This article, which comprises the third part of a series on surgical anatomy for Asian rhinoplasty, addresses the lower one-third of the nose, including the alar cartilage and tip-supporting structures, known as distal mobile framework. As discussed in earlier parts of this series, diversity in surgical anatomy results in different surgical techniques in Asian rhinoplasty compared to rhinoplasty in Caucasian patients. Nasal tip structures are especially important due to their crucial importance for changing the nasal shape in Asians. This article, along with the previous ones, will provide both basic and advanced knowledge of practical surgical anatomy for Asian rhinoplasty.

Surgical anatomy is an important and fundamental aspect for all surgical procedures. Anatomy provides a surgeon with the basic and in-depth knowledge that is required and mandatory when performing an operation. Although this subject might be tedious and routine, it is compulsory and should not be overlooked or neglected to avoid any possible postoperative complications. An aggressive and hasty operation without anatomic considerations might cause adverse effects that are irreversible even though a surgical anatomy of the nose is quite simple.
Asian Continental Ancestry Group ; Humans ; Musculoskeletal System ; Nervous System ; Nose ; Postoperative Complications ; Rhinoplasty ; Skin

Surgical anatomy for Asian rhinoplasty Part I reviewed layered anatomy with neurovascular system of the nose. Part II discusses upper two-thirds of nose which consists of nasal bony and cartilaginous structures. Nasal physiology is mentioned briefly since there are several key structures that are important in nasal function. Following Part III will cover lower one-third of nose including in-depth anatomic structures which are important for advanced Asian rhinoplasty.

Deviated nose is highly challenging in rhinoplasty since the surgeon should consider both aesthetic and functional aspects of the nose. Deviated nose correction is surgically complex, and a thorough understanding of the mechanical and physiological changes of intranasal structures, including the septum and turbinates, is necessary for functional improvement.

Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting.

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.
Abscess ; Aged ; Anti-Bacterial Agents ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Brain Abscess* ; Brain* ; C-Reactive Protein ; Cognition Disorders ; Craniotomy ; Ear, Middle ; Edema ; Embolization, Therapeutic ; Female ; Frontal Lobe ; Headache ; Humans ; Leukocyte Count ; Lung ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Middle Aged ; Paresis ; Pulmonary Artery ; Thorax ; Tomography, X-Ray Computed ; Veins

BACKGROUND: Atherosclerosis, a major problem in patients undergoing chronic dialysis treatment, has been characterized as an inflammatory disease. Cardiovascular disease is the major cause of mortality, accouting for approximately half of all deaths in this population. The present study was aimed whether CRP, an important inflammatory marker, might be associated with cardiovascular risk in dialysis patients. METHODS: We performed retrospective study in 77 dialysis patients. Patients were divided into the elevated CRP group (>8 mg/L, n=11) and the normal CRP group (8 mg/L) showed significant higher cardiovascular events (by chi-squre test, p=0.032). BMI, smoking, alcohol, dialysis modality, lipid parameters, BUN, serum creatinine, serum protein, serum albumin and seurm TIBC did not show significant difference between two groups. Correlation between CRP and other biochemical parameters was analysed. Only ESR was positively correlated with CRP. In a subsequent analysis, elevated CRP group had significantly higher cardiovascular risk (by stepwise logistic regression method, odd ratio = 6.59;95% CI, 1.13 to 38.28). CONCLUSION: These results suggest that CRP level is correlated with cardiovascular risk in dialysis patients.
Atherosclerosis ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases* ; Creatinine ; Dialysis* ; Ferritins ; Humans ; Inflammation ; Logistic Models ; Male ; Mortality ; Peritoneal Dialysis ; Renal Dialysis ; Retrospective Studies ; Serum Albumin ; Smoke ; Smoking

PURPOSE: We performed this study to evaluate the risk of rehospitalization for respiratory syncytial virus(RSV) infection among premature infants discharged from a neonatal intensive care unit(NICU). METHODS: We performed a retrospective study for rehospitalization for RSV infection and risk factors among premature infants who were admitted to NICU and discharged between May 2001 and April 2003 in Wonkwang University Hospital. RSV detection was utilized by direct fluorescent antibody tests in nasopharyngeal aspirates. We also reviewed various risk factors including gestational age, birth weight, sex, ventilatory care, surfactant administration, chronic lung disease(CLD), siblings in school or kindergarten age, and month of discharge. RESULTS: The rehospitalization rate for RSV infection was 6.6%(26/381) in premature infants and 22.2%(4/18) in premature infants with CLD. The most common season of rehospitalization for RSV infection was between November to January, this was 69.2%(18/26) in premature infants, the same as children: 61.2%(93/152). The risk factors for RSV rehospitalization among premature infants were CLD, siblings in school or kindergarten age and discharge between October to December from NICU. CONCLUSION: The risk for RSV rehospitalization among premature infants from NICU was low. Preterm infants subject to risk factors of CLD, siblings in school or kindergarten age, and discharge between October to December from NICU, were most likely to require hospitalization for RSV disease. In CONCLUSION: Prophylaxis for RSV infection should be considered one month before discharge from NICU in the RSV season between October and December.
Birth Weight ; Child ; Gestational Age ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Lung ; Respiratory Syncytial Viruses* ; Retrospective Studies ; Risk Factors* ; Seasons ; Siblings

PURPOSE: Retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) in diabetic patients with normal tension were analyzed using optical coherence tomography (OCT), which revealed that diabetes induce morphologic changes in optic disc and RNFL thickness. METHODS: A total of 192 patients with type 2 diabetes were analyzed with fundus examination and classified as having normal retina, mild - moderate, severe nonproliferative retinopathy (NPDR), or proliferative retinopathy (PDR). These patients were evaluated with OCT and compared with normal control group. RESULTS: The mean average thickness and nasal average thickness of RNFL in mild-moderate, and severe NPDR groups decreased compared with those of the other groups. There was an increase in the temporal average thickness of RNFL in the PDR group. As the duration of diabetes increased, the mean average and nasal average of RNFL thickness also decreased. The severity of diabetic retinopathy didn't show statistically significant differences in a topographic analysis of the optic nerve head. CONCLUSIONS: The mean average thickness and nasal average of RNFL decreased in NPDR groups. Diabetic changes should be considered when diabetes patients are diagnosed with glaucoma or glaucoma progression.
Diabetic Retinopathy ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

Lumbar plexopathy is characterized by an abrupt onset of sensory disturbances, weakness, and loss of deep tendon reflexes of lower extremities. The various causes of lumbar plexopathy include trauma, infections, space-occupying lesion, vascular diseases, metabolic diseases, and the use of drugs such as heroin. Postoperative rhabdomyolysis occurs secondary to prolonged muscle compression due to surgical positioning. Herein, we report a case of lumbar plexopathy, complicating an injury to the paraspinal muscle and iliopsoas muscle that occurred in the flexed lateral decubitus position following radical nephrectomy.
Heroin ; Lower Extremity ; Metabolic Diseases ; Muscles ; Nephrectomy ; Reflex, Stretch ; Rhabdomyolysis ; Vascular Diseases