Otolaryngologic Clinics of North America

Finesse in Caucasian Endonasal Rhinoplasty The nasal anatomy of Caucasian people includes thin skin, limited soft tissue volume, a high dorsum, strong cartilaginous framework, and narrow elliptical nasal inlets. A smooth dorsal contour, a well-defined tip, a naturally soft-feeling tip, and a functionally patent nasal valve constitute key objectives for Caucasian rhinoplasty. The author's focus on minimal-impact surgery has resulted in multiple novel techniques, embedded in a coherent algorithmic concept termed the S.O.F.T. (surgery and ongoing care free of trauma) concept. The foundation is the endonasal operation for the entire spectrum of primary and secondary deformities and maximal preservation of anatomic structures.

Concepts of Facial Aesthetics When Considering Ethnic Rhinoplasty Facial plastic surgeons must understand nasal aesthetics in the context of race, ethnicity, and culture. The lack of aesthetic norms and ideal standards in non-Caucasian patients and the variation in nasal anatomy and morphology among races can create a challenge in approaching ethnic rhinoplasty. Preoperative assessment of nasal and facial features that contribute to a nose that is unpleasing for a non-Caucasian patient cannot be based on neoclassical canons. This article describes the concepts of facial aesthetics important to approaching ethnic rhinoplasty. Understanding these features will allow the surgeon to achieve nasal symmetry and improved definition without effacing ethnicity.

Use of Nasal Implants and Dorsal Modification When Treating the East Asian Nose Dorsal augmentation and tip surgery are essential procedures for East Asians seeking rhinoplasty, because they generally have thicker skin and poorly developed nasal dorsum and tip. For dorsal augmentation, many Asian surgeons prefer using alloplastic material, like silicone, Gore-Tex, and filler injection, for cost-effectiveness, easy handling, and short operation times. Compared with autologous implant materials, the use of synthetic implant is suggested to be associated with many complications, such as infection, extrusion, and deviation. However, even with the use of the autologous material, problems such as reabsorption after grafting, donor site complications can take place.

Surgical Considerations in Patients of Middle Eastern Descent Rhinoplasty in patients of Middle Eastern descent presents a unique challenge. There are a large number of variations of skin tone, skin thickness, and structural deformities, which require a high degree of thoughtfulness and planning. A thorough history and physical examination is the cornerstone to achieving a good result. An open and honest discussion is necessary to fully understand the patient’s goals. The surgeon should clearly define which goals are achievable and which are not. Conservative techniques will help achieve a natural, balanced outcome and will allow for preservation of nasal function.

History of Cranial Nerve–Implanted Stimulators in Otolaryngology This article aims to clearly understand the historical development of cranial nerve–implanted stimulators in otolaryngology. The authors also discuss cranial nerve history; initial theory of the functional concept of animal spirit; electrical nerve impulse theory; first electrical otolaryngology cranial nerve stimulation devices; and the development of implanted stimulators.

Hypoglossal Nerve (Cranial Nerve XII) Stimulation Hypoglossal nerve stimulation is a novel strategy for the treatment of obstructive sleep apnea (OSA). Its anatomy allows for easy surgical access, and its function as a motor nerve allows for tolerable neurostimulation. It has shown success as a therapy for the treatment of OSA with a greater than 80% success rate. Patients who use the device not only show improvement in symptoms but also tolerate the device well with high rates of adherence to therapy as well as a high majority preferring it over continuous positive airway pressure therapy.

Brain-Nerve-Computer Interfaces in Otolaryngology Otolaryngologists are concerned with form and function of delicate, intricate structures. Until relatively recently, if a nerve could not be sewn back together or grafted, its function could not be restored. This issue of Otolaryngologic Clinics of North America, devoted to Cranial Nerve Stimulation in Otolaryngology and guest edited by Dr Michael Ruckenstein and Dr James Naples, looks at our specialty as it extends past cranial nerve deficits to reach new frontiers of reactivation, of incorporating biomedical technology to the patient experience.

Cranial Nerve Stimulation for Olfaction (Cranial Nerve 1) Like sensory maps in other systems, the sense of smell has an organizational structure based on converging projections of olfactory receptor neurons containing unique odorant receptors onto the olfactory bulb in synaptic aggregations termed glomeruli. This organizational structure provides the potential for electrical stimulation and restoration of smell. Prior animal and human studies support the feasibility of an olfactory stimulation device, encouraging ongoing work in development of olfactory implants.

Special Considerations in Patients with Cranial Neurostimulatory Implants Over the past 50 years, incredible progress has been made with implantable devices. Management can become complex, as unique issues arise with interaction of these devices with other devices and technologies. The cochlear implant (CI) is the most commonly implanted device in the head and neck. Because of its internal magnet, CIs can interfere with MRI, causing imaging artifacts, pain, and device complications. Other implants demonstrate similar issues with imaging and co-implantation. This article provides an overview of special considerations regarding neurostimulation devices within the head and neck. We focus on interactions between implantable devices and other technologies or devices.

Vagal Nerve Stimulation Vagal nerve stimulation (VNS) therapy is a surgical treatment that involves the implantation of a device to electrically stimulate the vagus nerve. It is indicated as an adjunctive treatment of epilepsy that is refractory to antiepileptic medications and for treatment-resistant depression. The exact mechanism by which VNS achieves its effects is not known, but various mechanisms have been proposed, including afferent vagal projections to seizure-generating regions of the brain and desynchronization of hypersynchronized cortical activity. The most common complications of VNS therapy include hoarseness, throat pain/dysphagia, coughing, and shortness of breath.