Facial plastic surgery : FPS
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Due to the nose's prominent location and functional and cosmetic importance, nasal fractures present a challenge to the facial plastic surgeon to restore all things to normal. Although little groundbreaking news has been reported recently in the literature on nasal fractures, there is ample literature already in print on virtually every topic concerning nasal fractures. This article concentrates on the details of actually managing nasal fractures, with comments on present-day coding of posttraumatic septorhinoplasty.
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The purpose of this article is to describe the newer surgical techniques and materials available for repair of lower eyelid retraction. The anatomic basis, classification, and prevention of lower eyelid retraction are explored, as well as traditional methods of surgical management. Two case reports involving the successful use of acellular human dermis (AHD) for lower eyelid retraction are presented. ⋯ Each surgical procedure and material used in the repair of eyelid retraction is associated with unique advantages and disadvantages. AHD has found multiple uses in oculoplastics, including reconstruction of the middle and posterior lamellae in eyelid retraction. An understanding of the mechanistic basis of lower eyelid retraction and familiarity with newer techniques and materials enable the oculoplastic surgeon to modify and individualize the operative repair, resulting in better surgical outcomes.
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The management of zygomaticomaxillary and midface fractures has been revolutionized in the past decade as a result of improved surgical access, rigid plating systems, and high-resolution computed tomography. Previously, virtually all midface fractures underwent mandatory orbital exploration to aid in reduction and stabilization. This article emphasizes the importance of reducing and fixating the facial buttresses involved in zygomatic complex fractures, and recommends orbital exploration on a selective basis. ⋯ Ninety-seven patients with zygomatic complex fractures were examined and treated with selective orbital rim and floor explorations. Most patients could be managed without the need for orbital exploration, and all were felt to have good fracture reduction and stability. We feel the selection criteria reliably identify patients who do require an orbital exploration and allow the treating surgeon to direct surgical treatment to the site of injury.