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BackgroundSeveral surgical techniques used for rhinoplasty can change the upper lip form over the long term. By eliminating the membranous septum and causing dysfunction of the depressor septi nasi muscle and performing other maneuvers, the tongue-in-groove (TIG) technique can exaggerate changes in the upper lip shape, length, and slope.MethodsThis study was conducted to compare the effects of the TIG technique with and without a septal extension graft (SEG) on lip slope and aesthetic angles on the profile view. A retrospective review was performed on 367 patients who underwent primary rhinoplasty using the TIG technique from 2016 to 2020. The upper lip angle (ULA), the nasolabial angle (NLA), and the columellar facial angle (CFA) were measured for comparison pre-and post-operatively.ResultsOf 367 patients, 209 underwent TIG, while the rest underwent TIG over SEG (TIG+SEG). Comparison of pre-and post-operative ULAs showed significant changes in both groups. Although mean ULAs increased in both groups, some of the patients in each group experienced a decrease in ULA. The percentage of the patients with increased post-operative ULA significantly grow with increase in the pre-operative NLA (p < 0.05). However, no significant correlation was found between pre-operative CFA and post-operative ULA.ConclusionThe present study suggests that TIG with and without SEG can change the lip slope on the profile view, possibly due to the shift of the subnasal point superiorly and posteriorly.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

ObjectiveThe outcome of rhinoplasty was evaluated in patients undergoing tongue-in-groove technique (TIG) with and without septal extension grafts (SEG) placement for stabilization of nasal tip rotation.Subjects and MethodsThree hundred and sixty-seven patients who underwent rhinoplasty using TIG from 2016 to 2020 were included in this study. SEG was used if the caudal segment of the septum was not suitable for TIG. All patients were photographed pre- and postoperatively. Columellar Facial angle (CFA) and Nasolabial angle (NLA) were measured preoperatively at three intervals including up to six months after the operation (early or T1), up to one year after T1 (midterm or T2), and up to two years after T2 (late or T3).ResultsTwo hundred and nine patients (56.94%) underwent TIG and the rest of them (43.06%) received SEG plus TIG (SEG+TIG). The TIG group had a mean CFA of 95.9±7.56 degrees preoperatively, 106.5±6.77 degrees at T1, 105.4±6.48 degrees at T2, and 104.8 ±7.52 at T3. The SEG+TIG had a mean CFA of 98.9±7.65 degrees preoperatively, 108.8±6.58 degrees at T1, 107.7±6.86 degrees at T2, and 106.2 ±15.6 at T3. Comparison of T1, T2, and T3 showed that the CFA changes were less than 1%, indicating a nonsignificant difference. The same results were obtained for NLA as well.ConclusionAdding of SEG to TIG may be an effective technique to create and maintain a stable rotation comparing to TIG independently.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BackgroundThe thick-skinned nose is still one of the most challenging aspects of rhinoplasty. The possible effects of oral isotretinoin on cosmetic results of rhinoplasty in patients with thick nasal skin have been considered during recent years.MethodsIn this double-blind placebo-controlled clinical trial, 48 cases were divided into two groups randomly. Oral isotretinoin (0.5-mg/kg) was started on the 31st day after surgery and given every other day for 1 month and after that daily for two additional months in the first group. The second group received a placebo in the same form, sequence and interval as the first group. The cosmetic results based on patient satisfaction and ranking by an expert surgeon were compared between the two groups at 3 months, 6 months and 1 year after surgery.ResultsPatient satisfaction and ranking by an expert surgeon in the isotretinoin group at 3 months and 6 months after surgery were significantly better than in the placebo group (p value < 0.05); however, at 12 months after surgery there was no statistically significant difference between the two groups (p value > 0.05).ConclusionThough postoperative use of oral isotretinoin in patients with thick nasal skin accelerates improvement in cosmetic results during the early months after surgery, it does not significantly affect the final cosmetic result 1 year after surgery.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BackgroundNostril sill asymmetry is one of the most challenging problems in rhinoplasty. Some studies have been performed regarding nostril shape; however, no studies have been conducted on nostril shape in the Persian population. Additionally, the shape of the nostril in frontal view has rarely been evaluated. This study has two aims. The first is to evaluate nostril shape in Persian patients who were candidates for primary rhinoplasty in basal and frontal views. The second is to assess augmentation silloplasty in patients with different sill heights to resolve nostril asymmetry.MethodsThis research was performed in two phases. The first phase was a cross-sectional study carried out on the deidentified photographs of 122 patients nominated for rhinoplasty surgery at the facial plastic clinic of a tertiary university hospital. The second phase of the research was an interventional study without a control group consisting of 22 patients. The subjects were categorized as Phase 1. Next, an attempt was made to symmetrize nostril heights by sill augmentation surgery. One year after silloplasty surgical outcome was evaluated by measuring the differences in sill heights.ResultsIn the first phase, classification was performed of the nostril shapes of the patients using two views: frontal and basal. Morphologic study has revealed that there are two types of nostrils in the frontal view and three types in the basal view. In the second phase of this research, augmentation silloplasty was employed for the correction of asymmetric sill heights between the right and left sides. The results show that the height differences in the two sills decreased by 44.26% one year after surgery compared to before surgery (CI: 95%, range  − 20.59 to − 67.93), which is statistically significant (p = 0.0002)ConclusionsClassification of nasal base and nostrils relying on visual inspection is still an important tool for clinical evaluation and communication among physicians. This classification is also crucial in selecting the proper method for correcting nasal base asymmetry. Augmentation silloplasty can help surgeons correct nostril asymmetry due to sill height discrepancy.level of evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

To achieve an acceptable result in septorhinoplasty, sufficient septal cartilage is needed. There are many cases in which septal cartilage is insufficient, especially in revision surgery or in some races such as Asian. To obtain an ideal outcome, a bony cartilaginous unit (septal cartilage/ethmoid bone composite graft) is proposed as a versatile graft for different purpose such as caudal extension graft.

