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OBJECTIVE: In this article, we present our academic experience with the reconstruction of the dorsum and nasal tip by folded paramedian forehead flap described by F.J. Ménick (LFPP). We take a closer look at the technical aspects of this surgical technique and the aesthetic results at the donor sites. We compare our surgical technique with those reported in the literature. MATERIAL AND METHOD: A monocentric retrospective study was carried out on patients operated on by LFPP for surgical reconstructions of the nasal dorsum and nasal tip between January 2017 and December 2022. In each case, we analysed the typology of the type of substance loss for reconstruction, the type of reconstruction and the aesthetic result of reconstruction. A satisfaction survey on the aesthetic and functional results was sent to patients who had undergone LFPP reconstruction at 6 months post-op. RESULTS: There was no necrosis, even partial in any of the 17 cases of LFPP reconstruction. The average size of the substance loss was 3.5±0.6cm [2.5-5]. The number of aesthetic subunit (SUE) to be reconstructed was 2.6±0.9 [1-4]. The etiologies of substance loss were mainly related to skin tumors, including 58% basal cell carcinoma basal cell carcinoma (n=10), 24% squamous cell carcinoma (n=4), 6% adenoid cystic carcinoma adenoid cystic carcinoma (n=1) and 12% melanoma (n=2). The patients were very satisfied overall, both from a functional point of view with a questionnaire result of 89% (8.94±1.98 [2-10]), aesthetic, with a result of 87% (8.76±1.75 [3-10]). CONCLUSION: Among the various techniques for reconstructing the nasal pyramid, including paramedian 2-stage paramedian forehead flaps combined with a local flap of the internal lining, the technique of reconstruction described by J.F. Menick using a 3-stage paramedian folded flap is the most reliable option for complex nasal reconstructions with low donor-site morbidity.

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Facial gunshots injuries remain challenging and present functional and aesthetic problems. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and the maxilla is especially delicate because it requires reconstitution of the facial buttresses, and replacement of bony hard palate, based on occlusion, as well as the restoration of the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue and bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. The scapula dorsal perforator flap is used in the case of a patient to successfully reconstruct the palate, the maxilla and the nasal pyramid in one stage. Free tissue transfer using thoracodorsal perforator flaps and scapula bone free flap have been already described in literature but never to perform the nasal pyramid reconstruction at the same time. Good functional and aesthetic results have been obtained in this case. This article also reviews, through the authors experience and literature, anatomical landmarks, indications, technical surgical tricks, advantages and disadvantages of this flap for palatal, maxillary and nose reconstruction.

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Historical mining left a legacy of abandoned mines and waste rock in remote headwaters of major river systems in the western United States. Understanding the influence of these legacy mines on culturally and ecologically important downstream ecosystems is not always straightforward because of elevated natural levels of mineralization in mining-impacted watersheds. To test the ecological effects of historic mining in the headwaters of the upper Salmon River watershed in Idaho (USA), we measured multiple community and chemical endpoints in downstream linked aquatic-terrestrial food webs. Mining inputs impacted downstream food webs through increased mercury accumulation and decreased insect biodiversity. Total mercury (THg) in seston, aquatic insect larvae, adult aquatic insects, riparian spiders, and fish at sites up to 7.6 km downstream of mining was found at much higher concentrations (1.3-11.3-fold) and was isotopically distinct compared with sites immediately upstream of mining inputs. Methylmercury concentrations in bull trout and riparian spiders were sufficiently high (732-918 and 347-1140 ng MeHg g-1 dry wt, respectively) to affect humans, birds, and piscivorous fish. Furthermore, the alpha-diversity of benthic insects was locally depressed by 12%-20% within 4.3-5.7 km downstream from the mine. However, because total insect biomass was not affected by mine inputs, the mass of mercury in benthic insects at a site (i.e., ng Hg m-2 ) was extremely elevated downstream (10-1778-fold) compared with directly upstream of mining inputs. Downstream adult aquatic insect-mediated fluxes of THg were also high (~16 ng THg m-2 day-1 ). Abandoned mines can have ecologically important effects on downstream communities, including reduced biodiversity and increased mercury flux to higher order consumers, including fish, birds, and humans. Environ Toxicol Chem 2022;41:1696-1710. Published 2022. This article is a U.S. Government work and is in the public domain in the USA.

