Importance of chin evaluation and treatment to optimizing neck rejuvenation surgery.

The chin is the keystone linking the aesthetics of the face and neck but is often neglected in the analysis. Procedures related to the chin play an important role in defining neck anatomy. Alloplastic implants can provide the illusion of a longer jaw line in a patient with retrogenia. Even greater anatomic changes to the neck result when a sliding genioplasty is performed. This effect is primarily due to the digastric attachments from the mentum and mastoid. Advancing the mentum may have a more direct effect of elevating the position of the hyoid, which sharpens the angle between the jaw and neck. Finally, the diagnosis of a witch's chin is also discussed for the patients who present for aging neck surgery.

Osteoradionecrosis of the anterior cranium.

Osteoradionecrosis occurs in approximately 10% to 15% of patients following radiation therapy for head and neck cancer. In these patients, it is most commonly reported in sites involving the mandible, but it has also been reported in the maxilla, sphenoid, and temporal bones. The majority of these cases are related to some type of trauma such as dental extraction or intraoral biopsies. However, approximately 40% of these entities occur spontaneously and are felt to be secondary to cell kill in intermediate tissues such as bone and periosteum. Our literature review yielded no previously reported cases of osteoradionecrosis involving the anterior cranium. The following two cases present patients who experienced osteoradionecrosis of their frontal bone flaps following subcranial approaches for tumor resection. Both patients suffered from carcinomas involving the ethmoid sinuses; one tumor was a moderately well-differentiated squamous cell carcinoma, the other a mucinous adenocarcinoma. One patient's radiation therapy consisted of external beam photons; the other patient received external beam neutrons. Treatment for these patients, as well as possible causative factors regarding their osteoradionecrosis, are discussed.

Sensorineural hearing loss associated with aortocoronary bypass surgery: a prospective analysis.

A prospective, clinical study was undertaken to assess the relationship between aortocoronary bypass surgery (ACBS) and sensorineural hearing loss (SNHL). Between August 1, 1988 and July 31, 1989, 1458 patients underwent ACBS and 181 volunteers were entered into the study based on availability and capability to complete preoperative and postoperative questionnaires and audiometric testing. One hundred forty-five patients completed the study. Intraoperative audiant brainstem response (ABR) testing was performed on 7 patients with essentially normal hearing. Although 4 patients (2.8%) reported a subjective change in hearing on postoperative questionnaires, objective testing did not confirm a significant hearing change in pure-tone, speech discrimination, or speech reception threshold testing. Acute or sudden SNHL within 2 weeks following ACBS was not identified in any patient completing the study. This study did not provide evidence to support a causal relationship between SNHL and ACBS. However, if SNHL does occur following ACBS, the well-established etiology of ototoxic therapy and subsequent SNHL demands exclusion in the absence of conflicting histopathologic information.