Screw failure during insertion is not an uncommon problem, especially with the micro and mini fix... more Screw failure during insertion is not an uncommon problem, especially with the micro and mini fixation systems. In this study, the holding power of 1-, 1.5-, and 2-mm screws was tested at various simulated bone thicknesses of 1, 2, 3, 4, and 5 mm with an increasing pilot hole size. This was done to ascertain the effects of pilot hole size on screw failure and any subsequent tradeoff with respect to decrease in holding power. For the 1-mm screws, there was no statistically significant decrease in holding power of the screws with increasing pilot hole size that ranged from 70 to 85 percent of the external diameter of the screw. For the 1.5-mm screw, a critical pilot hole size was found to be 1.24 mm (82 percent of the screw's external diameter), with no statistically significant decrease in holding power in the 1-, 2-, and 3-mm thickness blocks. For the 2-mm screws, the critical pilot hole size was found to be 1.65 mm (83 percent of the screw's external diameter). A statistically significant decrease in holding power was observed after this drill hole size in all thicknesses. Commercially available systems use drill bits that represent approximately 70 to 75 percent of the external diameter of the screw. Our results show that the pilot hole size for the 1-, 1.5- and 2-mm screws can be increased to 80 to 85 percent of the screw's external diameter without losing significant holding power.(ABSTRACT TRUNCATED AT 250 WORDS)
The history of rhinoplasty is absolutely fascinating. It is replete with mysterious practices, in... more The history of rhinoplasty is absolutely fascinating. It is replete with mysterious practices, intrigue, and imaginative thoughts. If necessity is the mother of invention, then sex, crimes, and punishment lay a legitimate claim to being the mother of rhinoplasty. The history of rhinoplasty is a global saga spanning the millennia. Practitioners of the art and science have included those demonstrating the most admirable traits espoused in the Hippocratic Oath, as well as those to whom the word “charlatan” might more aptly be applied. The truth of a story is illustrated in its telling, and we have attempted to be true historians. We recognize that observers and narrators, now well past (sic), have determined many of today's truths, and therefore their stories become our truths whether they were so or not. We have attempted to reference many who have contributed to the advance of this amazing surgical procedure, recognizing that we may have included some who have demonstrated marginal merit to be so. Assuredly, we have also unintentionally omitted some whom we should have included. From them we ask forbearance. Let the story begin, “Once upon a time…”
ImportanceFear is commonly experienced by individuals newly diagnosed with papillary thyroid canc... more ImportanceFear is commonly experienced by individuals newly diagnosed with papillary thyroid cancer (PTC).ObjectiveTo explore the association between gender and fears of low-risk PTC disease progression, as well as its potential surgical treatment.Design, Setting, and ParticipantsThis single-center prospective cohort study was conducted at a tertiary care referral hospital in Toronto, Canada, and enrolled patients with untreated small low risk PTC (<2 cm in maximal diameter) that was confined to the thyroid. All patients had a surgical consultation. Study participants were enrolled between May 2016 and February 2021. Data analysis was performed from December 16, 2022, to May 8, 2023.ExposuresGender was self-reported by patients with low-risk PTC who were offered the choice of thyroidectomy or active surveillance. Baseline data were collected prior to the patient deciding on disease management.Main Outcomes and MeasuresBaseline patient questionnaires included the Fear of Progressi...
Journal of Otolaryngology - Head and Neck Surgery, 2011
Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge f... more Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge for the reconstructive surgeon. Various grafting options have been proposed, but achieving good outcomes can be difficult. We conducted a retrospective analysis of 10 patients with WG who underwent reconstruction of saddle nose deformities by the senior author (A.G.) between 2005 and 2009. All patients were reconstructed using costal cartilage grafts. Primary surgery was functionally and cosmetically successful in 8 of 10 patients. Two patients experienced complications (graft resorption and columellar necrosis) requiring revision surgery; subsequently, they achieved good outcomes, with no further complications. There were no complications at the costal cartilage donor site. At the conclusion of the study, all patients were satisfied with their reconstructions. With a multidisciplinary team approach to pre- and postoperative patient management and careful surgical technique, reliable and ...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2011
BACKGROUND Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant ... more BACKGROUND Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge for the reconstructive surgeon. Various grafting options have been proposed, but achieving good outcomes can be difficult. METHODS We conducted a retrospective analysis of 10 patients with WG who underwent reconstruction of saddle nose deformities by the senior author (A.G.) between 2005 and 2009. All patients were reconstructed using costal cartilage grafts. RESULTS Primary surgery was functionally and cosmetically successful in 8 of 10 patients. Two patients experienced complications (graft resorption and columellar necrosis) requiring revision surgery; subsequently, they achieved good outcomes, with no further complications. There were no complications at the costal cartilage donor site. At the conclusion of the study, all patients were satisfied with their reconstructions. CONCLUSIONS With a multidisciplinary team approach to pre- and postoperative patient management and ca...
The authors present their views on the merits of external rhinoplasty in the context of a renewed... more The authors present their views on the merits of external rhinoplasty in the context of a renewed awareness of the endonasal approach. Why do we continue to perform rhinoplasty via an open approach? The benefits of this technique such as its unparalleled exposure, the opportunity for technical precision, and the ability to better preserve nasal function are thoroughly explored. The criticisms of this technique are presented and discussed. The authors thoughts on rhinoplasty as a whole are examined.
