Operative Technique in Plastic Surgery – Kevin C.Chung

imaging, 2034–2035
low, 2036–2040
merits and demerits, 2036b, 2041b
nonoperative management, 2035
outcomes, 2042
pathogenesis, 2033
patient history and physical findings, 2033–2034
postoperative care, 2042
sensory deficits, 2032, 2033f
surgical management
approach, 2035
patient positioning, 2035
preoperative planning, 2035
thermoplastic splints, 2035, 2035f
Combined sensory index (CSI), 1979
Comminuted fractures
angle and ramus fractures, 911–912, 911f–912f
body fractures, 911
symphysis/parasymphysis, 910
Commissuroplasty, 2729, 2732, 2733f
Common peroneal nerve
decompression, 2413, 2413f
traction injury, 2413
Communication, 334
Compartment syndrome, 2331, 2334
complications, 1765, 1765f
definition, 1760
diagnostic studies, 1760–1761
fasciotomy
dorsal forearm, 1764, 1764f
hand, 1762–1763, 1762f, 1763f
with two longitudinal incisions, 1764, 1764f
volar forearm with curvilinear incision, 1763, 1763f

merits and demerits, 1765b
natural history, 1760
outcomes, 1765
pathogenesis, 1760
patient history and physical findings, 1760, 1761f
postoperative care, 1765, 1765f
surgical management
alternative forearm fasciotomy, 1762, 1762f
alternative parallel forearm incision approach, 1762, 1762f
dorsal forearm longitudinal approach, 1762, 1762f
patient positioning, 1761
preoperative planning, 1761
ulnar incision, 1762
volar forearm curvilinear approach, 1761, 1762f
Volkmann ischemic contracture, 1765, 1765f
Complete clefts, 2606, 2668
Complex regional pain syndrome (CRPS), 2533
Component dorsal hump reduction, 335, 335f
Component separation technique
anatomy, 1563
complications, 1570–1571
definition, 1563
imaging, 1564
laparoscopic component separation, 1565, 1565f
merits and demerits, 1564b
minimally invasive component separation, 1566–1567, 1566f
open component separation, 1564–1565, 1564f
outcomes, 1568–1570, 1568f–1569f
pathogenesis, 1563
patient history and physical findings, 1563
periumbilical perforator-sparing technique, 1565–1566
posterior component separation, 1567, 1567f
postoperative care, 1568

surgical management, 1564
Composite grafts
alar rim reconstruction, 1182
complications, 1182
definition, 1180
graft placement, 1181, 1181f
merits and demerits, 1181b
patient history and physical findings, 1180
postoperative care, 1182
surgical management
approach, 1180
patient positioning, 1180
preoperative planning, 1180
Computed tomographic angiography (CTA)
ankle reconstruction with free flap, 2392, 2394f
debridement of soft tissue infections of lower leg, 2427
free flap, reconstruction of heel and plantar defects, 2380, 2383
free flaps, 2487
medial plantar flap, 2374
microvascular free flap transfer, 2440, 2441f
open fractures, 2468
pedicled rectus flap, 2518
Computed tomography (CT)
bone grafting for foot and ankle, 2356–2357
bone reconstruction of knee, 2473, 2474f
condyle fractures, 917
conjoined twins, 3093
crooked nose, 325, 325f
debridement of soft tissue infections of lower leg, 2427
enophthalmos, 848
femoral bone debridement, 2507
free flaps, soft tissue defects of thigh, 2522
Le Fort I fracture, 890, 890f

malignant bone tumors of the foot and ankle, 2345
mandible fractures, open treatment of, 908
nonunion of mandible fracture, 927, 927f–928f
open fractures, 2468
orbital roof fractures, 840
osteomyelitis, 2352, 2468
panfacial fractures, 935
pediatric mandible fractures, 958
pediatric midface fractures, 951, 951f
pediatric orbital fractures, 943
short nose, 338
zygomatic arch fractures, closed reduction and treatment, 872
Computer-aided design (CAD) 3D model, 770, 770f–771f
Computer-aided design/computer-aided modeling (CAD/CAM), in
fibula free flap reconstruction
anatomy, 1022f, 1023
complications, 1029
definition, 1022
dental implants, 1027
fibula flap harvest, 1025–1026
fibula flap osteotomy, 1026–1027, 1026f
flap inset, 1027
imaging studies, 1023–1024, 1024f
mandibular osteotomy, 1026
merits and demerits, 1025b
microsurgical anastomosis, 1027
outcomes, 1029, 1029f
pathogenesis, 1023
patient history and physical findings, 1023
postoperative care, 1028–1029
surgical management, 1024–1025
Concentrated synthetic growth factors, 2361
Concha bullosa, 329

Condylar fractures, 958
open treatment of, 908, 912–913, 912f
anatomy, 915–916, 915f–916f
complications, 922
definition, 915, 915f
imaging, 917, 917f
indications/contraindications, 918
merits and demerits, 921b
natural history, 916
nonoperative management, 918
outcomes, 922, 922f
pathogenesis, 916
patient history and physical findings, 917
postoperative care, 922
preauricular approach, 921
retromandibular approach, 919, 919f, 920f
Risdon (submandibular) approach, 920, 920f–921f
surgical management, 918
Cone beam CT (CBCT), 958
Congenital glaucoma, 2871
Congenital melanocytic nevi (CMN)
complications, 2743
definition, 2735
dermabrasion and curettage, 2737
differential diagnosis, 2735–2736
classification, 2735–2736
nevus distribution, 2736, 2736f
imaging, 2735
laser, 2737
malignancy risk, 2735
natural history, 2735
nevus excision with expanded flap reconstruction
approach, 2740, 2740f

closure, 2742, 2742f
excision, 2741f, 2743b
incision, 2740b, 2740f–2741f
merits and demerits, 2743t
patient position, 2739
postoperative care, 2743
preoperative planning, 2739
suturing, 2742, 2742f
nonoperative management, 2737
outcomes, 2743
pathogenesis, 2735
patient history and physical findings, 2736–2737
surgical management, 2737
tissue expander placement
approach, 2738
merits and demerits, 2739t
patient position, 2738
postoperative care, 2739, 2739f
preoperative planning, 2737–2738
technique, 2738b
Congenital midline nasal mass
anatomy, 2744, 2744f
complications, 2751
definition, 2744
differential diagnosis, 2746
endoscopic excision of intranasal glioma, 2750, 2750f
imaging, 2745, 2746f
medial orbit composite unit translocation, 2749–2750, 2749f
merits and demerits, 2747b
natural history, 2745
outcomes, 2751
pathogenesis, 2744–2745
patient history and physical findings, 2745, 2745f

