The upper and lower jaws play an essential role in mastication, articulation, and cosmetic form. The mandible provides support for tongue position and elevation of the larynx during swallowing, while the maxilla provides support for the nasal structures as well as an opposing structure to the mandible during mastication. The evolution of mandibular and maxillary reconstruction dates back to the early 19th century. Before the introduction of free tissue transfer, a variety of local flaps, regional flaps, and prosthetics were introduced, yet each was met with eventual failure. Since the introduction of free tissue transfer, mandibular and maxillary reconstruction has become as much of an art as it has a science. Whether the mandibular or the palatomaxillary defects are a result of trauma, congenital deformity, or tumor extirpation, the resultant effect often disrupts both form and function. With these considerations taken together, jaw reconstruction is a unique undertaking in which the artistic reconstruction of the facial skeleton is met with the science of reestablishing the mechanics of mastication. The site, size, and associated soft-tissue defects represent the 3 most important factors in determining the impact of a given defect on function and aesthetics. There is also an inherent difference between defects that are sustained in a controlled fashion, such as during cancer ablation, and those that result from trauma. The consideration of these complexities in jaw reconstruction is reflected in the wide variety of approaches and techniques that have evolved over the past century.

Objective  To determine the difference in nasal bone narrowing between 2 techniques: the low lateral intranasal perforating osteotomy technique and the low lateral continuous osteotomy technique.

Methods  A retrospective analysis of preoperative and postoperative photographs to determine the changes of the dorsal width of the nose (width of plateau of the nose, or dorsal nasal highlight) and the ventral width (junction of the flattened surface of the maxilla and the ascending nasal process of the maxilla).

Results  Twenty patients underwent continuous osteotomies, and 40 underwent intranasal perforating osteotomies. The continuous osteotomy technique had a preoperative to postoperative decrease in the ventral width of 7.0% (P < .01). The perforating osteotomy technique had a decrease in the ventral width of 3.6% (P < .001). Neither technique resulted in a statistically significant change in dorsal width (P < .25). There was no significant difference in ventral and dorsal narrowing when comparing continuous osteotomies to perforating.

Conclusions  Both the continuous and perforating osteotomy technique resulted in a decrease in the ventral nasal bone width. No statistical difference was found between continuous and perforating osteotomy techniques in the amount of nasal bone narrowing (P < .25).

Objective  To report a new technique for long-term cosmetic lip augmentation and demonstrate that sternocleidomastoid (SCM) muscle and fascia grafts have long-term persistence.

Methods  Measurements of vermilion show and lip projection were taken from before and after photographs of 25 consecutive patients who underwent SCM muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy and were compared with a control group of 25 cervicofacial rhytidectomy patients who did not undergo lip augmentation. All patients had a minimum follow-up period of 1 year.

Results  At a mean follow-up period of 2 years, mean upper and lower lip vermilion show increased 20% to 24% from baseline (P < .001), and mean upper and lower lip projection increased by 0.90 to 0.99 mm from baseline (P < .001).

Conclusions  Lip augmentation with SCM muscle and fascia grafts results in long-term enhancement of vermilion show and lip projection. The surgeon must account for some degree of postoperative graft resorption and atrophy when determining the size of the grafts to be transplanted. With careful patient selection and surgical technique, SCM muscle and fascia implantation is a valuable tool when treating the aging lip.

Objective  To describe a surgical technique to treat postoperative conjunctival chemosis.

Design  Case report.

Results  Two cases of postoperative chemosis in which the conventional methods failed were successfully treated by snip conjunctivoplasty, without recurrence.

Conclusion  Snip conjunctivoplasty is a simple and effective surgical approach to treat refractory postoperative chemosis.

Objective  To present our experience of reconstruction of the nasal septum using perforated and unperforated foils, particularly with respect to functional and aesthetic sequelae.

Methods  A retrospective medical record review of a prospectively conducted case series was undertaken of all consecutive patients who underwent septal reconstruction using polydioxanone foil in a 4-year period. Procedures included septorhinoplasty and isolated septoplasty via external and endonasal approaches using corporeal and extracorporeal techniques. The polydioxanone foils were in battens or sheets.

