We feel this is a safe and logical protocol. Compared to mandatory admission after nasal pack insertion, we saved 39 admissions in five months. There were also the added benefits to patients of being able to recuperate at home rather than in hospital and avoidance of the risk of hospital acquired infection.
IntroductionOsteoradionecrosis of the mandible and temporal bones has been extensively reported in literature, but cases of avascular necrosis of the cervical spine following radiotherapy to the larynx appear to be extremely rare. A review of the English language literature has shown only one other case where radiotherapy treatment of a laryngeal carcinoma has resulted in osteoradionecrosis of the cervical spine.Case presentationWe present the case of a 65 year old male patient who suffered from osteoradionecrosis of the cervical spine 20 years after radiotherapy treatment for a T1aN0M0 laryngeal carcinoma resulting in quadriplegia.ConclusionsRadiotherapy carries a long-term risk of complications, including osteoradionecrosis which may present 20 years later with significant implications.
Primary aesthetic rhinoplasty in Northern European females presents particular challenges and pitfalls that the rhinoplasty surgeon needs to be aware of. The authors completed a prospective study of 57 consecutive female patients of Northern European descent who underwent primary aesthetic rhinoplasty, with a minimum of 18 months follow-up. The anatomic features and operative techniques used are presented. Pitfalls that make classical steps of reduction rhinoplasty inappropriate are discussed and illustrated by case reports. Attention is drawn to (1) the dorsal hump with an overprojected tip, (2) the enlarged anterior nasal spine and/or posterior septal angle and strong depressor septi nasi muscle, (3) the dorsal hump tension nose, and (4) the bulbous nasal tip with lateral crus recurvature. The authors emphasize the need to maintain structure in the nose to secure middle third and tip support while achieving a balance between dorsal projection and tip position. The limitations and risks of each surgical step versus their potential benefit must be balanced. The surgeon must diligently manage patient expectation and in this population explain that achieving a better nasal shape may take precedence over size reduction.
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