J. Regan Thomas

Steps for a safer method of osteotomies in rhinoplasty

Knowledge of osteotomy technique is essential to rhinoplasty. Using cadaver specimens, in addition to clinical observation, a safer method of osteotomy was acquired. Discussion of anatomy with reference to medial and lateral osteotomy follows. Several safety tips for each type of osteotomy are given.

Surgical therapy of the eyelids in patients with facial paralysis.

Patients with facial paralysis have a degree of lagoph‐thalmos and paralytic ectropion. We present our experience in the surgical management of 25 consecutive patients treated for these problems. Paralytic lagophthalmos was corrected using gold weights inserted into the upper eyelid. The advantages and disadvantages of this surgical technique are reviewed. Medial canthoplasty and lateral can‐thoplasty were performed to rectify paralytic ectropion. Ancillary procedures included browpexy, upper‐lid blepha‐roplasty, and temporalis sling. The results were excellent in 23 of 25 patients and good in the remaining two. After a minimum of 6 months follow‐up, there were no complications. The authors believe that the above procedures will yield consistently excellent cosmetic and functional results in patients with paralysis of the eyelids.

The Relationship of Lateral Osteotomies in Rhinoplasty to the Lacrimal Drainage System

Damage to the lacrimal drainage system is a potentially complicating factor in rhinoplasty utilizing lateral osteotomies. The authors present data from osteotomies performed on a series of fresh cadavers. Following completion of the osteotomies, the lacrimal sac and nasal lacrimal ducts were Identified and cannulated. Soft tissue was dissected to demonstrate the osteotomy site. The specimen was inspected to delineate involvement (if any) of the lacrimal duct or sac. The proximity of the osteotomy site to the lacrimal drainage apparatus components was measured in each specimen. Various parameters were observed, including the effect of curved vs. straight osteotomes, guarded vs. unguarded osteotomes, and the effect of various widths of osteotomes. Likewise, the degree of risk to the lacrimal system was evaluated, and the technique of the novice and resident surgeon was compared to that of the experienced rhinoplastic surgeon. A low, curved osteotomy, performed with a sharp osteotome without subperiosteal tunnels, provides the safest maneuver. Lateral osteotomies, properly performed, prove to be an unusual cause of lacrimal drainage dysfunction.

Liposuction to debulk the pectoralis major myocutaneous flap

Pectoralis major myocutaneous flaps are very useful for head and neck reconstruction. However, excess bulk in these flaps due to subcutaneous fat can be a disadvantage in oral cavity, oropharyngeal, and cervical esophageal reconstruction. A variety of surgical modifications have been tried in an effort to overcome this problem. Liposuction was proposed by a member of this research group as a means to debulk such flaps. The purpose of this fresh cadaver study was to determine what effect this procedure might have on blood supply to the skin overlying the pectoralis major muscle. Gross and histologic observations suggest that liposuction would not significantly affect the vascular perfusion of these flaps. This report represents a preliminary study previous to a clinical trial using a potentially useful technique. It is hoped by the authors that this report will stimulate others to evaluate its possible clinical utility.

Facial plastic surgery in the otolaryngology training program: An update

In 1985, we demonstrated that, following the institution of a specific curriculum in facial plastic surgery, the number of cosmetic procedures generated and performed by residents rose dramatically. We have now demonstrated that this increase has been sustained in the 5 years since establishing the curriculum. We continue to maintain that the key to a successful curriculum in facial plastic surgery is the presence of at least one full-time staff member whose primary function is the practice and teaching of facial plastic surgery.

Classification of Nasal Defects: A Practical Guide for Reconstruction

Nasal defects are among the most complicated problems frequently facing the otolaryngologists—head and neck surgeon. The complex role of the nasal structure and its anatomy makes a practical guide for reconstruction particularly attractive. The nose, as a unique facial component, must ideally perform important airway functions, while also having an acceptable appearance. A range of reconstructive problems from simple defects to total nasal loss is addressed.