3-dimensional Defects Research Articles

D21. Failure Rates Based on Alveolar Cleft Size: An Analysis of the Critical Size Defect for rhBMP-2/DBM and Iliac Crest in Alveolar Bone Grafting

PURPOSE: Iliac crest bone graft (ICBG) is the standard of alveolar bone grafting (ABG). However, recombinant human bone morphogenetic protein(rhBMP-2) with demineralized bone matrix (DBM) has been proposed as an alternative. We aim to identify the critical size defect of failure rates for ICBG and rhBMP-2/DBM. METHODS: A retrospective review evaluated patients undergoing ABG from 2016-2022. Patients with genetic syndromes, bilateral clefts, and missing postoperative cone beam computed tomography (CBCT) were excluded. The 3-dimensional volumetric defect sizes were calculated using preoperative CBCT scans. The primary outcome was bony bridge formation based on postoperative imaging. Logistic regression was used to model graft failure rates and identify the maximal point, which defined the critical point. RESULTS: Among 148 patients screened, 62 were included who underwent ABG (ICBG: n=28; rhBMP-2/DBM: n=34). There was no significant difference in bridge formation between graft types. The critical point in failure rate was calculated to be 829.3mm3 and 857.8mm3 for rhBMP-2/DBM and ICBG, respectively. Upon Fisher-exact analysis, there were increased bridge failures in clefts greater than the critical point for both ICBG (p<0.001) and rhBMP-2/DBM (p=0.005). The critical point did not vary between graft types (p=0.772) CONCLUSION: Our findings identified a higher probability of graft failure beyond the predicted critical size defect for each respective bone graft. Clinicians can better counsel families of patients with larger defects with a higher probability of treatment failure using either ICBG or rhBMP-2/DBM.

3-dimensional defect TQFTs and their tricategories

We initiate a systematic study of 3-dimensional ‘defect’ topological quantum field theories, that we introduce as symmetric monoidal functors on stratified and decorated bordisms. For every such functor we construct a tricategory with duals, which is the natural categorification of a pivotal bicategory. This captures the algebraic essence of defect TQFTs, and it gives precise meaning to the fusion of line and surface defects as well as their duality operations. As examples, we discuss how Reshetikhin-Turaev and Turaev-Viro theories embed into our framework, and how they can be extended to defect TQFTs.

Regularized big bang singularity

Following up on earlier work on the regularization of the singular Schwarzschild solution, we now apply the same procedure to the singular Friedmann solution. Specifically, we are able to remove the divergences of the big bang singularity, at the price of introducing a 3-dimensional spacetime defect with a vanishing determinant of the metric. This particular regularization also suggests the existence of a "pre-big-bang" phase.

Extended Use of Chimeric Medial Sural Artery Perforator Flap for 3-Dimensional Defect Reconstruction.

The medial sural artery perforator (MSAP) flap has become increasingly popular because it is thin and pliable for small to moderate defect soft tissue reconstruction. Furthermore, chimeric MSAP flap, which includes a skin paddle and a separated piece of medial gastrocnemius muscle, allowed more freedom for flap insetting, especially in 3-dimensional defect reconstruction. Here we describe our experience regarding this clinical application. From 2007 to 2016, 14 male patients (average age, 46.9 ± 14.4 years) who received either a free or pedicled chimeric MSAP flap were included. Of these 14 patients, 7 received this flap for reconstruction in the head and neck, 2 in the upper extremities, and 5 in the lower extremities. Demographic data were collected and analyzed, and a literature review was performed. Ten patients received free chimeric MSAP flap, and 4 received the pedicled type. Thirteen of the 14 flaps (92.6%) survived, and 1 failed 2 days later owing to venous insufficiency. Venous congestion-related partial loss occurred in another case. The chimeric MSAP flap is a good alternative for deep space obliteration or reconstruction of adjacent but separate defects in both free and pedicled flap design. Donor site morbidity is limited. However, the perforator needs to be mobilized carefully to prevent postoperative venous compromise.

