Michael J. Groth, MD, and colleagues review the multiple challenges the reconstructive surgeon faces when confronted with complex orbitofacial defects. Restitution of eyelid function, globe position and motility, and external facial contour rely on exact anatomic reconstruction of the defect. The development of high-resolution computed tomography–assisted modeling has made prefabricated allogenic orbitofacial implants available for reconstruction. These implants allow exact contour match and minimize dead space formation. The authors describe 9 patients who underwent complex orbitofacial reconstructions with custom-made polymethyl methylacrylate implants. Well-illustrated representative cases demonstrate favorable functional and cosmetic outcomes.
Farhan Taghizadeh, MD, and colleagues retrospectively review the results of frontal sinus obliteration after mucocele formation. Among 54 patients included in the study, 38 patients underwent hydroxyapatite cement obliteration, and 16 patients underwent abdominal fat obliteration. Twenty-two patients required reconstruction of the anterior table with hydroxyapatite cement secondary to substantial loss of bone. Reported complications in both groups are minor and infrequent, including 2 patients with initial fat obliteration who experienced recurrence and whose procedures were revised using hydroxyapatite. The authors conclude that hydroxyapatite cement obliteration of the frontal sinus is a safe alternative to fat obliteration and may allow better reconstruction of the forehead contour in cases in which the anterior table is lost.
Fernando Pedroza, MD, and colleagues studied 60 revision rhinoplasties performed for overresection of the alar cartilages in the “mestizo” nose. Deformities observed among these patients include alar collapse, asymmetries, and overrotation of the nasal tip with resulting nasal valve obstruction. Reconstruction is achieved by endonasal placement of conchal cartilage grafts to reinforce the deficient alar cartilages. A complex of 2 domes conjoined at the mesial crura is created from conchal cartilage using suture techniques and is inserted in 1 piece. The authors describe and illustrate this elegant method in minute detail. Functional results are reported to be favorable, and impressive cosmetic results are illustrated in representative cases.
Primary reduction rhinoplasty frequently requires lateral osteotomies to prevent an open roof deformity. In addition to closing the open roof, lateral osteotomies are typically carried out in combination with medial, transverse, and occasionally intermediate osteotomies to narrow the bony dorsum. The contribution of each individual osteotomy to dorsal narrowing has not been quantified to date. Michael J. Kortbus, MD, and colleagues analyze the effect of isolated lateral high-low-high osteotomies in 20 patients undergoing primary reduction rhinoplasty. Photographs taken before and after surgery are studied, and the ventral and dorsal width of the bony dorsum is measured. Using computer-assisted analysis, the authors observed no change in dorsal width and a mild degree of narrowing of the ventral width of the bony nasal dorsum.
The Bird of Happiness by Leila Akhmet-Othman, MFA (1973- ). Article
This issue's Highlights were written by Holger G. Gassner, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2006;8(6):361. doi:10.1001/archfaci.8.6.361