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In This Issue of JAMA Facial Plastic Surgery
Nov/Dec 2014


JAMA Facial Plast Surg. 2014;16(6):387. doi:10.1001/jamafacial.2014.1256

Patrocínio and colleagues evaluated the short- and long-term results of the lateral crural steal (LCS) maneuver to increase nasal tip rotation and projection in 22 patients. To accurately compare before and after results, they measured nasal tip projection, length, and rotation and base projection with a digital caliper preoperatively, intraoperatively, and at the 1-, 3-, 6-, and 12-month postoperative periods. They performed the LCS maneuver through a tip delivery approach and after LCS placed a columellar strut. Their measurements indicated that every 1 mm of LCS resulted in a 5° increase in nasolabial angle and a slight but statistically insignificant increase in nasal tip projection.

Saman and colleagues provide the results of a retrospective review of 311 dentate patients who underwent open reduction–internal fixation (ORIF) of 413 total noncomminuted mandible fractures to assess for outcome differences based on whether patients were placed in postoperative maxillomandibular fixation (MMF) (224 patients) or not (189). These patients were retrospectively reviewed and analyzed according to fracture site and complication rate. This comparison demonstrated no statistically significant difference in rates of wound dehiscence, infection, plate removal, nonunion, malunion, and malocclusion between the groups, suggesting that MMF may be unnecessary following mandibular ORIF to achieve excellent occlusion. Application of this technique has the potential to avoid additional surgical risk without decreasing surgical success rates.

Mehta and Gantous retrospectively reviewed incisionless otoplasty performed in 60 children and 12 adults to correct absence of antihelical folds and, in several cases, conchal excess. Most patients (>13 years old) were treated under local anesthesia without skin or soft-tissue excision, using 2 to 4 transcutaneous horizontal mattress sutures placed from the postauricular side to recreate the antihelical fold (consistent with a Mustarde technique). Some patients also had percutaneous conchal mastoid sutures or cauda helicis repositioning sutures. Postoperative dressings were minimal. Complication rates over a mean 30-month follow-up period were comparable with those of open procedures and most commonly related to suture failure, exposure, or granuloma. The overall revision rate was 13%, most commonly for placement of an additional unilateral suture under local anesthesia. Photographs reinforce the authors’ assertion that incisionless otoplasty is a simple and effective option for correction of prominauris.

Author Video Interview

Lindsay and colleagues share their data from prospective quality-of-life (QOL) surveys documenting preoperative and postoperative scores of 66 patients who underwent successful free gracilis muscle transfer at Massachusetts Eye and Ear Infirmary for smile recreation in cases of flaccid or nonflaccid facial paralysis (NFFP). Preoperative and postoperative Facial Clinimetric Evaluation Scale (FaCE) surveys administered to assess QOL impact showed statistically significant improvements in all groups who underwent successful free gracilis muscle transfers in all groups (flaccid, nonflaccid, masseter nerve, and cross-face anastomosis). The authors comment on the lack of statistically significant difference in scores between masseter nerve and cross-face nerve-grafting patient-perceived QOL outcomes. Despite maintenance of tone, patients with NFFP achieved nearly as high rates of QOL improvement as those with flaccid paralysis, reinforcing the significant morbidity (and potential for improvement) associated with lack of meaningful smile.