postoperative care, 2751
surgical management
approach, 2746, 2747f
patient position, 2746
preoperative planning, 2746
transcranial NDSC resection
bandeau/frontal bone repair, 2748
completion, 2748
cranial base repair and seal, 2748, 2749f
incisions, dissection, and craniotomy, 2747, 2748f
keystone osteotomy and dermal sinus excision, 2747–2748,
2748f
nasal approach/frozen biopsy, 2747–2748, 2747f
Congenital ptosis, 2753
anatomy, 2849, 2849f
complications, 2856
definition, 2849
differential diagnosis, 2850
imaging, 2850
merits and demerits, 2856b
natural history, 2850
nonoperative management, 2850
outcomes, 2856
pathogenesis, 2849–2850
patient history and physical findings, 2850
postoperative care, 2856
surgical management, 2850–2856
approach, 2851–2856
patient position, 2851
preoperative planning, 2851
Congenital vaginal atresia. See Vaginal agenesis
Conjoined twin
anatomy, 3092, 3093f–3094f

complications, 3101
definition, 3092
differential diagnosis, 3094
imaging, 3092–3093
merits and demerits, 3100b
natural history, 3092
nonoperative management, 3094
outcomes, 3101
pathogenesis, 3092
patient history and physical findings, 3092
postoperative care, 3100
separation of ischiopagus, 3097–3100, 3097f–3098f
surgical management, 3094–3097
approach, 3097
patient position, 3096–3097
preoperative planning, 3095–3096, 3096f–3097f
Conjunctival scarring, 837
Conjunctival-lateral canthotomy, 886, 886f
Conjunctivitis, 2871
Conjunctivomullerectomy, 2854, 2855f
Constricted ear
anatomy, 2826
complications, 2831
definition, 2826, 2826f
markings, 2827, 2827f–2828f
merits and demerits, 2830b
nonoperative management, 2826–2827
outcomes, 2830, 2831f
patient history and physical findings, 2826
postoperative care, 2830
rib cartilage
harvest, 2828, 2828f
splitting, 2828, 2829f

skin tunnel creation, 2828, 2829f
surgical management
approach, 2827–2830
patient position, 2827
preoperative planning, 2827, 2827f
Continuous catheter technique, 2315–2316
nerve stimulator, 2318
supplies for, 2316
ultrasound-guided, 2320
Continuous epidural anesthesia, 2326
Continuous positive airway pressure (CPAP), 500
Contour irregularities, 200
Contracture release, 2766
with full-thickness skin grafting, 2774–2775, 2775f
Contralateral fibula flap, 1025, 2433f
Contralateral flap, 1031
Contralateral free fibula flap harvest, 2432
Contralateral mucoperichondrial septal flap, 1165f
Conventional angiographies, 2522
Conventional x-rays, 2522
CoolSculpting, 243
Copeland test, 2416
Cordeiro modification, skate flap
elevating and insetting, 1478–1479, 1478f–1479f
flap design, 1477, 1478f
Corneal abrasion, 119
Corneal injury, 837
Corneal neurotization
anatomy, 2942
complications, 2946–2947
definition, 2942
diagnostic studies, 2942
differential diagnosis, 2942–2943

imaging, 2942
merits and demerits, 2946b
natural history, 2942
nonoperative management, 2943
outcomes, 2946
pathogenesis, 2942
patient history and physical findings, 2942
postoperative care, 2946
surgical management, 2943
patient position, 2943
preoperative planning, 2943
Corneal shields, 825
Coronal approach, in orbital roof fractures, 843–845, 844f
Coronal brow lift, 72–74, 73f
Coronal synostosis, 531
Coronoid fractures, 913
Coronoidectomy, mandibular coronoid fractures, 925, 925f
Corporal body graft, 3047, 3047f
Corporal-sparing clitoroplasty, 3067
Corpus cavernosa, resection of, 1690f, 1691
Corrugator muscles
hypercontraction of, 3
transblepharoplasty excision of, 94, 94f
Corrugator supercilii (CS), 2
medial head of, 2
originates, 2
removal, transpalpebral corrugator resection, 111, 111f
transpalpebral corrugator resection, 109
Corticosteroids, 1860
Costal cartilage graft, dorsal augmentation
anatomy, 343, 343f
complications, 349
definition, 343

dorsal graft, preparing and affixing, 344–345, 345f–346f
harvesting, 344, 344f
merits and demerits, 348b
outcomes, 349, 349f
patient history and physical findings, 343
postoperative care, 349
surgical management, 343
transosseous suture/K-wire, use of, 347–348, 347f–348f
Costochondral graft
complications, 675
definition, 671
differential diagnosis, 673
glenoid fossa, 671
imaging studies, 673
mandible exposure and pocket creation, 673–674, 674f
mandibular anatomy, 671, 671f–672f
merits and demerits, 673b
natural history, 671
outcomes, 675
pathogenesis, 671
patient history and physical findings, 672–673, 672f
postoperative care, 675
rib harvest, 671f–672f, 673
rib osteocartilaginous junction, 671, 671f–672f
rib placement and fixation, 674, 674f
surgical management
patient positioning, 673
preoperative planning, 673
temporomandibular joint, 671, 671f–672f
Cottle elevator, 862, 863f
Cottle maneuver, 298
Cotton tip applicator
on awake patient, 58

on sedated patient, 57, 58f
Cranial base repair and seal, 2748, 2749f
Cranial index (CI), 453
Cranial osteotomy, 538, 539f
Cranial vault, 3D implant reconstruction
anatomy, 515
closure, 517
complications, 518
definition, 515
differential diagnosis, 515
free flap coverage, 516, 516f
imaging, 515, 515f
implant placement and fixation, 516, 517f
merits and demerits, 516b
natural history, 515
nonoperative management, 515
outcomes, 517, 518f
pathogenesis, 515
patient history and physical findings, 515
postoperative care, 517
surgical management
patient positioning, 516
preoperative planning, 516
Cranial vault defects
anatomy, 663
imaging studies, 664
merits and demerits, 666b
natural history, 664
outcomes, 668
patient history and physical findings, 664
postoperative care, 668
surgical management, 665, 665f
surgical technique, 667

