A Royal Pain in the Throat Tinnitus - ENT & Allergy Associates

More documents

Recommendations

Info

to soften sharp edges under the skin. Themain disadvantage of this substance is theunpredictability in the degree of resorption(up to 80% resorption at 12 months).Significant advancements in biomaterial sciencein the late twentieth century led to theincreased use of synthetic implants in facialplastic surgery. Alloplast materials can beclassified as porous versus solid, and noninjectableversus injectable substances. Thepredominant complications associated withalloplasts in rhinoplasty include infection,extrusion, and overlying skin discoloration.Foreign body reactions occur with fragmentation.Relatively inert materials between20 and 60 μm can be phagocytized, but ingestionleads to macrophage demise, releaseof inflammatory factors, and a foreign bodyreaction characterized by chronic inflammation(i.e. silicone gel and proplast). Alloplastmaterials that are associated with foreignbody reactions continue to be used in partsof the world. A Korean publication in 2006reported upon a series of 47 patients whorequired the removal of liquid paraffin causingforeign body reactions requiring complicatednasal reconstructions. Injectable alloplastsare used for volumetric filling of smalldefects. There are reports in the literaturereporting the use of Restylane, Collagen,Radiesse and Bioplastique (a copolymer thatis not FDA approved and composed of particlesranging from 100-400 μm) in rhinoplasty.The inability to predict and maintainlong-term volumetric correction continuesto be the major limitation of using injectablefiller material in rhinoplasty.Solid silicone provides excellent structuralsupport. It was the first alloplast to achievewidespread use in facial plastic surgery.A major disadvantage of silicone is itsnotorious mobility after implantation andits propensity for exposure or extrusionfollowing trauma. Large retrospectivetrials have shown high complication anddissatisfaction rates (ranges between 9.7-16%). Nevertheless, silicone has been verypopular for nasal augmentation in Asianpatients. Medpor, Gore-Tex, and Mersileneare the more commonly used porous meshalloplasts. Mesh implants are difficult toremove once fibrous ingrowth has takenplace. Large series of patients have beenstudied with the use of mesh implants withrelatively low complication rates (2.5-7%).However, long-term data is lacking.The use of autogenous cartilage in rhinoplastywas limited in the early 20th centuryby a lack of knowledge of the etiologyof warping. An understanding of thebiomechanical properties of mature cartilageand control of warping by incisionaltechniques resulted in the wider clinicalapplication of autologous cartilage. However,a lack of readily accessible autogenousgrafting has resulted in an explosion in theproduction of alloplasts, and hence, in theuse of a much wider range of implants. Itis imperative that the facial plastic surgeonmaintains a strong knowledge of the variousimplants which have been used in the past,as well as those which are used in modernday surgery.It is equally important for all types ofphysicians to recognize potential candidatesfor revision rhinoplasty. The forces ofmaturation and gravity lead to changes inthe appearance and function of the nose overtime. These changes may warrant referralfor a revision procedure. With the growingnumber of patients interested in revisionrhinoplasty, it has become increasinglyimportant for surgeons to know “what’s ina nose”. ■Seamless commercial real estate solutions...worldwide.Operating from over 165 offices on six continents, Newmark Knight Frankis one of the largest independent real estate service firms in the world.With a full range of services including leasing and corporate advisory, propertyand facilities management, investment sales and financial services, consultingand project management services, we provide comprehensive real estatesolutions to prominent corporations as well as medical associations, propertyowners, investors and developers across the globe.Newmark Knight Frank is proud to provide real estate services to ENT & Allergy Associates.Matthew T. LeonSenior Managing Director212.372.2041mleon@newmarkkf.comPeter RossiExecutive Managing Director201.460.5154prossi@newmarkkf.comNorth America • Europe • Asia-Pacific • Latin America • Africa • www.newmarkkf.com26
You used to think time was moneY.now, moneY is time.Managing both wiselywith wachoviaa shift in perspective comes after successfully managing bothwealth and life. wachovia wealth Management strategicallymaps out your financial future with your attorney, cPa and otheradvisors, combining their input with our expertise to createopportunities for you and your family. as your trusted advocate,we’ll help you realize your personal definition of success.For more information, please contact Douglas Macdonald,Relationship Manager, at 914-286-5061.investment managementfinanCial Planningbanking and Credittrust serviCesinsuranCeProducts and services provided by affiliates or subsidiaries of Wachovia Corporation and may not be available in all states. ©2008 Wachovia Corporation 083206
Page 2: RiskStratCo_Checks_8x10-Jordan:Risk
Page 7 and 8: (such as LPR or sensory neuropathy)
Page 9: you just take it off?!!”) could p
Page 13 and 14: The Backbone Of Your Software Solut
Page 15 and 16: O u r Ph y s i c i a n Pr o f i l e
Page 17 and 18: Daniel Grinberg, M.D., F.A.C.S.Otol
Page 19 and 20: St i c k s , St o n e s a n dB r o
Page 21 and 22: “Pe a r l o f t h e In d i a nO c
Page 23 and 24: and despair of the Sri Lankan Tamil
Page 25: “Wh a t ’s in a No s e ?”A h
Page 29 and 30: out for weapons being transported t
Page 32: Northeastern Technologies GroupWhen

A Royal Pain in the Throat Tinnitus - ENT & Allergy Associates

Create successful ePaper yourself

Delete template?

Save as template?