The role of silicone granulomas in recurrent capsular contracture: a review of the literature and an approach to management.

BACKGROUND: The silicone granuloma was first described in the literature in 1964. During the course of clinical practice, the plastic surgeon will encounter a silicone granuloma in a breast augmentation or reconstruction patient. This review addresses the clinical significance associated with silicone granulomas. Clinical implications and indications for intervention are discussed, and a reasonable management algorithm is proposed. METHODS: A review of the literature relating to silicone granulomas and their clinical implications was performed. RESULTS: Although case series have been reported, there is no consensus regarding the treatment of silicone granulomas. CONCLUSIONS: This important clinical entity warrants investigative attention to better understand its clinical implications and prevention. An algorithm for treatment is proposed.

Anatomy of the supratrochlear nerve: implications for the surgical treatment of migraine headaches.

BACKGROUND: Migraine headaches have been linked to compression, irritation, or entrapment of peripheral nerves in the head and neck at muscular, fascial, and vascular sites. The frontal region is a trigger for many patients' symptoms, and the possibility for compression of the supratrochlear nerve by the corrugator muscle has been indirectly implied. To further delineate their relationship, a fresh tissue anatomical study was designed. METHODS: Dissection of the brow region was undertaken in 25 fresh cadaveric heads. The corrugator muscle was identified on both sides, and its relationship with the supratrochlear nerve was investigated. RESULTS: The supratrochlear nerve was found in all 50 hemifaces. Three potential points of compression were uncovered in this investigation: the nerve entrance into the brow through the frontal notch or foramen, the entrance of the nerve into the corrugator muscle, and the exit of the nerve from the corrugator muscle. The nerve generally bifurcates within the retro-orbicularis oculi fat pad, and these branches enter into one of four relationships with the corrugator muscle: both branches enter the muscle, one branch enters the muscle and one remains deep, both branches remain deep, and the branches further branch into ever smaller filaments that cannot be identified cranially. CONCLUSIONS: Some patients are nonresponders to migraine decompression techniques that address the supraorbital nerve. The supratrochlear nerve may be compressed in these patients. A standard corrugator resection that comes more medially within 1.8 cm of the midline may be beneficial. The morphology of the frontal notch/foramen must be examined and addressed if necessary.

Ethnic rhinoplasty.

As the United States becomes more racially and ethnically diverse, the number of non-Caucasian patients seeking rhinoplasty is increasing. The non-Caucasian, or ethnic, rhinoplasty patient can be a surgical challenge due to the significant anatomic variability from the standard European nose as well as variability within each ethnicity. Becoming familiar with the common anatomic differences as well as the aesthetic goals in the ethnic rhinoplasty patient will assist the surgeon in attaining consistent, ethnically congruent, and aesthetically pleasing results.