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.

Routine incisions in the temporal area for rhytidectomy often remove hair-bearing skin anterior to the ear. This results in a cosmetic deformity, making the surgical intervention clearly visible. This is especially problematic for revision rhytidectomy or for patients with naturally high hairlines. This article describes a systematic approach to the temporal hairline and introduces a novel, hair-bearing, transposition flap that corrects iatrogenic loss of the preauricular tuft of hair.

The combination of IGF-I and bFGF in a serum-free and a serum-supplemented environment supports the growth and viability of human septal chondrocytes in short-term culture. In an SFM, the results obtained approximate those produced in a medium enhanced with 10% fetal calf serum.

Although plastic surgeons are increasingly incorporating computer imaging techniques into their practices, many fear the possibility of legally binding themselves to achieve surgical results identical to those reflected in computer images. Computer imaging allows surgeons to manipulate digital photographs of patients to project possible surgical outcomes. Some of the many benefits imaging techniques pose include improving doctor-patient communication, facilitating the education and training of residents, and reducing administrative and storage costs. Despite the many advantages computer imaging systems offer, however, surgeons understandably worry that imaging systems expose them to immense legal liability. The possible exploitation of computer imaging by novice surgeons as a marketing tool, coupled with the lack of consensus regarding the treatment of computer images, adds to the concern of surgeons. A careful analysis of the law, however, reveals that surgeons who use computer imaging carefully and conservatively, and adopt a few simple precautions, substantially reduce their vulnerability to legal claims. In particular, surgeons face possible claims of implied contract, failure to instruct, and malpractice from their use or failure to use computer imaging. Nevertheless, legal and practical obstacles frustrate each of those causes of actions. Moreover, surgeons who incorporate a few simple safeguards into their practice may further reduce their legal susceptibility.

We describe the case of a 56-year-old man who was admittedfor treatment ofa progressive destruction ofhis hard palate, septum, nasal cartilage, and soft palate that had been caused by chronic cocaine inhalation. Biopsy of the bony septum revealed acute osteomyelitis and an extensive overgrowth of bacteria and Actinomyces-like organisms. There was no evidence of granuloma or neoplasm. The patient received intravenous ampicillin! sulbactam for 6 weeks, followed by lifetime oral amoxicillin. When there was no further evidence that destruction was progressing, the patient underwent nasal reconstruction with a cranial bone graft. The surgery was completed with no complications. To our knowledge, this is the first reported case ofmidfacial osteomyelitis associated with chronic cocaine abuse. The severity of this patient's complications, coupled with the success of his reconstructive surgery, makes this case particularly interesting. We believe that it is importantforphysicians to understand that septal perforation in a cocaine abuser should not be underestimated because it could result in a secondary bone infection. Nasoseptal destruction secondary to intranasal cocaine abuse is a result ofcocaine 's vasoconstrictive properties, and a decrease in the oxygen tension of intranasal tissue can facilitate the growth of anaerobic pathogens.