Chimeric Reverse Temporal Muscle and Pericranial Flap for Double-Layer Closure of Deep Facial Defects

Volumetric or multiplane defects of the upper and midface remain a challenge for reconstruction because of limited regional flap options. In this study, the authors harvested the reverse temporalis muscle flap and pericranial flap (RTMP flap) based on the same vascular pedicle, the superficial temporal artery, in a chimeric manner to obtain double-layer closure of deep facial defects. This study was a prospective case series performed in the Department of Plastic Surgery of Ataturk University (Erzurum, Turkey). The outcomes, including flap survival, postoperative complications, reconstructive success, esthetic appearance, and donor site morbidity, were clinically evaluated. Fourteen patients (10 male and 4 female) with deep defects of the middle third of the face underwent reconstruction using the chimeric RTMP flap. All chimeric RTMP flaps survived without postoperative complications. All defects were successfully repaired and covered with chimeric RTMP flaps. Patients were satisfied with the esthetic results. The chimeric RTMP flap is a good reconstruction option and can be used safely for moderate to large 3-dimensional defects of the middle and upper face. Smooth and durable coverage over the bulky muscle flap used to fill the volume defect and a larger flap for larger volume defects can be obtained by including the pericranial segment of the chimeric RTMP flap.

Effect of Allogeneic Platelet Lysate and Cyanoacrylate Tissue Glue on the Fibrovascularization of the Porous Polyethylene Implant.

Because of limited autogenous tissue sources, donor site morbidity, and difficulty of shaping the autologous tissue, surgeons often need to use alloplastic frameworks in reconstruction of 3-dimensional tissue defects. Synthetic porous polyethylene (PP) implant is widely used in plastic surgery for 3-dimensional reconstruction of the lost or highly deformed tissues. One of the main factors of PP implant exposure is delayed fibrovascular ingrowth. In the present study, the authors investigated the effect allogeneic plateletlysate (PL) and cyanoacrylate tissue glue (CTG) (2-octyl cyanoacrylate) on the fibrovascularization of the PP implant.Twenty adult female Wistar rats were divided into 4 groups equally, according to the different surgical techniques and implanted materials used. Only PP implant was implanted subcutaneously through a skin incision on the chest wall skin of the rats in the control group; however, CTG was applied with PP implant in the cyanoacrylate group, PL was applied with PP implant in the platelet group, CTG and platelet was applied together with PP implant in the combination group. All of the implants in each group were histologically assessed at postoperative second week. Determination of the collagen density in the tissues, inflammation, and necrosis and vascularization status was assessed semiquantitatively.A denser collagen structure, low inflammation, and necrosis were found in PL groups. There was, however, a significant decrease in vascular density with PL-treated groups. PL treatment may have a potential to reduce complications related to PP implants.

Osteomyocutaneous peroneal artery perforator flap for reconstruction of the skull base

m i t s (Fig. 1). Two segments of vascularised bone were used to reconstruct the horizontal frontal buttress, and an intermediate segment of bone was used to reconstruct the nasal defect. raniofacial resection for the treatment of malignant disease ay result in complex 3-dimensional defects of the skull base. icrovascular free flaps are a good way to isolate the central ervous system from the upper aerodigestive tract, and restore he normal appearances and contours of the bony and soft issues.1 Although the rectus abdominis myocutaneous flap as been the workhorse for microvascular reconstructions of he skull base to date, some surgeons now use anterolateral ree flaps.2 Fibular free flaps have been described for the restoration f the frontal skeletal buttress,3 and the osteomyocutaneous

Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap

Chimeric anterolateral thigh free flaps are composed of multiple skin paddles or muscular components that allow for the reconstruction of complex 3-dimensional defects. We present our experience with the technique and applications for various head and neck defects. Retrospective chart review. Academic tertiary care center. Subjects include 24 consecutive patients undergoing reconstruction with a chimeric anterolateral thigh free flap by a single surgeon. Our algorithm for pharyngeal reconstruction with this technique is described. Data include demographics, indications, comorbidities, operative findings, and surgical outcomes. The most frequent defects were pharyngocutaneous (n = 12, 50%) and skull base (n = 6, 25%). The flap consisted of a double skin paddle in 11 cases (45.3%) and a skin paddle with an independent component of vastus lateralis muscle in 13 cases (54.7%). Revision surgery was required in 4 cases and was associated with malnutrition (P = .022). There were no total flap losses, but partial loss (distal skin paddle in all the cases) was observed in 3 patients and was related to severe congestive heart failure (P = .021) and malnutrition (P = .021). All except 1 patient who underwent pharyngeal reconstruction resumed oral diet and achieved alaryngeal speech. Chimeric anterolateral thigh free flaps represent an excellent option for reconstruction of complex head and neck defects. Modifications to the technique are proposed in patients at high risk of surgical complications.