Background The term “bulbous nose” is used to describe a large or boxy nasal tip. Typically, correction of the bulbous tip has been achieved through a variety of cartilage-modifying maneuvers based on incision or excision of the lower lateral cartilage. Methods Horizontal reduction with a cephalic hinged flap of the lateral crura was used for 28 patients during open rhinoplasty. Effort was made to preserve the structural integrity of alar cartilage as much as possible with this technique. Results The average follow-up period was 14 months. Satisfactory results were achieved. External nasal valve collapse and pinch deformity were not observed during the postoperative period. Conclusions The described technique improves nasal tip reduction while maintaining nasal tip support and strength. The hinged flap used with this technique can both prevent weakness of the lateral crura and support it.

Background Overresection of the lateral crura of the lower lateral cartilages is referred to as the most common cause of nasal valve collapse after rhinoplasty. The modern approach to functional rhinoplasty recognizes the importance of the tip framework’s structural integrity and preserves tip support. Methods Traditional cephalic resections of lateral crura were performed on one side of five adult cadaver noses. On the opposite sides, hinged flaps of lateral crura were created. The noses were cross-sectioned at or near the internal nasal valve level, and the difference between the two sides was described. Results The study findings demonstrated improvement in the postoperation nasal valve area of the hinged flap side compared with the cephalic trim side. Conclusions This preliminary study showed that the hinged flap is an option in nasal tip reduction surgery that may provide improved long-term aesthetic and functional outcomes through preservation of the nasal valve area.

Giant cell tumors are rare in the head and neck region. The most frequently involved sites of giant cell lesions in the head and neck are the maxilla and mandible, whereas the sphenoid and temporal bones are rarely involved. This tumor is usually located in the long bones of limbs. Reparative granuloma and brown tumor of hyperparathyroidism must be included in the differential diagnosis. Here we report the clinical and radiologic findings of a multicentric giant cell tumor with skull base involvement in a female patient. This case report demonstrates the similar pathophysiology of peripheral and central giant cell tumors.

In this study, epoxy hybrid nanocomposites reinforced by carbon fibers (CFs) were fabricated by a filament winding. To improve out-of-plane (transverse) mechanical properties, 0.5 and 1.0 Wt.% multi-walled carbon nanotubes (MWCNTs) were embedded into epoxy/CF composites. The MWCNTs were well dispersed into the epoxy resin without using any additives. The transverse mechanical properties of epoxy/MWCNT/CF hybrid nanocomposites were evaluated by the tensile test in the vertical direction to the CFs (90º tensile) and flexural tests. The fracture surfaces of composites were studied by scanning electron microscopy (SEM). The SEM observations showed that the bridging of the MWCNTs is one of the mechanisms of transverse mechanical properties enhancement in the epoxy/MWCNT/CF composites. The results of the 90º tensile test proved that the tensile strength and elongation at break of nanocomposite with 1.0 Wt.% MWCNTs improved up to 53% and 50% in comparison with epoxy/CF laminate composite, respectively. Furthermore, the flexural strength, secant modulus, and elongation of epoxy/1.0 Wt.% MWCNT/CF hybrid nanocomposite increased 15%, 7%, and 9% compared to epoxy/CF laminate composite, respectively.

Objective The primary objective of this systematic review and meta-analysis was to assess the association between iron deficiency anemia (IDA) and retinal changes via optical coherence tomography (OCT). Methods The search was conducted in MEDLINE, Scopus, Embase, Web of Science, and Google Scholar until February 1, 2024. Two independent researchers included the articles based on the inclusion and exclusion criteria. Data regarding the study design, patient characteristics, number of patients with and without IDA, mean and SD of the retinal nerve fiber layer (RNFL), C/D ratio, foveal avascular zone (FAZ) area and perimeter, foveal density and superficial and deep capillary plexus (SCP and DCP) vascular density (VD) were collected. STATA version 17.0 was used to compute pooled measures of the standardized mean difference. I2 and chi-square tests were used to assess heterogeneity between studies. Results We found 1378 nonduplicate studies, 35 of which were potentially relevant. 19 articles met the inclusion criteria and were included in the review. The meta-analysis confirmed that there was a statistically significant association between IDA and RNFL thickness reduction (SMD = -0.76, 95% CI: -1.09 to -0.44 ; p-value = 0.001, I2 = 86.88%), FAZ area (SMD =-0.35, 95% CI: -0.67 to -0.02; p value = 0.04, I2 = 59.76%) and SCP VD (SMD = -1.12, 95% CI: -1.85 to -0.39; p-value = 0.001, I2 = 83.15%). The associations between IDA and the C/D ratio (SMD = 0.07, 95% CI: -0.13 to 0.28; p value = 0.49, I2 = 0.0%) and DCP VD (SMD = -0.30, 95% CI: -0.89 to 0.29; ,p-value = 0.32 ,I2 = 77.20%) were not significant. There was no considerable publication bias. Conclusion The results of this meta-analysis demonstrated that, compared with healthy controls, individuals with IDA presented a thinner RNFL, a smaller FAZ, and lower SCP and DCP vascular densities. However, further studies are needed to reach more conclusive results.