Objectives To explore a comprehensive approach for the functional and aesthetic correction of septal deviation. Methods From Jan. 2007 to Dec. 2009, 48 patients with deviation of the frontier and ceiling border of the septal cartilage, 6 males, 42 females, average age of 26.5 years, were surgically treated with a comprehensive use of several techniques, such as septoplasty, reconstruction of septal support, precise osteotomies and nasal tip plasty. Results Functional improvement achieved in all the patients, contour satisfaction achieved in 91.7 % patients; 30 patients were very satisfied, and 14 satisfied with the outcome. Conclusions With the thorough understanding of surgical anatomy of the nose and the use of comprehensive surgical approach, satisfactory outcomes can be achieved both functionally and aesthetically in patients with septal deviation.

Objective To employ autologous septal cartilage grafting as a new method of elongating the nose and adjusting the nasolabial angle in order to correct the deformities of short nose and bulbous tip.Methods A set of techniques,including,yet not limited to,releasing and sculpturing of the alar cartilages,harvesting of septal cartilages and carving them into L shape and cap-like shape for transplant,moulding the soft tissue envelop with buried through and through sutures etc.were used to lengthen the nose and modify the tip.Results From 2004 to now,the new technique had been applied to 345 patients with short nose and bulbous tip.Follow-up ranged from 6- 48 months,satisfactory outcomes were obtained.Conclusions The new technique adopted by the author in which autologous septal cartilages are settled to the anterior angle of the nasal septum and between the domes of alar cartilages has been proved to be a viable and reliable way to lengthen the nose.Further advantages of this technique include the easiness of harvesting grafts,minimal injury,rare complications of infection and rejection etc.

Objective To compare the mandibular advancement appliance(MAA) with mandibular advancement and left-leaning appliance (MALA) in the treatment of mild or moderate obstructive sleep ap-nea-hypopnea syndrome (OSAHS). Methods Twenty-two cases of mild or moderate OSAHS were treated with MAA, and 19 cases with MALA. After 1-3 months, they were examined again with Epworth score and polysonmography (PSG). Results After 1-3 months of the MAA or MALA treatment, the Epworth score was improved evidently. The apnea -hypopnea index, max apnea time, mean apnea time, oxygen desaturatian index, and the longest time of oxygen desaturation were all lowered after the treatment, and the lowest SaO2 and the mean SaO2 were higher after the treatment. The differences were all distinctive (P<0.05 or<0.01). When patients treated with MAA were compared with those treated with MALA,only the max apnea time [(35.5±6.9),(31.3±6.0) s, respectively] and the longest time of oxygen desaturation [ (41.0±18.9), (29.9±9.3) s, respectively] had significant difference. Conclusion MALA may be helpful for shortening max apnea time and the longest time of oxygen desaturation, thus MAA is an effective alternative to patients of OSAHS. Further research should be done.

AIM: To study the effect of safflower injection on expression of COX-2 mRNA in chronic hypoxic hypercapnic rat pulmonary arterioles.METHODS: Sprague-Dawley rats were randomly divided into normal control group,hypoxic hypercapnic group(B),hypoxic hypercapnia+ safflower injection group(C).The concentration of TXB2 and 6-Keto-PGF1? in plasma and in lung were detected by the technique of radioimmunoassay.COX-2 mRNA was observed in arterioles from rats by the technique of in situ hybridization.RESULTS: ① Mean pulmonary arterial pressure(mPAP),weight ratio of right ventricle(RV) to left ventricle plus septum(LV+S) were much higher in B group than those in control group.No significant difference of mean carotid arterial pressure(mCAP) was observed in three groups.② The concentration of TXB2 and the ratio of TXB2/6-keto-PGF1? were significantly higher in B group than those in control group.③ Light microscopy showed that vessel wall area/total area,the density of medial smooth muscle cells and the thickness of medial smooth cell layer were significantly higher in B group than those in control group.Electron microscopy showed proliferation of medial smooth muscle cells and collagenous fibers in pulmonary arterioles in B group.Safflower injection reversed the changes mentioned above.④ Expression of COX-2 mRNA in pulmonary arterioles was much higher in C group than those in B group.Differences of COX-1 mRNA in pulmonary arterioles were not significant between these two groups.CONCLUSION: Safflower injection increases the expression of COX-2 mRNA in chronic hypoxic hypercapnic rat pulmonary arterioles,indicating an important mechanism that safflower injection inhibits the formation of hypoxic hypercapnia pulmonary hypertension and pulmonary vessel remodeling.

