Facial nerve injury is characterized by incomplete eye closure, nasal obstruction, impaired speech and oral competence, and the stigmata associated with hemifacial paralysis. Unfortunately, poor functional recovery is common following facial nerve division with subsequent microsurgical repair. Robin W. Lindsay, MD, and colleagues present their findings of improved whisking recovery secondary to mechanical stimulation during the recovery period following facial nerve transection and reanastomosis. Whisking kinematics were quantified, protraction and retraction stimuli evaluated, and statistically significant improvements observed in mechanically manipulated rodents compared with established controls.
The challenge of creating aesthetic, harmonious, and lasting results in rhinoplasty surgery has long remained an ambitious endeavor fraught with exceptional difficulty. Eric J. Dobratz, MD, and colleagues critically review the short- and long-term results in nasal tip stabilization techniques, including columellar strut, caudal septal extension graft, tongue-in-groove, and suture stabilization techniques in a population of 40 patients. In addition, a 5-specimen cadaveric study is presented, which objectively details the structural resilience of each of these techniques. The authors openly review their considerations in the development of uniform maintenance of nasal tip position in their patient population as well as the fundamentals in tip support mechanisms.
Large segmental defects of the facial skeleton represent a series of operative and restorative challenges. Current reconstructive techniques, whether autologous bone, allogeneic bone, or prosthetic implant, are often limited by bone supply, infection, extrusion, and donor site morbidity. Adam Terella, MD, and colleagues investigated the in vivo osteogenic capabilities of a protease-sensitive polyethylene glycol scaffold in the healing of critical-size calvarial defects in the rat model. The authors use microcomputed tomography at intervals of 1, 4, and 8 weeks after implantation and assess bone formation across various implant types and control groups. A statistically significant reduction in calvarial wound size, from 50% (in the control group) to 77% (in the polyethylene glycol–matrix metalloproteinase–treated group), was observed in this animal series.
Congenital soft-tissue defects of the external ear represent approximately 1% of all auricular malformations. Considerable psychological turmoil may develop in affected individuals because head and neck malformations are often easily visualized and poorly concealed. Christoph Schlegel-Wagner, MD, and colleagues discuss the application of an anterior scoring technique combined with mattress suturing in the treatment of prominent ears through a consecutive review of 421 otoplasties in 222 patients. The authors detail their concerns in perioperative evaluation and operative technique and review operative outcomes as well as the results of their patient questionnaire. Long-term stability was observed in 90% of patients with sequelae comparable to other long-term investigations.
Helen Sears, by John Singer Sargent (1856-1925).
This issue's Highlights were written by James Ridgway, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2010;12(3):140. doi:10.1001/archfacial.2010.23