Facial trauma is the most common injury to occupants in motor vehicle collisions (MVCs). Using the National Automotive Sampling System Crashworthiness Data System database (1993-2005), Brian T. McMullin, MD, and colleagues determined that the incidence of facial fractures from MVCs is decreasing. Newer car models and seatbelt use with frontal airbags were associated with a decreased risk of facial fracture from MVCs, whereas airbags alone had no impact on facial fracture risk, and side collisions as well as significant vehicle crash size mismatch were associated with a significantly higher risk of facial fracture.
Arteriovenous malformations (AVMs) in the head and neck can be quite aggressive and destructive. Surgical excision is the mainstay of treatment in the head and neck and has the potential for creating large and complex defects. Local tissue is often preferred for reconstruction of these defects, but at times is not feasible. Larry D. Hartzell, MD, and colleagues describe a series of 8 patients who had extensive head and neck AVMs that were resected and reconstructed using free tissue transfer. They found that most patients' AVMs recurred and that revision procedures were frequently necessary to remove residual malformation and improve the overall wound healing process, but that free tissue transfer offers a reliable and successful method of reconstruction.
Concurrent ablative skin resurfacing of areas of the face that have undergone surgical rejuvenation potentially creates significant risk of damage to the undermined tissue. Nitrogen plasma skin regeneration is non–chromophore dependent and involves the transduction of radio frequency energy to the skin surface using ionized nitrogen gas, resulting in predictable thermal damage to the skin without an open wound, and offers an alternative to traditional ablative laser method for facial resurfacing. J. David Holcomb, MD, and colleagues describe a series of 95 patients who underwent nitrogen skin plasma regeneration and facial rejuvenation surgery during a single operative setting. With a 1.8% overall rate of transient complication, they conclude that combining nitrogen plasma skin regeneration with aging face procedures is safe with improved outcomes compared with aging face surgery alone.
Nasal tip suture modification techniques provide reliable and reversible methods for controlling the nasal tip while maintaining nasal tip support mechanisms. Anthony Corrado, DO, and colleagues present the “dome stabilization suture” as another option for refining and securing the nasal tip. The dome stabilization suture is placed along the cephalic borders of the domes at the medial third of the lateral crura bilaterally, just posterior to the junction of the intermediate and lateral crura, as a final step of the tip rhinoplasty. The authors present their experience with 100 cases using this technique and conclude that it complements other nasal tip modification maneuvers, providing a predictable method to align and stabilize the individual dome segments without affecting nasal tip rotation or projection.
Le Repos, by Édouard Manet (1832-1883).
This issue's Highlights were written by Amit Bhrany, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2009;11(3):156. doi:10.1001/archfacial.2009.32