Cranialization
anatomy, 779–780, 779f–780f
complications, 784–785, 785f
definition, 779
differential diagnosis, 781, 781f
imaging studies, 780, 781f
merits and demerits, 781b
natural history, 780
nonoperative management, 781
outcomes, 784
pathogenesis, 780
patient history and physical findings, 780, 780f
postoperative care, 784
preparation and exposure, 781–782, 782f
repair and closure, 782–784, 783f
in situ, 779f–780f
surgical management
approach, 781
patient positioning, 781
preoperative planning, 781
Craniofacial
anatomy, 2752
disjunction, 897, 898f
Craniofacial anaplastology
anatomy, 3084, 3085f
auricular prosthesis implants, 3087, 3088f
complications, 3090
definition, 3084
imaging
implant placement, 3086–3087, 3086f–3087f
merits and demerits, 3089b
nasal prosthesis implants, 3088, 3088f
orbital prosthesis implants, 3089, 3089f

outcomes, 3090, 3090f
patient history and physical findings, 3084–3085
postoperative care, 3090, 3090f
surgical management
approach, 3086
patient position, 3086
preoperative planning, 3085–3086
Craniofacial dysostosis syndromes, 499
Craniofacial fibrous dysplasia (CFD), 762
Craniopagus, 3092, 3093f–3094f
Craniopagus twins
bony and soft tissue reconstruction, 527, 528f
circumferential venous sinus, 523, 523f
classifications, 523, 523f
closure, 526f, 527
complications, 528
definition, 523
imaging studies, 524, 524f–525f
merits and demerits, 526b
neurovascular separation, 527
nonoperative management, 524
outcomes, 528
patient history and physical findings, 524
postoperative care, 528
reinforced silicone sheet, 526f, 527
scalp flaps retracted with access craniotomy, 526, 526f
surgical management
approach, 526
patient positioning, 526
preoperative planning, 524f–525f, 525
tissue expansion, 527, 527f
venous drainage, 523, 523f, 526f, 527
Cranioplasty, 513

Cranioplasty reconstruction, with autogenous rib graft
allograft materials, 510
alloplastic materials, 509
autogenous bone grafts, 510
bone substitutes, 510
bony defect, 511
complications, 514
cranial defect exposure, 511
cranioplasty technique, 513
definition, 509
endochondral and intramembranous ossification, 509, 509f–510f
floating ribs, 509
imaging, 510
merits and demerits, 511b
nonoperative management, 510
outcomes, 514
pathogenesis, 509
patient history and physical findings, 510
postoperative care, 514
rib harvest, 512, 512f
scalp closure, 513
split rib technique, 513, 513f
surgical management, 510–511
Craniosynostosis
anatomy, 530, 530f
bicoronal synostosis, 531
closure, 534
complications, 535
coronal synostosis, 531
craniectomy, 533, 533f–534f
definition, 530
growth inhibition, 530
imaging, 531

lambdoid synostosis, 531
merits and demerits, 532b
metopic synostosis, 531
outcomes, 535
patient history, 530
physical examination, 530
postoperative care, 535
sagittal synostosis, 530, 532, 532f
surgical management
approach, 531
patient positioning, 531
preoperative planning, 531
Craniotomy, congenital midline nasal mass, 2747, 2748f
Craniotomy incision, 981, 981f–982f
C-reactive protein (CRP), 2467, 2471, 2474
Critical limb ischemia, 2400, 2406
Crooked nose
anatomy, 324
complications, 332
definition, 324
imaging, 325, 325f
local anesthesia, administration of, 326
lower lateral cartilage correction, 331
merits and demerits, 332b
nasal bone correction, 326–327, 327f
outcomes, 332
pathogenesis, 324
patient history and physical findings, 324–325
postoperative care, 332
septoplasty, 327–329, 328f–330f
upper lateral cartilage correction, 330, 330f
Cross face nerve graft, 2936, 2936f
anatomy, 2913, 2913f

complications, 2918
definition, 2913
imaging, 2914
merits and demerits, 2918b
natural history, 2913–2914
outcomes, 2918
patient history and physical findings, 2914
postoperative care, 2918
surgical management
approach, 2914
patient position, 2914, 2914f
preoperative planning, 2914
Cross face nerve grafting (XFNG), 1256, 1277
Cross-finger flap, 2099–2101, 2100f
Cross-hatching injection technique, 44, 44f
Crouzon syndrome, 445–446, 616
Crow’s feet, botulinum toxin injection to
anatomy, 7
complications, 8
definition, 7, 7f
imaging, 7
merits and demerits, 8b
outcomes, 8
patient history and physical findings, 7
positioning, 7
postoperative care, 8
preoperative planning, 7
Cruciate anastomosis, 1705
Crush injury, nerve repair and graft, 2006
Cryosurgery (liquid nitrogen), 2343
Cryptotia
anatomy, 2832
complications, 2835

definition, 2832
differential diagnosis, 2832
merits and demerits, 2834b
nonoperative management, 2832
outcomes, 2834–2835, 2835f
pathogenesis, 2832
patient history and physical findings, 2832, 2832f
postoperative care, 2834
surgical management
patient position, 2832–2834
preoperative planning, 2832
C-shaped structure
lunotriquetral ligament, 1857, 1857f–1858f
scapholunate ligament, 1851, 1852f
Cubital tunnel syndrome
anatomy, 1992, 1992f
complications, 1999
definition, 1992
differential diagnosis, 1993–1994
imaging, 1993
merits and demerits, 1994b
nonoperative management, 1994
outcomes, 1999
pathogenesis, 1992–1993
patient history and physical findings, 1993
postoperative care, 1999
in situ cubital tunnel decompression, 1994
surgical management
approach, 1994
patient positioning, 1994
preoperative planning, 1994
transposition of the ulnar nerve, 1995–1998, 1996f
Cultured epithelial autograft (CEA), 2769