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INTRODUCTION: The aesthetic reconstruction of full thickness defects of the entire ala is difficult because of its complex tridimensional anatomy. The triplan reconstruction of this unit which includes: -a lining with a mucosal flap, -a sculptured cartilage framework imitating the anatomy of the opposite ala -and a skin coverage by an immediate defatted forehead flap, gives regularly a very good aesthetic results, superior to the ones obtained by other techniques. PATIENTS AND METHODS: From may 2008 to December 2020, 26 patients aged between 49 and 78 years old have benefited from this triplan aesthetic reconstruction after an excision of evolved basal cell carcinomas interesting the ala unit. The defects resulting were located in the entire ala with slight extension to the adjacent units. In all cases, the lining was reconstructed by the BURGET'S homolateral septal mucosal flap. The shape of the ala was obtained by a precise sculpture of conqual cartilage, taking the opposite ala as the model. The cutaneous coverage was provided by a paramedian forehead flap tailored exactly to the defect's size and immediately defatted. RESULTS: With a mean follow up of 8 years, all the reconstructed ala were quasi symmetrical to the opposite ones with a very good shape of the new nostrils. No complications and no tumoral recurrence are reported. CONCLUSION: This triplan reconstruction of the entire ala's defects is really aesthetic and gives a natural look for the lower third of the nose.

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BACKGROUND: The Face is the most frequent localization for cutaneous carcinoma. The nose accounts for about 30% of these tumors. Nose tissue loss repair has to pursue 3 types of objectives: carcinologic, aesthetic and functional. The aim of this article is to identify a decision tree to guide the choice of surgical reconstruction technique based on localization and size of the defect. PATIENTS AND METHODS: We performed a retrospective analysis in Angers' CHU from 2013 to 2019 including 229 patients referred for cutaneous tumors excision in need of reconstruction. We analyzed the type of reconstruction, size of the tissue loss and localization of the defect in terms of nose aesthetic subunits. RESULTS: Among the 229 patients included, the most frequent localization was nose tip (32%). 44% of patients were reconstructed with skin grafts or composite graft, 56% with flaps (48% local flaps and 4% association of both methods). Limited central resections of nose tip were reconstructed with skingraft. The Rybka flap and bilobed flap were the preferred choice for lateral reconstruction of nose tip. Largest tip defects were reconstructed using Rieger flap or forehead flap. The dorsum was often reconstructed with local flap: glabellar on the upper part, Rieger on the lower part. Lateral side was perfectly reconstructed with island flap. Nose wings needed framework: composite graft was the judicious choice in case of limited tissue loss whereas forehead flap with framework or Schmid-Meyer flap were chosen for larger defects. CONCLUSION: Our past experience in nasal reconstruction has provided us with an original decision tree to guide surgeons in choosing the right reconstruction technique according to the size and localization of the defect.

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Fortunately, traumatic total amputations of the nose are rare, especially in children. Their reconstructions generally require several operative steps, most often associating cartilaginous grafts (rib and/or concha), a free radial antebrachial flap for mucosal reconstruction and a frontal flap for the skin covering. These are therefore long and complex procedures requiring a trained surgical team and maximum patient adherence to their treatment plan. The clinical case described is that of an 11-year-old child presenting a sub-total amputation of the nose and having undergone reconstruction with skin expansion of the frontal flap due to a horizontal frontal scar of unknown origin and a particularly low hair implantation.

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Environmental odor studies are usually done using two approaches: nuisance impact assessment and source identification. The latter may be done using chemical analysis or sensory analysis. While sensory analyses offer many advantages, they also face the main obstacle: odor nature description still uses conventional methods based on subjective evocations as odor descriptors. This makes the sensory method ineffective especially when the expected outcome is the source identification in the context of an industrial accident. This work wants to fulfill this gap proposing to build an objective database including the odor nature description of selected potentially emitted compounds using a promising approach: the Langage des Nez® (LdN). Using definite odorous compounds as odor referents, this work provides the odor nature description of 44 compounds, reported as potential incidentally released chemical compounds in the industrial zone of Le Havre. The city of Le Havre, France, was chosen as a model due to a history of odorous emissions of industrial origins. A trained panel described the odor of each compound using up to three referents of the LdN referents collection and attributed a score to each referent. A data analysis method was developed based on the frequency of citation of the referents and the attributed scores allowing the categorization of each compound in three types of consensus categories. The data analysis results showed that around 80% of compounds were described with a good consensus, showing the LdN as a well-adapted lexicon. This study does not point to any correlation between the chemical structures of the compounds of interest and their relative referents. When compared to conventional methods, LdN revealed a more objective and precise approach. The proposed experimental method and the results provided in this work offer the first insight for time-efficient approaches to objectively describe environmental odors, especially potentially emitted odors during incidents. This work may be supplemented by abatement and mixture effect investigations for a complete understanding of odor dispersion.

