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mparting surgical change to the nasal tip remains one of the most challenging aspects of rhinoplasty. The literature describes novel and differing techniques that have been proposed over the years. Sometimes, the surgeon's goal is to maintain the architecture and support of the nasal tip, and sometimes alteration is required. Herein lies the challenge: assess the tip preoperatively and execute the necessary maneuvers to impart the desired change. Anderson 1 traditionally described the tip support structure as a tripod with the medial crura together and the lateral crura individually making up the 3 limbs. 1 Tardy and Brown 2 later outlined the major and minor tip-supporting mechanisms, focusing more on specific supporting structures as opposed to a model. These concepts were refined and used in the description of the tripod as an "M-arch" to better account for the unity of the medial crura and the less-than-geometric shape of the cartilages. 3,4 To explain the physics of the nasal tip, a cantilevered spring model has been applied as well. This model suggests that perhaps the classical major and minor tipsupporting mechanisms are less important than once thought, and attributes the bulk of the stored potential energy supporting the tip to the tripod's intrinsic cartilaginous makeup. 5 Even with the knowledge of supporting structures, clinical evaluation of the nasal tip has traditionally relied on the rather crude method of finger palpation. Though this is inexact, it remains the mainstay of preoperative evaluation to this day. IMPORTANCE Imparting surgical change to the nasal tip remains one the most challenging aspects of rhinoplasty. The surgeon must assess the tip preoperatively and execute the necessary maneuvers to impart the desired change. OBJECTIVE To assess nasal tip resistance to compression in a cadaveric model before and after specific rhinoplasty maneuvers using a novel method. DESIGN, SETTING, AND MATERIALS Open rhinoplasty maneuvers were performed at an academic tertiary care center on 6 fresh-thawed cadaver heads. Assessment of tip support was performed with a motorized, computer-controlled test stand equipped with a digital load cell. Tip support was assessed by compression to a depth of 2.5 mm from contact both preoperatively and after each surgical maneuver. All force data were recorded in pound-force and converted to newtons (N) following analysis. MAIN OUTCOMES AND MEASURES Nasal tip support, measured as resistance to compression, before and after various rhinoplasty maneuvers. RESULTS Following the elevation of the skin-soft-tissue envelope with septoplasty, resistance to compression (1.82 N) was not significantly different from the preoperative assessment (1.60 N for all specimens). Tip support following placement of a caudal extension graft was significantly different from all other conditions (3.16 N; P < .01), showing support increased by more than 66% from preoperative assessment. Placement of columellar strut (1.28 N) did not show significant increase in tip support. Tip support was de...

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Chronic rhinitis (CR) is a common disorder in children.Allergic rhinitis (AR) isa riskfactorfor CR, and children with AR tend to suffermorefrom hypertrophic adenoids than do patients with nonallergic rhinitis (NAR). Few studies haveaddressed the issue of alleviating symptoms of pediatric CR or AR following adenoidectomy alone. We conducted a retrospective chart review to determine whether CRinchildren improves afteradenoidectomy and whetherchildren with AR will benefit more than those with NAR. Charts of 47 children who had undergone adenoidectomyfor nasalobstruction and chronic middle eareffusion were reviewed. AR and NAR subgroups were classified basedonsymptoms,signs, blood19B, and nasal smear (allergic criteria). Hypertrophic adenoids were gradedusingtheadenoid-to-nasopharyngeal ratio (ANr >0.8). A questionnaire was used to assess the change in chronic rhinitis postoperatively. Improvement in CR was reported in 37 of 47 (79%) children. Patients with AR improved to a higherextent than those with NAR (12 of 14 {86%] vs. 25 of33 (76%], respectively), but the difference wasnot statistically significant. A totalof 41 lateral postoperative nasopharyngeal x-rays were obtained. The x-rays revealed that 20 of 26 (77%) of patients with ANr >0.8 had complete and 4 of 26 (15%) had partial resolution of symptoms of CRfor a total resolution rate of 92%, compared to only a 53% resolution in the ANr <0.8 subgroup (6 of 15 and 2 of 15 patients, respectively (p

As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.