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INTERESTING CASE: When you can’t see the wood: a foreign body pitfall
J. Kunjur et al. / British Journal of Oral and Maxillofacial Surgery 44 (2006) 89–93
apex of the brow should be above the lateral canthus and that the medial position that was suggested by Westmore would give a surprised look to the face. None of the previous studies have given a definite description for the ideal position of the eyebrow. In our study, we found that the eyebrow was arch- or bowshaped. In nearly all the subjects, the apex or superciliare was between the lateral canthus and the lateral limbus, except in the Indian men in whom it was about 1–2 mm lateral to the lateral canthus. Connell et al.10 offered numerical guidelines for an ideal position of the brow. They estimated the mean distance from the upper lid crease to the lower brow margin to be about 15 mm. We found that the mean distance ranged from 7 to 12 mm. We also looked for differences in the dimensions of the palpebral fissure between the three racial groups. We found significant differences in the dimensions and in the inclination of the palpebral fissure with respect to the intercanthal line among the three racial groups. During the past 30 years, many authors have attempted to define aesthetic objectives, but their likes and dislikes have been no more than individual preferences with little scientific support. Reconstruction of the face requires a combination of art and science. We have contributed towards the science by quantifying the position of the eyelids and eyebrows in three racial groups. We found that the eyebrow is more or less bow- or arc-shaped among the different races, but there are significant sexual and racial differences in the position of
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the highest point or apex. The significant differences noted among some of the measurements involving shape and position of the eyebrow and dimensions of the eyelid emphasise that this knowledge must be available for facial surgeons.
References 1. Le TT, Farkas LE, Ngim RC, Levin LS, Forrest CR. Proportionality in Asian and North American Caucasian faces using neoclassical facial cannons as criteria. Aesthet Plast Surg 2002;26:64–9. 2. Gunter JP, Antrobus SD. Aesthetics analysis of the eyebrows. Plast Reconstr Surg 1997;99:808–16. 3. Farkas LG, Hreczko TA, Kolar JC, et al. Vertical and horizontal proportions of the face in young adult North American Caucasian: revision of neoclassical canons. Plast Reconstr Surg 1985;75:328–37. 4. Dawei W, Guozheng Q, Zhang M, Farkas LG. Differences in horizontal neoclassical facial canons in Chinese (Han) and North American populations. Aesthet Plast Surg 1997;21:265–9. 5. Borman H, Ozgur F, Gursu G. Evaluation of soft-tissue morphology of the face in 1050 young adults. Ann Plast Surg 1999;42:280–8. 6. Farkas LG, Forrest CR, Litsas L. Revision of neoclassical facial canons in young adult Afro-Americans. Aesthet Plast Surg 2000;24:179–84. 7. Ellenbogen R. Transcoronal eyebrow lift with concomitant upper blepharoplasty. Plast Reconstr Surg 1983;71:490–9. 8. Whitaker LA, Morales L, Farkas LG. Aesthetic surgery of the supraorbital ridge and forehead structures. Plast Reconstr Surg 1986;78:23–32. 9. Cook TA, Brownrigg P, Wang TD, Quatela VC. The versatile midforehead browlift. Arch Otolaryngol Head Neck Surg 1989;115:163–8. 10. Connell BF, Lambros VS, Neurohr GH. The forehead lift: technique to avoid complications and produce optimal results. Aesthet Plast Surg 1989;13:217–37.
