Faculty Bibliography

Nine patients (7 men, 2 women) with external nasal deviation underwent corrective procedures using a monobloc nasal osteotomy technique. The deformities ranged from mild to severe. Eight patients had post-traumatic deviations, whereas 1 had a unilateral cleft nasal deformity. For this monobloc technique, osteotomies were performed at unequal levels to correct the height difference, no periosteal undermining was performed, and septal dissection was undertaken only after monobloc repositioning. There was no need for grafts or microplate fixation. Minimum follow-up was 8 months. All patients had improvement in their external deviation, 1 patient was mildly undercorrected, and only 1 patient (cleft nasal) required a radical submucosal resection

A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. Children were divided into three groups: (group 1) no surgery and no splint (n = 21), (group 2) nonsurgical management with splint appliance (n = 8), and (group 3) commissuroplasty (n = 9). Mean age was 3 years, and minimum follow-up was 1 year. Subjective evaluation of standard photographs was performed by six surgeons. Group 2 had a less noticeable scar and more normal lip parameters. Group 3 and group 1 had similar percent scar involvement and overall poor subjective scores. All evaluators felt that commissuroplasty (group 3) improved patients' appearance compared with no surgery and no splint (group 1). Therefore the application of our easily constructed splint alone yielded the best cosmetic results

The effects of unilateral facial nerve ablation on craniofacial development in the rabbit were examined. In this experimental model, 10 newborn rabbits 12 days of age underwent unilateral resection and cautery of the facial nerve. They were allowed to grow to skeletal maturity and were sacrificed at 6 months. Analysis of variance was used to compare direct measurements of prepared skulls in the experimental animals with 3 unoperated control litter mates and with 5 litter mates who underwent a sham procedure (exposure of the facial nerve without section). The animals with facial nerve resection demonstrated an average snout deviation toward the side of injury of 8.3 degrees, apparently due to shortening of the maxilla and mandible on the affected side. This study provides new data regarding the role of the functional matrix in the modulation of craniofacial growth and development

The principle of distraction osteogenesis, well-established in the enchondral bones of the axial skeleton, has recently been applied to the membranous bones (mandible, cranium) of the craniofacial skeleton in the experimental animal and in the human. In the craniofacial skeleton, however, the technique has been used only to lengthen bone in a direction along its major axis, i.e., unidimensional distraction. A canine model is presented to demonstrate the feasibility of distracting membranous bone away from its dominant axis, i.e., multidimensional distraction. Four mongrel dogs, 5 months of age, were the subjects of this study. Two osteotomies were made in the zygomatic arch, and the bone-lengthening device was fixed to the zygoma. After 7 days of external fixation, the osteotomized segment was lengthened 1 mm/day away from the long axis of the bone for 15 days. External fixation was then maintained for a minimum of 4 weeks, after which the dogs were sacrificed. Craniofacial CT with three-dimensional reconstruction documented multidimensional bone lengthening, and histologic analysis of the specimen confirmed the presence of new cortical bone in the expanded areas. Refinement in technique and miniaturization and internalization of the bone-lengthening device may allow for more precise changes in the amount and direction of lengthening, thus making distraction osteogenesis more widely applicable for use in the human craniofacial skeleton

A model to study the blink reflex in the experimental setting has been established. The behavioral, electrophysiologic, pathologic, and surgical methods and results obtained parallel those utilized and observed in the human and simulate the problem of facial paralysis. The observation that the blink can be elicited in an animal model, with the same stimuli as in humans, strengthens the value of this model, as do the similarities seen in the electrophysiologic recordings of NCV studies. The dual innervation of the rat eye sphincter allows application of the principle of selectively neurectomizing eye branches and 'borrowing' motor-nerve fibers from the normal side, without causing eye-sphincter paralysis, a concept employed extensively in cross-facial nerve-grafting procedures in humans with facial paralysis

The accumulation of leukocytes is believed to contribute to reperfusion injury following ischemia. The purpose of this study was to determine if pentoxifylline (PTX) would ameliorate reperfusion injury by preventing activation of leukocytes. Male Wistar rats received 40 mg/kg of PTX orally in water for 6 days, and a single dose of PTX (30 mg/kg) intraarterially before experiments. Control measurements of red-cell velocity and inside diameter were made in first-through-third-order arterioles (1A-3A) of the cremaster muscle, along with the number of rolling and sticking leukocytes (WBC) in venules and the density of flowing capillaries, by intravital microscopy. The muscles were then subjected to total ischemia for 2 hr by arterial clamping, followed by a repeat of the measurements during reperfusion. The number of both rolling and sticking WBCs was not different between the two groups during the control period but, following reperfusion, there were significantly fewer WBCs rolling and sticking in the venules of the PTX group at the measured times (immediately, 1, 2, and 3 hr after reperfusion). Arteriolar blood flow was lower than initial values during the first hour of reperfusion in both groups. But while blood flow decreased further in the untreated group, it significantly improved in the PTX group. There were no significant differences in arteriolar diameter or density of flowing capillaries between the two groups at any time. Treatment with PTX prevented accumulation of rolling and sticking leukocytes following reperfusion. This may contribute to the improved arteriolar blood flow following 2 hr of ischemia

Eighty-six patients with anterior neck burn sequelae underwent scar resection up to the limits of the aesthetic unit of the neck and immediate resurfacing with a scapular-parascapular free flap (the extended scapular flap). The flap was raised in all patients above the deep fascia as a thin skin-subcutaneous tissue flap, providing an initially acceptable aesthetic result. The flap was anastomosed to the facial artery and vein. The donor area was closed directly, or a 4- to 5-cm-wide skin graft was used which could be completely removed in a secondary procedure if the patient requested it. There were four failures early in the series but no losses in the last 70 patients. In order to improve the final aesthetic result, 45 patients underwent complementary defatting procedures (average of three) and Z-plasties initiated 30 days after the initial surgery at intervals of 1 month. Analysis revealed 96 percent good aesthetic results (as determined by the cervicomental angle obtained and the subjective opinion of the patients). There were no recurrences of scar contractures, and good function of the neck was regained in the majority of the patients. Anterior neck burn sequelae thus can be safely treated with en block resection and resurfacing using this flap