Evaluating Facelift Complications and the Effectiveness of the Smasectomy Technique: A Single Center’s 15-Year Experience

Background Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, SMAS manipulation, by way of plication, overlap or SMASectomy are common and have been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique. Objectives To assess the benefits and risks of the SMASectomy technique. Methods The records of all patients who underwent a facelift procedure between December 2004 and March 2019, were reviewed for this study. All procedures were performed at an AAAASF-accredited outpatient facility in Marina Del Rey, CA. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications. Results Average operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes was observed amongst those patients that underwent SMASectomy. This was significantly lower (p < 0.000001) than those that did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients that underwent SMASectomy. No DVT events were observed in this patient population. Conclusions In the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results.

Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures

Study Design: A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures. Objectives: To evaluate and compare the primary functional outcome using the Helkimo’s dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches. Methods: In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association. Results: Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group. Conclusions: Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.

ENDOSCOPIC ASSISTED APPROACH TO FACIAL FRACTURES

Endoscopic exploration and repair of sub-condylar and ramal fractures of the mandible is technically feasible, and, though there is a steep learning curve, once experience is gained, it can be performed in a reasonable amount of time. There have been no permanent facial nerve injuries to date, and the functional results seem to be satisfactory. Of the 5 sub-condylar and ramal fractures, plate fixation was achieved at primary endoscopic repair in all the patients. It remains for prospective studies to determine the relative safety and effectiveness of this procedure.

Can MDCT Scan of the Temporal Bone Looking at Pneumatization Predict Surgical Vulnerability of the Facial Nerve?

Objectives: The aim of this study is to investigate the scutum–cochleariform process (CP) and scutum–promontorium distances according to the mastoid pneumatization condition. Methods: Two hundred temporal multidetector computed tomography scans (90 males and 110 females) were evaluated retrospectively. The scutum-CP and scutum–promontorium distances were measured. Facial canal dehiscence (FCD) in the tympanic segment and mastoid pneumatization were also evaluated. Results: The distances between scutum-CP and scutum–promontorium were not different between males and females and between right and left sides. Facial canal dehiscence in the tympanic segment was detected: 5.6% (right) and 7.8% (left) in males and 5.5% (right) and 10.0% (left) in females. Grade 4 (100%) pneumatization was detected mainly in 55.6% to 57.8% of the patients in both genders. Grade 0 (0%) pneumatization (sclerosis) was detected in 22.2% to 28.2% of both males and females. In more pneumatized mastoids, the scutum-CP and scutum–promontorium distances increased. In sclerotic mastoids, the scutum-CP and scutum–promontorium distances decreased. Facial canal dehiscence rates were not related to the mastoid pneumatization levels. Conclusion: Cochleariform process is an important landmark to localize the tympanic segment of the facial canal. In sclerosed mastoids, scutum-CP and scutum–promontorium distances decreased. There was no relationship between FCD rates and mastoid pneumatization levels. It may be due to the development of FCD that occurs during the intrauterine period. In endoscopic and classic ear surgeries, mastoid pneumatization must be evaluated preoperatively to avoid facial nerve injuries.

Facial nerve injuries cause changes in central nervous system microglial cells

Introducción. El grupo de investigación del Laboratorio de Neurofisiología Comportamental de la Universidad Nacional de Colombia ha descrito modificaciones estructurales y electrofisiológicas en neuronas piramidales de la corteza motora producidas por la lesión del nervio facial contralateral en ratas. Sin embargo, poco se sabe sobre la posibilidad de que dichos cambios neuronales se acompañen también de modificaciones en las células gliales circundantes.Objetivo. Caracterizar el efecto de la lesión unilateral del nervio facial sobre la activación y proliferación de las células de la microglía en la corteza motora primaria contralateral en ratas.Materiales y métodos. Se hicieron pruebas de inmunohistoquímica para detectar las células de la microglía en el tejido cerebral de ratas sometidas a lesión del nervio facial, las cuales se sacrificaron en distintos momentos después de la intervención. Se infligieron dos tipos de lesiones: reversible (por compresión, lo cual permite la recuperación de la función) e irreversible (por corte, lo cual provoca parálisis permanente). Los tejidos cerebrales de los animales sin lesión (grupo de control absoluto) y de aquellos sometidos a falsa cirugía se compararon con los de los animales lesionados sacrificados 1, 2, 7, 21 y 35 días después de la lesión.Resultados. Las células de la microglía en la corteza motora de los animales lesionados irreversiblemente mostraron signos de proliferación y activación entre el tercero y séptimo días después de la lesión. La proliferación de las células de la microglía en animales con lesión reversible fue significativa solo a los tres días de infligida la lesión.Conclusiones. La lesión del nervio facial produce modificaciones en las células de la microglía de la corteza motora primaria. Estas modificaciones podrían estar involucradas en los cambios morfológicos y electrofisiológicos descritos en las neuronas piramidales de la corteza motora que comandan los movimientos faciales.