Colton H. McNichols

Contemporary techniques for the correction of temporal hollowing: augmentation temporoplasty with the classic dermal fat graft.

Introduction Temporal hollowing is a depression within the soft tissues overlying the temporal fossa, sometimes seen after surgical dissection for access to the facial skeleton. Surgeons have successfully used bone grafts, hydroxyapatite, methyl methacrylate, and autogenous tissue to correct the deformity. A systematic review of the literature demonstrated that the most popular technique for the correction of temporal hollowing seems to be the use of nonbiologic materials. These materials have been used successfully but are associated with some complications. There has been a growing experience with augmentation of the soft tissues of the temporal fossa using dermal fat grafts at our institutions, and this article describes this experience. Methods Two senior surgeons’ recent experience with the correction of temporal hollowing was reviewed and analyzed. Results The retrospective review revealed 5 cases of temporal hollowing treated with dermal fat graft placement. Follow-up at 1 year revealed aesthetically pleasing results. Conclusions A thorough understanding of temporal anatomy and conscious effort to respect structural integrity during dissection are essential in avoiding temporal hollowing. Sometimes, however, this deformity is impossible to avoid. In these patients, there are a number of options for correction. Open placement of the classic dermal fat graft is a technique that seems to offer good long-term aesthetic results.

Optimizing pediatric interdental fixation by use of a paramedian palatal fixation site.

Condylar fractures are the most common injury seen in pediatric mandibular trauma. These injuries often cannot be adequately stabilized by conservative techniques such as splinting. The pediatric condyle fracture often requires a period of intermaxillary fixation. Because of the characteristics of the developing dentition, circumdental wiring is often not possible. Surgeons commonly achieve interdental stabilization by the connection of a circum-mandibular wire and a second wire placed through a drill hole in the piriform aperture. This method can be problematic in the young patient whose palatal suture is still patent. In this brief technical note, the use of a paramedian drill hole through the palate posterior to the maxillary incisors is described. It is believed that this method is superior to other techniques because it avoids injury to the deciduous tooth buds and allows for the maxillary wire to be seated in more structurally sound tissues.

A paradigm shift in correcting medial orbital fracture-related enophthalmos: Volumetric augmentation through a lateral approach

Background Posttraumatic enophthalmos resulting from medial orbital wall fractures presents a complex challenge. Access to this area through traditional incisions is limited, making visualization of the fracture site difficult. This can be ameliorated by the transcaruncular approach, but with the potential for complications both with access and with reconstructive materials. The authors sought a new technique where enophthalmos correction would be based on augmenting soft tissue volume, rather than reducing the volume of the bony orbital cone. This was successfully accomplished using porous high-density polyethylene wedges. In an effort to increase overall knowledge of this technique, a retrospective review was undertaken. Methods A retrospective chart review was undertaken to examine the senior authors’ (J.F.T. and L.H.H.) experience using a lateral approach to address medial orbital fracture–related enophthalmos, aided by porous high-density polyethylene wedges to increase orbital volume. The relevant literature was reviewed and reported here. Results Three patients with post–medial orbital wall fracture enophthalmos were treated using a lateral approach to place porous high-density polyethylene wedges; this technique adequately corrected enophthalmos in these patients. Conclusions Porous high-density polyethylene wedges can be placed into the orbit through a small lateral incision to reverse enophthalmos secondary to loss of volume after medial orbital wall fractures. Current techniques for orbital reconstruction typically focus on reduction of bony volume; this technique focuses on augmentation of soft tissue volume.

Infected Medpor implant in the trauma setting

Porous polyethylene implants are frequently used in treating facial trauma and reconstructive needs. They are increasingly common in the treatment of orbital fractures. The literature supports the contention that they have very low complication rates [1] and certainly shorter operative times [2] than the use of autogenous materials such as bone graft. Reports of infection are very uncommon. In this case report, we describe a severe infection that developed in the early postoperative period following placement of a Medpor orbital implant.

A split latissimus dorsi/serratus anterior muscle flap used for traumatic wrist and forearm reconstruction

Injuries to the upper extremity are at the top of the list for injury-related visits to the emergency department [1]. The complexity of these injuries varies, and the treatment of each requires individualized attention to ensure the best outcome possible. While some injuries are isolated to one part of the extremity, often multiple areas of one extremity require treatment. Here, we present a patient requiring coverage of the medial and lateral epicondyles of the elbow, as well as the osseous structures of the wrist. A split latissimus dorsi/ serratus anterior muscle flap without skin or bone was used for the reconstruction of the wrist and forearm, allowing for coverage with one flap in a single operative session.