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Newly modified double eyelid blepharoplasty
Otolaryngology Head and Neck Surgery P56
Scientific Sessions-- Monday
8:24 A M
Discussion 8:30 AM
Optimal Treatment of Human Bite Injuries to the Face MAISIE SHINDO, MD, DAVID S O C O L (presenter),and VINCENT P. NALBONE, MD, Los Angeles, Calif.
Objective: The most appropriate management of facial human bite injuries remains controversial. The question of primary versus delayed repair and the necessity for intravenous antibiotics remains unanswered, as only a few studies in the literature have addressed these issues. The data that are available in the literature have focused mainly on extremities. A retrospective review of a large series of human bite injuries managed at our institution was undertaken to help resolve these issues. Methods: One hundred sixty patients with facial human bite injuries were treated at our institution between 1985 and 1995. Forty-nine were lost to follow-up, leaving 111 for data analysis. The most common sites were ears (42%) and lips (21%). For data analysis, the patients were divided into four groups. Group I consisted of 48 patients whose wounds were immediately repaired and who were then admitted to the hospital for intravenous antibiotics. Group II consisted of 41 patients whose wounds were immediately repaired and who were then discharged home with oral antibiotics. Group III consisted of 14 patients who were admitted to the hospital and given intravenous antibiotics for at least 24 hours prior to wound repair. Group IV consisted of four patients who were discharged with oral antibiotics and local wound care instructions after the wounds were thoroughly cleaned in the emergency room. Results: The wound infection rates following repair were 10% in group I and 34% in group II. None of the patients in groups III and IV developed wound infections. Conclusions: The results suggest that wound complications can be minimized by performing initial local wound care and subsequent repair when the wound appears to be "cleaner." It also appears that intravenous antibiotics may not be essential; however, the number of patients in group IV is too small to reach a definite conclusion. 8:38 A M
Gunshot Injuries of the Peripheral Facial Nerve C. PHILIP AMOILS, MD (presenter), VINCENT P. NALBONE, MD, DALE H. RICE, MD, and MAISIE L. SHINDO, MD, Los Angeles, Calif.
In an effort to determine an optimal management strategy, a 12-year retrospective analysis of 64 patients treated for facial nerve gunshot injuries at a large metropolitan trauma center was performed. This study specifically focuses on management of cranial nerve (CN) VII injuries distal to the geniculate ganglion. Fifty-one patients had involvement of the peripheral facial nerve, 33 of whom presented as a grade VI (HouseBrackmann grading system); 18 presented with injuries to
August 1996
selected branches. Thirteen patients had combined intra- and extratemporal CN VII injuries. Thirty-three patients underwent surgery (14 mastoid decompressions [group I], two primary repairs [group II], and 17 cable grafts [group III]), 23 patients were observed (group IV), and eight patients were lost to follow-up. Of group I patients, one had complete recovery and six had partial recovery of facial function. In groups II and III, functional recovery up to grade III was seen in approximately 50% of the patients. In group IV, only 28% demonstrated improvement. Follow-up CN VII evaluations ranged from 6 months to 2 years. Early exploration, debridement of devitalized nerve and neurorrhaphy (primarily or cable graft) offers the best chance of some functional return. Evaluation and management of these injuries will be discussed in detail. 8:46 AM
Temporal Augmentation With a Layered Expanded Polytetrafluoroethylene Implant FRED G. FEDOK, MD, DAVID W. VANKOOTEN, MD (presenter), and ROGER J. LEVIN, MD, Hershey, Pa.
