The goal of this article is to explain both the options and the techniques that are available when considering the rejuvenation of the eyelid and brow complex. We first explain the relevant anatomy. We then list and explain the different techniques with both the brow lift and the blepharoplasty. During this discussion we also explain a newer technique that we have been using. This combines the endoscopic technique with a trichophytic incision. The selection of patients is discussed in reference to which technique is appropriate given each patient's particular anatomy and desired effects. We also highlight the unique differences that the male patient presents.
P enetrating head injuries are always a unique type of trauma that have been associated with poor outcomes. Although penetrating head injuries are typically the result of firearm-related violence and motor vehicle crashes, 1 sporadic cases of penetrating craniofacial injuries caused by sharp objects or even wooden sticks have been reported. [2][3][4] For these injuries, the interest lies in the likely mechanism of injury and the evaluation and treatment by trauma staff and other specialists.In this case report, we describe an unusual penetrating injury in which a patient was stabbed by a knife that entered the craniofacial junction through the left orbit and orbitofrontal junction and reached the contralateral infratemporal fossa. It exemplifies a multidisciplinary approach of management that is well organized in Level I trauma centers. CASE REPORTA 56-year-old man was transferred to our center from a local hospital after being stabbed in the left forehead with a knife. The patient was conscious with a Glasgow Coma Score (GCS) of 15. Although a knife handle protruded from his left forehead and orbit, no neurologic deficits could be identified at that time.Skull radiographs (Fig. 1) and a head computed tomography (CT) scan ( Fig. 2 and 3) showed that the knife had entered through the left frontal bone and the roof of the left orbit, passed through the left frontal sinus and ethmoid sinuses, crossed the midline to the right maxillary sinus, and exited at the right infratemporal fossa anterolateral to the carotid sheath. The knife tip was observed adjacent to the carotid and jugular foramina. An angiogram showed no evidence of vascular compromise to the internal carotid artery (ICA).Removal of the knife and reconstruction of the injured cranial base was planned in collaboration with the otolaryngology team. After a bicoronal skin flap was made, an additional skin incision was extended down from the free edge to the base of the skin flap at the knife cut. This incision allowed the reflection of the skin flap down to expose both orbital rims and the nasal root. A vascularized pericranium flap was made for the later reconstruction of the cranial base. After the bifrontal craniotomy was performed, the supraorbital bony cuts were extended to meet the bony cut caused by the knife on both sides. The bone flap straddling the knife was then elevated and dissected from the underlying dura and frontal sinuses mucosa. At the same time, the carotid artery in the neck was exposed to permit emergency proximal control in case of vascular injury during removal of the knife. After elevation of bone flap, the knife was found to split the left orbital roof and the periorbital membrane, frontal dura, cribriform plate, and planum sphenoidale, and was deeply embedded in the right cranial base. The frontal dura was dissected and reflected posteriorly from the floor of the anterior cranial fossa, which was further exposed by extradural bifrontal retraction.After freeing the knife from the surrounding structures, we applied a balanced tracti...
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