İntroduction and aim: The nose is a critically important aesthetic and functional portion of the face.  Rhinoplasty is an elective surgical procedure to attain an aesthetic and functional improvement of the nose.

Rhinoplasty is a surgery with different approaches that are applied according to the patient, the shape of the nose, the pathologies detected during the examination, whether it is primary or revision, the surgeon's experience, the surgeon's knowledge and skills, the available opportunities and the patient's wishes. There were many rhinoplasty techniques classified. Each technique has advantage and disadvantage. In open technique rhinoplasties, although there are differences in each surgery and each patient, according to the reasons I just listed, it consists of roughly similar steps. Today, I will try to explain the open technique rhinoplasty surgery to you step by step with videos.

 Conclusion: The level of expectation of the patient-and the surgeon-regarding the outcome of a rhinoplasty is usually high, and any result that is less than perfect can be seen as a failure. To achieve consistently good results in rhinoplasty, the surgeon should be meticulous at every step of the procedure. Rhinoplasty requires lifelong dedication of the surgeon for providing the best outcomes to patients entrust their noses to the surgeon's surgical skills. The rhinoplasty surgeon has been labeled an "eternal student", and this should reflect the delicateness and humbleness of the rhinoplasty surgeon. I believe that this presentation will be very useful, especially for my friends who want to learn rhinoplasty and those who are just starting out.

“The modern day management of chronic otitis media/cholesteatoma: combining european and american perspectives over a half-century of combined experience”

alexandre karkas, MD, phd 2 , ravi n. Samy, MD, FACS 1

1LVHN/jefferson health, sidney kimmel college of medicine, thomas jefferson university, professor and chief, OHNS

2alexandre karkas, MD, phd, professor and chairman, dept. Of OHNS, university medical center of saint-etienne

modern day management of epidermoid cysts/cholesteatomas/chronic otitis media is still a challenge and a conundrum. While the principles never change (i.E., making an ear clean, safe, and dry), adapting new technologies and treatment modalities should reduce the morbidity of this disease and improve the potential for rehabilitation (e.G., auditory, vestibular, and facial).

the 2 presenting physicians will review their cases over their prior 25 years each (between fellowship and attending level practice)

the physicians have used a variety of approaches to treat their cholesteatomas, including: 1) standard otologic approaches: transmastoid (CWD/CWU/CWR mastoidectomy), transcanal, endaural 2) mastoid obliterations with bone pate/bioactive glass 3) skull base approaches (middle cranial fossa, retrosigmoid, retrolabyrinthine/translabyrinthine). The endoscope has been important to assess for hidden cholesteatomas. MRI DWI images have reduced the need for 2nd looks while monitoring for recurrence. The laser has been useful to eradicate microscopic disease. One presenter is investigating the use of oncolytic virus in animal models for eradication of disease. This will also be discussed. And finally, the utilization of adjunctive techniques and technologies will discuss how to manage any deficits (e.G., hearing, balance, or facial nerve related).

the evolution of the management of COM/cholesteatoma continues unabated. While the progress may be slow, it is steady and shows the promise for a disease that has existed for 1000’s of years of mankind’s history. The case examples show how otolaryngologists can continue to learn and progress in the management of this challenging disease.

cholesteatoma, chronic otitis media, laser, endoscopy, mastoid obliteration, microscope, MRI, otologic drill, bone pate, bioactive glass

the presenters (drs. Ravi n. Samy and alex karkas) will include video presentations of their significant and vast experiences.

Overcoming difficulties in frontal sinus surgery