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Highlights of Archives of Facial Plastic Surgery
Arch Facial Plast Surg. 2007;9(4):233.
In Vitro Effects of Combined and Sequential Bone Morphogenetic Protein Administration
Surgical reconstruction of osseous defects remains a challenge, and the current armamentarium of treatment modalities comes with important inherent drawbacks. Controlled pharmacological osteoinduction could provide for less invasive, more anatomic, and more physiologic methods of repair. Oneida A. Arosarena, MD, and David Puleo, PhD, present results from a pluripotent murine mesenchymal cell study. The effects of separate and sequential administration of bone morphogenetic protein (BMP) 2 and 7 were quantified. Assays of extracellular matrix formation, alkaline phosphatase activity, and expression of osseous markers served as outcome measures. The authors document the variable effects of separate vs sequential administration of BMP-2 and BMP-7 and discuss implications for further research.
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Pharyngeal Flap and Obstructive Apnea
Burke E. Chegar, MD, and colleagues describe a retrospective series of patients who underwent high superiorly based pharyngeal flap procedures for velopharyngeal insufficiency (VPI). The authors applied a protocol of measures to quantify and reduce the postoperative incidence of obstructive sleep apnea (OSA) and complications. Complete elimination of VPI was observed in 94% of 54 patients. At postoperative follow-up of more than 1 year, no cases of OSA were identified. The authors conclude that modifications to the surgical technique, a staged approach to tonsillectomy and adenoidectomy, and additional medical measures contributed to the high success rate and low complication rate.
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Temporalis Tendon Transfer as Part of a Comprehensive Approach to Facial Reanimation
Standard temporalis transfer techniques to reanimate the paralyzed face have inherent shortcomings. Patrick J. Byrne, MD, and colleagues report a modified technique of orthodromic temporalis transfer. The temporalis muscle is released in the temporal fossa, and its insertion is detached from the coronoid process. The muscle is then advanced and the temporalis tendon sutured to the perioral soft tissues. Retrospective outcome data from 7 patients were collected. The surgical technique and impressive postoperative results support the authors' conclusion that the modified technique has multiple advantages over the established, antidromic transfer of the temporalis muscle. They recommend performing selected adjunctive procedures with temporalis transfer for the comprehensive treatment of the paralyzed face.
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The Subzygomatic Fossa
Philip J. Miller, MD, and colleagues investigate the hypothesis that the subzygomatic fossa serves as a clinically useful landmark for the identification of the zygomaticus major muscle in face-lift surgery. Using cadaveric facial halves, a junior-level resident was instructed to identify the subzygomatic fossa located anterior to the zygomaticotemporal suture. A line connecting the modiolus to the subzygomatic fossa was marked. A second line connecting the malar eminence with the modiolus served as a historically established control. Subsequent surgical dissection revealed that the subzygomatic fossa allowed for consistent identification of the zygomaticus major muscle. This was found to be more reliable than identification using the malar eminence. The authors conclude that the subzygomatic fossa is a clinically useful and easily identifiable landmark for the identification of the zygomaticus major muscle in deep-plane face-lift surgery.
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Self-portrait by Sofonisba Anguissola (ca 1532-1625).
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This issue's Highlights were written by Holger G. Gassner, MD.
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