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Travis T. Tollefson, MD, and colleagues define the intrinsic and extrinsic contributions to congenital nasal deformities in orofacial clefting. This retrospective series reviews the medical history of patients with congenital nasal deformities to determine factors affecting the deformations by analyzing the patients' clinical characteristics. Family histories were also obtained. The authors differentiate intrinsic and extrinsic causal factors and discuss whether there is a carrier state of cleft lip that presents as a nasal deformity without an obvious cleft lip. Further genetic studies and continued anthropometric documentation may substantiate their hypothesis.
Andrew R. Scott, MD, and colleagues present a retrospective medical chart review of 19 children who underwent mandibular distraction osteogenesis within the first 3 months of life. They examine the long-term outcomes and complications in these infants who presented with upper airway obstruction and feeding difficulty. Their minimum 3-year follow-up showed that performing the procedure at such an early age has low morbidity and is a relatively safe and effective strategy to deal with airway and feeding problems in patients who have isolated Pierre Robin sequence. Infants with other specific comorbidities had less optimal outcomes. The authors also demonstrate that, in most patients, the effect of this procedure persists through early childhood.
Yadranko Ducic, MD, FRCSC, and Lindsay Young, MD, present a retrospective review of a consecutive series of free tissue transfers in patients younger than 18 years. Eighteen of these patients underwent surgery for trauma and 33 for oncologic reasons. The authors present demographic data, techniques used, and complications They discuss techniques and principles for airway management, temporomandibular joint reconstruction, mastication muscle management, soft-tissue injury management, and ideal incisions that may allow for minimal long-term scarring. Most patients had excellent outcomes, and the authors discuss the modifications that have also been applied successfully to adults.
Tessa A. Hadlock, MD, and colleagues use an objective validated measure of functional outcome to quantify gracilis muscle excursion in 19 consecutive pediatric free gracilis transplant operations. They compare these results with those from adults who underwent the same operation. The average gracilis excursion in the pediatric group was well matched with the adult patients but with few complete failures of excursion. Prospective evaluation of quality-of-life outcomes in the children indicate statistically significant improvements following dynamic smile reanimation. The authors suggest that this type of reanimation should be considered first-line therapy in pediatric patients who lack meaningful smile secondary to facial paralysis.
Symphony in Flesh Colour and Pink: Portrait of Mrs Leyland by James Abbott McNeill Whistler (1834-1903).
This issue's Highlights were written by Richard A. Zoumalan, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2011;13(3):143. doi:10.1001/archfacial.2011.22
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