Rhytidoplasty: SMAS Imbrication Vector Comparison.

To determine if there are aesthetic differences in patients who have undergone a SMAS lifting with predominantly oblique-horizontal vectors versus predominantly oblique-vertical vectors. To determine if there are aesthetic differences in the results of the neck using sutures placed in specific areas of the platysmal muscle versus randomly placed sutures for platysmal plication to the mastoid. Comparative, retrospective, blind, and randomized study. Evaluation of preoperative and postoperative photographs of 54 patients who underwent predominantly oblique-horizontal SMAS lifting versus 53 patients who underwent predominantly oblique-vertical traction of the SMAS flap, reviewed by three external, unbiased facial plastic surgeons in a blind study. A 7-point scale was used to grade the improvement of the face and the neck. In the face, SMAS lifting with predominantly oblique-vertical vectors used during the procedure offer statistically better results (p ≤ 0.001) in comparison to predominantly oblique-horizontal vectors in the aesthetical improvement of the malar eminence, melolabial fold and jowls. In the neck, both techniques offer excellent results, but the sutures used for platysmal plication in specific areas offer no statistical differences in aesthetical results from those sutures that are randomly placed in the platysmal muscle. In our study of 107 patients, SMAS lifting using predominantly oblique-vertical vectors seem to have better results than using predominantly oblique-horizontal vectors. For the neck, we do not find statistical differences between randomly placed sutures for platysmal plication versus sutures placed in specific areas of the muscle.

Effect of mitomycin in the surgical treatment of tracheal stenosis.

OBJECTIVE: To assess the capacity of high and low doses of the antimitotic drug mitomycin to prevent laryngeal stenosis in an animal model. METHODS: A prospective, randomized, double-blind, controlled study was carried out. End-to-end anastomosis was performed in 18 rabbits after tracheal annulus resection to produce inflammation. There were 3 treatment groups: topical saline (isotonic sodium chloride solution) and low-dose (0.2 mg/mL) and high-dose (0.5 mg/mL) topical mitomycin. RESULTS: A total of 107 procedures were performed: 54 surgical procedures, 35 fibrobronchoscopies, and 18 biopsies. The effect of mitomycin was dose related. In the high-dose mitomycin group, most rabbits progressed to stenosis with a percentage decrease in airway diameter that was significantly greater than in the other 2 groups (P <.001). The mean (SD) percentage of maximum stenosis in the high-dose group was 51% (22%). In the low-dose and saline groups, it was 18% (13%) and 16% (9%), respectively. No significant differences in tracheal stenosis between the low-dose mitomycin and saline groups were observed. Blinded histopathological analysis also showed no significant differences between the saline group and the low-dose mitomycin group. Compared with the other 2 groups, the high-dose mitomycin group had a significant increase in fibroproliferative tissue (P <.001). CONCLUSION: These results suggest that topical mitomycin is not effective for avoiding tracheal stenosis and may provoke the opposite effect if the dose is not carefully selected.