Objective: Temporal hollowing secondary to the loss of the temporalis muscle either through atrophy or removal is a common outcome in the population of patients who have undergone extensive craniofacial procedures for malignancy or trauma. The repair of such defects has been traditionally performed with the u ~ of alloplastic implants. Previously, silicone has been widely used. The purpose of this report is to describe the alternative use of a layered expanded polytetrafluoroethylene implant in the correction of this defect. Methods: Five patients underwent augmentation of a temporal h o l l i n g defect using layered e x p a n d e d polytetrafluoroethylene. The results of correction were examined through retrospective analysis of the medical records with particular attention to the occurrence of infection, facial nerve injury, and extrusion. The aesthetic results of the correction were judged clinically with regard to symmetry, contour, patient satisfaction, and surgeon's subjective impression of the adequacy of correction. Results: The implant was well tolerated in all of the patients. There were no facial nerve injuries. One patient required a subsequent procedure placing additional implant material. Conclusion: Expanded polytetrafluoroethylene is an acceptable material for alloplastic augmentation of the temporal area. 8:54 AM
Discussion 9:00 AM
Newly Modified Double Eyelid Blepharaplasty JEFFREYM, AHN, MD, and PHILIPT, HO, MD (presenter), New York, N.Y.
Double eyelid blepharoplasty is the most commonly performed facial plastic surgery in Asian patients. Traditional
Otolaryngology Head and Neck Surgery
Scientific Sessions- - Monday
Volume 115 Number 2
double eyelid blepharoplasty techniques have been the incisional technique and the suture technique. In the incisional method, excess eyelid tissues are excised and subcutaneous tissues and the levator aponeurotic layer are fixed to the tarsal plate to promote the adhesion among these structures. Drawbacks of the incision technique include irreversibility of the result, scar formation, and increased surgical time. On the other hand, in the sutureonly technique, one to three through-and-through sutures are typically placed between the upper eyelid skin and the conjunctiva to create adhesion and, therefore, double upper eyelid folds. The suture-only method is a more reversible technique with minimal scarring and reduced operation time; however, this technique has been criticized for higher incidence of the loosening of created double folds during long-term follow-up. In this paper, a newly developed double eyelid blepharoplasty technique that combines both the incisional and suture methods is introduced. With interrupted partial incisions, the surgeon can gain access to the underlying orbicularis oculi muscle and orbital fat while minimizing the chance of excessive scar formation. Moreover, the chance of loosening of sutures and loss of created eyelid folds have been markedly reduced with this newer combined method. This technique is not suitable for older patients who need extensive eyelid skin excision; however, we believe that this can be an ideal technique for young Asian patients seeking more permanent, natural appearing double eyelid folds. A step-by-step description of this newly combined technique and long-term follow-up results will be discussed. 9:08 AM
Gender and Racial Variance in Cephalometric Analysis SYLVESTERG. RAMIREZ (presenter) and JAMES J. LEE, San Antonio, Tex.
Objective: Cephalometric analysis has earned a vital role in the evaluation of patients with obstructive sleep apnea. However, the normal measurements cited in the literature are not gender or racial specific. Skeletal differences in different genders and races have been established. This study was initiated to examine whether soft tissue differences exist in different genders and races.
P 57
Methods: A total of 89 subjects underwent cephalometric analysis for non-sleep apnea reasons. The x-rays were analyzed by the method of Riley et al. Results: There were statistically significant differences (PL0.05) in SNA and SNB (facial to skull base relationship) between racial groups in males. There were statistically significant differences between caucasian males and females in posterior airway space and the level of the hyold. Conclusion: This data mandates that physicians using cephalometric analysis understand gender and racial variance in skeletal and soft tissue measurements. 9:16 AM
Pre- and Postoperative Nasal Septal Surgery Assessment with Acoustic Rhinometry LARRY SHEMEN, MD (presenter), a n d RICHARD HAMBURG, MD, New York, N.Y.
Objective: Conventional anterior rhinometry has been used to assess nasal patency before and after nasal septal surgery. This study used the acoustic rhinometer to measure the same parameters. Methods: Fifty patients underwent evaluation with use of the acoustic rhinometer before and 6 weeks after septal surgery. The parameters measured included Req (resistance of an equivalent duct segment), total volume of the nasal cavity, minimal cross-sectional area and the distance of the minimal cross-sectional area from the anterior naris. Results: Using these parameters, 85% of patients had significant improvement of Req, volume, and cross-sectional area. This compares favorably with the number subjectively reporting a significant improvement in their breathing after surgery. Conclusion: Acoustic rhinometry is an excellent tool for the preoperative assessment of nasal patency and for the postoperative evaluation of the success of surgical correction thereof. 9:24 AM
Discussion
Scientific Sessions-- Monday
8:24 A M
Discussion 8:30 AM
Optimal Treatment of Human Bite Injuries to the Face MAISIE SHINDO, MD, DAVID S O C O L (presenter),and VINCENT P. NALBONE, MD, Los Angeles, Calif.