Cultures, 2507
Cupid’s bow, 2597–2598, 2598f, 2603f
anatomy, 2606
deformities, 2645b, 2645f
asymmetry more than 2 mm high, 2647, 2647f
mismatch of 1 to 2 mm, 2646, 2646f
Curved tip osteotomy, 623f, 626
Customized chest wall implants, 2980, 2980f
Cutaneous lip, 2596
Cutaneous melanom
tenzel semicircular rotational flap, 1084
Cutaneous paddles of chimeric flaps, 1226
Cutaneous scar modifications, 2733, 2733f
Cutler-beard, eyelid coloboma, 2846–2847, 2846f–2847f
Cutler-Beard flap
anatomy, 1089, 1089f
anterior lamella, 1089
blood supply, 1090
external carotid, 1090
lower eyelid retractors, 1090
posterior lamella, 1089
upper eyelid retractors, 1090
complications, 1093
definition, 1089
flap creation, 1091–1092, 1092f
flap separation, 1092, 1092f
imaging, 1090
merits and demerits, 1090b
outcomes, 1093
patient history and physical findings, 1090
postoperative care, 1093
surgical management
patient positioning, 1090

preoperative planning, 1090
C-V flap, nipple reconstruction
anatomy, 1482
complications, 1484
definition, 1482
elevation and insetting, 1483, 1483f
flap design, 1483, 1483f
merits and demerits, 1484b
outcomes, 1484
patient history and physical findings, 1482
postoperative care, 1484
surgical management
patient positioning, 1482
preoperative planning, 1482, 1483f
Cyst(s)
inclusion, 147
keratin-filled, 66
mucous
anatomy, 2281
complications, 2286
definition, 2280
differential diagnosis, 2282
imaging, 2282
merits and demerits, 2286b
natural history, 2281
nonoperative management, 2282
outcomes, 2286
pathogenesis, 2281
patient history and physical findings, 2282
postoperative care, 2286
surgical management, 2282
Cysts. See specific types

D
Dacryocystorhinostomy (DCR), 2871–2872
Dacryoscintigraphy, 2871
Dal Pont modification, 697
DALs (dorsal aesthetic lines), 334
DAO. See Depressor anguli oris (DAO)
Darrach procedure, for distal radioulnar joint arthritis, 1969, 1970f
DCFG (diced cartilage fascia graft), 366–367, 372
placement of, 370, 371f
DCIA (deep circumflex iliac artery) flap, 928
De Novo umbilicoplasty without midline incision, 3039, 3039f
de Quervain syndrome
anatomy, 2093
complications, 2095
definition, 2093
differential diagnosis, 2093
imaging, 2093
merits and demerits, 2094b
nonoperative management, 2093
outcomes, 2095
pathogenesis, 2093
patient history and physical findings, 2093
postoperative care, 2095
surgical management
approach, 2093
patient positioning, 2093
Debridement
of bone infection
anatomy, 2352
complications, 2354
definition, 2352

differential diagnosis, 2353
imaging, 2352–2353, 2352f
medial malleolar chronic wound, 2353f
merits and demerits, 2354b
nonoperative management, 2353
outcomes, 2354
pathogenesis, 2352
patient history, 2352
patient positioning, 2353
physical findings, 2352
postoperative care, 2354
preoperative planning, 2353
surgical management, 2353, 2353f
pressure injury, 2787b, 2792
Debulking, sacrococcygeal teratoma, 3019, 3020f
Dedifferentiated chondrosarcoma, 2502
Deep circumflex iliac artery (DCIA) flap, 928
Deep flexor-pronator aponeurosis, 1994
Deep infection
bone tumors of femur, 2505
bone tumors of knee, 2464
Deep inferior epigastric artery (DIEA), 1414
Deep inferior epigastric perforator (DIEP) flap breast reconstruction
abdominal donor site closure, 1435f, 1436
anatomy, 1429–1430, 1429f
breast shaping, 1435, 1435f
complications, 1437
definition, 1429
footprint control, 1434–1435, 1435f
harvest, transfer and revascularization, 1435, 1435f
incision and flap elevation, 1432
internal mammary recipient vessels, exposure and preparation,
1433–1434, 1434f

merits and demerits, 1431b, 1436b
natural history, 1430
nonoperative management, 1430
outcomes, 1437
pathogenesis, 1430
patient history and physical exam, 1430
perforator dissection, 1433
perforator location and selection, 1432–1433
postoperative care, 1437
surgical management
patient positioning, 1431
preoperative markings, 1431
preoperative planning, 1430
vessel dissection, 1433, 1433f
Deep motor branch, 1989, 1990f
Deep muscular fascia, 1649
Deep neurovascular structures, 2486f–2487f, 2486
Deep pars marginalis, 2616
Deep peroneal nerve, 2323, 2323f, 2338
Deep plane face-lift
anatomy, 231
complications, 237
definition, 231
merits and demerits, 236b
modified deep plane rhytidectomy, 232b, 233f
natural history, 231
nonoperative management, 231
outcomes, 236
patient history and physical findings, 231
postoperative care, 236
surgical management, 231–232
approach, 232
positioning, 232

preoperative planning, 232
Deep pyriform space, 32
Deep sarcoma, 2499, 2499f, 2500f
Deep sternal wound infections (DSWIs), 1522
Deep temporal fascia (DTF), 872, 873f
Deep temporal fascia harvest, 363, 363f
Deep transverse incisions of tunica albuginea (DTITA), 3046
Deep vein thrombosis (DVT), 1536, 2444
history, 1230
prophylaxis, 1121
Deeper interdigastric fat, 242
Deeper peels, 60
Degloving injuries, 2429
Dehiscence, 2635
Delayed breast tissue expansion
anatomy, 1377, 1377f
capsule scar release, 1378
complications
bleeding/hematoma, 1379
infections, 1379
mastectomy skin necrosis, 1379
definition, 1377
mastectomy skin necrosis, 1379
merits and demerits, 1378b, 1379b
outcomes, 1379
patient history, 1377
physical findings, 1377
postoperative care, 1379
submuscular tissue expander pocket, 1378, 1378f
surgical management
approach, 1377
patient positioning, 1377
preoperative planning, 1377

tissue expander insertion, 1378, 1378f
wound closure, 1378
Delayed enophthalmos repair, 817
Delayed hard palate repair
anatomy, 2658
definition, 2658
hard palate repair, 2659–2660, 2660f
imaging and diagnosis, 2658
merits and demerits, 2661b
outcomes, 2661
pathogenesis, 2658
soft palate repair, 2659, 2659f
surgical management
patient position, 2658
Delayed primary closure, 2366
Delayed repair, with nonvascularized bone graft, 1038
Delayed reverse sural artery flap, 2390
Deltopectoral flap, 1230
Demineralized bone matrix (DBM), 2360–2361
Demyelination, 1977
Dental compensation, 698
Dental implants, 1027
Dental model analysis, 592
Deoxycholic acid (DOCA), 243
anatomy, 257
complications, 261–262
definition, 257
differential diagnosis, 257
imaging, 257
merits and demerits, 260b
nonsurgical management, 258
approach, 258
positioning, 258