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The birth of rhinoplasty in the West was driven by a great demand for reconstruction of noses destroyed voluntarily or not, post-traumatic or medical. Two men emerge strongly through their work and writings: Gaspare Tagliacozzi for the brachial flap and Joseph Carpue for the frontal flap. Both of them describe a different method but based on the same skin flap principles. But were they really the first? History tells us that other, more anonymous people before them had used these same methods on a large scale but without leaving any conclusive or very significant written trace. The use of flaps or grafts, methods, which are the true pillars of plastic surgery, opened up perspectives much wider than the nose. But history has retained the name of these two men through their writings. If they were not the precursors, they were nevertheless promoters, laying the foundations of modern plastic surgery and promoting the spread of these great principles throughout the world.

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Pseudogymnoascus destructans, the fungal pathogen that causes white-nose syndrome, has killed millions of bats across eastern North America and continues to threaten new bat populations. The spread and persistence of P. destructans has likely been worsened by the ability of this fungus to grow as a saprotroph in the hibernaculum environment. Reducing the environmental growth of P. destructans may improve bat survival. Volatile organic compounds (VOCs) are attractive candidates to target environmental P. destructans, as they can permeate through textured environments that may be difficult to thoroughly contact with other control mechanisms. We tested in hibernaculum sediment the performance of VOCs that were previously shown to inhibit P. destructans growth in agar cultures and examined the inhibition kinetics and specificity of these compounds. Three VOCs, 2-methyl-1-butanol, 2-methyl-1-propanol, and 1-pentanol, were fungicidal towards P. destructans in hibernaculum sediment, fast-acting, and had greater effects against P. destructans than other Pseudogymnoascus species. Our results suggest that use of these VOCs may be considered further as an effective management strategy to reduce the environmental exposure of bats to P. destructans in hibernacula.

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As a very challenging surgery, primary rhinoplasty can lead to secondary. After a primary, patient's concerns can sometimes be pretty easy to fix (remaining bump), but may some other request long and very difficult surgeries (short nose). This article describes the most common reasons of secondary rhinoplasties and provides, for each of them, a surgical treatment.

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INTRODUCTION: The mouth plays an important role in the overall aesthetic appearance of the face. The aims of this study were to determine the optimal antero-posterior (AP) lip position relative to various rotations of the nasal tip and assess the impact of the nasolabial angle on facial aesthetics. MATERIAL AND METHODS: Three-dimensional facial volumes, in motion, of one Caucasian male and one Caucasian female with a Class I malocclusion and an orthognathic profile were modified to alter the nasal tip rotation (3 rotations) and the AP lips position (6 positions). 72 generated models were created in two and three-dimensions. Generated models were rated online by 60 dentists, 60 orthodontists and 60 laypeople, using a Visual Analogue Scale. Scores were analysed according to lip position, rater's profession and gender. RESULTS: General agreement was found between all groups on the most and least preferred lip positions. No differences between male and female raters were found. All raters were more influenced by the 3-dimensional rotating facial volume than by 2-dimensional angles. Similar angular values for the nasolabial angles were found in the most and least preferred profiles, showing that the most influential factor in facial aesthetics was the lip position, and stressing the need to evaluate each component of the nasolabial angle independently. CONCLUSION: The lip position was the determinant factor in facial aesthetics with little influence of the nose tip rotation. Three-dimensional evaluation of the nose and lip were needed to establish a soft tissue-based treatment plan.

