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No abstract

A variety of grafting materials have been described to help camouflage irregularities. 1 Crushed cartilage, temporalis fascia, fascia lata, and acellular dermis have been used to cover irregularities in the tip or rhinion region. Crushed cartilage, temporalis fascia, and fascia lata can have problems with irregularities, resorption, additional morbidity, and increased surgical time for harvest. Acellular dermis has the inherent issues of being a foreign substance and a substantial resorption rate. 2 An ideal camouflage graft would be present in necessary amounts, located within the operative site, easily harvested in a short amount of time, and provide long-term benefit with a low resorption rate.The superficial musculoaponeurotic system of the nose has been well described. 3 As part of this system, the fibrous tissue between the medial and intermediate crura has been characterized and referred to by several names. The terms Pitanguy's ligament, the in-terdomal ligament, interdomal sling, dermocartilaginous ligament, and intercrural soft tissue are likely all in reference to this fibrous tissue in between the crura. 4,5 The senior author (P.A.A.) has previously described harvest of this tissue as a vascularized rotational flap for premaxillary augmentation. 6 This same tissue can be harvested in primary rhinoplasty and used as a camouflage graft, a graft we term the intercrural fascia graft. Our technique and experience is described.

Although endoscopic laser cricopharyngeal myotomy and stapler diverticulostomy have become standard treatments for Zenker's diverticulum, this case of a large recurrent diverticulum illustrates a situation in which older techniques may be preferred. Use of the mechanical stapler allowed for a shorter surgery time than traditional suture techniques, and the potential for an earlier return to a normal diet.