Identification of nasal morphologic features that indicate susceptibility to nasal tip deflection with the LeFort I osteotomy.

The goal of this investigation was to identify and quantify nasal morphologic features which predispose to the nasal tip deflection associated with the LeFort I osteotomy. Fifty patients who had undergone LeFort I osteotomies were studied retrospectively from presurgical and postsurgical cephalograms and facial photographs. The magnitude of hard tissue change was measured in the vertical and horizontal planes, and soft tissue nasal change was measured in the vertical plane at two points on the outline of the soft tissue nose. Additional parameters were tested as potential predictors of nasal tip deflection, including the Deflection Resistance Index (DRI), which is a quantitative measure of nasal morphologic features. Data were subjected to a hierarchical multiple regression analysis allowing for multivariate prediction capability. At the supra nasal tip (SNt), magnitude of advancement, magnitude of impaction, and the DRI were all significant predictors (multiple R = 0.86). At the anterior nasal tip (ANt), magnitude of advancement, preoperative columellar angle, magnitude of impaction, the DRI, the interactions of advancement and DRI, and columellar angle and DRI were the significant predictors (multiple R = 0.89). It is concluded that the vertical deflection of the nasal tip resulting from the LeFort I osteotomy is influenced not only by the hard tissue movements but also by nasal structure. The DRI is a quantitative measure that can be used clinically to improve the predictability of vertical nasal tip deflection.

Melkersson-Rosenthal syndrome and Crohn's disease: one disease or two? Report of a case and discussion of the literature.

In 1985, a 19-year-old woman had clinical features suggesting anorectal Crohn's disease. Two years later, swelling of the vulva associated with perianal swelling developed. The clinical manifestations responded to oral prednisone until 1989, when she returned with a swelling of the upper lip, a polypoid lesion of the oral buccal mucosa, and swelling of the anus and vulva. The lip biopsy demonstrated granulomas. The illness failed to respond to systemic immunosuppressive therapy, wider consultation was made, and the diagnosis of the Melkersson-Rosenthal syndrome was made. Such an appearance of this rare condition is unusual. We describe her case and discuss the literature, raising the possibility that the Melkersson-Rosenthal syndrome and Crohn's disease are the same condition with different initial clinical appearances.

Facial muscle reanimation using the trigeminal motor nerve: an experimental study in the rabbit.

Surgical repair of facial nerve deficits may be marred by lack of muscle control and donor region paresis. Using New Zealand white rabbits, a study was undertaken to evaluate facial muscle reanimation with a donor source not previously used: the motor division of the trigeminal nerve. The results were compared with the severed facial nerve and hypoglossal-facial coaptation. An atrophy scale was calibrated for facial muscles of the rabbit. Clinical, electromyographic, and histomorphometric findings confirmed that the trigeminal nerve was a suitable donor source. The neurorrhaphy produced an exponential rate of repair.

Atypical facial pain: a retrospective study.

Among the most challenging patients seen for evaluation by a health care practitioner are those suffering from the atypical facial pain syndrome. They have almost inevitably been subjected to extensive treatment which either has had no effect on the symptoms or has aggravated them. This article reports a retrospective study of thirty-four randomly selected cases of atypical facial pain that have been seen by a multidisciplinary pain group.