There has been an alarming increase in methicillin-resistant Staphylococcus aureus (MRSA) infections. Richard A. Zoumalan, MD, and David B. Rosenberg, MD, retrospectively reviewed the cases of 780 patients who had undergone deep-plane rhytidectomy. They identified 5 patients (0.64%) as having postoperative site infections, and 4 patients (0.51%) as having culture findings that were positive for MRSA; 2 (0.26%) required incision and drainage, hospitalization, and intravenous antibiotics. The authors give a detailed discussion of management for each of the 5 cases and discuss screening, prevention, postoperative surveillance, and treatment of the infections. They conclude that MRSA-positive infections may become more prevalent and will require enhanced screening, prevention, and treatment strategies.
Ritvik P. Mehta, MD, and Tessa A. Hadlock, MD, investigated the effect of botulinum toxin chemodenervation on the quality of life (QOL) in patients with facial nerve paralysis (FNP). They used the Facial Clinimetric Evaluation (FaCE) scale to assess the QOL benefit in patients with FNP with synkinesis and hypertonicity. The overall FaCE score improved from 51.7 in the pretreatment group to 63.7 in the posttreatment group. A statistically significant improvement was also seen in facial movement, facial and eye comfort, oral and social functions, and lacrimal control. The authors conclude that botulinum toxin is an important tool in the overall treatment strategy for patients with FNP with synkinesis and hypertonicity.
Nasal musculature, also known as the nasal superficial musculoaponeurotic system (SMAS), has been previously studied. Yves Saban, MD, PhD, and colleagues give an overview of this knowledge as well as a unified concept of muscles and ligaments of the nose. They performed dissections on 30 fresh cadavers in the subcutaneous, the sub-SMAS, and combined subperichondrial/periosteal planes. They also used 3 different approaches for dissection: radix to tip, tip to radix, and midline to lateral. Histologic examination of 9 cadavers was also performed. The extent of the nasal SMAS is demonstrated in photographs and histologic slides. The authors view the nasal SMAS as a unified layer spanning from the glabellar region to the nostril margin and also recognize its division into deep and superficial layers at the level of internal nasal valve.
There is a lack of objective measurements of quality of life (QOL) within facial plastic surgery literature. Jason A. Litner, MD, FRCSC, and colleagues investigated perioperative QOL changes in patients who had undergone cosmetic nasal and facial surgery in this 3-year prospective cohort study. The Derriford Appearance Scale (DAS59), a validated survey that assesses psychological distress related to self-image, was used to measure the main outcome. The scores were analyzed by groups: for all patients, according to sex, and according to the main surgical procedure. Ninety-three surveys were administered preoperatively and 3 months postoperatively. Significant differences in perioperative QOL were noted in all DAS59 domains in this patient population. Minor differences were noted between sexes. There were also some differences in responses from patients who underwent rhinoplasty vs those who underwent aging-face surgery, yet both types of procedures improved patients' QOL.
Kiss Me and You’ll Kiss the ’Lasses by Lilly Martin Spencer (1822-1902).
This issue's Highlights were written by Joseph Shvidler, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2008;10(2):78. doi:10.1001/archfaci.10.2.78