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Highlights of Archives of Facial Plastic Surgery
November 2003

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2003;5(6):462. doi:10.1001/archfaci.5.6.462
Mandibular Angle Fractures

Various techniques have been used to repair angle fractures, but the location and thinness of the bone make it difficult to reduce and fixate accurately. Albert J. Fox, MD, and Robert M. Kellman, MD, perform a retrospective analysis of the outcomes and complications in patients treated using monocortical 2-miniplate fixation. They describe the technique they applied to 68 patients who had a minimum follow-up of 6 weeks. Complications included infection, dehiscence, malocclusion, and trigeminal nerve injury. However, the overall infection rate was only 2.9%. This study supports the use of rigid fixation of angle fractures via a noncompression, 2-miniplate fixation to avoid the potential problems associated with maintaining the fracture with maxillomandibular fixation.


Thickness and Histologic and Histochemical Properties of the Superior Pharyngeal Constrictor Muscle in Velocardiofacial Syndrome

Velocardiofacial syndrome (VCFS) is diagnosed with increasing frequency owing to greater awareness and genetic testing. Pharyngeal hypotonia often contributes to hypernasal speech and velopharyngeal incompetence. Shane Zim, MD, and associates evaluate the thickness as well as the histologic and histochemical properties of the superior pharyngeal constrictor. On magnetic resonance imaging, the muscle was significantly thinner in these patients. Histologically, the muscle fibers in patients with VCFS were more rounded and loosely packed, showed a higher proportion of type 1 than type 2 muscle fibers, and displayed a type 1 fiber that was significantly smaller in diameter. This study is important in elucidating the cause of pharyngeal hypotonia and hypernasality in patients with VCFS.


Midfacial Rejuvenation Via a Minimal-Incision Brow-lift Approach

Various techniques are available to address the midface in facial rejuvenation, and each has its own set of potential complications. Edwin F. Williams III, MD, and associates critically evaluate their patients who underwent a midface-lift via an endoscopic brow approach, with direct visualization achieved with a headlight and converse retractor. Three independent evaluators who examined the elevation of 3 facial zones in 100 patients observed marked improvements in the malar/infraorbital complex (zone I) and mild improvements in the jaw line (zone III). Change of the lateral-canthal position was also evaluated; even though a statistically significant change in elevation was calculated for the right eye, no clinical significance was noted. Finally, only 11 complications developed in 325 patients, most of which occurred early in the senior author's experience. Some of these complications have subsequently been avoided with slight technical modifications. This study supports the use of the extended brow approach, which should be part of the armamentarium of the surgeon to rejuvenate the midface.


The Precaruncular Approach to the Medial Orbit

Current approaches to the medial orbit either provide poor surgical access or may result in unsightly scarring or web formation. The transcaruncular approach recently used has improved access but caused prolonged edema and erythema in the area. Kris. S. Moe, MD, developed a new technique to access the medial orbit. He determined that the plane medial to the caruncle was relatively avascular and provided the most direct surgical path to the lacrimal crest and medial orbit. The technique was used in 15 consecutive procedures for conditions that included orbit fractures, medial cantholysis, abscess drainage, and entropion or ectropion repair. No complications occurred, and edema resolved in the first 24 to 48 hours. This innovative technique has many applications for surgery of the orbit.


Queen Henrietta Maria With Sir Jeffrey Hudson, by Anthony Van Dyck (1599-1641).Article


This issue's Highlights was written by Carlo P. Honrado, MD.