Correction of the retracted alar base.

Alar base retraction is a common yet difficult problem faced by the rhinoplasty surgeon. It may be caused by weakened, overresected lateral crura, vestibular lining deficiencies, or congenital alar malpositioning. Methods of correction include soft tissue manipulation, auricular composite grafting, and cartilage grafting. We present the senior author's graded approach to alar retraction using auricular composite grafting, alar rim grafting, and lateral crural strut graft placement with caudal lateral crural repositioning.

Anatomy of the Skin and the Pathogenesis of Nonmelanoma Skin Cancer.

Skin is composed of the epidermis, dermis, and adnexal structures. The epidermis is composed of 4 layers-the stratums basale, spinosum, granulosum, and corneum. The dermis is divided into a superficial papillary dermis and deeper reticular dermis. Collagen and elastin within the reticular dermis are responsible for skin tensile strength and elasticity, respectively. The 2 most common kinds of nonmelanoma skin cancers are basal cell and squamous cell carcinoma. Both are caused by a host of environmental and genetic factors, although UV light exposure is the single greatest predisposing factor.

Polylactide-co-glycolide fiber-reinforced calcium phosphate bone cement.

OBJECTIVE: To compare the strength of polylactide-co-glycolide fiber-reinforced calcium phosphate bone cement (FRC) with nonreinforced calcium phosphate bone cement (NRC) subjected to simulated dural pulsations in defects larger than 25 cm(2). METHODS: Seven NRC and 7 FRC specimens were set in both medium (37.5 cm(2)) and large (50.0 cm(2)) model skull defects while subjected to simulated dural pulsations. Specimens were removed after 24 hours and analyzed using 3-point flexural testing. RESULTS: All 14 FRC specimens maintained structural integrity during extraction and testing. Only 2 of 7 (29%) medium specimens and 2 of 7 (29%) large NRC specimens survived setting. The mean (SD) energy to peak force (in newton millimeters [Nmm]) of the medium and large NRC specimens was 0.88 (0.83) and 3.00 (3.54) Nmm, respectively, compared with 28.97 (16.52) and 49.91 (38.10) Nmm for the medium and large FRC specimens. The material strength (in megapascals) of the medium and large NRC specimens was 0.17 (0.15) and 0.39 (0.33) MPa, respectively, compared with 3.73 (0.99) and 2.62 (1.34) MPa for the medium and large FRC specimens. The energy to peak force and material strength of the medium and large FRC specimens were significantly greater than for the corresponding NRC specimens; results were not statistically significant between medium and large FRC specimens. CONCLUSIONS: Fiber-reinforced calcium phosphate bone cement exhibits superior structural integrity and material strength than NRC when subjected to unshielded simulated dural pulsations. Further studies are needed to evaluate the biophysical parameters of FRC in vivo.

Advances in craniofacial surgery.

The past 10 years have witnessed many advances in craniofacial surgery. Advances in surgical techniques, such as distraction osteogenesis and endoscopic procedures, combined with refinements in surgical equipment, such as resorbable plating and distractors, have improved surgical outcomes, while minimizing morbidity. Technological advances in 3-dimensional imaging, computer simulation, and intraoperative navigation facilitate diagnosis, preoperative planning, and surgical execution. Rising cases of deformational plagiocephaly owing to increased supine infant sleep positioning necessitated the development of appropriate diagnosis and treatment and the avoidance of unnecessary surgery. A greater understanding of the genetic basis of craniofacial disorders has allowed better preoperative assessment and counseling. Finally, efforts to develop better bone graft substitutes with gene therapy and nanotechnology are ongoing.

Comprehensive airway management of patients with maxillofacial trauma.

Airway management in patients with maxillofacial trauma is complicated by injuries to routes of intubation, and the surgeon is frequently asked to secure the airway. Airway obstruction from hemorrhage, tissue prolapse, or edema may require emergent intervention for which multiple intubation techniques exist. Competing needs for both airway and surgical access create intraoperative conflicts during repair of maxillofacial fractures. Postoperatively, edema and maxillomandibular fixation place the patient at risk for further airway compromise.

Direct gingivoperiosteoplasty with palatoplasty.

Gingivoperiosteoplasty creates a mucoperiosteal bridge across the alveolar cleft associated with cleft lip and palate. The subperiosteal tunnel allows for bone generation in the absence of bone grafting in young patients. The original procedure required wide maxillary subperiosteal dissection and flap rotation but has since evolved along with techniques to narrow the alveolar cleft toward limited dissection and direct closure. Multiple studies reveal superior facial growth parameters, particularly vertical maxillary growth, when compared with primary bone grafting typically performed within the first year of life and a reduced need for later secondary bone grafting. Most centers that perform gingivoperiosteoplasty do so in conjunction with primary lip closure after initial narrowing of the cleft with presurgical orthopedics. We present our method of direct gingivoperiosteoplasty performed simultaneously with palatoplasty after alveolar cleft narrowing without presurgical orthopedics via a two-stage lip repair. Preliminary data suggest bone growth capable of supporting tooth eruption without significant growth disturbances in a majority of patients treated with this protocol.