Midface-lifting: evolution, indications, and technique.

The youthful face is often defined by malar and lateral cheek fullness with associated submalar concavity, giving a smooth contour between the different subunits coupled with an aesthetically pleasing convex lower eyelid-cheek continuum. This article reviews the key anatomical concepts of midfacial aging, the evolution of midface-lifting techniques, and indications and contraindications for their use.

Back to basics: a case series of angular dermoid cyst excision.

Angular dermoid cysts are common peri-orbital tumours in children. Characteristically benign and slow growing, they are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis. We present a review of 25 cases, managed by our unit over the past 9 years, which underwent surgical excision by a single-stage procedure using the superior eyelid crease approach only. We show that despite the evolution of many techniques, including endoscopy, the superior eyelid crease remains superior in our opinion, affording simple complete excision with a well-concealed scar. Therefore, we recommend this technique as the optimal technique for lateral eyebrow dermoid cyst excision.

Multidisciplinary surgical management of cherubism complicated by neurofibromatosis type 1.

UNLABELLED: Cherubism is a rare, autosomal dominant, mostly self-limiting disease of the jaw. It is characterized by bilateral fibrous tissue hyperplasia, giant cell proliferation, and bony degeneration in the lower facial skeleton, which can result in a massive and severely deforming prominence of the maxillomandibular structure. This case study examines the multidisciplinary management of a severe case of cherubism complicated by neurofibromatosis type 1, 2 codominant nonsegregating conditions that were clinically and genetically diagnosed, an extremely rare combination. Adequate mandibular reduction, reconstruction, and dental implantation afforded good restoration of oral function as well as a marked aesthetic improvement. METHODS: A 14-year-old Fijian girl was referred to our unit for management of severe overgrowth of her mandible that compromised her speech and deglutition. In addition, she displayed clinical features consistent with neurofibromatosis type 1. Radiologic, histologic, and genetic analyses confirmed the diagnosis of both conditions. Our craniofacial multidisciplinary team undertook mandibular reconstruction followed by placement of osseointegrated dental implants. RESULTS: Mandibular reduction, reconstruction, and dental implantation resulted in a significantly improved functional and aesthetic outcome with no further regrowth at 3-year follow-up when she returned to the United Kingdom for osseointegrated dental implant insertion. CONCLUSIONS: The successful outcome of this surgically challenging, grossly disfiguring, and rare condition was largely a result of the combined input from our multidisciplinary team, adequate preoperative planning, and the use of a novel surgical technique in debulking and reconstructing her mandible.

Surgical management of two complex cases of large juvenile orbital ossifying fibroma.

Ossifying fibroma is a rare benign tumour of the craniofacial skeleton, which can have an aggressive biological behaviour in the paediatric population. Complete surgical excision, where possible, is the ideal. This case report discusses the multidisciplinary, surgical management of two complex cases of large juvenile ossifying fibroma (JOF), involving the orbit. Both patients underwent resection of the orbital ossifying fibroma with no macroscopic evidence of recurrence at 4 years follow-up. Full functional outcome was achieved with preservation of vision and facial nerve function as well as good facial symmetry and aesthetics. The successful surgical outcome of these cases was due to a combination of a multidisciplinary team approach, rigorous pre-operative planning, maximal tumour resection, and the use of a novel surgical technique involving a medial zygomatic-orbito-maxillary rotational osteotomy.