preoperative planning, 258
outcomes, 260–261
patient history and physical findings, 257
postoperative care, 260
surgical management, 257
techniques, 258, 259f
Depressor alae nasi, 2596
Depressor anguli oris (DAO), 15
anatomy, 11, 11f, 14, 1073f
approach, 15
complications, 13, 16
definition, 11, 14
imaging, 15
merits and demerits, 15b
outcomes, 15–16
pathogenesis, 11
patient history and physical findings, 14–15
positioning, 15
postoperative care, 15
preoperative planning, 15
surgical management, 15
Depressor labii inferioris (DLI), 14–16, 1073, 1073f
Depressor septi nasi (DSN) muscle
anatomy, 373
columella, animation deformity of, 375, 375f
columellar base deformity, 376, 376f
complications, 376
definition, 373
imaging, 373
merits and demerits, 376b
outcomes, 376
patient history and physical findings, 373
postoperative care, 376

short upper lip/transverse crease, 375, 375f
surgical management, 373–374, 374f
tip descent, 374, 374f
tip descent illusion, 374, 375f
Depressor supercilii
removal, transpalpebral corrugator resection, 111, 111f
transpalpebral corrugator resection, 109
Dermabrasion
and curettage, 2737
to face
anatomy, 67
approach, 67
complications, 68
definition, 67
mechanical dermabrasion, 67, 68f
merits and demerits, 68b
outcomes, 68
patient history and physical findings, 67
positioning, 67
postoperative care, 68
preoperative planning, 67
surgical management, 67
Dermal sinus excision, 2747–2748, 2748f
Dermatochalasis, 138
Dermoid cysts, 2745
Descending genicular artery, approach to, 2488
Desmoplastic melanoma, 1105, 1106f
Deviated caudal dorsum correction, 329
Dexamethasone, 1979
Dextran, 2444
Diabetes mellitus, 2365, 2373
Diabetic foot ulcers
aggressive wound debridement, 2408

anatomy, 2407
definition, 2407
differential diagnosis, 2408
flaps and grafts, 2408
imaging, 2408
merits and demerits, 2408b
natural history, 2407
nonoperative management, 2408
outcomes, 2409
pathogenesis, 2407
patient history and physical findings, 2407–2408
surgical management, 2408
Diabetic ulcers, 2365
Diabetics, 2350
Diagnostic laparoscopy, ambiguous genitalia, 3063
Diaphyseal fractures, 2471
Diaphyseal fragments, 2468
Diaphyseal tibia tumor resection and reconstruction, 2424
Diazepam, 2683
Diced cartilage
fascia graft, for dorsal augmentation
anatomy, 362
complications, 365
deep temporal fascia harvest, 363, 363f
definition, 362
differential diagnosis, 362
imaging, 362
merits and demerits, 364b
nonoperative management, 362
pathogenesis, 362
patient history and physical findings, 362
postoperative care, 364
surgical management, 362–363, 363f

techniques, 363, 364f
in rhinoplasty
anatomy, 366
combined techniques, 371
complications, 372
DCFG, placement of, 370, 371f
definition, 366
fascial wrapping, 370, 370f
harvest, 368–369, 368f
imaging, 366
merits and demerits, 371b
nonoperative management, 367
outcomes, 372
patient history and physical findings, 366
postoperative care, 371–372
surgical management, 367–368, 372f–371f
techniques, 369, 369f
temporal fascia harvest, 369, 369f
Diced cartilage fascia graft (DCFG), 366–367, 372
placement of, 370, 371f
DIEA. See Deep inferior epigastric artery (DIEA)
Dieffenbach technique, 1135
DIEP (deep inferior epigastric artery perforator) flap, 2487–2488
Diet, 2386, 2444
Digit(s)
duplication (see Polydactyly)
revision amputation and shortening of
fingertip (see Fingertip)
Digital artery sympathectomy
anatomy, 2156, 2156f
complications, 2159
definition, 2156
differential diagnosis, 2157

exposure, 2157, 2158f
imaging, 2156–2157
merits and demerits, 2157b, 2158b
natural history, 2156
nonoperative management, 2157
outcomes, 2159
pathogenesis, 2156
patient history and physical findings, 2156
postoperative care, 2159
surgical management
approach, 2157
patient positioning, 2157
preoperative planning, 2157
Digital fascia, 2176
Digital nerves
anatomy, 1754
definition, 1754
local anesthesia, 1755–1757, 1756f, 1757f
DIO (dorsal interosseous), 2109
DIPJs. See Distal interphalangeal joints (DIPJ) of hand
Diplopia, 877, 951, 957
Direct closure and lateral cantholysis
anatomy, 1078, 1079f
canthotomy, 1081, 1081f–1082f
complications, 1082
definition, 1078
merits and demerits, 1080b
natural history, 1078
nonoperative management, 1079
outcomes, 1082
pathogenesis, 1078
patient history and physical findings, 1078–1079
postoperative care, 1082

primary wound closure, 1080, 1080f–1081f
surgical management, 1079
techniques, 1081
wound preparation, 1080
Direct-to-implant (DTI) breast reconstruction
anatomy, 1398
complications, 1403
definition, 1398
imaging, 1398
merits and demerits, 1401b
outcomes, 1402–1403
with partial muscle coverage and acellular dermal matrix,
1399–1400, 1400f, 1401f
patient history and physical findings, 1398
postoperative care, 1401–1402
surgical management
approach, 1399
patient positioning, 1399
preoperative planning, 1399, 1399f
Disease-modifying antirheumatic drugs (DMARDs), 1939–1940
Distal anterior interosseous nerve transfer
anatomy, 2043
complications, 2047
definition, 2043
differential diagnosis, 2044
imaging, 2044
internal topography, 2043, 2043f–2044f
merits and demerits, 2047
outcomes, 2047
patient history and physical findings, 2044
postoperative care, 2047
surgical management
approach, 2045, 2045f

