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Of all the methods for repair of the unilateral cleft lip, none has gained as much popularity as the rotation-advancement. Millard's original principle of 50 years ago continues to guide surgeons in closure of the cleft lip. Unlike earlier procedures, the brilliance of the rotation-advancement is that it permits individual manipulation and modifications while maintaining Millard's original surgical and anatomical goals. Millard and many other surgeons have made modifications to adjust the procedure to each specific patient, to address some of its faults, and to gain new advantages. In this article, the authors review the techniques of Drs. Ralph Millard, Steve Byrd, Court Cutting, John Mulliken, and Samuel Stal. The variations from Millard's original technique are highlighted, including a discussion of the benefits of each modification.

As the most prominent facial feature, the nose carries an increased risk of traumatic injury. Nasal fracture is the most common bone injury of the adult face and frequently results from motor vehicle accidents, sports-related injuries, and altercations. Although often initially considered minor, nasal fracture may eventually result in significant cosmetic or functional defects. Optimal management of nasal trauma in the acute setting is critical in minimizing secondary nasal deformities. In recent years, numerous guidelines have been described to refine and optimize acute nasal trauma management. However, restoration of pretraumatic form and function remains a challenge. Commonly the product of a poorly addressed underlying structural injury, posttraumatic nasal deformity requiring subsequent rhinoplasty or septorhinoplasty remains in as many as 50 percent of cases. In this article, the authors review the anatomic, diagnostic, and management considerations as well as discuss their own experience in approaching nasal trauma and the deviated nose.

Background: Distraction osteogenesis was initially devised as a way to lengthen the lower extremity. All the basic tenets of the technique were developed based on this use. This includes both the supposed need for a latency period before distraction begins (3 to 5 days) and the ideal rate of distraction (1 mm/day). There is no evidence that these values apply to craniofacial distraction osteogenesis, particularly in children. Indeed, with the markedly improved blood supply in the face when compared with the lower extremity and the use of the technique in children versus adults, one might assume that a shorter latency period and a more rapid rate of distraction are possible., Methods: This study is a retrospective review of 22 pediatric patients with mandibular hypoplasia undergoing mandibular distraction osteogenesis. All patients were operated on by a team consisting of an oral surgeon and a plastic surgeon. All the distraction devices used were external. All patients had a latency period, before activation, of less than 24 hours and a distraction rate of 2 mm/day., Results: Two patients developed cellulitis at the pin sites, one patient developed premature healing, one patient developed a nonunion that required further surgery. This was the only patient in the series who had distraction of a previous bone graft. No patient undergoing distraction of native mandible developed a nonunion., Conclusions: Eliminating the latency period and rapidly distracting the mandible in pediatric cases has an acceptably low complication rate. This benefits the patient in terms of an overall reduction in the amount of time that the child needs to remain in the distraction device. The patient spends less time with the distraction device, thus reducing the potential morbidity and increased cost of the treatment. Potential explanations for why this variation in distraction technique is successful include the improved blood supply in the face of children and the failure of external devices to translate all the distracted movements to the bone interface. Some of this force is translated into both bending of the pins and migration of the pins through bone. Although a latency period might be necessary in the distraction of the lower extremities, the application of this concept to the craniofacial skeleton in children is erroneous.

Background: Acellular porcine dermis has been used as a soft-tissue substitute in Europe since 1998 and in the United States since 2000. Processing renders the composite acellular, reducing antigenicity and crosslinking the dermal collagen. The purpose of this study was to determine the long-term histologic response of this material to the transfer into a subcutaneous soft-tissue location in an in vivo mouse model., Methods: A total of 24 mice (ICR strain) underwent an initial procedure transplanting a segment of acellular porcine dermis into a dorsal subcutaneous pocket. The implants were examined for qualitative characteristics including rigidity, migration, inflammation, and healing response. Composites of skin, subcutaneous tissue, implant, and underlying muscle were harvested for histologic evaluation. The specimens were analyzed for inflammatory response, degree, and character of tissue incorporation and degree of implant resorption., Results: One of the 24 animals studied experienced extrusion of the implant. The remaining 23 implants persisted within their respective hosts until the time the animals were killed. The volume and weight of all of the implants remained unchanged from the preoperative to postoperative measurements. Dystrophic calcification and bone formation was seen at 12 months., Conclusions: The results do not suggest characteristics optimal for implants used in soft-tissue augmentation for the purpose of aesthetics. The porcine dermis would appear from these results to be better suited for situations that require strength and permanence of the implant.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the different technical options available for repairing facial fractures. 2. Know which technical points facilitate performance of fixation of the facial skeleton by relatively inexperienced surgeons. 3. Have a basic understanding of the most common complications arising after facial fracture repair. 4. Have an understanding of how to avoid surgical complications following facial fracture repair., Background: The treatment of facial trauma is associated with a myriad of potential complications. This may be compounded by the relative lack of compliance seen in the patient population within an urban trauma center and by the requisite involvement of residents in this care., Methods: This study retrospectively evaluated 189 patients with a total of 294 separate fractures treated over a 3.5-year period., Results: The overall rate of complications was 7.8 percent., Conclusions: The experience at a high-volume level I trauma center with residents as the primary physicians has confirmed that facial trauma surgery may be undertaken with an acceptably low complication rate. Numerous technical factors were thought to be responsible for this, including the use of miniplates for treatment in the majority of mandibular fractures, overcorrection of orbital volume in fractures involving the globe, and the use of a transconjunctival incision with a lateral canthotomy for access to the lower eyelid structures.