The past two decades have witnessed significant advances in the repair of extensive craniofacial injuries. Rigid fixation techniques and the adaptation of craniofacial surgical approaches have made exposure and fixation of the entire anterior craniofacial skeleton possible. Given this capability, much attention has been focused on developing an organized plan of repair that optimizes restoration of pretraumatic facial form and function. Successful reconstruction can be achieved through a flexible approach that adheres to several key principles. First, comminuted subunits are individually reconstructed, then rigidly fixed to each other and finally connected to a region of stability via their associated buttresses. Second, reestablishment of occlusion and facial width is of paramount importance. Management of the naso-orbital-ethmoid region, the aesthetic core of the face, should be considered early in the sequencing of fractures. Finally, soft-tissue relationships must be reestablished after wide craniofacial exposure.

The scalp may be involved in traumatic injury, resulting in significant disfigurement and psychologic morbidity. Scarring alopecia is seen after burn injuries, avulsion injuries, accidents, and treatment of tumors. Historically, hair restoration procedures have included scalp reduction, pedicle flaps, expanders, and hair transplantation. This article describes the special techniques required to restore a patient's appearance when treating these injuries, while emphasizing the versatility of scalp expansion, advancement flaps, and follicular unit hair transplantation. The scalp may be involved in traumatic injury, resulting in significant disfigurement and psychologic morbidity. Scarring alopecia is seen after burn injuries, avulsion injuries, accidents, and treatment of tumors. Historically, hair restoration procedures have included scalp reduction, pedicle flaps, expanders, and hair transplantation. This article describes the special techniques required to restore a patient's appearance when treating these injuries, while emphasizing the versatility of scalp expansion, advancement flaps, and follicular unit hair transplantation.

The use of plates and screws composed of a resorbable copolymer of poly L-lactic acid and polyglycolic acid (LactoSorb) for the repair of a variety of midfacial fracture patterns (orbital, zygomatic, and maxillary) was performed in 127 patients. Other than technique variations in application for screw insertion and plate adaptation, no clinical differences were observed in intraoperative bone stability or postoperative long-term results from prior experience with traditional metal devices. No occurrences of postoperative infection; abnormal, prolonged, or delayed soft-tissue swelling; or maxillary sinusitis occurred in this series with a 1- to 7-year follow-up. Resorbable fixation devices work well in the midface when good bone stock is available and extensive comminution of important bony buttresses is not present. Their use requires certain conceptual and technical differences from metal fixation and these issues are highlighted in this clinical review. The use of plates and screws composed of a resorbable copolymer of poly L-lactic acid and polyglycolic acid (LactoSorb) for the repair of a variety of midfacial fracture patterns (orbital, zygomatic, and maxillary) was performed in 127 patients. Other than technique variations in application for screw insertion and plate adaptation, no clinical differences were observed in intraoperative bone stability or postoperative long-term results from prior experience with traditional metal devices. No occurrences of postoperative infection; abnormal, prolonged, or delayed soft-tissue swelling; or maxillary sinusitis occurred in this series with a 1- to 7-year follow-up. Resorbable fixation devices work well in the midface when good bone stock is available and extensive comminution of important bony buttresses is not present. Their use requires certain conceptual and technical differences from metal fixation and these issues are highlighted in this clinical review.

Along with recent advances in rigid fixation, the adaptation and expansion of craniofacial surgical access technique has significantly improved the management of facial skeletal trauma. Four surgical approaches—coronal, transconjunctival, maxillary gingival buccal sulcus, and mandibular gingival buccal sulcus—provide access to the entire craniofacial skeleton while avoiding additional soft-tissue deformities or marring scars. Added modifications to these techniques widen exposure to adjacent subsites, thus enhancing the surgeon's ability to employ rigid fixation through concealed incisions. Recent applications of endoscopic technique to facial skeletal trauma provide an additional means of repair with minimal associated morbidities. These endoscopic approaches may become an important component of the facial trauma surgeon's armamentarium in the future. Along with recent advances in rigid fixation, the adaptation and expansion of craniofacial surgical access technique has significantly improved the management of facial skeletal trauma. Four surgical approaches—coronal, transconjunctival, maxillary gingival buccal sulcus, and mandibular gingival buccal sulcus—provide access to the entire craniofacial skeleton while avoiding additional soft-tissue deformities or marring scars. Added modifications to these techniques widen exposure to adjacent subsites, thus enhancing the surgeon's ability to employ rigid fixation through concealed incisions. Recent applications of endoscopic technique to facial skeletal trauma provide an additional means of repair with minimal associated morbidities. These endoscopic approaches may become an important component of the facial trauma surgeon's armamentarium in the future.

Enlarged tonsils can cause chronic signs and symptoms of upper airway obstruction in adults and chidden. The condition has been associated with sleep-related breathing disorders such as snoring, upper airway resistance syndrome, and apnea, as well as dysphagia and dysphonia. Temperature-controlled radiofrequency tonsil reduction is a new technique for the treatment of symptomatic tonsil hypertrophy and selected cases of inflammatory cryptic tonsil disease. The technique ablates tonsil tissue while leaving the overlying mucosa relatively intact. Intact mucosa accounts for the minimal pain, risk of bleeding, and infection, and rapid return to a normal diet and activity associated with this procedure. This chapter describes the procedure, and discusses both its advantages and shortcomings.

Proper treatment of fractures of the mandible is dependent on proper diagnosis of the lesion. Panoramic radiography has become the standard of care for the evaluation of mandibular fractures in many institutions. The ability to obtain these views while the patient is in the supine position is a great asset in trauma centers where the patient may be unstable, and in patients for whom the cervical spine (C-spine) has not been cleared. Proper radiologic evaluation of the C-spine may be the most important part of the radiologic workup in the evaluation of mandibular trauma since it influences the options for evaluation of the mandible. Panoramic views with posteroanterior or reverse Towne's views are likely to give a higher yield than the panoramic view alone. The periapical view can be useful to identify specific dental trauma or abscesses. Occlusal views are under utilized, and can be very useful when used intraoperatively on patients with symphyseal and parasymphyseal fractures to avoid splaying of the lingual cortex, and widening of the mandibular width. The use of computed tomography (CT) as a diagnostic tool has been controversial in the past. Early studies comparing the sensitivity of CT to other modalities of the radiographic workup suggested that CT was not as sensitive. More recent studies performed with improved, higher resolution CT suggest that CT is superior to panoramic radiography, both in sensitivity and in offering the surgeon a better understanding of the nature of the fractures. Three-dimensional CT may have an important role in the future for evaluating pre- and postreduction techniques, particularly of subcondylar fractures. New multislice CT technology will further improve the resolution and speed of CT imaging and reconstructions.