Minor contour deformities, especially of the nasal dorsum, remain a frequent indication for revisions after rhinoplasty surgery. Howard D. Stupak, MD, and colleagues present prospective data for a pilot trial investigating the use of a novel filler for the correction of postrhinoplasty contour deformities. The study included 13 patients who received a single injection of 0.1 to 0.3 mL of hydroxylapatite gel over the nasal dorsum, side wall, and supra tip. Outcome measures include blinded assessment of photographs taken before and after surgery. Favorable results are reported, and no complications are observed. Injection of hydroxylapatite to improve contour irregularities in patients who have undergone rhinoplasty promises to become a useful, safe alternative if long-term studies confirm these early encouraging results.
Krista L. Olson, MD, and colleagues present a modified technique to improve auricular projection in microtia repair. At the time of rib harvest for first-stage repair, a block of costal cartilage is inserted through a postauricular sulcus incision into a posterior supragaleal pocket. At third-stage repair, the chondrofascial flap is advanced anteriorly into the postauricular sulcus. The authors describe a series of patients who underwent unilateral microtia repair using the chondrofascial flap technique. Auricular projection was measured in the reconstructed and the contralateral ears. Statistical analysis demonstrates good approximation between the 2 sides, and no complications associated with the use of the chondrofascial flap were observed.
The effects of subperiosteal vs subgaleal brow-lift dissection in a rabbit model are described by J. Regan Thomas, MD, and colleagues. They hypothesize that their clinical observation of accelerated healing and improved flap adhesion in the subgaleal approach is reproduced in the animal model. Ten rabbits were randomized to subperiosteal vs subgaleal flap elevation with subsequent wound closure, and 2 animals served as controls. Outcome measures included histologic analysis and biomechanical measurement of tensile strength of the flaps at different stages of healing. The group dissected in the subgaleal plane showed increased strength with wound healing compared with those dissected in the subperiosteal plane. Histologic examination findings support these observations. These results confirm the authors' clinical observations that a subgaleal plane of dissection results in enhanced wound healing when compared with the subperiosteal plane of dissection.
Robert M. Schwarcz, MD, and colleagues present a modified technique of dacryocystorhinostomy with fornix-based transconjunctival Jones tube placement. After transconjunctival rhinostomy, a Pyrex tube is inserted into the nasal cavity and suture fixated to the conjunctiva in the medial fornix. External skin excisions are avoided. A retrospective series of 13 patients who underwent the modified technique is compared with a series of 7 patients who underwent conventional dacryocystorhinostomy with transcaruncular Jones tube placement. Results associated with the modified transconjunctival technique are reported to be more favorable than those of the conventional technique; 85% of these procedures were successful, and 1 complication of tube migration occurred.
Portrait of the Dwarf Michol by Juan Carreño de Miranda (1614-1685). Article
This issue's Highlights were written by Holger G. Gassner, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2007;9(2):81. doi:10.1001/archfaci.9.2.81