Nasal tip sutures part I: the evolution

Suture techniques for reshaping the nasal tip have been in use for many decades. However, the past two decades have been the most influential in the advancement of the procedures commonly used today. This report details the origin of the major tip suture techniques and tracks their evolution through the years. The early techniques in tip rhinoplasty share a basic principle: the sacrifice of lateral crus integrity to augment the middle and medial crural cartilage to gain tip projection and height. These techniques often disrupt the support mechanisms of the tip lobule, leading to undesirable postoperative results, including supratip fullness, tip asymmetry, tip drop, and an overoperated appearance. Modern nasal tip surgery is founded on the philosophy that suture placement does not simply secure partially excised sections of alar cartilage; rather it aims to directly reshape and reposition the various nasal tip components. The principal suturing methods available in the repertoire of today's rhinoplasty surgeon are the medial crural suture, the middle crura suture, the interdomal suture, the transdomal suture, the lateral crura suture, the medial crura anchor suture, the tip rotation suture, the medial crura footplate suture, and the lateral crura convexity control suture. This report acknowledges past contributions to nasal tip surgery and looks at the recent evolution of techniques commonly used today.     

A contribution to knowledge of the compartments and the fascial and septal formations of the popliteal fossa in the human fetus and the adult.

A contribution to knowledge of the compartments and the fascial and septal formations of the popliteal fossa in the human fetus and the adult. A study was made in human fetuses from the 3rd month onwards, newborn and the adult of the fascial and septal formations and the compartments of the popliteal fossa. Observations of serial sections of the knee of human fetuses, of macroscopic preparations of the knee of newborns and of ultrasound images of the popliteal fossa in adults showed that: the fascial formation covering the popliteal fossa consists of the popliteal fascia and the superficial fascia. The bud of the popliteal fascia is observable in the 3-month fetus as a layer of thin fibrillar connective tissue which is thicker in the tracts between the muscle buds. At birth the popliteal fascia is clearly a separate anatomical entity of continuous laminar structure which is thicker in the tracts between the muscles and thinner where it covers them. The superficial fascia becomes evident in fetuses at a later stage (6th month) in the form of a thin lamina in the frontal plane which at birth is well defined and observable as a thin continuous line deep below the subcutaneous layer. The septal formation consists of four septa: two in the sagittal plane (lateral and medial) and two in the frontal plane (lateral and medial). The bud of these septa appears in 4-month fetuses after the appearance of the popliteal fascia. They branch off from the thicker connective areas between the muscles buds as connective prolongations which later assume a laminar aspect and eventually become compact and form septa. In at-term fetuses and newborns these septal formations are clearly recognizable as antomical entities, which branch off from the deep surface of the thicker tracts of the popliteal fascia and are inserted into the femur. The relationships and connections with the muscular groups are also clearly visible. The organization and demarcation of the compartments, which is already delineated in the 6-month fetus, seems to be completed at birth, considering the presence of the superficial fascia, the popliteal fascia and the septa. It is possible to distinguish a superficial compartment between the popliteal and the superficial fascia an a deep compartment between the frontal septa, the skeletal plane and the popliteal fascia. This deep compartment is clearly subdivided by the two sagittal septa into three sectors (medial, intermediate and lateral). The medial and lateral sectors contain muscles, while the intermediate compartment contains the vasculonervous bundle and the popliteal adipose body.     

In-vivo analysis of sliding distance and cross-shear in Bi-cruciate retaining total knee arthroplasty

