Nasal obstruction must frequently be addressed during functional rhinoplasty. Even after a properly performed septorhinoplasty correcting septal deflection and/or nasal valve collapse, nasal obstruction may persist due to turbinate hypertrophy. Turbinates have many important functions, including warming and humidification of inspired air, and numerous factors can contribute to pathologic enlargement. Management of inferior turbinate hypertrophy has been actively debated for more than a century. The primary goal of therapy is to maximize the nasal airway for as extended a period as possible while minimizing complications of therapy, such as nasal drying and hemorrhage. This review describes the various medical and surgical therapeutic modalities widely used today, with emphasis placed on surgical management of the inferior turbinates. Advantages, disadvantages, complications, and controversies of each form of treatment are reviewed and discussed. A staged protocol of increasingly invasive interventions is proposed.
Localization ofthe round window membrane is desirable in order to allow a more direct application ofmedication to the inner ear. A new procedure has been developed to deliver direct, near-continuous inner ear perfusion to the round window with the Silverstein MicroWick. In this office procedure, the wick is inserted through a tympanostomy tube into the round window niche. Accurate localization of the round window is a necessary component ofthis procedure. In an effort to ascertain the precise location of the round window, we examined 25 cadaveric human temporal bones and measured the distance from the umbo to the round window in each sample. We found that the round window was an average of 3.44 mm (±O.68)from the umbo and was situated at an average angle of113.2 0 (±9.8)from the long process of the malleus. Our simple and reliable determination of the relationship between the malleus handle and the round window niche allows for the accurate placement ofthe Silverstein MicroWick and other devices.
Background: A technical evolution of ALPPS was accompanied by a better understanding of the importance of patient selection, not only to minimize morbidity and mortality, but also to achieve the most oncological benefit. Methods: The following strategy was applied in 6 surgeons performing ALPPS:
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