patient positioning, 2045
preoperative planning, 2045
Distal femur osteosarcoma, 2462f
Distal fibula bone tumor, straight lateral approach for, 2344f
Distal fibula resection, 2343–2344
Distal flap necrosis, 2449
Distal foot/toe amputation, 2322
Distal hypospadias repair, tubularized incised plate urethroplasty for
anesthesia, 3043
initial approach, 3043, 3043f
Distal interphalangeal joints (DIPJ) of hand
arthrodesis, 1959, 1959f
mucous cysts in (see Mucous cysts)
rheumatoid arthritis
arthrodesis of, 1947
boutonniere deformity, 1938, 1938f
dorsal tenodermodesis of, 1947
swan-neck deformities, 1937, 1938t
Distal lower extremity autografts, 2357
Distal osteotomy, 2435, 2514
Distal phalanx fractures
anatomy, 1775
closed reduction and pinning, 1776–1777, 1776f–1777f
complications, 1779
definition, 1775
imaging, 1776
in mallet fingers, 1775
merits and demerits, 1778b
natural history, 1775
nonoperative management, 1776
open reduction and internal fixation, 1777
open seymour fractures (see Seymour fractures)
outcomes, 1779

pathogenesis, 1775
patient history and physical findings, 1776
postoperative care, 1779
surgical management, 1776
approach, 1776
patient positioning, 1776
types of, 1775, 1775f
Wehbe and Schneider classification, 1775
Distal radioulnar joint (DRUJ) osteoarthritis
Darrach procedure for, 1969, 1970f
hemiresection arthroplasty, 1970, 1971f
provocative testing of, 1956
Distal radius fractures (DRFs)
anatomy, 1913, 1913f–1914f
classification systems and eponyms, 1915, 1916f
complications, 1929–1930
definition, 1913
differential diagnosis, 1915
dorsal bridge plate fixation, 1917
additional fracture reduction and fixation, 1926
completion and closure, 1926
equipment, 1925
pertinent anatomy, 1925, 1925f
plate placement, 1925–1926, 1926f
postoperative care, 1926, 1927f
site preparation and exposure, 1925, 1925f
dorsal plate fixation of, 1923, 1923f, 1924f
external fixation, 1917
completion and closure, 1920
equipment for, 1919
fracture reduction, 1919, 1919f
pertinent anatomy, 1919, 1919f, 1920f
pin and external fixation frame placement, 1919–1920, 1920f

postoperative care, 1920
imaging, 1915, 1915f
initial management, 1915–1916, 1916f
merits and demerits, 1927b
nonoperative management, 1916
outcomes, 1929
patient history and physical findings, 1913–1915, 1915f
percutaneous pinning, 1917
equipment, 1917, 1917f
Kapandji intrafocal technique for, 1917, 1918f
Kirschner wire (K-wire) insertion, 1917–1918, 1918f
placement, 1918, 1918f
postoperative care, 1918–1919
surgical management, 1916–1917
approach, 1917
patient positioning, 1917, 1917f
preoperative planning, 1916
volar plating, 1917
completion and closure, 1922, 1922f
equipment for, 1921
exposure, 1921, 1921f
fracture reduction and plate fixation, 1921–1922, 1922f
pertinent anatomy, 1919f, 1921
postoperative care, 1922, 1922f
wrist OA, 1957
Distal thigh, 2317f
Distal ulna, hemiresection arthroplasty of, 1970, 1971f
Distal ulnar groove deepening, 2088
Distally based medial hemisoleus flap, 2448–2449, 2448f
Distraction osteogenesis (DO), 447
Le Fort II osteotomy
anatomy, 606, 607f
complications, 615

definition, 606, 606f
imaging studies, 606
indications, 609b
merits and demerits, 614t
outcomes, 615
postoperative care, 614–615
pyramidal pattern, 609, 609f
quadrangular osteotomy, 610–613, 610f–611f
surgical management, 606–608
zygomatic repositioning, 610, 610f
temporomandibular joint
anatomy, 691
complications, 696
definition, 691
differential diagnosis, 692
imaging studies, 692
indications, 693
merits and demerits, 693b
natural history, 691–692
outcomes, 695–696
pathogenesis, 691
patient history and physical findings, 692
postoperative care, 695
reverse distraction, 693–695, 694f
surgical management
extraoral/submandibular approach, 693
intraoral approach, 693
patient positioning, 693
preoperative planning, 691f, 693
DLI (depressor labii inferioris), 14–16
Dog bites, 3075
Dominant nutrient artery, 2432
Donor and recipient nerves, mobilization and transection, 2052

Donor site closure, 1658, 1658f, 1694–1695
Donor strip harvest, hair transplantation, 424, 424f
Donor-site defect, keystone flaps to close, 1747, 1747f
Donor-site repair, flap advancement and final closure, 1087, 1087f
Doppler Allen test, 2115
Doppler probe, 2512, 2515, 2524
Doppler sonography, 2134
Doppler ultrasound, 2129
Dorsal aesthetic lines (DALs), 334, 380
Dorsal augmentation
diced cartilage, fascia graft for
anatomy, 362
complications, 365
deep temporal fascia harvest, 363, 363f
definition, 362
differential diagnosis, 362
imaging, 362
merits and demerits, 364b
nonoperative management, 362
pathogenesis, 362
patient history and physical findings, 362
postoperative care, 364
surgical management, 362–363, 363f
techniques, 363, 364f
using alloplastic material
anatomy, 350, 350f–351f
completion, 359, 359f
complications, 360, 360f
definition, 350
e-PTFE implant, pretreatment of, 356, 356f
implant carving, 353–354, 353f
implant deviation, correction of, 359, 359f
implant insertion, 356, 357f

implant wrapped with temporal fascia/allograft dermis, 358,
358f
incision, 354–355, 354f
merits and demerits, 359b
patient history and physical findings, 350
pocket, dissection for, 355–356, 355f–356f
postoperative care, 360
supratip area, management of, 357, 357f–358f
surgical management, 350–352, 351f, 352f
using costal cartilage graft
anatomy, 343, 343f
complications, 349
definition, 343
dorsal graft, preparing and affixing, 344–345, 345f–346f
harvesting, 344, 344f
merits and demerits, 348b
outcomes, 349, 349f
patient history and physical findings, 343
postoperative care, 349
surgical management, 343
transosseous suture/K-wire, use of, 347–348, 347f–348f
Dorsal foot arterial anatomy, 2168, 2168f–2169f
Dorsal hand compartment release, 1762, 1762f
Dorsal hump, open rhinoplasty with
anatomy, 294
complications, 296
correction of, 294, 295f
definition, 294
imaging, 294
merits and demerits, 296b
outcomes, 296
patient history and physical findings, 294
postoperative care, 296