Screw failure during insertion is not an uncommon problem, especially with the micro and mini fix... more Screw failure during insertion is not an uncommon problem, especially with the micro and mini fixation systems. In this study, the holding power of 1-, 1.5-, and 2-mm screws was tested at various simulated bone thicknesses of 1, 2, 3, 4, and 5 mm with an increasing pilot hole size. This was done to ascertain the effects of pilot hole size on screw failure and any subsequent tradeoff with respect to decrease in holding power. For the 1-mm screws, there was no statistically significant decrease in holding power of the screws with increasing pilot hole size that ranged from 70 to 85 percent of the external diameter of the screw. For the 1.5-mm screw, a critical pilot hole size was found to be 1.24 mm (82 percent of the screw&#39;s external diameter), with no statistically significant decrease in holding power in the 1-, 2-, and 3-mm thickness blocks. For the 2-mm screws, the critical pilot hole size was found to be 1.65 mm (83 percent of the screw&#39;s external diameter). A statistically significant decrease in holding power was observed after this drill hole size in all thicknesses. Commercially available systems use drill bits that represent approximately 70 to 75 percent of the external diameter of the screw. Our results show that the pilot hole size for the 1-, 1.5- and 2-mm screws can be increased to 80 to 85 percent of the screw&#39;s external diameter without losing significant holding power.(ABSTRACT TRUNCATED AT 250 WORDS)
The history of rhinoplasty is absolutely fascinating. It is replete with mysterious practices, in... more The history of rhinoplasty is absolutely fascinating. It is replete with mysterious practices, intrigue, and imaginative thoughts. If necessity is the mother of invention, then sex, crimes, and punishment lay a legitimate claim to being the mother of rhinoplasty. The history of rhinoplasty is a global saga spanning the millennia. Practitioners of the art and science have included those demonstrating the most admirable traits espoused in the Hippocratic Oath, as well as those to whom the word “charlatan” might more aptly be applied. The truth of a story is illustrated in its telling, and we have attempted to be true historians. We recognize that observers and narrators, now well past (sic), have determined many of today's truths, and therefore their stories become our truths whether they were so or not. We have attempted to reference many who have contributed to the advance of this amazing surgical procedure, recognizing that we may have included some who have demonstrated marginal merit to be so. Assuredly, we have also unintentionally omitted some whom we should have included. From them we ask forbearance. Let the story begin, “Once upon a time…”
ImportanceFear is commonly experienced by individuals newly diagnosed with papillary thyroid canc... more ImportanceFear is commonly experienced by individuals newly diagnosed with papillary thyroid cancer (PTC).ObjectiveTo explore the association between gender and fears of low-risk PTC disease progression, as well as its potential surgical treatment.Design, Setting, and ParticipantsThis single-center prospective cohort study was conducted at a tertiary care referral hospital in Toronto, Canada, and enrolled patients with untreated small low risk PTC (<2 cm in maximal diameter) that was confined to the thyroid. All patients had a surgical consultation. Study participants were enrolled between May 2016 and February 2021. Data analysis was performed from December 16, 2022, to May 8, 2023.ExposuresGender was self-reported by patients with low-risk PTC who were offered the choice of thyroidectomy or active surveillance. Baseline data were collected prior to the patient deciding on disease management.Main Outcomes and MeasuresBaseline patient questionnaires included the Fear of Progressi...
Journal of Otolaryngology - Head and Neck Surgery, 2011
Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge f... more Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge for the reconstructive surgeon. Various grafting options have been proposed, but achieving good outcomes can be difficult. We conducted a retrospective analysis of 10 patients with WG who underwent reconstruction of saddle nose deformities by the senior author (A.G.) between 2005 and 2009. All patients were reconstructed using costal cartilage grafts. Primary surgery was functionally and cosmetically successful in 8 of 10 patients. Two patients experienced complications (graft resorption and columellar necrosis) requiring revision surgery; subsequently, they achieved good outcomes, with no further complications. There were no complications at the costal cartilage donor site. At the conclusion of the study, all patients were satisfied with their reconstructions. With a multidisciplinary team approach to pre- and postoperative patient management and careful surgical technique, reliable and ...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2011
BACKGROUND Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant ... more BACKGROUND Saddle nose deformity secondary to Wegener granulomatosis (WG) presents a significant challenge for the reconstructive surgeon. Various grafting options have been proposed, but achieving good outcomes can be difficult. METHODS We conducted a retrospective analysis of 10 patients with WG who underwent reconstruction of saddle nose deformities by the senior author (A.G.) between 2005 and 2009. All patients were reconstructed using costal cartilage grafts. RESULTS Primary surgery was functionally and cosmetically successful in 8 of 10 patients. Two patients experienced complications (graft resorption and columellar necrosis) requiring revision surgery; subsequently, they achieved good outcomes, with no further complications. There were no complications at the costal cartilage donor site. At the conclusion of the study, all patients were satisfied with their reconstructions. CONCLUSIONS With a multidisciplinary team approach to pre- and postoperative patient management and ca...
The authors present their views on the merits of external rhinoplasty in the context of a renewed... more The authors present their views on the merits of external rhinoplasty in the context of a renewed awareness of the endonasal approach. Why do we continue to perform rhinoplasty via an open approach? The benefits of this technique such as its unparalleled exposure, the opportunity for technical precision, and the ability to better preserve nasal function are thoroughly explored. The criticisms of this technique are presented and discussed. The authors thoughts on rhinoplasty as a whole are examined.
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