Donald J. Harvey

Nose Elongation: A Review and Description of the Septal Extension Tongue-and-Groove Technique

Several articles have been published about the short nose, many of which begin with a statement about the difficulty and complexity that this deformity poses for the rhinoplasty surgeon. Regardless of the challenges, many surgeons have undertaken the task of elongating the short nose and have subsequently shared with the rhinoplasty community the subtle techniques they have developed through their experience. The authors present a review of the literature that has contributed to the understanding of the etiology, evaluation, assessment, and operative procedures in the reconstruction of the short nose, specifically with regard to septal extension grafts. Additionally, the senior authors (BG) technique and experience of nearly 30 years of practice is described.

Unilateral Congenital Blepharoptosis Repair by Anterior Levator Advancement and Resection: An Educational Review

Background: Simple congenital blepharoptosis is caused by levator muscle dysgenesis and commonly presents unilaterally. A complete preoperative evaluation, including ophthalmic, neurologic, and levator function examinations, is essential for ensuring proper diagnosis and selecting the correct procedure. Correction is frequently delayed until the anatomical structures of the eye are fully developed and the child can cooperate with the preoperative examination between the ages of 3 and 5 years, except in cases of visual disturbances. After the preoperative evaluation, the proper treatment can be selected from commonly described procedures, including levator advancement, tarsomyectomy, and frontalis suspension. Methods: The authors provide a description of the pediatric levator advancement procedure and demonstrate the procedure with supplemental video content. Results: Levator advancement provides appropriate correction for moderate blepharoptosis repair in pediatric patients with fair to good levator function. Conclusions: Levator advancement in children presents unique challenges because of difficulty performing the preoperative examination and the inability of the patient to provide intraoperative cooperation for proper lid placement because of general anesthesia.

A Prospective Randomized Outcomes Comparison of Two Temple Migraine Trigger Site Deactivation Techniques.

Background: The authors compared the reduction of migraine headache frequency, days, severity, and duration after surgical decompression versus avulsion of the zygomaticotemporal branch of the trigeminal nerve for treatment of temporal migraine headache. Methods: Twenty patients with bilateral temporal migraine headache were randomized to undergo avulsion of the zygomaticotemporal branch of the trigeminal nerve on one side and decompression via fasciotomy and removal of the zygomaticotemporal artery on the other side. Results were analyzed after a minimum of 12 months of follow-up. Results: Nineteen patients completed the study. The patients experienced greater than 50 percent improvement in frequency, migraine days, severity, and duration in 34 of the 38 operative sites (89 percent). Complete elimination of symptoms was noted in 21 of the 38 operative sites (55 percent). In the decompression group, migraine frequency was reduced from 14.6 to 2.2 per month, migraine days from 14.1 to 2.3, severity from 7.0 to 2.9, duration from 9.6 to 4.8 hours, and Migraine Headache Index score from 42 to 2.9. In the neurectomy group, frequency decreased from 14.2 to 1.9 per month, migraine days from 14.1 to 2.3, severity from 6.8 to 2.6, migraine duration from 10.1 to 5.3 hours, and the Migraine Headache Index score from 41 to 2.5. There was no statistical significance in reduced migraine headache frequency, days, severity, and duration between the two groups. Conclusions: Neurectomy and decompression of the zygomaticotemporal branch of the trigeminal nerve are both appropriate treatment for temporal migraine headache. If decompression fails to provide sufficient relief, neurectomy is another option. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Periorbital and Orbital Aging: Senile Enophthalmos as a Cause of Upper Eyelid Ptosis

BACKGROUND The aim of this study was to assess the effects of orbital aging over a prolonged period. METHODS The orbit and periorbital region were assessed in 21 adult patients over 6 to 24 years with medical-quality facial photographs. The anteroposterior and lateral photographs were evaluated for orbital changes, including enophthalmos and upper eyelid position. Quantitative analysis was performed on the anteroposterior photographs, and qualitative analysis was used to assess enophthalmos. RESULTS The mean age of the patients was 40 years at initial photography and 57 years at the time of secondary photography. At initial photography, eight of the 21 patients had ptosis: six had bilateral mild ptosis (<2 mm), one had bilateral moderate (2 to 3 mm) ptosis, and one had unilateral mild ptosis. At the second time point, only two patients did not have ptosis: four had unilateral mild, seven had bilateral mild, and eight had bilateral moderate ptosis. One patient had unilateral and two patients had bilateral enophthalmos at the initial photography. Nineteen of the 21 patients had relative enophthalmos at the second time point, and all 19 of the patients had eyelid ptosis (p < 0.00001). CONCLUSIONS This study demonstrates the development of age-related enophthalmos and eyelid ptosis and the strong association between age-related enophthalmos and upper eyelid ptosis, which is commonly undetected.

A Novel Single-Staged Technique for the Treatment of Soft Tissue in an Oblique Facial Cleft.

Introduction:Oblique facial clefts are extremely rare and cause significant morbidity. Treatment of these clefts is complex and requires a fundamental understanding of cleft classification and techniques used for treatment of clefts. Methods:We describe a novel single-staged technique to repair the Tessier no. 4 soft tissue cleft and reconstruct the buccal sulcus and bilaminar lower eyelid by preserving normally excised tissue combined with standard procedures. We also present a case report demonstrating the technique in an adolescent female. The procedure incorporates turnover flaps from soft tissue preservation within the cleft, a Mustarde cheek advancement flap, an anatomical subunit lip repair, a dorsal nasal Rieger flap for ala repositioning, and a lateral nasal flag flap. Results:The single-staged soft tissue repair eliminated the Tessier no. 4 cleft while simultaneously reconstructing the bilaminar lower eyelid and buccal lining. Our patient had no complications within the perioperative period. Conclusions:This novel single-staged technique for the treatment of the soft tissue Tessier no. 4 cleft not only repairs the cleft but also reconstructs the buccal sulcus and bilaminar lower eyelid with turnover flaps preserved from the normally discarded excess soft tissue within the cleft. The novel repair allows for the creation of a deeper fornix to aid with placement of an orbital prosthesis and is ideal for use in underserved or remote locations.

15-Year Assessment of Craniopagus Twins: What Factors Increase the Likelihood of Successful Separation?

MethodS: Fifty-five conference attendees represented a broad range of expertise, including anesthesiology, craniofacial surgery, pediatric dentistry, genetics, hand surgery, intensive care medicine, neurosurgery, nursing, ophthalmology, oral and maxillofacial surgery, orthodontics, otolaryngology, pediatrics, psychology, public health, radiology, social work, and speechlanguage pathology. Representatives from sixteen professional societies as well as editors of relevant peer-reviewed journals also attended the conference. The current state of knowledge related to each discipline was reviewed. Based on areas of expertise, four breakout groups were created to reach a consensus and draft specialty-specific parameters of care based on evidence-based literature or, in the absence of such literature, broad clinical experience. In an iterative manner, the specialtyspecific draft recommendations were presented to all conference attendees. Participants discussed the recommendations in multidisciplinary groups to facilitate exchange and consensus across disciplines.