Tirbod Fattahi

Traumatic carotid-cavernous fistula: pathophysiology and treatment.

Traumatic carotid-cavernous fistulae are rare yet potentially lethal vascular anomalies in the skull base seen after craniomaxillofacial trauma. This aberrant vascular communication has been extensively evaluated and classified, with a number of treatment modalities available to clinicians. The ultimate and definitive treatment of carotid-cavernous fistulae falls beyond the scope of craniomaxillofacial surgery. Nevertheless, clinicians treating patients with craniofacial injuries should have a complete understanding of this pathological entity, because urgent intervention may improve patient outcome.

Internal nasal valve: significance in nasal air flow.

c u asal air flow has been extensively studied. It is a ell-known fact that air traversing through the nosrils into the nasal complex passes through several tructures before it enters the nasopharynx and the rachea. The narrowest portion of the nasal airway is nown as the internal nasal valve, also referred to as he limen vestibuli or the os internum. The internal nasal valve is an isosceles triangle ormed by the confluence of the caudal edge of the pper lateral cartilages and the nasal septum (Fig 1). he valve is present on both sides. It was originally escribed by Mink in 1903; since then, nasal air flow as become the focus of many rhinometric studies. he internal nasal valve is a portion of a larger region nown as the nasal valve area, which is bounded by he junction of the caudal edges of the upper lateral artilages and the nasal septum medially, the head of he inferior turbinates posteriorly, and the piriform perture and the nasal floor inferiorly. The internal asal valve is a slitlike opening within this region with cross-sectional area of 55 mm. The angle of the ormal internal nasal valve in the white population is etween 10° and 15°.

Incidence of Retrobulbar Hemorrhage in the Emergency Department

Retrobulbar hemorrhage is a rare but potentially devastating complication of midface trauma. Management of this entity requires prompt diagnosis and medical and surgical interventions. The incidence of retrobulbar hemorrhage has been cited to be lower than 1%; however, despite a low rate of occurrence, lack of immediate care can lead to major morbidity for the patient. This report presents a retrospective evaluation of the incidence and management of post-traumatic retrobulbar bleed in the emergency department by an oral and maxillofacial surgery service at a tertiary care trauma center.

Submental Liposuction Versus Formal Cervicoplasty: Which One to Choose?

PURPOSE Esthetic rejuvenation of the submental area is a fairly common concern of patients seeking cosmetic surgery. There are several techniques used to obtain esthetic results. A common dilemma is the proper determination as to which procedure, liposuction versus formal cervicoplasty, is more appropriate. This manuscript describes the factors involved in the aging process of the submental area, as well as the inherent advantages of formal cervicoplasty over liposuction. MATERIALS AND METHODS A comprehensive review of the intrinsic and extrinsic aging process is described, and advantages and disadvantages of liposuction as well as cervicoplasty are detailed. RESULTS On the basis of the specific factors leading to the fullness of the anterior neck/submental area, proper rejuvenation technique must include platysmaplasty, in addition to liposuction. Isolated liposuction is only beneficial in an isolated group of cosmetic patients. CONCLUSIONS Formal cervicoplasty, including open liposuction and platysmaplasty, is a superior operation compared with isolated liposuction of the submental area. Whereas liposuction does have a role in cosmetic surgery of the submental area, it is not a comprehensive procedure and does not address all of the anatomic components leading to submental fullness.

Fellowship Training and Academic Careers

Postresidency fellowship training is available in many subspecialty areas. This article discusses some of the rationales, advantages, and disadvantages in choosing a postresidency fellowship and/or entering a career in academic oral and maxillofacial surgery. It also discusses factors to bear in mind when evaluating fellowships.

Considerations in Revision Rhinoplasty: Lessons Learned

This article is intended to deal with the difficult subject matter of revision rhinoplasty. Since there is consensus that rhinoplasty is one of the most difficult aesthetic surgery procedures, one would make the inference that a revision rhinoplasty should also be one of the more difficult revision surgeries. The intent of this article is to share with the readers a few pearls and lessons learned dealing with revision rhinoplasty.

Septoplasty: thoughts and considerations.

PURPOSE Septoplasty has been around for thousands of years. It is considered an extremely valuable procedure to address multiple issues and patient complaints. The purpose of this manuscript is to detail exact surgical procedure, as well as different variations available to the practitioner. Terminology and nomenclature used in this procedure will also be highlighted. METHODS Various types of septoplasty including access and incision variations were discussed and evaluated in this manuscript. Benefits of each method as well as specific surgical approach were described. RESULTS Each specific method of performing a septoplasty has its own benefits and advantages. Irrespective of the method, septoplasty is a valuable procedure in nasal surgery. CONCLUSION Septoplasty is an extremely useful surgical procedure. There are multiple different methods of performing this operation.

Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography

The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001). This study used an objective measure to demonstrate the long-standing belief that hypotensive anesthesia is efficacious in reducing tissue perfusion in the surgical field. The data suggest that pharmacologically depressing the level of mean arterial pressure by 18% may result in a 41-52% decrease in facial soft tissue perfusion. This study reports a novel method of quantitative analysis.

Trichophytic brow lift: a modification

Trichophytic brow lifting is a popular method of repositioning the brows/upper lid complex. The procedure has traditionally been described in a subcutaneous plane of dissection. An equally effective, yet safer modification of the trichophytic brow lift, performed in the deeper, subgaleal plane, is described herein. This modification significantly improves the vascularity of the forehead flap.

Reoperative soft tissue trauma.

Trauma remains the leading cause of death in the first 4 decades of life and is surpassed only by cancer and atherosclerotic disease as the overall leading causes of death in the United States. Many of the injuries involve the facial region, including soft tissue trauma. This article highlights the current available modalities used in the management of unsightly scars or those scars whose location and appearance compromise function.