myringosclerosis is one of its most frequent long-term complications. The objective of this study is to identify clinical factors and technique variations that may have a relation with the appearance of myringosclerosis, after tube insertion. Patients submitted to myringotomy with transtympanic short-term tube insertion were studied in a longitudinal prospective and analytical cohort study with the prospective randomized open, blinded endpoint (PROBE) methodology, to study the influence of the location of myringotomy (anterior-inferior quadrant or posterior-inferior), directions of the incision (radial or nonradial) and aspiration or not of the middle ear. Our study included 156 patients (297 ears). Myringosclerosis was observed in 35.7 % of the operated ears. It appeared more often in patients with greater number of otitis (p = .001) and with greater number of otorrhea episodes (p = .029) and in patients in whom the tympanogram after the tube extraction was type A (according to Jergeŕs classification) (p = 0.016). We identified myringosclerosis in less patients, if the tube was in the tympanic membrane for less than 12 months (p = .009). Myringosclerosis was present more extensively if the tympanic incision was located in the anterior-inferior quadrant, with tympanic involvement superior to 25 % (p = .015). The results observed prove that, underlying the appearance of myringosclerosis, there exists an early inflammatory or infectious process and a final cicatricial process. It was also found that when myringotomy is made in the anterior-inferior quadrant, myringosclerosis appears in a higher percentage of the tympanic membrane; therefore, it is not recommended to do the incision in this quadrant, because it may lead to a reduction of the tympanic membrane vibration.

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