Directed self-assembly lithography for half-pitch sub-15 nm pattern fabrication process

ABSTRACTThis paper introduces a fabrication method to achieve sub-15 nm line-and-space (L/S) patterns by combining grapho- and chemo-epitaxy using poly(styrene-block-methyl methacrylate) copolymer (PS-b-PMMA). The fabrication method is simple, since it eliminates photoresist stripping and also does not require any special materials to form pinning patterns. In this process, the ridges formed on spin-on-glass (SOG) surface work as physical guides and the photoresists on them are utilized as a pinning layer. Fine PS-b-PMMA L/S patterns were obtained in sufficient critical dimension (CD) range of the guide patterns that corresponded to the 15% dose margin using ArF immersion lithography. 3-dimensional grid defects were found to be the origin of the short defects. The half-pitch (hp) 15 nm L/S patterns were transferred successfully to SOG/spin-on-carbon (SOC) stacked substrate.We also describe fabrication of sub-10 nm L/S patterns using a high-chi block copolymer (BCP).

Medial Wall Orbital Reconstruction using Unsintered Hydroxyapatite Particles/Poly L-Lactide Composite Implants.

BackgroundPoly-L-lactide materials combined with hydroxyapatite (u-HA /PLLA) have been developed to overcome the drawbacks of absorbable materials, such as radiolucency and comparably less implant strength. This study was designed to evaluate the usefulness of u-HA/PLLA material in the repair of orbital medial wall defects.MethodsThis study included 10 patients with pure medial wall blow-out fractures. The plain radiographs were taken preoperatively, immediately after, and 2 months after surgery. The computed tomography scans were performed preoperatively and 2 months after surgery. Patients were evaluated for ease of manipulation, implant immobility, rigidity and complications with radiologic studies.ResultsNone of the patients had postoperative complications, such as infection or enophthalmos. The u-HA/PLLA implants had adequate rigidity, durability, and stable position on follow-up radiographic studies. On average, implants were thawed 3.4 times and required 14 minutes of handling time.ConclusionThe u-HA/PLLA implants are safe and reliable for reconstruction of orbital medial wall in terms of rigidity, immobility, radiopacity, and cost-effectiveness. These thin yet rigid implants can be useful where wide periosteal dissection is difficult due to defect location or size. Since the u-HA/PLLA material is difficult to manipulate, these implants are not suitable for use in complex 3-dimensional defects.

Use of Allogenic (Iliac) Corticocancellous Graft for Le Fort I Interpositional Defects: Technique and Results

We performed a retrospective review of a consecutive series of 50 patients who had undergone Le Fort I with interpositional grafting during a 3-year period. Maxillary repositioning included horizontal advancement and vertical and transverse change to the extent that an interpositional graft was considered necessary. Allogenic (iliac) corticocancellous bone was used in all cases. Each patient underwent analytic model planning to document the maxillary vector change data points. The recorded data served as an indicator of the osteotomy site gaps requiring grafting. Standardized photographs in centric relation at a minimum of 12 months after treatment were analyzed to measure overjet, overbite, midline position, and first molar lateral occlusion. Specific maxillary region wound healing parameters were reviewed. The patients' mean age at surgery was 32 years (range 15 to 60). Analytic model planning clarified that the study patients had an average of 8 mm horizontal advancement, 2 mm vertical lengthening, and 2 mm of transverse expansion. The data confirmed a favorable occlusion at a minimum of 1 year after surgery with maintenance of a normal overjet (49 of 50 patients, 98%), normal overbite (48 of 50 patients, 96%), planned dental midline positioning (45 of 50 patients, 90%), and ideal first molar lateral occlusion (48 of 50 patients, 96%) for most patients. None of the study patients sustained wound healing complications. Also, no cases of postoperative sepsis or viral illness developed. The results of the present study have confirmed that iliac corticocancellous allograft has minimal systemic or recipient site complications and can be safely used to fill complex 3-dimensional interpositional defects associated with Le Fort I osteotomy and/or repositioning.

Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap: Indications, Outcomes, and Technical Considerations

Objectives: Chimeric anterolateral thigh (ALT) free flaps are comprised of multiple skin paddles or muscular components, which allow for the reconstruction of complex 3-dimensional defects. There is a paucity of data in the literature regarding the outcomes with this reconstructive option. We sought to describe our results with this technique and identify outcome predictors. Methods: Retrospective review of 24 patients undergoing reconstruction with a chimeric ALT free flap at an academic tertiary institution between 2009 and 2013. Demographics, indications, comorbidities, flap and functional outcomes were retrieved from the medical records and review of intraoperative photography. SPSS was used for data analysis. Results: The mean age was 57 years and the cohort primarily consisted of males (87.5%). The most frequent defects were: through-and-through pharyngoesophageal, n = 12 (50%) and skull base, n = 6 (25%). The flap consisted of double skin paddles in 11 cases (45.3%) and a skin paddle with an independent muscular component in 13 (54.7%). The mean skin paddle area was 62 cm2. There were no total flap losses; partial loss (secondary skin paddle) was observed in 3 cases and was related to severe congestive heart failure ( P = .005) and malnutrition ( P = .002). Postoperative fistula was associated to immunodeficiency ( P = .02) and malnutrition ( P = .004). All except one patient who underwent pharyngeal reconstruction resumed oral diet. The mean time to resume diet was 27 days. Conclusions: Chimeric ALT flaps represent an excellent alternative for reconstruction of complex defects. Patients with congestive heart failure, with immunodeficiency, and who are malnourished are at higher risk of partial flap loss. A second muscle paddle might be indicated in these cases.

Flap reconstruction of the knee: A review of current concepts and a proposed algorithm.

A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.

Flap prefabrication using high-density porous polyethylene in an animal model – an experimental study

BackgroundThe search for new surgical flap techniques and modifications of already existing ones is gaining increasing popularity. Progress in flap designing and harvesting have improved the functional and aesthetic results, especially in head and neck reconstruction.Material/MethodsTen pigs were used in this study. In the first operation, high-density porous polyethylene prefabrication was performed bilaterally in all pigs. After 8 weeks, each prefabricated complex was explored, resected, and macroscopically evaluated.ResultsAll of 20 prefabricated flaps survived. No serious surgical complications were observed. In 2 cases there was chronic inflammation and in 4 cases there was instability of the implant.ConclusionsAfter this experimental study, we believe that the use of high-density porous polyethylene in flap prefabrication may be a good option for reconstruction of 3-dimensional defects, especially in patients with limited donor tissues.

Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction

Composite tissue defects in the head and neck region present unique challenges. Definitive head and neck reconstruction of these cases is often complicated by complex 3-dimensional defects that may require multiple flap or chimeric flap procedures. These advanced techniques can have serious repercussions should poor perfusion of the flap cause flap failure, which can be devastating. A retrospective review was completed for those complex reconstructions using free tissue transfers and fluorescent indocyanine green angiography (Lifecell SPY Elite imaging, Lifecell Corporation, Bridgewater, NJ) at Walter Reed National Military Medical Center over a 24-month period. Data analyzed included flap type (myocutaneous, osteocutaneous, or fasciocutaneous), flap success and failure rates, and complications. These also were compared with data from the institution before the study period and the incorporation of SPY technology. Sixty-one free flaps, including 11 head and neck flaps, were performed. The head and neck flaps included 1 latissimus, 3 gracilis, 1 vastus lateralis, 4 anterior lateral thigh, and 2 fibular flaps. The overall success rate was 98.4%; 1 flap was lost (1.6%) and 2 flaps developed partial flap necrosis (3.3%). Where SPY Elite was used, there was no unpredicted partial flap necrosis. The only total flap loss was related to a hypercoagulable condition. Free tissue transfer can be technically challenging, especially in complex head and neck reconstruction. An algorithmic approach using SPY Elite imaging aids in pedicle location, angiosomal assessment, anastomotic flow visualization, and cutaneous and osteocutaneous flap perfusion assessment. This objective tool can assist the reconstructive surgeon in avoiding perfusion-related complications and total and partial flap losses, thus improving patient outcomes.

