Otoplasty: critical review of clinical results.

Although it is generally believed that otoplasty provides uniformly gratifying results, thorough patient follow-up reviews are quite rare. Otoplasty surgery performed on 119 ears was retrospectively reviewed to assess the results of our cartilage-sparing technique. This method of otoplasty relies on a conchal set-back and suture transfixation technique to improve the antihelical contour. Auricular medialization averaged 10.3 mm. Over-correction is required, particularly in the superior pole, as loss of correction with healing was approximately 40% of the initial medialization. Revision surgery due to loss of correction was necessary for 6.6% of the ears initially operated on by the senior author. Patients who presented following cartilage-cutting procedures tended to have a higher rate of revision and persistent postoperative stigmata. Complications in general were few; however, mersilene suture extrusion occurred in 8% of ears. Only one of these required revision surgery for associated loss of correction. Despite these drawbacks, over 95% of patients achieved satisfactory results using cartilage-sparing otoplasty techniques.

Incision and scar analysis in open (external) rhinoplasty.

Open (external) rhinoplasty is becoming increasingly popular. Two of its disadvantages most frequently espoused are the difficulty in making the external incision atraumatically and the resulting scar. To diminish these concerns, different incision lines and methods of exposure have been proposed by various authors. These are reviewed along with our preferred technique. We reviewed 100 consecutive cases of open rhinoplasty, yielding 81 patients who underwent subjective and objective scar analysis. There was 1 subjective failure (1.2%), and 2 minor objective failures (2.5%). Recommendations are made to minimize difficulties in performing the open approach and to maximize scar cosmesis.

Extended blepharoplasty.

Extended blepharoplasty involves extending the dissection of the skin-muscle flap used in standard lower eyelid blepharoplasty to a level below the infraorbital rim. This technique is useful in the management of infraorbital, or malar, bags that are seen in as many as 10% of blepharoplasty candidates. A concomitant eyelid shortening procedure is frequently needed to treat horizontal eyelid laxity. Achievement of satisfactory results depends on the proper suspension of the skin-muscle flap to the lateral canthal periosteum. Extended blepharoplasty is an innovative way to improve infraorbital pouching, which is otherwise beyond the reach of the standard blepharoplasty procedure.

The hanging columella.

A hanging columella significantly detracts from otherwise pleasing nasal esthetics. Preoperative assessment of the nasal base is crucial to determine the etiology of a pre-existing hanging columella, and to assess the potential for creating such a deformity with rhinoplasty. Prevention or correction of a hanging columella requires surgical techniques that take into consideration the anatomic tip dynamic factors involved. We discuss the anatomy of the nasal base, define the hanging columella, and distinguish this entity from others with which it can be confused. We propose a methodical approach to the evaluation of the hanging columella, and recommend corrective techniques which we have found successful in achieving good cosmetic results.

The contribution of brainstem electric response audiometry (BERA) to the evaluation and management of infants with cleft palate.

In the three-year period ending December 1986, 31 infants followed by the Cleft Palate Team of our institution were evaluated with BERA one or more times. Seventy-four percent presented auditory threshold elevation on initial examination; none was observed to resolve spontaneously in the first year of life. Myringotomy and tympanostomy tube insertion normalized auditory thresholds effectively in most children with serous otitis media. In a few cases, however, recovery required several months. BERA can assist the early detection of children with sensorineural hearing loss. It may also be valuable as an additional consideration in selecting treatment of serous otitis media in these children. Precise guidelines as to the ideal time to perform tympanostomy requires further substantiation of the effects of early hearing loss on speech and language development.

Cervicofacial liposuction: results and controversies.

Obtaining ideal results with cervicofacial rhytidectomy has long frustrated facial plastic surgeons due to the difficulty of removing local excesses of adipose tissue in the parotid, melolabial, submental and submandibular areas. Open and closed liposuction techniques are being developed in conjunction with the facelift to improve definition of the facial, mandibular and cervical contours. A review of the senior author's (PAA) cases of cervicofacial liposuction and rhytidectomy is presented with emphasis placed on surgical techniques and results. Current literature is reviewed. Recommendations are made regarding analysis, surgical techniques and postoperative management of patients presenting for rejuvenation of the lower face.