Polyethylene remains the most popular bearing material for total knee arthroplasty (TKA). Despite its widespread use, wear continue to be one of major factors implicated in revision surgery. Sliding distance, cross-shear, and contact stress are the major factors influencing polyethylene wear. As previous studies have either relied on wear simulations, computational modeling, or in vitro measurements to quantify sliding distance and cross-shear, in vivo subject-specific sliding distance and cross-shear after bi-cruciate retaining (BCR) TKA has not been previously reported. The objective of this study was to quantify the 6°-of-freedom (6DOF) in vivo kinematics, sliding distance, and cross-shear in BCR TKA patients during gait. Twenty-nine unilateral BCR TKA patients performed level walking on a treadmill under dual fluoroscopic imaging system (DFIS) surveillance. Cumulative normalized sliding distances between the lateral and medial compartments did not change significantly (p > 0.05) during the gait cycle. Although the total normalized sliding distance was similar between the lateral and medial compartments, the cross-shear at the lateral compartment differed significantly from that at the medial compartment (p < 0.001). Significant differences in the relative length positions of the peak sliding distance and cross-shear were found between the lateral and medial bearing components. The flexion-extension motion of the reconstructed knee was more associated with the linear displacements (anterior-posterior, R² = 0.6; lateral-medial, R² = 0.8, proximal-distal, R² = 0.7) than the angular displacement (varus-valgus, R² = 0.18; internal-external rotation, R² = 0.28). Despite some differences in peak sliding distance and cross-shear positons, our results suggest similar articular contact patterns between the lateral and medial compartments in BCR TKA patients during gait. The data could provide insights into understanding the potential wear patterns in BCR TKAs.     

Nasal tip sutures part II: the interplays

The achievement of consistently superior results in rhinoplasty is rendered difficult in part by a number of complex interplays between the anatomical structures of the nose and the techniques used for their alteration, such as tip sutures. The effects of sutures depend largely on the magnitude of suture tightening, the intrinsic forces on the cartilages, cartilage thickness, and the degree of soft-tissue undermining. The tip complex is perhaps the most intricate of the nasal structures, exhibiting subtle but evident responses to manipulations of the lower lateral cartilages. The three-dimensional effects of nine suture techniques that are frequently used in nasal tip surgical procedures are discussed and illustrated. (1) The medial crura suture approximates the medial crura and strengthens the support of the tip. The suture also has effects that are less conspicuous immediately. There is slight narrowing of the columella, caudal protrusion of the lobule, and minimal caudal rotation of the lateral crura. (2) The middle crura suture approximates the most anterior portion of the medial crura. There is greater strengthening of the tip and some approximation of the domes with this suture. (3) The interdomal suture approximates the domes and can equalize asymmetric domes. However, the entire tip may shift to the short side if there is a significant difference in the heights of the domes because of short lateral and medial crura. (4) Transdomal sutures narrow the domal arch while pulling the lateral crura medially. The net results are increased tip projection, alar rim concavity, and the potential need for an alar rim graft. In addition, depending on suture position, cephalic or caudal rotation of the lateral crura may be observed. (5) The lateral crura suture increases the concavity of the lateral crura, reduces the interdomal distance, and may retract the alar rims. Perhaps the most significant inadvertent results of this suture are caudal rotation of the tip and elongation of the nose. This is important because patients who undergo rhinoplasty would often benefit from cephalic, rather than caudal, rotation of the tip. (6) The medial crura-septal suture not only increases tip projection but also rotates the tip cephalically and retracts the columella. (7) The tip rotation suture shifts the tip cephalad while retracting the columella. (8) The medial crura footplate suture approximates the footplates, narrows the columella base, and improves undesirable nostril shape. (9) The lateral crura convexity control suture alters the degree of convexity of the lateral crura. The nuances of these sutures and their multiplanar effects on the nasal tip are discussed.     

Eustachian tube cartilage and medial movement of lateral pharyngeal wall on phonation

Several authors have demonstrated the importance of medial movement of the lateral pharyngeal wall in velopharyngeal closure upon phonation. However, it remains controversial what muscle is responsible for lateral pharyngeal wall movement and where is the main site of this movement. The purpose of this study was to address the above two unanswered questions. In 22 subjects (12 normal volunteers, 10 patients with cleft palate), lateral pharyngeal wall movement upon phonation was evaluated by using rapid magnetic resonance imaging (MRI). Before rapid MRI, their lateral pharyngeal wall movements were classified into three groups: the poor, moderate, and good, according to the findings of nasopharyngoscopy. Inward displacement of the eustachian tube cartilages upon phonation, which was quantified as distance ratio in the transverse plane of MR images, was compared with nasopharyngoscopic findings. In addition, the level of lateral pharyngeal wall movement was observed in the plane 5 mm lateral to the mid-sagittal plane of MR images. Inward displacement of the eustachian tube cartilage in the transverse plane of MR images was coincident with medial movement of lateral pharyngeal wall observed by nasopharyngoscopy in all 22 subjects. By using one-way analysis of variance, a statistically significant correlation was found between nasopharyngoscopic classification and distance ratio. The sagittal plane of MR images revealed that the main site of movement occurred at the level of the hard palate and above. It is concluded that medial movement of the lateral pharyngeal wall consists of inward displacement of the eustachian tube cartilage, which is caused by contraction of the levator veli palatini muscle, and that the primary site of this movement is at the level of the hard palate and above, where the eustachian tube, but not the superior constrictor muscle, exists.     