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The restoration of voluntary muscle activity in posttraumatic paraplegia in both animal experiments and other clinical applications requires reproducibility of a technically-demanding microsurgical procedure, limited by physicians' understanding of Brunelli's spinal cord grafting paradigm. The insufficient clinical investigation of the long-term benefits of the CNS-PNS graft application warrants additional inquiry. The objective of this study is to explore the potential benefits of the first replicated, graft-induced neuroregeneration of denervated skeletal muscle regarding long-term clinical outcomes and to investigate the effect of Cerebrolysin on neuromodulation. A randomized study evaluating 30 rats, approved by the National Animal Ethics Advisory Committee was performed. The medication was administered postoperatively. For 14 days, 12 rats received Cerebrolysin (serum), 11 received NaCl 0.9% (shams), and 7 were controls. For microsurgery, the lateral corticospinal tract T10 was grafted to the denervated internal obliquus abdominal muscle. On day 90, intraoperative proof of reinnervation was observed. On day 100, 15 rats were euthanized for fixation, organ removal, and extensive histology-morphology examination, and the Wei-Lachin statistical procedure was employed. After an open revision of 16 rats, 8 were CMAP positive. After intravenous Vecuronium application, two (Cerebrolysin, NaCl) out of two rats showed an incomplete compound muscle action potential (CMAP) loss due to glutamatergic and cholinergic co-transmission, while two others showed a complete loss of amplitude. Cerebrolysin medication initiated larger restored muscle fiber diameters and less scarring. FB+ neurons were not observed in the brain but were observed in the Rexed laminae. Brunelli's concept was successfully replicated, demonstrating the first graft induced existence of cholinergic and glutamatergic neurotransmission in denervated grafted muscles. Statistics of the histometric count of muscle fibers revealed larger fiber diameters after Cerebrolysin. Brunelli's CNS-PNS experimental concept is suitable to analyze graft-neuroplasticity focused on the voluntary restoration of denervated skeletal muscles in spinal cord injury. Neuroprotection by Cerebrolysin is demonstrated.

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Rhinitis and asthma are common diseases that are strongly linked from both the epidemiological and patho-physiological point of view. A precise aetiological diagnosis is required in order to optimize treatment. Nasal provocation tests (NPT) determine precisely the role of the allergen in the initiation of the symptoms of rhinitis particularly when the history does not produce convincing evidence of the clinical relevance of an allergen. It may also have important consequences for the choice of an allergenic immunotherapy. NPT are not standardized but simple methods based on international recommendations provide us with good diagnostic accuracy. In this paper, we will discuss the practical aspects of NPT as well as the clinical or research situations where they may be useful for the respiratory physician.

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AIM OF STUDY: Five cases of the same congenital malformation of the nose, affecting the nasal dorsum and the supra-tip, were supported in our university plastic surgery center. This malformation has not been described in the literature known to the authors. The aim of this study is to analyze this nasal deformity. PATIENTS AND METHODS: Five children presented this congenital deformity between 1994 and 2014. The patients were examined and the malformation precisely described. Genetic and histological examinations were carried on. The diagnosis and treatment of this pathology were discussed. RESULTS: This malformation associated 4 anomalies: hypertrophy of soft tissue of the dorsum located in the middle third of the nasal bridge, deformed alar cartilages turned back downward and outside, advanced support default and median skin brand similar to a scar. These patients showed no other abnormalities of the midline or respiratory disorders. No genetic disorder was found for these five patients, and no histological arguments were found. Three patients were operated, one until adulthood with a satisfying cosmetic result. CONCLUSION: Bibliographic research has not allowed us to make an accurate diagnosis of this malformation that appears to be non-syndromic and to have a genetic origin. Our therapeutic approach became more clear and it now seems legitimate to propose early excision of fat mass to prevent alar deformations, associated with a cortico-cancellous graft, which in our experience grows with age, to support the tip.

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For 18 years our protocol has corrected the cleft lip nose and achieved an intravelar veloplasty at the time of the first operation, leaving the least scaring as possible. No doubt that the best treatment of the sequellae is their prevention: - the oro-nasal fistulas have disappeared; the nostril is almost normal; the continuity of a wide maxillary arch is restored in primary dentition - all that favor a nasal ventilation. This context has changed the nature of the secondary treatment described here. When lip and nose are not good enough we must address the residual deformities with the primary surgery principles. The velopharyngeal insufficiency calls for a velar re-repair and the pharyngeal depth is to be reduced by lipofilling. The rare cases of failure are improved by an Orticochea sphincteroplasty.

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Pelger-Huet anomaly is usually autosomal dominant, although it is likely that new mutations are common. This condition is characterized by granulocytes that are either bilobed or completely unsegmented. Here is a report of a 46 year old Indian lady who presented with fever to the hospital and on evaluation, her peripheral blood smear showed extreme hypolobation of granulocytes. Along with normal appearing neutrophils there were many neutrophils with bilobed and single monolobated nuclei which accounted for 82 % of the neutrophils. After identifying these neutrophilic abnormalities which were suggestive of Pelgeroid changes, the other family members were also screened and were found to be having similar morphologic abnormalities in granulocytes. As these changes were evident in granulocytic leucocytes of the patient as well as her mother, both her sisters and her son, with exception of her brother, the diagnosis of familial Pelger-Huet Anomaly was considered in this case.

