Faculty Bibliography

This case report illuminates the high possibility of catastrophic complications in the lateral neck, the vagaries associated with the preoperative therapeutic information, the technical effort to gain maximum surgical security, and the overwhelming complications associated with chemotherapy, irradiation, and surgical intervention.

Thread augmentation, a subsurface technique for correcting facial rhytides, is especially applicable to perioral wrinkles, melolabial furrows, and frown lines about the forehead. It is basically an augmentation technique which places a volume of well-tolerated, slowly absorbable or nonabsorbable sutures underneath the wrinkle. These threads produce augmentation by their volume and the mild local reaction of edema, lymphocytic infiltration, and fibrosis. This process gradually progresses to internal scar formation as the suture material is dissolved by slow hydrolysis in the presence of tissue fluid over a period of months; the nonabsorbable suture remains as a permanent implant. A high level of patient satisfaction with minimal complications has proved the value of this technique in over 100 cases.

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 effects of the antipsychotic/antidepressant drug CI-686 on apomorphine- and amphetamine-induced stereotypies, dopamine metabolism, neuroleptic binding, and serum prolactin levels were determined. CI-686 displayed profiles of activity in each of these systems that differs markedly from those of other antipsychotics. CI-686's unique preclinical profile suggests a mechanism of action other than dopamine antagonism which could have implications regarding current thinking on the pathophysiology of schizophrenia

A photographic record of the appearance of the patient's face and neck preoperatively, and of the changes resulting from surgery is a most important aspect of facial cosmetic surgery. This report describes a practical, efficient system of photography performed in the surgeon's own office. The photographic equipment can be placed in a relatively small area at a total cost of well under $1000. The procedure described, when smoothly running can provide almost 99% efficacy in obtaining consistently good photographs with a minimum of effort and time spent by the surgeon and his office staff. The photographs are a precise, valuable record (medically and legally) of the patient's preoperative and postoperative appearances, and are important for the patient to see and for the surgeon to study. The patient is provided with a striking reminder of preoperative reality; the surgeon with insight into the progress of his surgical expertness

Injury to the facial nerve in rhytidectomy has been occurring in less than one percent of the cases, and a spontaneous return of function in more than 80 percent of these injuries has resulted within 6 months. With the introduction of the newer and more aggressive techniques of platysmal and subplatysmal flaps and SMAS dissections, the risk of injury to facial nerve branches is obviously increased. Though there has not yet been an increase in the facial nerve injuries reported, these techniques are still relatively recent additions to the face-lift operation-and usually they have been done by more experienced surgeons, taking more time and working under direct vision with a more careful dissection. More care is needed to prevent injuries. We discuss here the detailed anatomy of the muscular branches of the facial nerve, how to prevent injuries to them during rhytidectomy, and how to manage injuries when they do occur

The hypoglossal-facial nerve crossover is a valuable surgical procedure for the treatment of certain types of facial paralysis. It is most effective when used as an integral part of a primary ablative operation for the treatment of cancer in this region. In the treatment of long-standing facial paralysis, its application requires an intact peripheral facial nerve system and some functioning mimetic muscles with an obliterated proximal facial nerve segment. It is recognized that other procedures are available for repair in patients who meet essentially these same criteria. The disadvantages are minimal intraoral crippling, mass movements of the face and, in some instances, hypertonia of the face. The advantages are improved facial tone, protection of the eye, intentional facial movements controlled by the tongue, and movements associated with physiological functions of the tongue