Objective: The most appropriate management of facial human bite injuries remains controversial. The question of primary versus delayed repair and the necessity for intravenous antibiotics remains unanswered, as only a few studies in the literature have addressed these issues. The data that are available in the literature have focused mainly on extremities. A retrospective review of a large series of human bite injuries managed at our institution was undertaken to help resolve these issues. Methods: One hundred sixty patients with facial human bite injuries were treated at our institution between 1985 and 1995. Forty-nine were lost to follow-up, leaving 111 for data analysis. The most common sites were ears (42%) and lips (21%). For data analysis, the patients were divided into four groups. Group I consisted of 48 patients whose wounds were immediately repaired and who were then admitted to the hospital for intravenous antibiotics. Group II consisted of 41 patients whose wounds were immediately repaired and who were then discharged home with oral antibiotics. Group III consisted of 14 patients who were admitted to the hospital and given intravenous antibiotics for at least 24 hours prior to wound repair. Group IV consisted of four patients who were discharged with oral antibiotics and local wound care instructions after the wounds were thoroughly cleaned in the emergency room. Results: The wound infection rates following repair were 10% in group I and 34% in group II. None of the patients in groups III and IV developed wound infections. Conclusions: The results suggest that wound complications can be minimized by performing initial local wound care and subsequent repair when the wound appears to be "cleaner." It also appears that intravenous antibiotics may not be essential; however, the number of patients in group IV is too small to reach a definite conclusion. 8:38 A M
Gunshot Injuries of the Peripheral Facial Nerve C. PHILIP AMOILS, MD (presenter), VINCENT P. NALBONE, MD, DALE H. RICE, MD, and MAISIE L. SHINDO, MD, Los Angeles, Calif.
In an effort to determine an optimal management strategy, a 12-year retrospective analysis of 64 patients treated for facial nerve gunshot injuries at a large metropolitan trauma center was performed. This study specifically focuses on management of cranial nerve (CN) VII injuries distal to the geniculate ganglion. Fifty-one patients had involvement of the peripheral facial nerve, 33 of whom presented as a grade VI (HouseBrackmann grading system); 18 presented with injuries to
August 1996
selected branches. Thirteen patients had combined intra- and extratemporal CN VII injuries. Thirty-three patients underwent surgery (14 mastoid decompressions [group I], two primary repairs [group II], and 17 cable grafts [group III]), 23 patients were observed (group IV), and eight patients were lost to follow-up. Of group I patients, one had complete recovery and six had partial recovery of facial function. In groups II and III, functional recovery up to grade III was seen in approximately 50% of the patients. In group IV, only 28% demonstrated improvement. Follow-up CN VII evaluations ranged from 6 months to 2 years. Early exploration, debridement of devitalized nerve and neurorrhaphy (primarily or cable graft) offers the best chance of some functional return. Evaluation and management of these injuries will be discussed in detail. 8:46 AM
Temporal Augmentation With a Layered Expanded Polytetrafluoroethylene Implant FRED G. FEDOK, MD, DAVID W. VANKOOTEN, MD (presenter), and ROGER J. LEVIN, MD, Hershey, Pa.
Objective: Temporal hollowing secondary to the loss of the temporalis muscle either through atrophy or removal is a common outcome in the population of patients who have undergone extensive craniofacial procedures for malignancy or trauma. The repair of such defects has been traditionally performed with the u ~ of alloplastic implants. Previously, silicone has been widely used. The purpose of this report is to describe the alternative use of a layered expanded polytetrafluoroethylene implant in the correction of this defect. Methods: Five patients underwent augmentation of a temporal h o l l i n g defect using layered e x p a n d e d polytetrafluoroethylene. The results of correction were examined through retrospective analysis of the medical records with particular attention to the occurrence of infection, facial nerve injury, and extrusion. The aesthetic results of the correction were judged clinically with regard to symmetry, contour, patient satisfaction, and surgeon's subjective impression of the adequacy of correction. Results: The implant was well tolerated in all of the patients. There were no facial nerve injuries. One patient required a subsequent procedure placing additional implant material. Conclusion: Expanded polytetrafluoroethylene is an acceptable material for alloplastic augmentation of the temporal area. 8:54 AM
Discussion 9:00 AM
Newly Modified Double Eyelid Blepharaplasty JEFFREYM, AHN, MD, and PHILIPT, HO, MD (presenter), New York, N.Y.
