BACKGROUND:To address functional and smile dysfunction associated with post–facial paralysis synkinesis, the senior author (B.A.) has offered “modified selective neurectomy” of the lower division of ...the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure.
METHODS:A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure.
RESULTS:Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery.
CONCLUSION:Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post–facial paralysis synkinesis.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.
The relationship of the skin, the superficial and deep fat compartments, and the ligaments that connect these structures is key to performing any rhytidectomy. In order to successfully mobilize, ...elevate, and reposition the facial soft tissues, a detailed understanding of facial anatomy is required. This article details the anatomy of the midface and neck that is essential to understanding and performing the face-lift operation.
Objectives/Hypothesis
To characterize the histologic and biochemical properties of auricular and septal cartilage and analyze age‐related changes in middle‐aged to older adults.
Study Design
...Cross‐sectional study of auricular and septal cartilage from 33 fresh cadavers.
Methods
Auricular and septal cartilage specimens were stained using Safranin O for glycosaminoglycans, Verhoeff's stain for elastin, and Masson's trichrome for collagen. Percentage of tissue stained, cell density and size were quantified. Relationships between donor characteristics and histologic properties were evaluated using mixed model analyses.
Results
The average donor age was 75 years (standard deviation = 11 years; range, 55–93 years). In auricular cartilage, each 1‐year increase in age was associated with a 0.97% decrease in glycosaminoglycans (P < .001) and a 0.98% decrease in elastin (P < .001). In septal cartilage, glycosaminoglycans decreased 2.4% per year (P < .001). Age did not affect collagen content significantly in auricular (P = .417) or septal cartilage (P = .284). Cell density and cell size declined with age in auricular (both P < .001) and septal cartilage (P = .044, P = .032, respectively). Compared to septal cartilage in patients of all ages, auricular cartilage had more glycosaminoglycans, less collagen, higher cell density, and smaller cells.
Conclusions
In auricular and septal cartilage, glycosaminoglycans, elastin, cell density, and cell size decrease significantly with age in patients over 55 years of age. Glycosaminoglycan content declines faster with age in septal cartilage than auricular cartilage. These age‐related changes may affect biomechanical properties and tissue viability, and thereby have implications for graft choice in functional, aesthetic, and reconstructive nasal surgery.
Level of Evidence
NA. Laryngoscope, 127:E399–E407, 2017
Global Rhinoplasty Ghavami, Ashkan; Most, Sam P; Cerkes, Nazim
2023
eBook
A unique ethnocentric guide to rhinoplasty anatomy and techniques from globally renowned experts In order for a facial plastic surgeon to create a harmonious relationship between the face and nose, ...it's paramount to consider each patient's ethnicity and gender identity. Nasal anatomy varies widely in terms of proportion, thickness, size, and resilience and many of these differences are specific to ethnicity. Although rhinoplasty has been available for many decades, applying Caucasian rhinoplasty guidelines to Hispanic, Middle Eastern, Black, and Asian patients increases the risk of adverse outcomes and the need for multiple or revision surgeries. Global Rhinoplasty: A Multicultural Approach edited by world-renowned facial plastic surgeons Ashkan Ghavami, Sam P. Most, and Nazim Cerkes fills a gap in the literature, providing in-depth coverage of non-Caucasian nasal anatomy and rhinoplasty approaches for each subtype. The textbook includes 39 chapters and is organized in five sections: Principles, Anatomical Considerations, Primary Rhinoplasty, Secondary Rhinoplasty, and Special Considerations. Seventeen chapters cover anatomical and surgical techniques specific to the skin and soft tissue, dorsum, nasal tip, and nostrils for each ethnic group. Each of the 16 rhinoplasty chapters features expert commentary from the editors. The text concludes with discussion of preservation rhinoplasty, the use of fillers for nonsurgical and revision surgeries, evaluating psychosocial factors in patients seeking rhinoplasty surgery, and the role of marketing and social media in global practice. Throughout the book, authors share firsthand insights on potential pitfalls and strategies to prevent complications. Key Highlights Contributions and clinical pearls from globally recognized experts In-depth analysis of ethnic variations in skin and nose anatomy and
its impact on outcomes Primary, secondary, and nonsurgical rhinoplasty videos provide invaluable visual guidance High-quality case study operative photos and illustrations enhance understanding of anatomy, approaches, and outcomes This must-have resource will help facial plastic surgeons significantly improve pre-surgical, surgical, and postoperative phases of rhinoplasty in Hispanic, Middle Eastern, Black, and Asian patients.
