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Surgery of the nasal tip has stimulated the creation of more surgical techniques than any other aspect of rhinoplastic surgery, to achieve an improved shape that seems natural while enhancing the balance and harmony of the face. The region described as tip of the nose is extremely varied from person to person, because of the different shape of its anatomical structures. For that reason to obtain a good result is necessary for the surgeon the perfect knowledge of the anatomy, the acquisition of surgical concepts and technical skill. The purpose of this paper is to describe the anatomy, the surgical technique and the principal method to correct the most common defects of the nasal tip; some of these proposed by many Authors are also discussed critically. Concerning the anatomy, the Authors describe the upper and the lower lateral cartilages, the lateral and medial crura of the alar cartilages, that form the "dome", the sesamoid complex: smaller cartilage that support the lateral crus, the septum cartilage, their ligaments and the maxillary spine. Are also exposed some concepts regarding the weak triangle of Converse and, in general, the soft tissues of the nasal tip. They also described some basilar incisions to approach the tip cartilage: marginal, intercartilaginous, intracartilaginous and transfixion. This surgical techniques allow to modified the cartilages that can be corrected in different manner. Some of these modifications concerning alar cartilages, septal cartilage, area of dome cartilage, and the most common techniques to operated on it, eversion and luxation, are also exposed. The last part of the paper concerning: a) the exposition of some anesthetical problems and their surgical approach; b) the description and discussion of some surgical techniques proposed in the literature by many Authors. Regarding the most common necessities to modified the nasal tip we include: a) to change the tip projection: in its two opposite directions, increasing and decreasing, where the first purpose is one of the most difficult objectives in tip surgery, using the medial cruras or in more difficult cases a colummellar strut; b) to reduce tip fullness, that normally requires a partial resection and/or a weakening of the lateral crura; c) to alter tip rotation: normally to obtain a upward, rarely for a down ward rotation to increase the length of the nose. In this case all these modifications are described following the theoretical concept of tripod, where the nasal tip is considered mechanically as a tripod with a lower leg represented by the medial crura and the two upper legs of the two lateral cruras.

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Septorhinoplasty plays an important role in childhood, particularly from the functional point of view. In fact, normal nasal respiration makes it possible to develop physical harmony throughout the entire body, particularly within the facial area. Nasal respiration serves as a defense mechanism, filtering air, thus relieving the lower respiratory tract of some work during the episodes of upper aero-digestive tract infection and inflammation so typical of childhood and early adolescence. The surgical indications should consider the central points in nasal surgery in childhood: there must be marked functional compromise; the aesthetic defect, if present, must be highly evident; the surgical treatment must be as limited and focused as possible as to prevent interfering with subsequent development of the nose, paranasal sinuses and facial structures. In those cases where the above conditions are not found, it is advisable to postpone surgery until the child has reached 16 years of age, when the development of the nasal and facial skeleton has been completed.

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Fine-needle aspiration biopsy is of particular interest in the parotid sites because, here, pathology with different treatments and prognosis manifest themself in the same way. The preoperative diagnosis of neoplasm is often problematic. As is known, this is correlated to several factors including histology, clinical and instrumental semiology. The instrumental image techniques (sialography, thermography, scintigraphy, ultrasound diagnosis, tac sialo-tac) give information as to size and location of the mass in question. Only rarely does it give any indication of whether the mass is malignant or benign. The authors systematically studied 386 parotid tumors. The method utilises a traditional technique (needle n. 12/2 gauge 1/4) and microscope examination with immediate dyeing to verify the correctness of the sample. 352 cases underwent surgery with subsequent histological verification. The results demonstrated a generical concordance of cytology and histology in the diagnosis of malignancy equal to 95%. The concordance of exact histology was 91%. The discordance regards, above all, the malignant neoplasm and particularly the mucoepidermoide and the adenoid cystic carcinoma. Fine needle aspiration demonstrates absolute specificity in the differential diagnosis between parotid and extraparotid pathology.

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Nasal and paranasal sinus tumors extending through the cribriform plate to the overlying dura of the frontal lobe can be successfully treated by anterior craniofacial resection. During the period from 1986 to 1990, 14 patients (11 males, 3 females, age 18-67) with nasal/paranasal tumors extended to the nasal basis underwent craniofacial resection. From a histological point of view these patients were classified as follows: --8 adenocarcinomas --2 squamous cell carcinomas --2 esthesioneuroblastomas --1 cylindroma --1 haemangiopericytoma. In 6 of the 14 patients post-operative complications were encountered, 3 being resolved. Radical surgery was realised in 12 cases; post-operative radiotherapy was performed in 7. No contraindications were found because of previous chemo- and/or radiotherapy, even if it had been performed as treatment. Four of the patients died because of recurrences between the 6th and 20th month after surgery; 5 patients (all adenocarcinoma subjects) are disease-free respectively 8, 16, 17, 22 and 24 months after surgery.

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For an operation as technically demanding as rhinoplasty, surprisingly few studies have examined the results of this procedure. A retrospective study was, therefore, made of 5470 patients who had undergone rhinoplasty, performed by different surgeons, from 1970 to 1989. The patients were followed up for a minimum of one year. As for all forms of surgery, aspecific complications such as infections, hemorrhage and side-effects from anesthesia will occasionally occur but, fortunately, such cases are quite rare. The specific classification included both early and late complications. Post-rhinoplasty failures may be estimated at approximately 28% of all cases; this figure taking into account typical deformities, both minor and severe, as well as functional sequelae and patient dissatisfaction. Approximately 4% have required secondary procedures. Some causes for failure derive from patient characteristics; for example, the importance and complexity of initial deformity are, of course, partly responsible, particularly after trauma. The skin quality (i.e. thickness, or whether it is fatty or loose) also affects the results. Furthermore, uncontrollable factors inherent to healing (i.e. excessive scar contraction in the intranasal area, connective tissue hyperplasia, particularly at the tip, and periosteal proliferation either to the osteotomy site or over the nasal dorsum) can all lead to residual deformities. Nevertheless, most failures can be attributed the operator. The commonest mistakes are linked to cartilaginous dorsum and nasal tip (approx. 22%). There are several polymorphic deformities the main sites of which should be known well in order to prevent, or at least reduce, such risks.

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The effects of hypotensive drug urapidil on human platelet functions were investigated. Urapidil failed to evidence direct aggregating properties or potentiating effects. Furthermore, drug high concentrations inhibited the platelet response to ADP, PAF, collagen, adrenaline and bovine thrombin, and influenced the platelet release reaction induced by ADP and PAF. Data indicate that urapidil possesses negligible agonistic effects on human platelet alpha 2-adrenoceptors and interferes at high concentrations with the platelet activation, as evidenced for other anti-aggregating compounds.

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