中国橄蝗属的分类研究（直翅目：蝗亚目：蝗总科）

本文对中国橄蝗属Tagasta Bolivar, 1905进行了系统的分类研究, 该属同似橄蝗属Pseudomorphacris Carl, 1916 近似, 其不同之处为前胸背板侧片后下角近乎直角, 后翅为红色或玫瑰色, 雄性尾须短而直, 不向上弯曲。本文共记述产于中国的橄蝗属7种, 包括1新种。并附该属中国已知7种的检索表。     

四川自贡晚侏罗世西蜀鳄一新种

记述了四川省自贡市汇东新区自贡市乳品厂发现的西蜀鳄一新种——周氏西蜀鳄(Hsisosuchus chowi sp.nov.)。新种区别于西蜀鳄已知种的特征是:鼻骨后部沿缝合线有一浅的纵凹,额骨的眶缘向上凸起成嵴,沿额骨缝合线也隆起成一微弱的纵嵴,上颞窝的内侧缘向上凸起呈明显的嵴,顶骨具一前中突,侧视颧骨腹缘呈明显的波曲状,眶后骨前侧角约90°,鳞骨后侧突特别拉长,向侧下后方伸展,使鳞骨侧缘明显向内侧弓曲,左右外枕骨的枕髁部分不相接,翼骨的腹中嵴源于翼骨主体部分,内鼻孔位置比较靠前。此外,齿骨外面和夹板骨腹面具有发达的沟和嵴状雕饰,夹板骨参与下颌联合的部分比较长,肩胛片异常扩展,乌喙骨远端宽于近端,肱骨头增厚并强烈向内侧扩展,三角肌嵴发达,桡侧腕骨具发达的尺骨突,尺侧腕骨远端宽于近端,6列荐前部腹部骨板和3列尾部腹部骨板,也可能是周氏西蜀鳄的衍生特征,但这些性状在大山铺西蜀鳄中情况不明,有待更多的材料来证实。杨钟健、周明镇(1953)在建立西蜀鳄属之初就已注意到西蜀鳄是一种特化的鳄类,认为西蜀鳄不仅将原始特征和进步特征混存于一身,而且还具有一些一般鳄类所没有的独特性质。以此为基础,他们建立了西蜀鳄科。目前西蜀鳄类动物发现并不多,仅有1属2种,即重庆西蜀鳄和大山铺西蜀鳄,而且材料不完整,特别是头后骨骼保存不理想。周氏西蜀鳄的发现不仅扩大了西蜀鳄类的分布范围,而且还增加了我们对这一特化鳄类的认识。     

Polarity determinants Tea1p, Tea4p, and Pom1p inhibit division-septum assembly at cell ends in fission yeast

Correct positioning of the cell-division plane is crucial for cell function in all organisms. The fission yeast Schizosaccharomyces pombe divides by utilizing an actomyosin-based contractile ring and is an attractive model for the study of cytokinesis. The metazoan anillin-related protein Mid1p stimulates medial assembly of the division septum by recruiting actomyosin-ring components to the medial cortex. Here, we describe an inhibitory mechanism, involving the cell-end-localized polarity determinants Tea1p, Tea4p/Wsh3p, and Pom1p (tip complex), which prevents division-septum assembly at the cell ends. While Mid1p and the tip complex are dispensable for cell viability, their simultaneous loss leads to lethality. The FER/CIP homology protein Cdc15p, which organizes the actomyosin ring and cell membranes during cytokinesis, is a candidate for regulation by the tip complex. Since dual regulation of division-site placement is also seen in nematodes, such regulation might be a general feature of eukaryotic cytokinesis.     

