Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Jan 2008
Cervical spine injury in association with craniomaxillofacial fractures.
The incidence of cervical spine injuries associated with facial fractures varies from study to study. There is general agreement that immediate management of cervical spine injuries is mandatory to prevent further neurologic injury. Nevertheless, disagreement exists as to the actual incidence of cervical spinal trauma in conjunction with various facial fracture patterns. The purpose of this study was to review the incidence of cervical spine injury associated with various types of facial fractures presenting to St. Michael's Hospital Regional Trauma Center, Toronto, Ontario, Canada. ⋯ The relationship between cervical spinal injuries and craniomaxillofacial trauma has been better defined as it relates to a regional trauma registry. The implications as related to the trauma assessment, diagnosis, and treatment of these injuries are reviewed.
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Plast. Reconstr. Surg. · Jan 2008
Dexmedetomidine in aesthetic facial surgery: improving anesthetic safety and efficacy.
Dexmedetomidine is an alpha2-agonist anesthetic with several properties that are advantageous in aesthetic facial surgery. By attenuating sympathetic nervous system activity, it induces sedation and analgesia while lowering blood pressure and preventing pain-induced hemodynamic fluctuations. It spares the respiratory drive and decreases the need for supplemental oxygen, thus reducing the fire risk of electrocautery. It decreases narcotic use, thereby further improving respiratory safety and decreasing postoperative nausea and vomiting. This retrospective study evaluated the safety and efficacy of dexmedetomidine in rhytidectomy. ⋯ Dexmedetomidine lowered blood pressure, decreased the frequency of oxygen desaturations, and reduced narcotic, anxiolytic, and antiemetic use. When compared with conventional sedation, dexmedetomidine appears to improve anesthetic safety and efficacy for rhytidectomy patients.
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Plast. Reconstr. Surg. · Jan 2008
Primary transcutaneous lower blepharoplasty with routine lateral canthal support: a comprehensive 10-year review.
Rejuvenation of the lower eyelid often requires tightening of excess skin and muscle and removal or transposition of orbital fat. Although transcutaneous lower blepharoplasty can accomplish these aesthetic demands, it has been associated with an increased risk of lower lid malposition. Routine lateral canthal support during lower blepharoplasty has recently been advocated to minimize this risk. This study reviewed the outcome of a surgeon's 10-year experience with primary lower transcutaneous blepharoplasty and lateral canthal support consisting of canthopexy, canthoplasty, and orbicularis suspension. ⋯ Lateral canthal support should be considered a routine component of lower transcutaneous blepharoplasty to obtain the desired aesthetic result and maintain the natural appearance of the eyelid shape. The associated complication rate is acceptable.
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The legal system depends on the medical expert for evidence. Doctors readily complain about frivolous cases that go to trial, yet a lawyer cannot bring a frivolous claim to trial without a physician expert witness stating that the claim is not frivolous. ⋯ For without the physician expert witness, no medical malpractice lawsuit can take place. It is the expert physician, not the attorneys or insurance companies, who defines "meritless" and "frivolous" and who ultimately controls the courts' medical malpractice caseload.