Avoiding facial nerve injuries in rhytidectomy. Anatomical variations and pitfalls

Injury to the facial nerve in rhytidectomy has been occurring in less than one percent of the cases, and a spontaneous return of function in more than 80 percent of these injuries has resulted within 6 months. With the introduction of the newer and more aggressive techniques of platysmal and subplatysmal flaps and SMAS dissections, the risk of injury to facial nerve branches is obviously increased. Though there has not yet been an increase in the facial nerve injuries reported, these techniques are still relatively recent additions to the face-lift operation-and usually they have been done by more experienced surgeons, taking more time and working under direct vision with a more careful dissection. More care is needed to prevent injuries. We discuss here the detailed anatomy of the muscular branches of the facial nerve, how to prevent injuries to them during rhytidectomy, and how to manage injuries when they do occur.     

Frontal and facial flatness of major human populations

In the present study, the frontal and facial features of 112 populations from around the world are compared in terms of frontal and facial flatness measurements. Univariate analyses and canonical correlation analysis were applied to six indices representing flatness of frontal and facial bones. The deep infraglabellar notch, marked prognathism, and flat frontal bone show distinctive Australian/Melanesian characters among recent populations. Very flat faces in the transverse plane are the most common condition in eastern Asians. Some subSaharan Africans share similar characteristics with Australians in terms of marked prognathism and flat frontal bones in the sagittal plane on the one hand, and with eastern Asians on the other hand, for flat nasal and zygomaxillary regions. These results are not necessarily inconsistent with the evidence for regional continuity. The examination of relationships between frontal and facial flatness through canonical correlation analysis reveals a significant association between morphological features such as a deep infraglabellar notch, prognathism, flat frontal bone, and flat faces in the transverse plane. In this context, together with the generalized features of the late Pleistocene fossil record, the features of Australians having transversely projecting faces and of eastern Asians showing weak infraglabellar notches, ortho-/mosognathism, and rounded frontal bones can be interpreted as a differential retention of ancestral traits of anatomically modern humans. This may allow us to suppose that the frontal and facial flatness features treated herein can be explained by the hypothesis of a single origin of anatomically modern humans.     

Xeroradiography in the diagnosis of facial fractures

Xeroradiography, because of its unique phenomenon of "edge enhancement," has some advantages for assessing facial fractures. In 17 of the 19 patients in our pilot study group, this technique was as valuable as, or more so than, plain films. The xerogram done prior to laminagraphy is a useful "map" for the radiologist to use in planning laminagraphic cuts. For the surgeon this technique offers a relatively accurate diagnostic tool, useful early after the facial injury.     

Exposure through a coronal incision for initial treatment of facial fractures.

The coronal incision approach to Le Fort III fractures gives excellent exposure for anatomical reduction and internal fixation of the fracture sites. Either an extracranial, or a combined intracranial procedure, is feasible. The exposure obtained not only facilitates the reduction and the fixation but, with the addition of transconjunctival incisions, the patient benefits by not having multiple surgical scars in the face.     

Review of traumatic injuries in regional federal penitentiaries.

The incidence of major injuries in inmates of Canadian prisons has steadily increased in recent years. The medical records of the emergency department serving virtually all prisoners at federal penitentiaries in the Kingston, Ont. area were reviewed for cases of traumatic injury. In the 30-month period ending Mar. 1, 1984 there were 353 visits to the emergency department, of which 140 were for accidental injuries and 213 for injuries resulting from violence. Of the injuries caused by violence 75 (35%) were self-inflicted and 138 (65%) were inflicted by others. Of the 75 inmates with self-inflicted injuries 17 required admission to hospital, and 12 of these underwent surgery. Of the 138 inmates injured by others 50 were admitted to hospital, and 6 of these were transferred to the neurosurgical or cardiothoracic department at Kingston General Hospital; 31 of the 50 underwent surgery, and 4 died in hospital as a result of their injuries.