Mandibular fossa of fossil Australians

Many questions about the skeletal adaptations and morphology of hunter-gatherers on the Australian continent remain unanswered. One anatomical region receiving little research in Australian fossils to date is the mandibular fossa. Here we report a study of three size dimensions, three shape indices and three morphological (non-metric) features of the mandibular fossa in 11 fossil Australians comparing them with modern Australo-Melanesian samples. We find broad similarities in past and modern populations in this region. Early and modern Australians and modern Papua New Guineans have elongate, broad and shallow fossae. All three populations show similarity in articular tubercle size, but postglenoid tubercle and entoglenoid process sizes show unexpected affinities. We also test for the possible presence of temporal trends in mandibular fossa size among fossil Australians. Our analyses indicate that none are present.     

A modified Goldman nasal tip procedure for the drooping nasal tip

A modification of Irving Goldman's nasal tip procedure that borrows from the lateral crus to augment the height of the medial crus is described. Goldman's procedure has been modified by not including the vestibular skin with the segment of the lateral crus that is rolled medially to increase nasal tip projection, by adding a nasal septal cartilage strut between the medial crura for support when the medial crura are weak, and by maintaining a small separation caudally of the repositioned lateral crura at the new nasal dome to simulate a double nasal dome. This modified Goldman nasal tip procedure allows the surgeon to reshape the lower lateral nasal cartilage to increase nasal tip projection as an alternative to the use of a shield-type nasal tip graft, and at the same time it narrows the nasal tip with minimal resection of the lateral crus of the lower lateral nasal cartilage.     

T2 relaxation time measurements in tibiotalar cartilage after barefoot running and its relationship to ankle biomechanics

The influence of ankle kinematics and plantar pressure from mid-range barefoot running on T2 relaxation times of tibiotalar cartilage is unknown. This study aimed to quantitatively evaluate the T2 relaxation time of tibiotalar cartilage and ankle biomechanics following 5 km barefoot running. Twenty healthy runners (who had no 5 km barefoot running experience) underwent 3.0-Tesla magnetic resonance (MR) scans and assessment of running gait before and after 5 km barefoot running. Participants were divided into two groups consisting of marathon-experienced (n = 10) and novice (n = 10) with equal number of males and females in each group. Three musculoskeletal radiologists measured T2 relaxation times in 18 regions of the ankle cartilage: anterior zone, central zone, and posterior zone, or lateral, middle, and medial sections in the sagittal plane. Three-dimensional ankle kinetics, kinematics, and plantar pressure were all also assessed during barefoot running. In the novice group, the T2 relaxation time in the posterior zone of tibial cartilage (p = 0.001) and lateral section in both tibial (p = 0.02) and talar (p = 0.02) cartilage were significantly increased after barefoot running. Ankle kinematics exhibited significant changes in females. Plantar loading was shifted from the medial to lateral aspect after running. This included a significant reduction in the loading under the toes and the 1st, 2nd and 3rd metatarsals, with a significant increase under the 4th and 5th metatarsals and lateral midfoot. The results suggest that plantar pressure may directly lead to local increases in cartilage T2 signal, which was not associated with changes in ankle kinematics.     

A reappraisal of the genus Phyllodiaptomus Kiefer, 1936, with the description of P. wellekensae n.sp. from India,and a redescription of P. tunguidus Shen & Tai, 1964 from China (Copepoda,Calanoida)

Phyllodiaptomus wellekensae n. sp. is described from south India. In the female, the genital somite is dilated at the left proximal margin and armed with an extraordinarily large, somewhat curved, laterally-directed spine; the right genital spine is much smaller than the left one. The terminal claw of leg 5 has a secretory pore at its tip and a characteristic conveyor canal on its anterior surface. In the right male P5, the coxal plate is short and unique in shape. The basis is 1.3 times as long as wide, with a long, sinuous, hyaline lamella on its medial margin. The first exopodite segment is short and optuse at its outer distal corner. The second segment is rectangular and has a short, hyaline, spinous projection between the lateral spine and the terminal claw. The left P5 has a large, serrate, hyaline fan between its apical thumb and medial apical seta. P. tunguidus is redescribed based on material newly collected from three localities in China.     