Results  Fifty patients underwent septal reconstruction using unperforated (first 26 patients) or perforated (next 24 patients) polydioxanone foil. Median total postoperative follow-up was 51.5 months (range, 34-60 months) for unperforated foil and 20.5 months (range, 12-31 months) for perforated foil. All the patients were reviewed for assessment of appearance and function. Forty-three patients had satisfactory results, needing no further treatment. Three patients required minor septal or tip revision surgery. Four patients experienced moderate saddling of the dorsum (all involved unperforated polydioxanone foil) and underwent successful revision surgery using auricular cartilage grafts.

Conclusions  Synthetic materials are a useful alternative to autologous tissues during reconstruction of the nasal septum. To our knowledge, we present the largest single-center series of septal reconstructions using unperforated and perforated polydioxanone foils—shown to be useful in the correction of complex septal deformity. However, the unperforated form seems to be associated with a significant risk of postoperative saddling, and we warn against its use in this context. No such complications were observed with the use of thin, 0.15-mm perforated polydioxanone foil, which we exclusively recommend for this application. The use of this implant warrants further evaluation.

Objective  To assess the long-term efficacy of irradiated homologous rib grafts (IHRGs) for both augmentation and support function in rhinoplasty in general and for specific recipient sites within the nose.

Design  A retrospective study was conducted at an academic medical center to evaluate the loss of volume and support function of IHRGs in 9 specific recipient sites in the nose.

Results  We studied 66 patients, with a total of 177 IHRGs, dating back 9 years, with an average follow-up of 51 months. The rate of resorption increased with duration of follow-up. Complete resorption was found in 1 IHRG, and moderate resorption was observed in 55 IHRGs (31%). Resorption was characterized by a loss of support function rather than a loss of volume. Moderate resorption had a negative clinical outcome for shield grafts only.

Conclusions  Irradiated homologous rib grafts were safe to use in rhinoplasty. In cases requiring a shield graft, IHRGs should be avoided.

Objective  To develop a reproducible free-flap animal model to study the effects of irradiation on flap revascularization.

Design  After institutional animal care and use committee review and approval, 16 Sprague-Dawley rats were subjected to either 23- or 40-Gy electron beam irradiation to their ventral abdominal wall. After a recovery period, the animals then underwent a ventral fasciocutaneous flap pedicled on the inferior epigastric vessels with subsequent pedicle ligation at 10 days. An additional 16 rats were subjected to 40 Gy of irradiation and underwent pedicle ligation at 8 or 14 days postoperatively to determine if time to pedicle ligation affected percentage of flap viability.

Results  Rats receiving 23 Gy of irradiation had the same viability as rats undergoing no radiation. Rats receiving 40 Gy of irradiation had a significantly lower average percentage of flap viability (56.9%) than animals receiving 23 Gy (90.9%) (P < .001). Furthermore, the longer duration until pedicle ligation after 40 Gy of irradiation led to significant increases in flap viability (P < .001 for analysis of variance).

Conclusions  This animal model establishes that external beam irradiation at a total dose of 40 Gy leads to significantly delayed flap revascularization over time compared with 23-Gy irradiation. This model will allow future investigators to study novel therapies to improve healing and flap revascularization.

Objective  To determine the resting and aesthetically desired position of the eyebrows and the range of eyebrow mobility.

Methods  Photographs were taken of 40 adult subjects in 5 poses: eyes open and eyes closed, maximum brow elevation and brow contraction, and brow positioned optimally by the subject. The height of the brow was measured relative to the orbital rim and surrounding structures in 6 locations: the medial brow, above the medial canthus, midpupil, lateral canthus, brow peak, and brow tail.

Results  Women desired the lower border of the brow to fall just below the orbital rim at the medial canthus, at the rim at the midpupillary line and several millimeters above the rim at the lateral canthus. Men desired a lower brow with a lower tail and a less accentuated peak. The brow peak in both women and men was just medial to the lateral canthus. Range of movement was greater medially in men and at the brow tail in women.

Conclusions  The aesthetic position of the medial and central brow is relatively low. The brow peak should be just medial to the lateral canthus. Surgeons planning forehead and brow surgery should consider these parameters to avoid creating an unnatural brow appearance.

Trial Registration  clinicaltrials.gov Identifier: NCT00347308.