Double eyelid blepharoplasty is the most commonly performed facial plastic surgery in Asian patients. Traditional
Otolaryngology Head and Neck Surgery
Scientific Sessions- - Monday
Volume 115 Number 2
double eyelid blepharoplasty techniques have been the incisional technique and the suture technique. In the incisional method, excess eyelid tissues are excised and subcutaneous tissues and the levator aponeurotic layer are fixed to the tarsal plate to promote the adhesion among these structures. Drawbacks of the incision technique include irreversibility of the result, scar formation, and increased surgical time. On the other hand, in the sutureonly technique, one to three through-and-through sutures are typically placed between the upper eyelid skin and the conjunctiva to create adhesion and, therefore, double upper eyelid folds. The suture-only method is a more reversible technique with minimal scarring and reduced operation time; however, this technique has been criticized for higher incidence of the loosening of created double folds during long-term follow-up. In this paper, a newly developed double eyelid blepharoplasty technique that combines both the incisional and suture methods is introduced. With interrupted partial incisions, the surgeon can gain access to the underlying orbicularis oculi muscle and orbital fat while minimizing the chance of excessive scar formation. Moreover, the chance of loosening of sutures and loss of created eyelid folds have been markedly reduced with this newer combined method. This technique is not suitable for older patients who need extensive eyelid skin excision; however, we believe that this can be an ideal technique for young Asian patients seeking more permanent, natural appearing double eyelid folds. A step-by-step description of this newly combined technique and long-term follow-up results will be discussed. 9:08 AM
Gender and Racial Variance in Cephalometric Analysis SYLVESTERG. RAMIREZ (presenter) and JAMES J. LEE, San Antonio, Tex.
Objective: Cephalometric analysis has earned a vital role in the evaluation of patients with obstructive sleep apnea. However, the normal measurements cited in the literature are not gender or racial specific. Skeletal differences in different genders and races have been established. This study was initiated to examine whether soft tissue differences exist in different genders and races.
P 57
Methods: A total of 89 subjects underwent cephalometric analysis for non-sleep apnea reasons. The x-rays were analyzed by the method of Riley et al. Results: There were statistically significant differences (PL0.05) in SNA and SNB (facial to skull base relationship) between racial groups in males. There were statistically significant differences between caucasian males and females in posterior airway space and the level of the hyold. Conclusion: This data mandates that physicians using cephalometric analysis understand gender and racial variance in skeletal and soft tissue measurements. 9:16 AM
Pre- and Postoperative Nasal Septal Surgery Assessment with Acoustic Rhinometry LARRY SHEMEN, MD (presenter), a n d RICHARD HAMBURG, MD, New York, N.Y.
Objective: Conventional anterior rhinometry has been used to assess nasal patency before and after nasal septal surgery. This study used the acoustic rhinometer to measure the same parameters. Methods: Fifty patients underwent evaluation with use of the acoustic rhinometer before and 6 weeks after septal surgery. The parameters measured included Req (resistance of an equivalent duct segment), total volume of the nasal cavity, minimal cross-sectional area and the distance of the minimal cross-sectional area from the anterior naris. Results: Using these parameters, 85% of patients had significant improvement of Req, volume, and cross-sectional area. This compares favorably with the number subjectively reporting a significant improvement in their breathing after surgery. Conclusion: Acoustic rhinometry is an excellent tool for the preoperative assessment of nasal patency and for the postoperative evaluation of the success of surgical correction thereof. 9:24 AM
Discussion