Differential sensitivity of tongue areas and palate to electrical stimulation: a suprathreshold cross-modal matching study

A cross-modal matching procedure was used, in twelve subjects,to evaluate regional differences in suprathreshold sensitivityof the oral cavity to electrogustometric stimulation. Stimulationof five loci on each side of the oral cavity was performed:tongue tip (one cm from the midline), anterior tongue side (2.5cm from tip on lateral margin), posterior tongue side (regionof the foliate papillae), posterior medial tongue (one cm frommidline on circumvallate papillae), and soft palate (one cmfrom midline, one cm above superior pole of anterior palatinearch). The tip of the tongue was significantly more sensitivethan the other areas to electric stimulation, as evidenced bythe slope and absolute position of the psychophysical powerfunctions. Strong correlations were observed in the sensitivitymeasures across tongue loci and between tongue and palate sides.No effects of subject gender or mouth side were found.     

Compressive loading on bone surfaces from muscular contraction: an in vivo study in the miniature pig,Sus scrofa

Several authors have speculated that muscles contracting adjacent to bony surfaces may cause compressive loads against the bone and thus influence skull development. This study was undertaken to evaluate the premise of this argument. A flat, semiconductor pressure transducer was surgically placed on bony surfaces beneath muscle attachments. Pressures were recorded during normal mastication (n = 7) and while overlying muscles were stimulated in anesthetized pigs (n = 15). The transducer was highly specific; no pressure was recorded in quiescent or passively stretched muscles or when other muscles were stimulated. Contraction of the overlying muscles exerted high normal loads on the bone, always exceeding systolic blood pressure (16 kPa). Temporal fossa pressure during mastication followed temporalis electromyographic (EMG) signals with a lag period approximating the twitch contraction time. When three different sites were compared in anesthetized animals, compressive load was highest on the temporal fossa (111.4 ± 56.5 kPa, n = 15), intermediate on the mandibular angle (58.4 ± 28.3 kPa, n = 4), and lowest on the medial side of the zygomatic arch (37.2 ± 19.7 kPa, n = 15). Pressure amplitudes were not related to body size or relative muscle size. Muscle complexity and compartmental constraints did appear to influence pressure. Disruption of the external aponeurosis of the masseter decreased pressure on the mandibular angle by 45%, confirming the importance of tendinous constraint in determining pressure production. Thus, contracting muscles exert substantial but site-specific compressive loads on adjacent bone surfaces. J. Morphol. 238:71–80, 1998. © 1998 Wiley-Liss, Inc.     

Principles and techniques of bilateral complete cleft lip repair

Important principles for repair of bilateral complete cleft lip are symmetry, primary orbicularis continuity, proper prolabial size and shape, median tubercle and mucocutaneous ridge formation from lateral lip tissue, and early construction of nasal tip and columella with anatomic placement of the alar cartilages. A two-stage repair employing techniques based on these concepts is described. At the initial procedure, the lateral crura are positioned and a tiny biconcave prolabium is shaped in anticipation of the changes with growth. The second stage (nasal correction) includes apposition of the alar genua, medial crural relocation, and intranasal transposition of banked forked flaps without disjunction of the columella-labial angle. The complete bilateral cleft lip is a four-dimensional problem.     

Rescue of an in vitro palate nonfusion model using interposed embryonic mesenchyme

The authors previously established an in vitro palate nonfusion model on the basis of a spatial separation between prefusion embryonic day 13.5 mouse palates (term gestation, 19.5 days). They found that an interpalatal separation distance of 0.48 mm or greater would consistently result in nonfusion after 4 days in organ culture. In the present study, they interposed embryonic palatal mesenchymal tissue between embryonic day 13.5 mouse palatal shelves with interpalatal separation distances greater than 0.48 mm in an attempt to "rescue" this in vitro palate nonfusion phenotype. Because no medial epithelial bilayer (i.e., medial epithelial seam) could potentially form, palatal fusion in vitro was defined as intershelf mesenchymal continuity with resolution of the medial edge epithelia bilaterally. Forty-two (n = 42) palatal shelf pairs from embryonic day 13.5 CD-1 mouse embryos were isolated and placed on cell culture inserts at precisely graded distances (0, 0.67, and 0.95 mm). Positive controls consisted of shelves placed in contact (n = 6). Negative controls consisted of shelves placed at interpalatal separation distances of 0.67 mm (n = 6) and 0.95 mm (n = 7) with no interposed mesenchyme. Experimental groups consisted of embryonic day 13.5 palatal shelves separated by 0.67 mm (n = 11) and 0.95 mm (n = 12) with interposed lateral palatal mesenchyme isolated at the time of palatal shelf harvest. Specimens were cultured for 4 days (n = 19) or 10 days (n = 23), harvested, and evaluated histologically. All positive controls at 4 and 10 days in culture showed complete histologic palatal fusion. All negative controls at 4 days and 10 days in culture remained unfused. Five of six palatal shelves separated at 0.67 mm interpalatal separation distance with interposed mesenchyme were fused at 4 days, and all five were fused at 10 days. At an interpalatal separation distance of 0.95 mm with interposed mesenchyme (n = 12), no palates (zero of four) were fused at 4 days, but seven of eight were fused at 10 days. These data suggest that nonfused palatal shelves can be "rescued" with an interposed graft of endogenous embryonic mesenchyme to induce fusion in vitro.     