The Application of Distally Pedicled Peroneus Brevis Muscle Flaps and Retrograde Neurocutaneous Accompanying Artery Flaps for Treatment of Bony and Soft-Tissue 3-Dimensional Defects of the Lower Leg and Foot

To investigate the clinical effect of distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous flaps on treatment of bone and soft-tissue 3-dimensional defects of the lower leg and foot, the authors retrospectively studied all the patients admitted in their center in 3 consecutive years with bone and soft-tissue defects from March 2008 to February 2011; 21 patients suffering from traumatic and osteomyelitis were treated with peroneus brevis muscle flaps, for obliterating the hole-shaped bony defects after osteomyelitis debridement, and neurocutaneous flaps, for repairing associated soft-tissue defects. After thorough debridement, the average size of soft-tissue defects was 2 cm × 2 cm to 13 cm × 9 cm and that of bony defects was 2 cm × 2 cm × 2 cm to 6 cm × 3 cm × 3 cm. Neurocutaneous flaps completely survived in 20 cases, and the wounds healed at stage I; 1 case developed necrosis in the distal part of the peroneus brevis muscle flap and sural nerve flap, and the wound healed with a saphenous nerve flap. The flaps maintained good texture and shape during a follow-up of 6 to 24 months. Recurrence of osteomyelitis was not observed in any of the patients. In conclusion, distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous flaps are simple, safe, reliable, and suitable for clinical treatment of hole-shaped bony defects and reconstruction of soft-tissue defects within a single stage, especially when the 2 defects are located in different 3-dimensional spaces.

The Use of the Multi-Island Vertical Rectus Abdominis Myocutaneous Flap in Head and Neck Reconstruction

Head and neck cancer extirpation frequently creates complex 3-dimensional defects involving both intraoral and external tissues. Reconstruction can be accomplished either with 2 free flaps, a simultaneous free and pedicle flap, or a single double-island folded free flap. Herein, the outcomes and rationale for reconstruction of multilaminar head and neck defects using the multi-island vertical rectus abdominis myocutaneous (MI-VRAM) flap are reported. A retrospective review was performed of a prospectively collected database of all head and neck reconstructions completed by a single surgeon between 1992 and 2011. Forty-six patients were identified who underwent reconstruction of composite defects using MI-VRAM flaps. Oncologic defects were classified into 3 categories based on anatomic location, namely, the midface, lower face, and neck. Indications and outcomes were reviewed. Patients' ages ranged from 7 to 84 years with two thirds being male; 45% received preoperative radiation. Average MI-VRAM skin paddle size was 9×25.5 cm. Of the 46 reconstructions, 27 (59%) were performed in the midface, 14 (30%) in the lower face, and 5 (11%) in the neck region. There were no complete flap loses; however, 1 patient lost the external skin island, requiring pectoralis flap coverage. Of these cases, 15% had surgically related complications. Ten patients required secondary contouring procedures to revise bulky flaps. The MI-VRAM flap is a safe and reliable technique for reconstruction of complex defects throughout the head and neck region. Compared to 2 simultaneous free flaps or a free flap combined with a regional flap, it saves time and eliminates a second donor site. Level IV. Clinical question addressed in this paper is whether a multi-island VRAM flap is a safe technique in head and neck reconstruction.

Three-dimensional surgical simulation

In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases.

Torticollis of a Specific C1 Dislocation With Split Atlas

A case report. We report a novel case of torticollis disorder because of a congenital split atlas after minor trauma. Torticollis experienced after minor trauma in childhood is usually because of atlantoaxial rotatory fixation, which is a common disorder in pediatric patients and is usually diagnosed with computed tomography (CT). CT scanning with 3-dimensional reconstruction, however, showed a unique rotation of split atlas, a congenital anomaly that presented with torticollis. A female child aged 3 years and 11 months presented to the orthopedic clinic with torticollis after a fall. CT imaging showed no rotatory dislocation of C1-C2. On the 3-dimensional CT reconstruction images, however, anterior and posterior defects in the atlas, the so-called split atlas, and an atypical rotation with malalignment of the posterior arch and asymmetry of the atlantoaxial facet joint were noted. The child was treated with closed reduction using skull traction under general anesthesia. Repositioning of the atlas rotation was confirmed using intraoperative 3-dimensional scanning, and open reduction therapy was avoided. The patient was treated with halo vest for 8 weeks and had full recovery of neck motion with resolution of the torticollis. We present a novel torticollis disorder caused by C1 rotation of a split atlas with closed reduction treatment.

