Objective To create a clinical consensus statement to address ambiguities and disparities in the diagnosis and management of nasal valve compromise (NVC). Methods An updated systematic review of the literature was conducted. In addition, a Modified Delphi Method was used to refine expert opinion and facilitate a consensus position. Results After two rounds of surveys and conference calls, thirty six items reached consensus, six items reached near consensus, and ten items reached no consensus. The categories that had the greatest percentage of consensus or near consensus items were: definition, history and physical examination, outcome measures, and management. Conversely, the categories with greater percentage of no consensus items were: adjunctive tests and coding. Conclusions The consensus panel agreed that NVC is a distinct clinical entity that is best evaluated with history and physical exam findings. Endoscopy and photography are useful but not routinely indicated, while radiographic studies are not useful in evaluating NVC. Other objective nasal outcome measures may not be useful or accepted for NVC. Nasal steroid medication is not useful for treating NVC in the absence of rhinitis, and mechanical treatments may be useful in selected patients. Surgical treatment is the primary mode of treatment of NVC, but bill coding remains ambiguous and confusing.

A significant number of patients who undergo revision septoplasty also have nasal valve collapse. We recommend that in addition to septal deviation and inferior turbinate hypertrophy, nasal valve function be fully evaluated before performing septoplasty. This will help to ensure a complete understanding of a patient's nasal airway obstruction and, consequently, appropriate and effective surgical intervention.

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Objectives/Hypothesis Advances in bone repair have focused on the minimally-invasive delivery of tissue-engineered bone (TEB). A promising injectable biopolymer of chitosan and inorganic phosphates was seeded with mesenchymal stem cells (MSCs) and a bone growth factor (BMP-2), and evaluated in a rat calvarial critical size defect (CSD). Green fluorescent protein (GFP)-labeled MSCs are used to evaluate patterns of cell viability and proliferation. Study Design Prospective, controlled trial in an animal model. Methods In 30 male rats, 8-mm calvarial CSDs were created, and divided into five groups of six animals each. In the experimental groups, the defects were injected with either chitosan gel, gel loaded with MSCs (0.3 × 106 cells/defect), gel loaded with BMP-2 (2 µg/defect), or gel loaded with both MSC and BMP-2. In the control group, the defect was left untreated. At 4 weeks, in vivo microcomputed tomography (micro-CT) analysis was performed. At 8 weeks, calvarial specimens were examined by micro-CT, histology, and immunohistochemistry. Results New areas of bone growth were seen in the defects of all treated animals. Micro-CT analysis revealed a significant (P < .001) time-dependent increase in the regeneration of bone volume and bone area in defects treated with gel/MSC/BMP-2 as compared to all other groups. Histological analysis confirmed this difference. GFP–labeled TEB was detected within the areas of new bone, indicating cell viability and contribution to new bone growth by the injected MSC. Conclusions This study demonstrates that an injectable form of TEB using a chitosan gel, MSC, and BMP-2 can enhance bone formation in a rat calvarial CSD.

Smokers with full-thickness defects are shown to be at greater odds for developing a postoperative complication. Laryngoscope, 2009.

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onmelanoma skin cancer (NMSC), encompassing basal cell carcinoma (BCCA) and squamous cell carcinoma (SCCA), is the most common cancer and continues to increase in incidence. Squamous cell carcinoma has distinct potential to metastasize if left untreated. Although BCCA does not typically spread beyond the primary site, it can be locally destructive. Recurrent lesions behave more aggressively and are far more challenging to treat; it is imperative to remove cutaneous malignant lesions in their entirety at the primary attempt. Lesions of the head and neck pose unique challenges in that surgical excision almost always involves a balance between oncologic responsibility and preservation of both function and cosmesis. Thus, when considering methods of treatment, it is a balance between removing the cancer in its entirety and preserving as much normal tissue as possible. 1,2 It seems that various factors could predispose NMSC lesions to behave more aggressively. Not surprisingly, tumor grade and stage have a considerable effect on prognosis. Recurrent as well as larger lesions also have a higher risk of incomplete excision and further recurrence. 1,3-9 Although lesion histologic margins, size, and recurrent status are most frequently listed as primary risk factors, other aspects of a patient's medical history may also affect NMSC behavior. Age, sex, immunosuppression, certain syndromes, radiation and sun exposure, and pres-IMPORTANCE Surgical excision of skin cancer is a common treatment, yet the proper surgical margin remains unclear. This study reviews data on lesions and their margins as defined by Mohs micrographic surgery. OBJECTIVE To review margins as defined by Mohs micrographic surgery. DESIGN Retrospective review of data from patients with skin cancer. SETTING Academic medical center. PARTICIPANTS All patients with nonmelanoma skin cancer. MAIN OUTCOME AND MEASURE Size and final defect size were compared to calculate the margins needed. All lesions were categorized based on histologic characteristics. RESULTS A total of 495 lesions were reviewed. All tumors and defects had precise measurements. The mean margins for low-risk basal cell carcinomas, high-risk basal cell carcinomas, low-risk squamous cell carcinomas, and high-risk squamous cell carcinomas were 2.4 mm, 3.7 mm, 2.6 mm, and 5.3 mm, respectively. Statistical differences in surgical margins were found between all low-and high-risk cancer types. Established high-risk zones (H-zone) for basal cell carcinoma and squamous cell carcinoma were not associated with larger margins. Margins required to excise completely 95% of all the low-risk basal cell carcinomas, high-risk basal cell carcinomas, low-risk squamous cell carcinomas, and high-risk squamous cell carcinomas, were 4.75 mm, 8 mm, 5 mm, and 13.25 mm, respectively. CONCLUSIONS AND RELEVANCE Differences are noted between low-and high-risk cutaneous lesions. When primary excision instead of Mohs micrographic surgery is the only option, the aforementioned margins may be considered guidelines. The relevanc...

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