Faculty Bibliography

A review of thread augmentation has added helpful points to the technique and given an opportunity to assess the long-range results. It is obvious at this stage that there is no panacea for the wrinkling process. Each technique has advantages and disadvantages. The simplicity and low complication rate of thread augmentation supports this appeal. It is reasonable to state that the full application of the concept of this type of augmentation has not as yet been realized with this ongoing principle. This technique has been found of value when used as a single procedure or in combination with blepharoplasty or rhytidectomy.

Masseter and temporalis muscle transpositions may be considered in cases of longstanding facial paralysis and in the congenital absence of the facial nerve or muscles. The basic advantage of this technique is the introduction of a large volume of living and dynamic muscle into the face. Additional advantages include simplicity, the support provided, enhancement of the possibility of myoneurotization, and no loss of other significant function. In many instances, facial movement improves for a period of approximately two years, and the long-range effect would suggest some degree of rehabilitation of the facial muscles. Our combined experience with over 100 muscle transpositions indicates the efficacy and success of this technique in selected patients.

Olfactory neuroblastoma is an uncommon malignant tumor arising from olfactory epithelium. Generally considered to be a tumor of slow growth, it varies in aggressiveness and may cause death by distant metastasis or local invasion. The pathologic diagnosis is difficult, and this tumor is often erroneously diagnosed. Nine previously unreported cases are presented, and a review of the various treatment modalities and course of the disease is given. Maximum therapeutic succes is best achieved by radical excision followed by a full course of radiation. Because of the high incidence of local recurrence (46%) and slow growth, patients should be followed up closely for life.

The results of treatment of 42 cases of lentigo maligna and 16 of lentigo maligna melanoma at the New York University Medical Center was reviewed. The recurrence rate after surgical excision of 22 lesions of lentigo maligna was 9% (2/22), but after treatment of 20 such lesions with destructive techniques (X rays, curettage-electrodesiccation, cryosurgery), it was 35% (7/20). Of 11 cases of lentigo maligna melanoma that were excised, none recurred locally, but fatal metastases ensued in one case. Five patients who were eventually classified as having lentigo maligna melanomas had been treated by destructive techniques. In four of them there were local recurrences and in two, metastases as well; the fifth patient had metastases without local recurrence. On the basis of this review of these 58 cases, we conclude that surgical excision and careful histologic study of step sections through the entire lesion insure accurate diagnosis and provide the highest cure rates for lentigo maligna and lentigo maligna melanoma

One-stage radical reconstructive surgery for the common craniofacial deformities has become standard procedure in a few medical centers. With increasing experience and expertise, young children and adolescents, as well as a few adults have been greatly benefited. It has long been recognized that both the cranial and facial deformities of Couzon's disease and Apert's syndrome are progressive, having their inception either before birth or in the neonatal period, and evolving to the full blown syndrome during the first years of life. The authors believe that the progressive nature of these anomalies is secondary to a combination of permaturely fused sutures of the calvarium and cranial base (coronal, sphenozygomatic, frontoethmoidal and frontosphenoidal). In an effort to arrest and correct both the cranial and facial deformities as well as obviate the need for future radical surgery the authors have treated several children with Crouzon's disease and Apert's syndrome with suture craniectomy along the base of the skull. Following this procedure, deformity has regressed and ultimate cosmetic improvement has been dramatic. It is unlikely that radical craniofacial surgery will be necessary in this group of patients at any future time. On the basis of this experience, it is believed that the pendulum is now swinging and that in the future, stripping of the appropriate sutures along the base of the skull will limit deformity and make additional surgery unnecessary

Olfactory and gustatory function can be reiably studied in patients with craniofacial anomalies over the age of 7 years. In our unoperated patients with orbital hypertelorism or craniofacial dysostosis, preoperative evaluation of the olfactory and gustatory functions showed normal values. The same techniques were employed to study any changes in these modalities following reconstructive craniofacial surgery, and the results are presented