Joseph Niamtu

Carotid cavernous fistula.

Although carotid cavernous fistulas from head trauma are rare, definitive diagnosis is usually not difficult. The presence of a temporal, orbital, or supraorbital bruit on auscultation enables the clinician to exclude most other pathologic conditions that affect the orbital structure. Recent advances in neuroangiography seem to make balloon catheterization the treatment of choice, precluding the necessity to embolize the fistula or ligate the internal carotid artery outside the cavernous sinus. Early recognition and treatment usually results in total resolution, but return of full visual acuity and ocular mobility was delayed approximately four months in our patient.

Essentials of Cheek and Midface Implants

c i t his author has placed cheek implants sporadically for he past 25 years. Previous to 2004, expanded polytetafluoroethylene cheek implants were used, but since hat time, only Silastic implants (ImplanTech, Ventura, A) have been placed. Since 2004, the author’s practice has been limited o cosmetic facial surgery and with this focus many ore implants were placed as a solitary procedure or ore commonly with facelift or other cosmetic proedures. From January 2004 to December 2007, 204 ilastic cheek implants were placed in 102 patients. f these 204 implants, 3 implants were removed due o infection for an infection rate of 1.5%. All 3 of these ere replaced after resolution of the infection. Three ther patients had implants electively removed and eplaced with different size implants for a replaceent rate of 3%. A single patient electively had imlants removed and not replaced for an elective reoval rate of 1%. In the author’s experience, most implant infections anifest early in the recovery period, usually within 2 hours. The clinical manifestations are very similar o maxillary dentoalveolar infections and present with ain, swelling, erythema, purulence, and drainage rom the incision site. Delayed infections have been are and could be associated with a mobile implant roducing a foreign body reaction or a sinus or dental nfection whose spread can involve the implant. When a patient presents with a suspected infecion, he or she is placed on antibiotics and, if there is rainage, the incision is opened. Salvage may be atempted for implants that have been secured with igid fixation screws and are not mobile. Any infecion associated with a mobile implant requires explanation. For the secured infected implant, the incision s opened and the purulence is expressed and the ntire surgical site is copiously irrigated with an apropriate antibiotic irrigation solution. The incision is ot resutured and the patient is seen daily for irrigaion. The author has salvaged several implants by this

The anesthetic skin patch for topical anesthesia

La technique utilise un melange de 4 gr de couche de lidocaine et 30 g. de creme acide. La preparation est placee sur une compresse et un crayon pour le marquage de la peau est utilise pour delimiter la peripherie de la compresse. Le pansement est laisse en place 30 minutes. Le marquage de la peau definit la zone anesthesiee

Surgical repair of the cleft earlobe

Piercing of the earlobes has been performed in both sexes for thousands of years for social, religious, and cosmetic purposes in the most primitive as well as the most affluent cultures. Ancient Indian writings’ describe the need for repair of the cleft earlobe. During the past decade, there has been a resurgence of body piercing by in both men and women. Body art in the form of multiple piercing is a hallmark of the so-called generation X. Acquired clefts or splitting of the earlobes commonly occur from prolonged traction of heavy earrings. In rare cases, it can also occur from pressure necrosis from the clip-on earring,2 as well as from intentional and unintentional trauma.’ Children pulling on an adult’s earring, inadvertent snagging of an earring with a hairbrush, and altercations are common causes of traumatic earlobe clefts. These clefts are most commonly incomplete (Fig 1) and bilateral; however, complete clefts are also common (Fig 2). Ear clefts usually involve a linear tear in the case of protracted traction and may be angular in the direction of traumatic vectors in traumatically induced clefts. In either case, the fleshy portion of the earlobe is torn and the cartilaginous portion of the auricle is rarely involved. Bleeding is minimal, and the defect edges heal with little scar formation2 except when keloids occur. A congenital anomaly, Coloboma lob&, a clefting of the earlobe at birth, is treated in the same manner. Most women desire expedient repair so they can once again wear earrings. Because they are reluctant to go for an extended period without an earring, procedures that favor immediate or quick repiercing are perceived as desirable by the patient. The literature describes repair techniques that do not provide for repiercing as well as procedures that leave an opening for the reinsertion of an earring. Boo-Chai’ in 1961 described excision of the cleft and placement of a portion of a sterile toothpick to preserve an opening for an earring post repair. Pardue’ in 1972 pre-

The Accredited Cosmetic Facial Surgery Office: A Paradigm Shift in Oral and Maxillofacial Surgery

In the recent past, it was not unusual to admit elective surgery patients the day before their surgery to obtain the laboratory assessment, history, and physical examination and to “settle them in” to the hospital routine. Today, outpatient surgery is the norm, and the surgeon must justify any hospital stay. Also, surgical reimbursement is much lower than in the past, and efficiency in care is needed. My personal story illustrates the issues faced today in ambulatory major surgery. I began private practice in 1983 similar to all enthusiastic residents ready to “hit the private practice pavement running.” I hired 2 staff members and opened a 1,200 square-foot office. The practice quickly took off, and we have not slowed down since. We now have a group practice of 8 surgeons in 6 offices with 75 employees. I did as much major surgery as a practitioner could do, and, with the help of my competent partners, our business has continued to grow and prosper.

Esthetic Removal of Head and Neck Nevi and Lesions With 4.0-MHz Radio-Wave Surgery: A 30-Year Experience

PURPOSE The cosmetic removal of facial nevi and related lesions is a frequent patient request of cosmetic surgeons. Many patients live with esthetically bothersome lesions, unaware that scar-free or minimal scar treatment modalities are available. MATERIALS AND METHODS The author has used a protocol of treating thousands of nevi and related benign lesions with 4.0-MHz radio-wave ablation during the past 30 years. A review of this technique is presented with substantiation by before and after images. Indications, diagnosis, and complications also are reviewed. RESULTS Conservative ablation of nevi and benign lesions of the face and neck can be predictably removed with minimal and frequently imperceptible scarring. CONCLUSION Facial surgeons see multiple patients on a daily basis requesting the removal of nevi and other benign lesions of the face and neck. Many patients are misinformed by experienced practitioners that the resulting scar will be worse than the lesion. This unfortunate dictum has been disproved hundreds of times by the authors treatment using 4.0-MHz radio-wave surgery to ablate benign lesions of the face and neck, with excellent cosmetic results. Even if practitioners do not offer this treatment, they should be aware that it exists and offer patients exposure to this modality.

Pyoderma Gangrenosum after Facelift and Otoplasty Surgery: Case Presentations and Literature Review

PURPOSE Pyoderma gangrenosum (PG) is an uncommon autoimmune, neutrophilic, ulcerative skin condition of uncertain etiology believed to result from dysregulation of the immune system. Although this entity is well recognized by dermatologists, other specialists are less familiar with diagnosis and treatment. This report describes a severe PG reaction to an elective cosmetic facelift, which is believed to be the second reported case of PG after facelift surgery. A second case after otoplasty surgery is described. MATERIALS AND METHODS An unusual presentation of PG after cervicofacial rhytidectomy (facelift) is presented and discussed with a review of the literature. RESULTS The present case was a rare complication after facelift surgery and followed the natural progression of PG. Delayed diagnosis and treatment extended the disease process. CONCLUSIONS PG can mimic other surgical complications and delay diagnosis and treatment. This case is believed to represent the second reported incidence of PG after elective facelift surgery.