First Bite Syndrome Following Rhytidectomy: A Case Report.

BACKGROUND: First bite syndrome (FBS) is a known complication of parotid gland resection, parapharyngeal space dissection, and cervical sympathetic chain injury. It can be described as severe cramping or spasms in the parotid region triggered by the first bite of a meal, with the pain lessening during each subsequent bite. Although dissection for a rhytidectomy is in the vicinity of the parotid parenchyma, face-lift is not typically characterized as a procedure that can lead to FBS. CASE DESCRIPTION: A 53-year-old female underwent a deep plane face-lift to address her goals of improving jowls, nasolabial folds, and cervicomental angle. Intraoperatively, the dissection proceeded without any complications. Initially, her postoperative course was uneventful; 3 weeks after surgery, she noticed pain at the start of mastication that would improve throughout the course of a meal. She elected to proceed with observation. At 6 months after surgery, she began to experience improvement in her symptoms, and shortly thereafter had complete resolution. DISCUSSION: First bite syndrome is a complication associated with deep lobe parotid resection, first described in 1998. The innervation of the parotid gland is complex and includes contributions from the auriculotemporal nerve, the great auricular nerve, and the cervical sympathetic chain. During rhytidectomy, dissection occurs along the parotidomasseteric fascia in order to elevate a flap of the superficial musculoaponeurotic system. Inadvertent injury to the parotid parenchyma can lead to damage to the postganglionic sympathetic fibers innervating the myoepithelial cells. Ultimately, expectant management is the mainstay of treatment and symptoms typically resolve within 6 months to 1 year. CONCLUSION: First bite syndrome is a complication that can be seen with a variety of facial surgeries. In the case of rhytidectomy, FBS should be considered a potential risk, as dissection into the parenchyma of the parotid gland can result in postoperative autonomic dysfunction.

Biocompatibility comparison of novel soft tissue implants vs commonly used biomaterials in a pig model.

OBJECTIVE: To develop a model to evaluate biocompatibility, integration, and substrate independence of novel porous bioscaffolds for maxillofacial and plastic reconstruction using sphere-templated angiogenic regeneration technology compared with currently available synthetic and biologic soft tissue implants. STUDY DESIGN: A prospective pilot study using animals. SETTING: Military medical center. SUBJECTS AND METHODS: Five pigs underwent dorsal subcutaneous implantation of a polypropylene-based material coated with precision pore silicone granules (sphere-templated scaffold), expanded polytetrafluoroethylene, human dermis, and porcine dermis. Sham and undissected sites were also used as controls. Specimens were harvested 7, 21, 90, and 180 days after surgery and evaluated histologically for inflammation, neovascularization, and collagen deposition. RESULTS: All materials and sham sites induced a mild to moderate inflammation that decreased over time, except for human dermis, which elicited a moderate to severe inflammatory response. The responses were varied and measurable using subjective scoring methods. The sphere-templated scaffold demonstrated numerous foreign body giant cells adjacent to the silicone granules, which were not seen in any of the other specimens. CONCLUSION: Subjective scoring of pathology slides and measurement of capsule thickness appeared to show differences between the materials, but these differences require a larger number of subjects and proper statistical analysis to assess. The robust foreign body reaction elicited by the polypropylene/silicone-based scaffold argues against the use of this material in future studies. The authors advocate using inert biodegradable substances for future bioscaffold constructs.

Camera and lens selection for the facial plastic surgeon.

Clinical photography is a critical component of the practice of facial plastic surgery. Potential for a wide variety of applications for these photographs, such as medicolegal documentation, patient counseling, teaching of colleagues and physicians in training, and lecture presentations. Photographs are important to facilitate understanding of surgical techniques described in the literature. Clinical photographs are also used for advertising in many practices. Good-quality photographs are therefore important. There are several factors that contribute to quality, such as the appropriate setting and background, standardization of subject position, and the type of flash. However, none of these factors can be effective without a good camera and lens. A multitude of cameras and lenses are available, and choosing the correct equipment for your practice can be confusing. In many practices, the surgeon also functions as his or her own photographer. At a minimum, it is important to have a basic knowledge of camera and lens equipment.

Long-term outcomes of a rhinolift procedure for obstructive symptoms in the aging nose in 2 patients.

Age-related changes in the structure of the nose can obstruct the nasal airway and adversely affect quality of life. Several procedures are available to restore the patency of the airway, but not all are appropriate for all patients. Also, long-term outcomes data on such procedures are lacking. We describe our use of a rhinolift procedure with local anesthesia to correct nasal obstruction caused by nasal tip ptosis in 2 elderly men. In both cases, the procedure resulted in a complete or near-complete resolution of obstructive symptoms. We also conducted long-term follow-up of these 2 patients. Both experienced a recurrence of symptoms 1 to 2 years postoperatively. We conclude that the rhinolift procedure we describe is safe and effective for the short-term relief of age-related nasal obstruction in selected patients.

Treatment of the posttraumatic and postrhinoplasty crooked nose.

Successful management of the persistently crooked nose after a previous trauma or surgery is best achieved through careful analysis of the problem and clear communication with the patient regarding his or her goals of revision surgery. To address the nose in a systematic fashion, the surgeon should divide the crooked nose into horizontal thirds with appropriate management directed toward the structural abnormality in each third. A review of the treatment of the postrhinoplasty and posttraumatic crooked nose is presented with an emphasis on re-establishing structural support and improving appearance while preserving or creating a functional nasal airway.

Childhood nasal trauma with previous rhinoplasty and persistent deformity.

This article reviews a case of a young woman with a history of childhood trauma resulting in nasal deformity along with chronic nasal obstruction. Discussion for correction of these problems includes septoplasty, tip shield graft, cap graft, alar batten graft, an crushed cartilage graft. Pre- and postoperative photographs are provided with corresponding preoperative diagrams and schematics.

Nasal trauma, two prior rhinoplasties.

This article reviews a case of a woman presenting with nasal deformity following childhood nasal trauma and two subsequent rhinoplasties. Discussion for correction of these problems includes tip dome graft, shield and cap graft, superior and inferior cartilage onlay grafts, spreader graft, columellar strut, and lateral osteotomies. Pre- and postoperative photographs are provided with corresponding preoperative diagrams and schematics.