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

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 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.

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.

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.

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