AIM: To study the effect of chronic hypoxic hypercapnia on gene expression of thromboxane synthase and prostacyclin synthase in pulmonary arterioles. METHODS: Sprague-Dawley rats were randomly divided into two groups: control group and hypoxic hypercapnic group. TXS mRNA and PGI 2-S mRNA were observed in pulmonary arterioles by in situ hybridization. RESULTS:mPAP, weight ratio of right ventricle (RV) to left ventricle plus septum(LV+S), contents of TXB 2 and 6-keto-PGF1 ? in plasma and lung and TXS mRNA in pulmonary arterioles were much higher in rats of hypoxic hypercapnic group than those of control group. Differences of PGI 2-S mRNA in pulmonary arterioles were not significant in two groups. Light microscopy showed hypertrophy of vessel smooth muscle cells and vessel cavity straitness were found in hypoxic hypercapnic group. CONCLUSION: Changes of gene expressions of thromboxane synthase and prostacyclin synthase and imbalance of TXA 2/PGI 2 may play an important role in hypoxic hypercapnic pulmonary hypertension.

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage,and to observe the outcome and summarize the possible complications.Methods A 6-7 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes.A lancet shaped piece was used for dorsal augmentation,several cartilage bars for collumellar elevation and nasal tip elongation.Comprehensive structural rhinoplasty was then done with open rhinoplasty incision.Results 52 patients were treated with this method and satisfying aesthetic contouring of the nasal tip and dorsum was achieved.Among these patients,no such complications as implant extrution or dislocation,cartilage distortion,pneumothorax,hemothorax,infection or hemotoma were observed.The scar on the donor site was not obvius.Conclusions Costal cartilage can meet the demands of patients who consider prosthesis as an unacceptable option.For secondary revision rhinoplasties,costal cartilage provides sufficient materials to ensure a promising outcome with lower risk of infection and other complications.

Objective To evaluate the effect of double L-shape osteotomy combined bony Z-plasty for prominent malar complex.Methods Thirty-two patients with prominent malar complex were treated with double L shape osteotomy combined bony Z plasty for prominent malar complex.Width of lower face was observed during follow-up phase.Questionnaires were used to assess the patents' level of satisfaction at 6 months after operation.Results All wounds got primary intention healing and no severe complication in perioperative period.Postoperative appearance of all 32 cases showed that the width of middle face was efficiently reduced.All patients expressed high levels of satisfaction 6 months after operation.Conclusions Double L-shape osteotomy combined bony Z-plasty for prominent malar complex is an effective and safe method for the treatment of prominent malar complex.

Objective To correct the nasal deformities of cleft lip by expanded-polytetrafluoroe thylene (e-PTFE) combined with autologous nasal septal cartilage.Methods e-PTFE was placed nearby verge of anterior nasal aperture to raise the fundament of nose.Autologous nasal septal cartilage was harvested and combined with e-PTFE to form a sandwich structure.Nasal tip and collapsed nasaI alar were repaired by this method.Results Fifty cases were treated by this method and 42 cases were followed up for about one year.The results were satisfying.The contour of the nose was similar to normal.Only 3 cases were relapsed after one year.Conclusions e-PTFE combined with autologous nasal septal cartilage is an ideal method to correct nasal deformities of cleft lip.

Objective To compare the efficacy between autologous fat and hyaluronic acid in filling nasolabial grooves.Methods Sixty patients who wanted improvement of nasolabial grooves were involved in the study.They were randomly and equally classified into two groups:autologous fat injection group and hyaluronic acid injection group.Photographs were taken before,half a year,and one year after injection.The nasolabial grooves were also graded before,half a year,and one year after injection.The grade improvement was obtained after postoperative grade minus preoperative grade.If the grade improvement was more than 1 grade,the treatment was regarded as effective to evaluate the outcome between the two methods.Results The results of the two groups were tested by SPSS 13.0 software.The effects of the two methods were not significantly different after half a year of filling (P＞0.05).The difference was significant one year after filling (P＜0.05).In autologous fat injection,the patients had a long and magnificant swelling and redness around the nasolabial grooves;on the contrary,the patients who underwent hyaluronic acid had slight and short-time local reaction like swelling and redness.No other serious complications were found in both the groups.Conclusions The effects of the autologous fat and the hyaluronic acid are equal after half a year of filling.The autologous fat has a longer effect in one year.Both methods are safe and effective.Surgeons can select the method accordingly.