Ideal Facial Relationships and Goals.

Analysis of the face is an essential component of facial plastic surgery. In training, we are taught standards and ideals based on neoclassical models of beauty from Greek and Roman art and architecture. In practice, we encounter a wide range of variation in patient desires and perceptions of beauty. Our goals seem to be ever shifting, yet our education has provided us with a foundation from which to draw ideals of beauty. Plastic surgeons must synthesize classical ideas of beauty with patient desires, cultural nuances, and ethnic considerations all the while maintaining a natural appearance and result. This article gives an overview of classical models of facial proportions and relationships, while also discussing unique ethnic and cultural considerations which may influence the goal for the individual patient.

Split thickness skin grafting in canal wall down tympanomastoidectomy.

OBJECTIVE: To characterize the effects of a split thickness skin graft (STSG) on the healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. STUDY DESIGN: A prospective randomized study. SETTING: Tertiary referral center. PATIENTS: Twenty-four patients, ages 21 to 82 years, with a diagnosis of cholesteatoma, undergoing CWD tympanomastoidectomy for the first time. INTERVENTION: Placement of a STSG to line the mastoid cavity at the time of surgery. MAIN OUTCOME MEASURES: The primary outcome was the amount of time required for epithelialization of the mastoid cavity. Secondary outcomes included postoperative complications, specifically, presence of otorrhea, granulation tissue, meatal stenosis, or tympanic membrane perforation. RESULTS: Twenty-four patients met inclusion criteria. Thirteen patients were randomized to the study group and 11 patients to the control group. Data were collected at follow-up appointments scheduled at postoperative Weeks 3, 6, 9, and 12, as well as every 6 months thereafter. Average time for successful epithelialization of the cavity in the STSG group was 3.2 weeks. Average time for successful epithelialization of the control group was 6.6 weeks. Using a 1-sided 2 sample t test, this was found to be statistically significant with a p value of 0.000137. There was no significant difference in complications rates between the 2 groups. CONCLUSION: Placement of a STSG is a technique available to the otologist to facilitate rapid healing and epithelialization in patients undergoing CWD tympanomastoidectomy.

Sinus balloon catheter dilation after adenoidectomy failure for children with chronic rhinosinusitis.

OBJECTIVE: To assess surgical outcomes in children undergoing sinus balloon catheter dilation for whom previous adenoidectomy has failed. Adenoidectomy is the first line of surgical management for children with chronic rhinosinusitis (CRS). This procedure is successful in about 50 percent of patients. DESIGN: Prospective review of children who had surgery for CRS. SETTING: A referral tertiary health care system. PATIENTS: Children with persistent symptoms after adenoidectomy, despite medical treatment, as documented by the sinonasal 5 (SN-5) score and the Lund-Mackay computed tomography (CT) score. MAIN OUTCOME MEASURE: The SN-5 score at 1 year post procedure. RESULTS: Twenty-six children met the inclusion criteria. The age range was 4 to 12 years (mean [SD] age, 9.0 [2.5] years). The mean (SD) CT score was 7.3 (2.9). The minimum preoperative SN-5 score was 3.0 (mean [SD], 4.6 [0.9]). The mean (SD) time of postoperative follow-up was 13 (3.0) months. The mean (SD) SN-5 score at 1 year was 3.0 (1.2). This was a significant change from preoperative scores (P < .001). Surgical success, measured by a decrease of more than 0.5 on the postoperative SN-5 score, was achieved in 21 children (81%). CONCLUSIONS: Sinus balloon catheter dilation has previously been shown to be safe and effective in children. This current study demonstrates that balloon dilation is effective in children for whom previous adenoidectomy has failed. Balloon catheter dilation may be considered prior to proceeding to functional endoscopic sinus surgery in children with CRS.