Rhinoplasty has always been one of the most challenging aspects of facial surgery as it requires a precise assessment of the deformity, a strong grasp of nasal support mechanisms plus soft tissue skin envelope and a realistic appraisal of the outcome expected acutely and over a long period of time. This fine balance is often achieved by retrospective analysis of post-rhinoplasty results in order to highlight repeated problems and improve upon them. This study reviews 110 patients in which a total of 407 deformities were found. These are divided into upper, middle and lower thirds with a subdivision of individual deformities within each group. There is also a comparison of the results obtained from similar studies over a period of four decades to those in our study, which reveals that the post-rhinoplasty deformities noted in these studies occur with a similar frequency to those in our paper.

Out of the numerous implant materials that have been used for augmentation of the nasal dorsum, autogenous cartilage is considered to be the optimal grafting material due to its versatility and long-term survival. However, in the case of extensive augmentation often an alternative grafting material is needed. Homologous cartilage seems an attractive option, but is not commonly used because of the fear of disease transmission, the long-term unpredictability and the possibility of warping. Alloplastic grafts have offered varying degrees of success in rhinoplasty, but have resulted in significant complications as well. Lately, expanded polytetrafluorethylene (Gore-Tex(R)) has proven to be a promising synthetic material in nasal dorsal augmentation. However, convincing long-term success compared to autogenous cartilage grafts is still lacking and numbers are insufficient. This paper consists of a prelimary report about the use of Gore-Tex(R) soft-tissue patches in nasal dorsal augmentation in 66 patients over a 6-year period, which forms the largest European series so far. No complications were observed in either primary (29%) or revision rhinoplasties (71%).

The foundation of mastoid surgery for cholesteatoma has traditionally been a thorough knowledge of the anatomy and familiarity with landmarks, constant alertness to detect unsuspected complications and the experience to tailor the surgery to the pathology encountered. Whilst not indispensable, computed tomography (CT) scanning is a useful adjunct whose potential predictive value is only truly appreciated by skilled interpretation. We present a guide to analysis to maximize the value of pre-operative radiology.

Background: Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias, particularly in susceptible patient groups.Objectives: We investigated the incidence of cardiac arrhythmias during and after controlled exposure to air pollutants in healthy volunteers and patients with coronary heart disease.Methods: We analyzed data from 13 double-blind randomized crossover studies including 282 participants (140 healthy volunteers and 142 patients with stable coronary heart disease) from whom continuous electrocardiograms were available. The incidence of cardiac arrhythmias was recorded for each exposure and study population.Results: There were no increases in any cardiac arrhythmia during or after exposure to dilute diesel exhaust, wood smoke, ozone, concentrated ambient particles, engineered carbon nanoparticles, or high ambient levels of air pollution in either healthy volunteers or patients with coronary heart disease.Conclusions: Acute controlled exposure to air pollutants did not increase the short-term risk of arrhythmia in participants. Research employing these techniques remains crucial in identifying the important pathophysiological pathways involved in the adverse effects of air pollution, and is vital to inform environmental and public health policy decisions.Citation: Langrish JP, Watts SJ, Hunter AJ, Shah AS, Bosson JA, Unosson J, Barath S, Lundbäck M, Cassee FR, Donaldson K, Sandström T, Blomberg A, Newby DE, Mills NL. 2014. Controlled exposures to air pollutants and risk of cardiac arrhythmia. Environ Health Perspect 122:747–753; http://dx.doi.org/10.1289/ehp.1307337

A best evidence topic in facial nerve surgery was written according to a structured protocol. The question addressed was: in [patients with Bell's palsy], does [acupuncture] improve [facial nerve function and/or pain]? A total of 43 papers were identified using the reported search protocol, of which three articles represented the best available evidence to answer the clinical question. Two of these articles were review papers and together encompassed 13 primary articles. Publication details, type of study, patients studied, outcomes and results are tabulated. The two level 1 articles concluded that before firm conclusions can be drawn, better designed trials are required in order to establish whether acupuncture confers any benefit to patients with Bell's palsy. The level 2 randomised controlled trial (RCT) suggested that two methods of acupuncture were associated with significant improvements in pain in Bell's palsy, although the trial was poorly controlled and had risk of bias. Therefore, the clinical bottom line is that until well designed trials are able to clearly demonstrate a role for acupuncture in Bell's palsy, its efficacy should be considered to remain unproven.