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Highlights of Archives of Facial Plastic Surgery
Sept/Oct 2009

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2009;11(5):284. doi:10.1001/archfacial.2009.63

Alar rim contour and resilience are important for nasal base harmony and function. The ideal alar rim transitions from the nasal tip–defining point to the nasofacial insertion as a gentle line with a slight convexity. Kofi D. O. Boahene, MD, and Peter A. Hilger, MD, determined indications for alar rim grafting after reviewing 150 patients who underwent rhinoplasty. Their technique involves creating a tunnel directly along the alar margin through the marginal incision and placing a 2- to 3-mm-wide and 15- to 25-mm-long cartilage graft in the tunnel. At follow-up, there were no graft infections, displacements, or extrusions. The 2 most common indications for alar rim graft placement were cephalic malposition of the lower lateral cartilages and correction of alar margin flare.

The pursuit of the absolute standard of beauty is an age-old undertaking common to many cultures. The ideal proportions of the nose remain controversial. Ashish Y. Mahajan, MD, and colleagues compared established parameters with actual patient preferences by using computer imaging during initial rhinoplasty consultation. Five parameters from the frontal and lateral views in 20 patients were analyzed before and after initial patient-directed manipulation, and 3 of 5 parameters were indistinguishable from ideal values after manipulation. Parameters included nasolabial angle, nasofacial angle, the Goode ratio, base width/dorsal length, and base width/interpupillary distance. The results suggest that these specific parameters are useful in creating satisfying proportions in aesthetic rhinoplasty and reconstructive surgery within our population.

The complications after parotidectomy include facial nerve injury, Frey syndrome, concave facial contour, auricular numbness, and an unsightly scar. A variety of techniques have been described to prevent these sequelae, but published outcomes have also been inconsistent. Joseph M. Curry, MD, and colleagues performed a meta-analysis of published studies from 2008 that specifically look at minimizing Frey syndrome and facial contour defects. Although many treatment methods have been studied, only a limited number were selected for meta-analysis. The meta-analysis found that surgical intervention was strongly favored for preventing both sequelae The authors discuss various techniques for prevention of Frey syndrome and contour defects.

Microtia has traditionally been classified as lobule-type and concha-type according to the remnant ear present. Lobule-type microtia typically has small cutaneous cartilage resting in the mastoid area. In microtia reconstruction, this remnant is used to reconstruct the inferior part of the auricle. Bo Pan, MD, and colleagues identified 268 patients who had unilateral lobule-type microtia. They studied this population and found they could further subclassify the group by comparing the location of the residual ear with the contralateral normal ear. Three types of remnant ears were classified: type A, in which the inferior location of the remnant ear was the same as the contralateral normal ear; type B, in which the inferior location of the remnant ear was higher than the opposite normal one; and type C, in which the inferior location of the remnant ear was lower than the contralateral normal one. Based on the classification schema, the authors developed 3 different ways to transpose the earlobe. There were no cases of flap necrosis, and the ears were symmetrical with the normal side. Twelve cases did need revisions with Z-plasties at the adjoining area of the cartilage framework and the transposed remnant ear.

La Savoisienne, by Edgar Degas (1834-1917).

This issue's Highlights were written by Amar Suryadevara, MD.