Highlights of Archives of Facial Plastic Surgery

Archives of Facial Plastic SurgeryVol. 11, No. 6 Free AccessHighlights of Archives of Facial Plastic SurgeryPublished Online:2 Nov 2009AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the NoseThe search for an ideal grafting material has long been a topic of intense interest and continued debate in facial plastic surgery. Various biologic and synthetic mediums have been rigorously investigated, but concerns about safety, reliability, and longevity have persisted. Russell W. H. Kridel, MD, and colleagues review 1 025 homograft cartilage grafts in 357 patients over a 24-year period with complication rates equal to, and in some circumstances less than, those associated with autologous cartilage grafts. The authors use homograft cartilage as a primary and alternative grafting material in a large and diverse patient population while demonstrating excellent long-term structural, cosmetic, and cost-effective results in primary and revision rhinoplasty.See page 378The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla TransplantIn the decades since the first microvascular free-tissue transfer, a new era of soft-tissue reconstruction, innovation, and challenges has developed. The treatment of complex 3-dimensional defects in the head and neck has evolved beyond local and distant tissues to engage a surgical realm previously reserved for organ transplantation. Daniel S. Alam, MD, and colleagues present the first successful near-total face, maxilla, and palate transplant. In an operative field depleted of viable recipient vessels from the patient's initial trauma and the ensuing 23 previous reconstructive surgical procedures, the authors detail their considerations in vascular and defect analysis, allograft design, and operative approach. In addition, they highlight the joint transfer of the midfacial skeleton and soft tissues based solely on the facial arterial system in this salvage operation.See page 369Defining the Facial Extent of the Platysma Muscle: A Review of 71 Consecutive Face-liftsThe platysma muscle has a significant facial component. Unfortunately, the details of the superior limits of the platysma are often poorly described and illustrated with the upper border of the muscle appearing to reach only the inferior margin of the mandible. In a study of 71 consecutive deep-plane rhytidectomies performed on 142 facial halves, Anil R. Shah, MD, and David Rosenberg, MD, delineated the superior extent of the platysma muscle. Measurements along the malar mandibular line (MML) were conducted and revealed, on average, that 56% of the MML was occupied by the platysma. These findings lend support to a greater role for the platysma not only in facial expression but in facial aging and surgical rejuvenation as well.See page 405Measurements of Orbital Volume Change Using Computed Tomography in Isolated Orbital Blowout FracturesAdvances in imaging technology have considerably improved the delineation of facial skeletal trauma, in particular the bony orbit. Using computed tomography, orbital fractures and the resulting orbital volume changes can be readily measured. Jaehwan Kwon, MD, and colleagues evaluated preoperative and postoperative volume changes observed in traumatic orbit disruption and the ensuing surgical correction of 24 patients with unilateral orbital trauma. Volume changes were measured using 2 unique 3-dimensional analysis software packages. Consistent orbital volume measurements were obtained in presurgical and postsurgical settings for both software programs. Such imaging studies may become a useful tool in the surgeon's armamentarium in preventing the development of enophthalmos.See page 395Brother and Sister: Charles Sumner Bird and His Sister Edith Bird (Mrs Robert Bass) by Cecilia Beaux (1855-1942).See page 436This issue's Highlights were written by James Ridgway, MD.FiguresReferencesRelatedDetails Volume 11Issue 6Nov 2009 InformationCopyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Highlights of Archives of Facial Plastic Surgery.Archives of Facial Plastic Surgery.Nov 2009.365-365.http://doi.org/10.1001/archfaci.2009.88Published in Volume: 11 Issue 6: November 2, 2009PDF download