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If the multiplicity of functional protocols of cleft lip and palate treatment has been bewildering, it is now a source of learning. The lessons we can draw from them assist us to choose the best age for the primary surgery and a chronology that prevents the palate from the worst scaring. Eventually, with 18 years of follow-up, the best functional achievement comes unexpectedly from an ambitious primary rhinoplasty that had till now been condemned. Not only do the patients have good appearance and social integration, but the nasal mode of breathing established at the time of the primary surgery favors a good facial growth without any compromise. Reciprocally, all the interacting functions benefit from a nasal ventilation.

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BACKGROUND: The purpose of this study was to evaluate the incomplete excision rate of nasal basal cell carcinomas (BCC) resected with different margins to demonstrate that 3-mm surgical margins could be used as safety margins to reduce esthetic consequences with a low risk of incomplete excision. METHODS: All patients with BCC of the nose excised from January 1st 2008 to December 31st 2011 were included. Data were analyzed and reviewed retrospectively. Tumors were treated with different surgical margins of excision: 3mm, 4mm, and 5mm. The primary outcome variable was the rate of incomplete excision. Other study variables were the histologic subtype, size, and recurrent lesions. RESULTS: Of the 132 patients, 115 were included corresponding on with 127 BCC. Median age was 75.5 (64-83) and sex ratio M:F=1.05. Of the 127 BCC, 80 were aggressive histologic subtype (63%), and 11 were recurrent (8.7%). The overall rate of incomplete excision was 17.3% (n=22). Of these 22, 17 (77.3%) were of an aggressive subtype. The incomplete excision rates within the groups were 12.5% (n=4), 22.2% (n=10), and 16% (n=8), respectively within the group with 3-, 4- and 5-mm surgical margins. No significant difference was observed between the groups (P=.519). The incomplete excision rate was not independently associated with the surgical margins, histologic subtype and recurrent type (P>.05). CONCLUSION: Three-millimeters margins could possibly be used to treat nasal BCC in chosen cases. Regarding the high rate of incomplete excision, reconstruction should be performed after receiving the pathologic report.

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Epistaxis is one of the most common ENT emergencies and highly prevalent in the general population. Most cases are self-limiting and patients do not usually seek medical attention. However, some cases can be severe and life-threatening. While most anterior bleeds can be effectively managed by simple measures, including pressure application, vasoconstrictive agents and cautery, some will require additional measures such as nasal packing. Posterior epistaxis can be difficult to control. Latest studies showed that surgical ligation of the sphenopalatine and/or anterior ethmoidal arteries is the most effective treatment and less painful and distressing than nasal packing. But packing is the therapeutic option that is readily available.

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BACKGROUND: The nasal sidewall and adjacent cheek are frequent sites of cutaneous tumour. The aim of this study is to present an advancement-rotation cheek flap technique for nasal sidewall and paranasal cheek defects. PATIENTS AND METHODS: This is a retrospective, non-comparative study of patients undergoing a cheek advancement-rotation flap for nasal sidewall and paranasal cheek defects between September 2008 and October 2012. Sex, age, histological type of the excised lesion, method of anaesthesia, size of the defects, any occurrence of complications and results were compiled from the medical record. RESULTS: Eleven patients with a mean age of 66 years were included. For 10 patients, the tumour was a basal cell carcinoma and in one case was a squamous cell carcinoma. The defects were located in the nasal sidewall and paranasal cheek in four cases, the paranasal cheek/lower eyelid in five cases and in the nasal sidewall, anterior cheek and lower eyelid in two cases. All but one had surgery under a local anaesthetic. No patients presented post-surgical complications. One patient had a subcutaneous granuloma which subsequently subsided completely. The aesthetic result was good: two of the 11 patients had a marked nasolabial fold, one patient had a mild cutaneous deformity due to flap movement under eyelid. No recurrence of carcinoma was observed during follow-up of between 14 and 40 months. CONCLUSION: This flap should be considered for defects measuring under 3 cm on all or part of the nasal sidewall, paranasal cheek and lower eyelid fold.

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