Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Large cutaneous defects of the face have traditionally been reconstructed with cervicofacial rotation flaps. Objective: To measure advancing distance and assess vascular reliability of superficial musculoaponeurotic system (SMAS) island flaps for reconstruction of large cutaneous facial defects. Methods: The study design was a retrospective case series of all patients who had undergone reconstruction of facial defects 3 cm or greater with fasciocutaneous SMAS island flaps from 2009 to 2023. Flap advancing distance and vascular compromise were analyzed. Results: The average patient age at the time of surgery was 69 (standard deviation [SD] 15) years with more males (n = 33, 92%) than females (n = 3, 8%). Of 36 patients, 18 had posterior defects, 16 had anterior defects, and 2 had defects straddling both regions. Fifteen cases had a full fasciocutaneous SMAS island flap, and 21 underwent the partial island modification. Flap ischemia occurred in three cases (8%). The mean flap advancing distance was 3.8 cm (SD 1.1). Of the 5 smokers, none had ischemia of the flap. The median follow-up time was 2 years (range 12-3,170 days). Conclusions: Fasciocutaneous SMAS island and partial island flaps are reliable options for the reconstruction of large cheek defects (3 cm or greater). Anterior pedicle blood supply is more reliable for defects anterior to the line from the lateral brow to the angle of the mandible, whereas the posterior pedicle is a better choice for defects posterior to that line.

Importance: Cross-Facial Nerve Grafting (CFNG) for facial palsy offers potential to restore spontaneous facial expression, but specific indications and associated outcomes are limited. Updates to this technique have aided in its successful employment in select cases. This review aims to explore the context in which CFNG has been successfully utilized as a primary modality. Observations: Literature review was performed auditing all studies investigating CFNG as a primary modality, which reported outcomes. A total of 326 cases reporting outcomes for primary CFNG were included. Eye closure outcomes were 83.3% successful at ages 0-18, 77.3% successful at ages 19-40, and 57.1% successful at ages 41+. Smile outcomes were 73.7% successful at ages 0-18, 81.5% successful at ages 19-40, and 52.8% successful at ages 41+. For synkinesis, 89% of cases were considered successful; 100% successful at ages 0-18, and 78.4% successful in adults. Conclusions and Relevance: CFNG may offer return of spontaneous facial function in select cases. Higher percentages of successful outcomes are observed in younger patients, when performed in two stages, and when performed earlier from the onset of FP in cases of eye closure restoration. In the modern era, CFNG has been more commonly employed as an adjunctive procedure to other reanimation techniques.

"Ethnic rhinoplasty" is a term that historically has been employed to categorize patterns in nasal anatomy, possible procedures to change appearance, and patient and surgeon expectations for expected outcomes for the multitude of patients with features that belong to non-White groups. Categorizing anatomical structures based on broad definitions of race or ethnicity may not be an accurate representation, nor give an accurate depiction of nasal anatomical features. A shift is needed regarding how race and ethnicity are employed in describing nasal anatomy and rhinoplasty. We present a categorization system based on nasal anatomical patterns that may have more meaningful surgical implications without generalization into ethnic groups. Common anatomical nasal features such as projection, rotation, skin thickness, and anthropometric measurements were grouped into types, which may also help in patient education and remove any ethnic or racial terms.

Numerous techniques achieve maxillomandibular fixation (MMF), each with benefits and risks. While using Erich arch bars to achieve MMF has remained the gold standard through the last century, the technique has multiple limitations, which have spurred innovative approaches, such as intermaxillary fixation (IMF) screws, hybrid arch bars, embrasure wires, and dental occlusion ties. The surge in new MMF technologies over the past decade prompted this analysis to compare these techniques. A PubMed search was conducted to identify all current FDA-approved modern MMF technologies from 2005 through 2023, evaluating their advantages and limitations. Studies with controlled scientific comparisons of techniques were limited, precluding a systematic review. Analysis showed no definitive data exist to endorse one technique as a universal option. As multiple MMF options offer appropriate stability, a surgeon may choose an approach based upon numerous factors: comminution/instability; need for physiotherapy, including guiding elastics; safety; time of application/removal; and patient comfort. This article guides the selection between techniques based on these factors and presents a decision algorithm to assist surgeons in selecting the ideal MMF technique for each patient.