The availability of three-dimensional imaging and software systems presents new opportunities for the facial cosmetic surgeon to plan, execute, and assess the outcomes in patients undergoing surgery of the face and neck.

Objective: To evaluate nasal changes after maxillomandibular surgery by means of images taken with a 3-dimensional digital camera. Design: Thirty-two patients (26 female and 6 male) with preoperative and postoperative 3-dimensional photographs were studied. The patients underwent maxillary movement with impaction (upward rotation), maxillary movement with lengthening (downward rotation), or maxillary movement without rotation. With the 3-dimensional imaging software, preoperative and postoperative calculations were performed for interalar width, internostril width, nasal tip projection, and columellar length from the 3-dimensional digital images. The nasolabial angle was also measured. Results: Postoperative interalar and internostril widening was significant (PϽ.05) for all 3 categories of maxillary movement. However, there was no statistically significant change in nasal tip projection and columellar length. Interestingly, movement of the maxilla with upward rotation did show a statistically significant decrease in the nasolabial angle. Conclusions: Changes to the nose clearly occur after orthognathic surgery. There was a statistically significant increase in postoperative interalar width and internostril width with maxillary movement. However, no clear correlation could be determined between amount of change and maxillary movement. Interestingly, maxillary advancement did not show any significant change in nasal tip projection or columellar length, with data showing both increases and decreases in measurements. The nasolabial angle in patients who underwent maxillary advancement with impaction (upward rotation) was the only measurement that showed a statistically significant increase.

Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.

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We diagnosed and treated a case ofLudwi g 's ang ina in a 45-year-old man who had edema ofthefl oor of mouth and the tongue along with bilateral submandibular sialadenitis and sialolithiasis. We secured the patient 's airway via nasal fi beroptic intubation in the surgical intensive care unit and ad ministered intr avenous antibiotics. The edema subsided, and the patient was extubated on the third postoperati ve day and discharged shortly thereafter. To our knowledge, this is the firs t reported case ofa patient with bilateral submandibular sialadenitis and sialolithiasis pres entin g as Ludw ig 's ang ina. Despite the decreasing incidence ofthis disease, Ludwig 's angina remai ns an important disease process because afa ilure to control the airway can ha ve disastrous conse quences. Proper diagnosis, airway control, antibiotic therapy, and occasionally surgical management are essential to ensure the safe ty of the patient.

Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as gravity and the action of the corrugator supercilli, procerus, and orbicularis draw on the progressively inelastic forehead skin. Facial mimetic muscle action reveals itself over time via the development of deep forehead rhytids. Facial plastic surgeons have at their disposal several effective surgical, and recently, medical interventions to address these changes. Each technique has merits and suitable applications. This review examines the history of rejuvenation of the upper face, details the pertinent treatment modalities, and evaluates the context in which each is applicable.

Background: Muscle suspension blepharoplasty remains a reliable method to tighten the loose skin and muscle of the lower eyelid.Objective: To evaluate the 30-year experience of the senior author (N.J.P.) with the skin-muscle suspension technique for lower-lid blepharoplasty.Patients and Methods: Of 4395 patients who underwent lower-lid blepharoplasty, 3988 had muscle suspension blepahroplasty performed with adequate follow-up.Results: Results of the 30-year review showed that most patients were very satisfied with the procedure. There were 67 complications (2 hematomas, 1 poor scar, 24 cases of scleral show Ͻ1 mm, and 40 cases of chemosis). Chemosis resolved in 2 to 8 weeks, and there were no cases of ectropion, scleral show greater than 1 mm, dry eye, or vision loss. Revision surgery was needed in 41 patients, all of whom were satisfied after the secondary procedure. Conclusion:Despite the recent drift toward orbital fat preservation for lower-lid blepharoplasty, conventional lower-lid muscle suspension offers the surgeon a reliable method to tighten the loose skin and muscle of the lower eyelid and give the patient a more attractive, youthful appearance.