The subperichondrial / subperiosteal dissection in preservation rhinoplasty: how histology can help us to perform better surgeries

Aim: The classical dissection plane in rhinoplasty is in the sub-SMAS plane with traumatic dissection of tissues and as a result significant and prolonged postoperative edema, especially in the external approach. A complete subperichondrial/periosteal route has been recently described. It seems to allow for simpler postoperative follow-up than external or closed approach performed in the sub-SMAS plane. However, little is known about the exact histological planes that are really dissected during surgery. Material and methods: Histological examinations of 10 cadavers noses dissected in the so-called subperichondrial/subperiosteal plane were performed. Results: The subperichondrial plane is truly subperichondrial and consists in a dissection under the chondrogenic layer of the perichondrium. Subperichondrial dissection necessitates sharp scrapping to separate the cartilage from the chondrogenic layer. The perichondrium is naturally thicker on the dorsum, which explains why it is easier to begin the dorsal dissection at the W point. Scroll cartilages are consistent and show between 9 and 13 isolated cartilages, most of the time, 1 major and several minors cartilages. Optimal strategy to ease the dissection is discussed Conclusions: The subperichondrial/subperiosteal route, although necessitating significant dissection of the teguments of the nasal pyramid, is respectful of the anatomy of the nasal pyramid. It allows minimal traumatic maneuvers than in the sub-SMAS route, despite of the large dissection performed

Motion Sickness Lessons from the Southern Ocean

BACKGROUND: The objectives were to assess the prevalence, severity, and medication taken, and to look for predictive factors, in order to better identify characteristics of passengers at risk of motion sickness during transport from Hobart in Tasmania to the French polar stations in Antarctica. METHODS: There were 239 passengers who were surveyed over 4 yr with 4 round trips per year using the Motion Sickness Susceptibility Questionnaire (MSSQ), Simulator Sickness Questionnaire (SSQ), state-trait anxiety test (STAI -Trait and STAI -State), and general parameters (age, gender, number of trips, jet-lag, direction of the trip), medication, calculation of the distance of each passenger’s cabin to the Centre of Gravity (CoG.). RESULTS: While the passengers had a low intrinsic sensitivity to motion sickness (MSSQ), 94% reported at least one SSQ symptom of motion sickness, and 38% vomited. Five associated factors were discovered: greater initial sensitivity (MSSQ), anticipation of being ill, younger age, higher level of anxiety at midtrip, and greater distance from the CoG. Of the passengers, there were 54% who took anti-motion sickness medication at different times of the trip, however, these passengers experienced more nausea. This could be due to self-selection since they were more sensitive to motion sickness. CONCLUSION: We identified three predictive factors of motion sickness (greater intrinsic susceptibility, younger age, and greater cabin distance from the CoG). For preventive purposes, two associated factors of MS (anticipation of being ill, MSSQ score) were determined to classify three groups of risk of MS to improve passenger care during the trip

The anterior cribriform plate foramina: from anatomy to surgery

Background: Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of the cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. Methods: Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. Results: The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove, which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." Clinical applications are discussed. Conclusion: The clinical applications of this new anatomic description concern both the cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans

The Sjögren’s syndrome – an interdisciplinary problem viewed by a dentist

Sjögren’s syndrome is common and chronic disease. So far there is no effective therapy. In 90% of cases, it affects women, usually in the peri-menopausal period. Many systems and organs may be involved in the course of the disease, thus it is interesting for many medical specialists. There are primary and secondary Sjögren’s syndromes, both characterized mainly by xerostomia and keratoconjunctivitis. The paper reviews basic symptoms in the oral cavity involving the oral mucosa, lips, tongue, gingiva, teeth and periodontium. Treatment and prevention in a dental clinic are also described. Lifestyle and pharmacotherapy to avoid symptom aggravation are additionally considered

How to perform microscopic/endoscopic resection of large petrous apex lesions

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Two distinct song populations of blue tits, Parus caerleus, in the French Mediterranean

Blue tits, as many other species, show much geographic variation in their songs. In blue tits, songs that include a trill (series of rapidly repeated notes) are widespread on the European mainland, but have not been reported in North Africa or the Canary Islands. We studied song structure of two blue tit populations from the French Mediterranean that are exposed to large differences in local selection pressures (food, vegetation, social factors). Songs from populations on the European mainland and the island of Corsica differed much in syntax, tempo, frequency, and the incidence of trills. The observed population differences could potentially be caused by a combination of different factors, including biotic and abiotic habitat characteristics, body size, and cultural drift. We suggest that songs without trill are acoustically adapted for transmission in habitats where the local breeding density of great tits is low. In addition, we suggest that songs with trill may reflect a character shift, to minimise territorial interactions with great tits

Skew deviation : un accident vasculaire cérébral de la fosse postérieure jusqu’à preuve du contraire, illustré par deux cas cliniques

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Influence de la teneur en oxygène sur le comportement au fluage d'alliages Ti-48Al

The influence of oxygen on microstructure and creep behaviour of Ti-48Al alloys is investigated. The metallurgical structure of the samples is essentially lamellar in spite of the appearance of small grains at the grain boundaries for the high purity alloy. Therefore, the presence of oxygen allows a stabilisation of the lamellar phase. Micro-hardness does not seem to depend on the content of oxygen but rather on the lamellar nature of these alloys. On the other hand, the presence of oxygen promotes creep resistance, whereas that of Mn and Nb reduces the extent of the secondary creep stage