Image-guided titanium implantation for craniofacial prosthetics.

Osseointegration implants have revolutionized craniofacial prosthetic reconstruction. Implant placement relies on adequate thickness and quality of bone to permit osseointegration. Positioning the implant is critical in craniofacial reconstruction because surface contours of the prosthesis must be preserved while housing attachment components securely and discretely. Also, the position of the final prosthesis must transition to native tissue smoothly. We report on the use of intraoperative stereotactic image guidance in the placement of implants for orbital, nasal, and auricular prosthetic reconstruction. Clinical data, intraoperative images, and postoperative rehabilitated results are presented to demonstrate the utility of the application of stereotactic image guidance for implant placement. In our experience, stereotactic image guidance facilitates optimal implant site selection if there is abnormal bone quantity or quality.

Botulinum toxin to improve facial wound healing: A prospective, blinded, placebo-controlled study.

OBJECTIVE: To test whether botulinum toxin-induced immobillzation of facial lacerations enhances wound healing and results in less noticeable scars. PATIENTS AND METHODS: In this blinded, prospective, randomized clinical trial, patients were randomized from February 1, 2002, until January 1, 2004, to botullnum toxin vs placebo injection into the musculature adjacent to the wound within 24 hours after wound closure. Blinded assessment of standardized photographs by experienced facial plastic surgeons using a 10-cm visual analog scale served as the main outcome measure. RESULTS: Thirty-one patients presenting with traumatic forehead lacerations or undergoing elective excisions of forehead masses were included in the study. The overall median visual analog scale score for the botulinum toxin-treated group was 8.9 compared with 7.2 for the placebo group (P=.003), indicating enhanced healing and Improved cosmesis of the experimentally immobilized scars. CONCLUSIONS: Botullnum toxin-induced Immobilization of forehead wounds enhances healing and is suggested for use in selected patients to improve the eventual appearance of the scar.