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Temporal augmentation with a layered expanded polytetrafluoroethylene implant
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
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