surgical management, 294
Dorsal intercalated segmental instability (DISI), 1851, 1857, 1899
Dorsal metatarsal artery flap, 2368f–2369f
Dorsal plication, correction of chordee with, 3044, 3044f
Dorsal rectangular flap, finger syndactyly release
anatomy, 2216, 2216f–2217f
complications, 2222
definition, 2216
dorsal markings, 2218, 2219f
dressings and immobilization, 2221–2222, 2222f
flap creation, 2219, 2221f
grafting, 2219–2221, 2221f
imaging, 2216–2217, 2217f
merits and demerits, 2218b, 2222b
natural history, 2216
outcomes, 2222
patient history and physical findings, 2216
postoperative care, 2222
surgical management
approach, 2218
patient positioning, 2218
preoperative planning, 2217–2218
volar markings, 2219, 2219f
Dorsalis pedis artery, 2369, 2378–2379
Dorsally displaced distal radius fractures, 1987
Dorsoulnar fibers, 1986f
Double barrel fibula technique, 2515, 2515f
Double crush, 2412
Double extended V-Y flap, 1183
“Double Eyelid” surgery. See Asian blepharoplasty
Double follicular units (DFU), 421
Double-barrelled fibula technique, 2436, 2436f
Double-injection method, 326

Double-opposing postauricular and preauricular flaps, 1138–1140,
1139f
Double-opposing Z-plasty
Doyle stents, 332
Drainage of abscesses. See Abscesses drainage, of lower leg and
foot
Drawbridge effect, 2676
Drop piriform wires, 959–962, 961f
DRUJ (distal radioulnar joint), 2126, 2128–2129
Dry eye, 2871
Dry liposuction, 2572–2573
DSN muscle. See Depressor septi nasi (DSN) muscle
DTF (deep temporal fascia), 872, 873f
Dual plane augmentation
anatomy, 1314
complications, 1318
definition, 1314
imaging, 1314–1315, 1314f
merits and demerits, 1316b, 1317b
outcomes, 1318
pathogenesis, 1314
patient history and physical findings, 1314
postoperative care, 1318
surgical management
approach, 1315–1316, 1315f–1316f
patient positioning, 1315
preoperative planning, 1315, 1315f
Duplex arteriogram, 2365
Dupuytren disease
anatomy, 2176, 2176f–2177f
Checkrein ligament release, 2183, 2183f
complications, 2184
definition, 2176

imaging, 2178
merits and demerits, 2183b
natural history, 2178
nonoperative management, 2178
outcomes, 2184
pathogenesis, 2177–2178, 2177f
patient history and physical findings, 2178
postoperative care, 2184
surgical management
approach, 2178–2179
patient positioning, 2178
preoperative planning, 2178
Dura and myofascial closure, 3015
Dura, myofascial, and skin closure, 3010, 3010f
Durkan carpal compression test, 1977
Dutasteride, 418
Dynamic rhytids, 5
Dynamic spacers, 2469
Dynamic sphincter pharyngoplasty
dissection, 2709, 2710f
markings, 2709, 2710f
surgical management, 2707
Dyschromia, 55
Dysesthesia, prominent ears, 2840
E
Ear cartilage exposure, cryptotia, 2834
Ear lacerations, 3080, 3081f
Ear lobe
anatomy, 1138
complications, 1141
definition, 1138

double-opposing postauricular and preauricular flaps, 1138–1140,
1139f
imaging, 1138
with local flaps, 1138, 1139f
longitudinally folded preauricular flap, 1140, 1140f
merits and demerits, 1139b
patient history and physical findings, 1138
postoperative care, 1141
surgical management, 1138–1139
Ear lobules. See Ear lobe
Ear reconstruction
antia-buch flaps
anatomy, 1129
“classic” helix-only defect, 1130, 1130f
complications, 1132
definition, 1129
helical-scaphal defect, 1131, 1131f
helical-scaphal-antihelix defect, 1131, 1131f
imaging, 1129
merits and demerits, 1130b
modifications, 1130
nonoperative management, 1129
outcomes, 1132
patient history and physical exam, 1129
postoperative care, 1132
superior and inferior incisions, 1130
surgical management, 1129
V-Y advancement flap, 1130, 1130f, 1131f
ear lobe
anatomy, 1138
complications, 1141
definition, 1138
double-opposing postauricular and preauricular flaps,

1138–1140, 1139f
imaging, 1138
with local flaps, 1138, 1139f
longitudinally folded preauricular flap, 1140, 1140f
merits and demerits, 1139b
patient history and physical findings, 1138
postoperative care, 1141
surgical management, 1138–1139
postauricular flap
anastomotic network, 1133
anatomy, 1133, 1133f
complications, 1137
definition, 1133
imaging sudies, 1134
marginal ear defects, 1134–1135, 1134f, 1135f
merits and demerits, 1135b
patient history and physical findings, 1134
postoperative care, 1136
surgical management, 1134
Ear region, panfacial fractures, 934
Early infection, 2469
ECA (extensor compartmental artery) vascularized bone flap
ECRL (extensor carpi radialis longus), 2001b, 2001f, 2002f
to flexor digitorum profundus transfer, 2212, 2212f
tenodesis, for scapholunate dissociation, 1903
ECU (extensor carpi ulnaris), 2126, 2130–2132, 2131f
ECU tendon subluxation. See Extensor carpi ulnaris (ECU) tendon
subluxation
EDC (extensor digitorum communis), 2109, 2131
Edema
antia-buch flaps, 1132
prevention, 2453
EDM (extensor digiti minimi), 2040, 2126, 2130–2132, 2131f

Ehrlich approach, prune belly, 3023
EIP (extensor indicis proprius), 2033f, 2036–2037, 2109
Elbow extension procedures
anatomy, 2186
complications, 2195
definition, 2186
imaging, 2188
merits and demerits, 2190b, 2194b
nonoperative management, 2188
outcomes, 2195
patient history and physical findings, 2186–2188
postoperative care, 2195
surgical management
approach, 2189
patient positioning, 2189
preoperative planning, 2189
Elbow flexion test, 1993
Elbow reconstruction. See also Neonatal brachial plexus palsy
(NBPP)
complications, 2968
elbow release, 2959–2960, 2960f
outcomes, 2968
postoperative care, 2967
restoration of elbow flexion
free functioning gracilis transfer, 2963, 2963f
latissimus dorsi transfer, 2962–2963, 2962f
steindler flexorplasty, 2961–2962, 2961f
Elbow splints, 2635
Electrocautery, 389f
Electrodiagnostic studies
cubital tunnel syndrome, 1993
median and ulnar nerve injuries, 2035
ulnar tunnel syndrome, 1988

