Alloplastic biomaterials, such as the bone substitute cements, provide an important new tool for the craniofacial surgeon. Hydroxyapatite and carbonated apatite are commercially available bone substitutes that can be easily contoured and applied. They have, in some cases, obviated the need for autologous bone grafts and thus decreased operative time and eliminated donor site morbidity. Kevin K. Mathur, MD, Sherard A. Tatum, MD, and Robert M. Kellman, MD, present a series of 35 patients with 46 sites of reconstruction using hydroxyapatite or carbonated apatite. They were equally effective in craniofacial reconstruction. Use of these materials in the sinonasal or oral cavities, however, resulted in increased risk of infection. These biomaterials add to the surgeon's armamentarium in craniofacial reconstruction.
Nasal tip bossae are knoblike protuberances of the lower lateral cartilages that can occur following rhinoplasty. Russell W. H. Kridel, MD, Patricia J. Yoon, MD, and R. James Koch, MD, describe their experiences with nasal tip bossae and recommend ways to prevent and correct them. Individuals with interlobular bifidity, thin skin, and strong alar cartilages are somewhat predisposed to develop bossae. There are 3 general principles to prevent and treat bossae: reinforce any weak area subject to contracture; maintain or reconstitute alar cartilage continuity; and avoid sharp edges, irregularities, and asymmetries. Attention to these principles should reduce the incidence of bossae in the postoperative rhinoplasty patient.
Tongue reconstruction presents a difficult problem because of the tongue's functional importance in speech and deglutition. A functional neotongue requires both adequate bulk and coordinated muscle function. Jennifer Kim, MD, and associates present an experimental animal study in which a unilateral mucosa-sparing partial glossectomy was performed, and the defects were filled with isotonic sodium chloride solution, collagen-rich gel, or a hydrogel containing a suspension of neonatal myoblasts. The group receiving the hydrogel-myoblast composite injections demonstrated an increase in mass compared with the control side. In addition, hemitongues from the tissue-engineered group demonstrated formation of new tissue, with areas of muscle-like tissue extending from islands of residual hydrogel and evidence of neovascularization and possible neurotization. The other groups showed no clear evidence of new tissue formation. This tissue-engineering approach represents a promising new strategy in tongue reconstruction.
Facial nerve palsy can result in ocular exposure due to lower lid retraction and ectropion. These ocular symptoms can be aggravated by concomitant paralytic ptosis of the malar soft tissues. Victor M. Elner, MD, and associates describe a comprehensive approach, which includes midface elevation, for the ocular complications of facial nerve palsy. Eleven patients were treated with subperiosteal midface elevation as a component of lower lid elevation. After an average of 17 months of follow-up, all patients reported improvement in symptoms and had good visual acuity. All but 2 of these patients had chronic facial palsy for 1 year or considerably more. The multimodality of the procedure precludes an exact analysis of the relative benefit of midface lifting. The success in this group of patients, however, emphasizes the anatomic unity of the lower lid and midface. The cosmetic improvement in the midface is an added benefit.
Saint Cecilia and an Angel, by Orazio Gentileschi (1563-1639).Article
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2003;5(5):370. doi:10.1001/archfaci.5.5.370