United States servicemen injured in Iraq receive state-of-the-art medical care from the time of injury to time of definitive treatment, a major reason for the increased survival rate of injured soldiers today vs those injured in past military conflicts. A recent addition of an otolaryngologist–facial plastic surgeon to the head and neck team has proven vital to management of complex head and neck wounds. Manuel A. Lopez, MD, and Jonathan L. Arnholt, MD, describe their experience in performing expedient and definitive repair of complex facial fractures in-theater in this retrospective review. They discuss the pros and cons of performing definitive repair of complex facial fractures in-theater.
The technique of endoscopic repair of orbital blowout fractures is part of a broader field of minimally invasive surgery, and has gained popularity among otolaryngologists. D. Gregory Farwell, MD, and colleagues have adopted this technique in their practice and discuss the successes and challenges of this approach. They analyzed 53 fracture repairs, 45 of which were performed endoscopically. Smaller defects confined to the medial floor were easily repaired, whereas repair of larger defects with extensive herniation was a much more difficult task. They concluded that, although endoscopic repair of orbital blowout fractures can be performed successfully, technical challenges of this operation tend to increase the difficulty of repair without improving the result. They argue that most fractures should be repaired via an open approach.
Müller's muscle conjunctival resection (MMCR) has been traditionally used to correct mild to moderate upper eyelid ptosis with normal levator function. This procedure requires careful preoperative calculations in contrast to anterior approach levator resection. Prior reports have suggested that preoperative administration of phenylephrine to stimulate Müller's muscle can accurately predict postoperative muscle position achieved by MMCR. A linear relationship between the amount of MMCR resected and the desired postoperative eyelid elevation has also been thought to exist. Guy J. Ben Simon, MD, and colleagues evaluated 80 patients who underwent 131 MMCR procedures. They found a mean increase in marginal reflex distance of 1.6 mm. Eyelid symmetry was achieved in 81% of patients. In contrast to prior studies, they found that the phenylephrine test underestimated the amount of ptosis correction by 40%. Also, there was a weak correlation between amount of MMCR and ptosis correction, which suggests a more complex relationship than a linear one.
Traditionally, malignant neoplasms of the superior nasal vault have been treated with radical craniofacial resection and orbital exenteration. Garth F. Essig, MD, and colleagues have used an eye-sparing technique with adjuvant chemoradiation for more than 2 decades. They established the oncologic safety of this procedure in prior reports. In this retrospective review, they build on their past experience and focus discussion on ophthalmologic evaluation and function of the spared eye. They examine the long-term functional outcomes of the eye-sparing surgery. A total of 59 patients underwent eye-sparing treatment, and an impressive 97% retained functional vision. The authors conclude that the eye-sparing protocol has few notable postoperative ophthalmologic impairments, and most patients retain adequate function.
The Rest on the Flight into Egypt by Gerard David (1460–ca 1523).Article
This issue's Highlights were written by Joseph Shvidler, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2007;9(6):381. doi:10.1001/archfaci.9.6.381