The search for an ideal grafting material has long been a topic of intense interest and continued debate in facial plastic surgery. Various biologic and synthetic mediums have been rigorously investigated, but concerns about safety, reliability, and longevity have persisted. Russell W. H. Kridel, MD, and colleagues review 1 025 homograft cartilage grafts in 357 patients over a 24-year period with complication rates equal to, and in some circumstances less than, those associated with autologous cartilage grafts. The authors use homograft cartilage as a primary and alternative grafting material in a large and diverse patient population while demonstrating excellent long-term structural, cosmetic, and cost-effective results in primary and revision rhinoplasty.
In the decades since the first microvascular free-tissue transfer, a new era of soft-tissue reconstruction, innovation, and challenges has developed. The treatment of complex 3-dimensional defects in the head and neck has evolved beyond local and distant tissues to engage a surgical realm previously reserved for organ transplantation. Daniel S. Alam, MD, and colleagues present the first successful near-total face, maxilla, and palate transplant. In an operative field depleted of viable recipient vessels from the patient's initial trauma and the ensuing 23 previous reconstructive surgical procedures, the authors detail their considerations in vascular and defect analysis, allograft design, and operative approach. In addition, they highlight the joint transfer of the midfacial skeleton and soft tissues based solely on the facial arterial system in this salvage operation.
The platysma muscle has a significant facial component. Unfortunately, the details of the superior limits of the platysma are often poorly described and illustrated with the upper border of the muscle appearing to reach only the inferior margin of the mandible. In a study of 71 consecutive deep-plane rhytidectomies performed on 142 facial halves, Anil R. Shah, MD, and David Rosenberg, MD, delineated the superior extent of the platysma muscle. Measurements along the malar mandibular line (MML) were conducted and revealed, on average, that 56% of the MML was occupied by the platysma. These findings lend support to a greater role for the platysma not only in facial expression but in facial aging and surgical rejuvenation as well.
Advances in imaging technology have considerably improved the delineation of facial skeletal trauma, in particular the bony orbit. Using computed tomography, orbital fractures and the resulting orbital volume changes can be readily measured. Jaehwan Kwon, MD, and colleagues evaluated preoperative and postoperative volume changes observed in traumatic orbit disruption and the ensuing surgical correction of 24 patients with unilateral orbital trauma. Volume changes were measured using 2 unique 3-dimensional analysis software packages. Consistent orbital volume measurements were obtained in presurgical and postsurgical settings for both software programs. Such imaging studies may become a useful tool in the surgeon's armamentarium in preventing the development of enophthalmos.
Brother and Sister: Charles Sumner Bird and His Sister Edith Bird (Mrs Robert Bass) by Cecilia Beaux (1855-1942).
This issue's Highlights were written by James Ridgway, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2009;11(6):365. doi:10.1001/archfacial.2009.88