Empty nose syndrome, 275
Encephalocele, 2745
Enchondroma
anatomy, 2295
complications, 2297
definition, 2295
differential diagnosis, 2295
excision and bone grafting, 2296, 2296f–2297f
imaging, 2295, 2295f
incidental, 2295
merits and demerits, 2297b
natural history, 2295
nonoperative management, 2295–2296
outcomes, 2297
pathogenesis, 2295
patient history and physical findings, 2295
postoperative care, 2297
radiograph of, 2295, 2295f
surgical management, 2296
approach, 2296
preoperative planning, 2296
Endochondral and intramembranous ossification, 509, 509f–510f
Endonasal access, 272, 272f
Endonasal rhinoplasty, 272
Endonasal spreader graft placement, 300–302
Endoprosthesis, 2424, 2503
Endoscopic brow lifting, 79–80, 79f
anatomy, 77, 78f
approach, 78
complications, 81
definition, 77
endoscopic brow lift, 79–80, 79f
imaging, 77

merits and demerits, 81b
nonoperative management, 77
outcomes, 81
pathogenesis, 77
patient history and physical findings, 77
patient positioning, 78
postoperative care, 81
preoperative planning, 78
surgical management, 78, 78f
suspension, 80–81, 80f
Endoscopic endonasal marsupialization
anterior ethmoidectomy, 804, 805f
completion process, 806
frontal dissection, 805, 805f
maxillary antrostomy, 804, 805f
uncinectomy, 804f
Endoscopy
ambiguous genitalia, 3063
Poland syndrome, 2980, 2980f
sagittal synostosis
incisions and endoscope insertion, 481, 481f
spring placement, 481, 482f
spring removal, 481
End-to-end microanastomoses, 2490
End-to-side anastomosis, 2442, 2526, 2526f
End-to-side microanastomoses, 2490
Enophthalmos, 809–810, 824, 951, 957
secondary correction of
anatomy, 847
complications, 851
definition, 847
imaging, 848
merits and demerits, 851b

natural history, 848
orbital floor repair, 851, 851f
outcomes, 851
pathogenesis, 847–848
patient history and physical findings, 848, 849f
periorbital repair, 849, 850f
postoperative care, 851
surgical management, 848–849
zygoma repair, 850, 850f
Enoxaparin, 2444
Enzymatic debridement, 2430
EPB (extensor pollicis brevis) tendon, 2112
Epiblepharon
anatomy, 2857
complications, 2862
definition, 2857
merits and demerits, 2862b
nonoperative management, 2858
outcomes, 2862
with outlining markings, 2858f
pathogenesis, 2857
patient history and physical findings, 2857, 2857f
postoperative care, 2861–2862
surgical management
approach, 2858–2861
patient positioning, 2858
preoperative planning, 2858
Epidural abscess, 2330
Epidural analgesia, 2326
Epidural anesthesia
anatomy, 2326, 2326t, 2328b
complications, 2330
contraindications to, 2327

definition, 2326
imaging, 2327
merits and demerits, 2329t
nonoperative management, 2327
outcomes, 2330
patient history, 2327
physical findings, 2327
postoperative care, 2329–2330
surgical management, 2327
anesthetic administration, 2329
epidural placement, 2328, 2328f
lumbar and thoracic epidurals, approaches to, 2327
patient positioning, 2327, 2328f
preoperative planning, 2327
preparation, 2328
Epidural hematoma, 2330
Epidural injection, vertebral levels for, 2328b
Epinephrine, 186, 2328–2329, 2631, 2633
bilateral cleft lip repair, 2638
emergency room anesthesia, 3077
eyelid coloboma, 2843
local anesthesia, 972
nasal tip hemangioma, 2888
neck contracture, 2781
secondary deformities, of lip and nose, 2645, 2648
Epineurial repair, 2004, 2004f
Epistaxis, open treatment of nasal fractures, 864
Epitendinous repair with Silfverskiold sutures, 2059, 2059f
Epithelioid sarcoma, 2421
e-PTFE (expanded polytetrafluoroethylene), 351, 356, 356f
Erector spinae
anatomy, 1727
complications, 1729

definition, 1727
imaging, 1727
muscle flap, 1728–1729, 1728f–1729f
outcomes, 1729
patient history and physical findings, 1727
postoperative care, 1729
surgical management
approach, 1727
patient positioning, 1727
preoperative planning, 1727
Erythematous follicular popular, 66
Erythrocyte sedimentation rate (ESR), 2467, 2471, 2474
Estlander flaps
anatomy, 1055, 1055f
complications, 1058
definition, 1055
external landmarks, 1055
imaging, 1056
lower lip, 1057, 1057f
merits and demerits, 1058b
outcomes, 1058, 1058f
patient history and physical findings, 1055, 1056f
postoperative care, 1058
surgical management
approach, 1056
patient positioning, 1056
preoperative planning, 1056
upper lip, 1056, 1056f–1057f
Ethmoid bone, medial orbit wall fractures, 829, 829f
Ethnic rhinoplasty
alar cartilage resection, 291
alar wedge resection, 292
anatomy, 288–289

complications, 293
definition, 288
dorsal resection, 290, 290f
graft placement and wound closure, 291–292
imaging, 289
merits and demerits, 292b
nasal spine–caudal septum, 290, 290f
open approach, 317, 317f
anatomy, 315
definition, 315
grafting, harvesting cartilage for, 316–317, 316f
middle nasal vault, 318, 318f
nasal base, stabilizing, 319, 319f
nasal dorsum, managing, 317, 318f
nasal septum, exposing, 317, 317f
nasal tip, managing, 319–321, 320f
patient history and physical findings, 315–316, 316f
surgical management, 316
osteotomy, 292, 292f
outcomes, 293, 293f
patient history and physical findings, 289
postoperative care, 293
septoplasty and spreader graft tunnels, 291
skeletonization, 290
surgical management, 289
approach, 289
patient positioning, 289
preoperative planning, 289
turbinectomy, 291
upper lateral cartilages and shortening the nose, 291, 291f
Etidocaine, 2329
European League Against Rheumatism (EULAR), 1931
Eustachian tubes, 2658