Identifying the Functional Flexion-extension Axis of the Knee: An In-Vivo Kinematics Study

Purpose

This study aimed to calculate the flexion-extension axis (FEA) of the knee through in-vivo knee kinematics data, and then compare it with two major anatomical axes of the femoral condyles: the transepicondylar axis (TEA) defined by connecting the medial sulcus and lateral prominence, and the cylinder axis (CA) defined by connecting the centers of posterior condyles.

Methods

The knee kinematics data of 20 healthy subjects were acquired under weight-bearing condition using bi-planar x-ray imaging and 3D-2D registration techniques. By tracking the vertical coordinate change of all points on the surface of femur during knee flexion, the FEA was determined as the line connecting the points with the least vertical shift in the medial and lateral condyles respectively. Angular deviation and distance among the TEA, CA and FEA were measured.

Results

The TEA-FEA angular deviation was significantly larger than that of the CA-FEA in 3D and transverse plane (3.45° vs. 1.98°, p < 0.001; 2.72° vs. 1.19°, p = 0.002), but not in the coronal plane (1.61° vs. 0.83°, p = 0.076). The TEA-FEA distance was significantly greater than that of the CA-FEA in the medial side (6.7 mm vs. 1.9 mm, p < 0.001), but not in the lateral side (3.2 mm vs. 2.0 mm, p = 0.16).

Conclusion

The CA is closer to the FEA compared with the TEA; it can better serve as an anatomical surrogate for the functional knee axis.     

Quantitative assessment of osseous, ocular, and periocular changes after hypertelorism surgery

The purpose of this study was to develop a methodology to quantify osseous, ocular, and periocular fat changes caused by correction of orbital hypertelorism to test the hypothesis that there is a quantitatively predictable relationship between the movement of the osseous orbit and that of the ocular globe. A retrospective review was performed of 10 patients who were status post unilateral or bilateral transcranial medial orbital translocation, for whom there were archival digital data for preoperative and postoperative (mean interval = 30 months) three-dimensional computed tomographic (CT) scans. In addition to standard demographic and surgical data, the clinical preoperative and postoperative interpupillary and intermedial canthal distances were recorded. By using a computer graphics workstation, the CT digital data were registered to four surgically unaltered anatomic fiducial points to allow longitudinal quantitative comparisons. The following three-dimensional measurements were made for each patient preoperatively and postoperatively: interdacryon and interocular centroid distances, and on a standard series of three horizontal and two vertical planes, the position of the medial and lateral orbital walls, and the thickness of the medial and lateral periorbital fat (20 orbits). CT digital distances were compared with similar clinical distances when possible. The age at operation ranged from 4.0 to 12.5 years (mean, 6.6 years). The reduction in interdacryon distance exceeded the reduction in intercentroid distance (mean interdacryon change = -5.3 mm versus mean intercentroid change = -2.7 mm). Although there was a strong correlation between the amount of reduction of the lateral orbital wall and intercentroid distances, there was only a moderate correlation between the reduction in the intercentroid distance and that of the medial orbital wall. Similarly, there was a moderate correlation between the decrease in thickness of the lateral periorbital fat and the reduction of intercentroid distance but not of the medial orbital fat. In conclusion, medial translocation of the orbit does not produce equivalent movement of the ocular globe; neither the intermedial canthal nor the interdacryon distance is a useful predictor of ocular centroid position; and if the goal of hypertelorism operation is reduction of interocular distance, then CT measurement of globe intercentroid distance is essential for outcome assessment.