INTERESTING CASE: When you can’t see the wood: a foreign body pitfall A healthy 58-year-old woman fell in her garden and struck her chin. On the following day she woke with a swelling in her right cheek and difficulty opening her mouth. A mandibular fracture was suspected. On examination she had trismus, mouth-opening being limited to 10 mm. There was a firm, tender swelling in the buccal space of her right cheek, but no external lacerations or abrasions. Intraoral examination was difficult but her occlusion was normal and radiographs showed no evidence of fracture or any other abnormality. She was treated conservatively with anti-inflammatory analgesics and chlorhexidine mouthwash. Over the next 2 weeks she gradually recovered. However, on day 15 she developed an intra-oral discharge and was admitted to hospital. Under general anaesthetic a large quantity of pus was evacuated and exploration yielded a wooden foreign body within the cavity, which seemed to be the end of a pruned shrub; it was 4 cm long and almost 1 cm in diameter (Fig. 1). The cavity was irrigated and a drain inserted which remained in place for five days. The patient recovered. Fig. 1. The recovered foreign body. C. Gallagher D. Sleeman Available online 9 February 2005
apex of the brow should be above the lateral canthus and that the medial position that was suggested by Westmore would give a surprised look to the face. None of the previous studies have given a definite description for the ideal position of the eyebrow. In our study, we found that the eyebrow was arch- or bowshaped. In nearly all the subjects, the apex or superciliare was between the lateral canthus and the lateral limbus, except in the Indian men in whom it was about 1–2 mm lateral to the lateral canthus. Connell et al.10 offered numerical guidelines for an ideal position of the brow. They estimated the mean distance from the upper lid crease to the lower brow margin to be about 15 mm. We found that the mean distance ranged from 7 to 12 mm. We also looked for differences in the dimensions of the palpebral fissure between the three racial groups. We found significant differences in the dimensions and in the inclination of the palpebral fissure with respect to the intercanthal line among the three racial groups. During the past 30 years, many authors have attempted to define aesthetic objectives, but their likes and dislikes have been no more than individual preferences with little scientific support. Reconstruction of the face requires a combination of art and science. We have contributed towards the science by quantifying the position of the eyelids and eyebrows in three racial groups. We found that the eyebrow is more or less bow- or arc-shaped among the different races, but there are significant sexual and racial differences in the position of
93
the highest point or apex. The significant differences noted among some of the measurements involving shape and position of the eyebrow and dimensions of the eyelid emphasise that this knowledge must be available for facial surgeons.
References 1. Le TT, Farkas LE, Ngim RC, Levin LS, Forrest CR. Proportionality in Asian and North American Caucasian faces using neoclassical facial cannons as criteria. Aesthet Plast Surg 2002;26:64–9. 2. Gunter JP, Antrobus SD. Aesthetics analysis of the eyebrows. Plast Reconstr Surg 1997;99:808–16. 3. Farkas LG, Hreczko TA, Kolar JC, et al. Vertical and horizontal proportions of the face in young adult North American Caucasian: revision of neoclassical canons. Plast Reconstr Surg 1985;75:328–37. 4. Dawei W, Guozheng Q, Zhang M, Farkas LG. Differences in horizontal neoclassical facial canons in Chinese (Han) and North American populations. Aesthet Plast Surg 1997;21:265–9. 5. Borman H, Ozgur F, Gursu G. Evaluation of soft-tissue morphology of the face in 1050 young adults. Ann Plast Surg 1999;42:280–8. 6. Farkas LG, Forrest CR, Litsas L. Revision of neoclassical facial canons in young adult Afro-Americans. Aesthet Plast Surg 2000;24:179–84. 7. Ellenbogen R. Transcoronal eyebrow lift with concomitant upper blepharoplasty. Plast Reconstr Surg 1983;71:490–9. 8. Whitaker LA, Morales L, Farkas LG. Aesthetic surgery of the supraorbital ridge and forehead structures. Plast Reconstr Surg 1986;78:23–32. 9. Cook TA, Brownrigg P, Wang TD, Quatela VC. The versatile midforehead browlift. Arch Otolaryngol Head Neck Surg 1989;115:163–8. 10. Connell BF, Lambros VS, Neurohr GH. The forehead lift: technique to avoid complications and produce optimal results. Aesthet Plast Surg 1989;13:217–37.
INTERESTING CASE: When you can’t see the wood: a foreign body pitfall A healthy 58-year-old woman fell in her garden and struck her chin. On the following day she woke with a swelling in her right cheek and difficulty opening her mouth. A mandibular fracture was suspected. On examination she had trismus, mouth-opening being limited to 10 mm. There was a firm, tender swelling in the buccal space of her right cheek, but no external lacerations or abrasions. Intraoral examination was difficult but her occlusion was normal and radiographs showed no evidence of fracture or any other abnormality. She was treated conservatively with anti-inflammatory analgesics and chlorhexidine mouthwash. Over the next 2 weeks she gradually recovered. However, on day 15 she developed an intra-oral discharge and was admitted to hospital. Under general anaesthetic a large quantity of pus was evacuated and exploration yielded a wooden foreign body within the cavity, which seemed to be the end of a pruned shrub; it was 4 cm long and almost 1 cm in diameter (Fig. 1). The cavity was irrigated and a drain inserted which remained in place for five days. The patient recovered. Fig. 1. The recovered foreign body. C. Gallagher D. Sleeman Available online 9 February 2005