A contemporary assessment of facial aesthetic preferences.

OBJECTIVES: To compare and characterize the ideal nasolabial angle, nasal tip width, and location of the eyebrow apex for Asian and white women. METHODS: From approximately January 1, 2005, to June 30, 2005, we photographed the faces of 2 Asian women and 2 white women of differing ages. Each model's image was modified to create different eyebrow shapes, unique nasolabial angles, and varying nasal tip widths. We subsequently recruited, and obtained demographic information from, volunteers from the general public to rate the modified images based on their aesthetic preferences. RESULTS: We found that neither the ethnicity of the models nor the ethnicity of the volunteers who rated them played a significant role in determining the ideal eyebrow apex location, nasolabial angle, or nasal tip width. However, generally speaking, a more lateral brow apex is preferable in younger faces, whereas a more medial apex is favored in older ones. Other preferences include a moderate nasolabial angle and a narrow nasal tip. As a result of individual variability, it has been difficult to establish a method to calculate a nasolabial angle that adequately portrays the apparent rotation of the nose in most people. We found that the angle formed by the line from the anterior columella to the subnasale and the line exactly perpendicular to the Frankfurt horizontal plane provides the best estimate. CONCLUSIONS: When planning facial plastic surgery, the goals of the patient are of paramount importance. Although it is important to understand the ways in which people of different ethnicities and ages differ in their facial proportions as a group, facial harmony must be pursued on an individual basis.

Complications and the time to repair of mandible fractures.

OBJECTIVE: Treatment delays in the operative management of mandible fractures are often unavoidable. We were interested in determining whether delays increased the incidence of complications in these patients. STUDY DESIGN AND SETTING: A retrospective chart review was performed on all patients who presented to the San Francisco General Hospital with an operative mandible fracture in 2002. On the basis of the number of days from initial injury to surgery, the patients were divided into two groups: those repaired in 3 days or less and those repaired after 3 days. The incidence of infectious and technical complications was then compared between these groups. Substance abuse was also evaluated for its role in complication risk. RESULTS: Of the 84 patients in the study, 11 had infectious complications, and 10 had technical complications. Although treatment delay did not increase the risk of developing an infectious complication, substance abuse considerably increased this risk. The incidence of technical complications was remarkably higher in patients repaired after 3 days. CONCLUSION: Although patients with mandible fractures treated after 3 days do not have a higher risk of developing an infectious complication, this risk is elevated in patients who abuse substances regularly. The risk of technical complications increases with treatment delay, and therefore the surgical team must be even more vigilant when reducing these fractures.

Coccidioidomycosis causing massive cervical lymphadenopathy.

Coccidioidomycosis involving the head and neck is uncommon. We present a case of a patient with disseminated coccidioidomycosis and massive submandibular cystic lymphadenopathy unresponsive to systemic antifungal treatment. It is our impression that significant clinical improvement resulted from concomitant needle aspiration of the cystic nodes to decrease fungal load and modification of systemic medication. Although reduction of fungal burden may provide an improved response to antifungal therapy, disseminated coccidioidomycosis is a systemic disease that requires appropriate systemic therapy.

The importance of etiology on the clinical course of neck abscesses.

OBJECTIVE: Formation of neck abscesses from injecting illicit drugs continues to be a common problem in the United States. We sought to determine whether neck abscesses resulting from direct inoculation differ in their clinical course and severity from those that arise from direct spread through inflamed tissue, as in pharyngitis or odontogenic infections. STUDY DESIGN AND SETTING: Patients were separated based on the cause of their neck abscess into either an injection drug use group or a noninjection drug use group. We retrospectively compared both groups of patients by examining multiple clinical endpoints, including the number of operations, length of hospital stay, and requirement for emergent airway intervention. RESULTS: Injection drug use was the most common cause of neck abscess. Only 1 of these patients needed more than 1 drainage procedure, and no patients required emergent airway intervention or an intensive care unit (ICU) stay. The majority of the patients in the noninjection drug group had a neck abscess as a result of unknown causes; nearly one half required an emergent operation for airway management and the mean ICU stay was 2.5 days. CONCLUSION: Neck abscesses formed by direct inoculation have a relatively more benign clinical course than those resulting from spread through inflamed tissue. The latter require a longer hospital stay, more days in the ICU, and more emergent intervention.