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Background: It is commonly assumed that a progressive sagging of the eyebrow occurs with the facial aging process. Only a few studies have analyzed this modification, and the findings are disparate and inconclusive. This study, based on reproducible and validated data, aimed to quantify the modifications of eyebrow position that may occur with aging. Also analyzed were the effects of these eyebrow position changes on the upper eyelid and on frontal muscle activity., Methods: The study included 95 Caucasian adults divided in three groups: 20 to 39, 40 to 59, and 60 to 79 years of age. Photographic portraits were made using a standardized photograph protocol. Eyebrow position was evaluated from the intercanthal line to four points along the upper margin of the eyebrow. The upper eyelid height, the lid sulcus height, and the upper iris coverage were measured. Severity of the forehead lines was analyzed using a validated scale. Reliability and validity of all measures were controlled beforehand., Results: No significant differences were found when comparing eyebrow height above the medial canthus, the pupil, the lateral sclero-corneal limbus, and the lateral canthus between groups (p > 0.5). In addition, results suggested an increase of dermatochalasis when eyebrow height decreased. Also demonstrated was a significant increase of frontal muscle activity with aging., Conclusions: In contrast to conventional descriptions, this study demonstrated the stability of the eyebrow position with aging. This results from a physiological state of muscular compensation and may help explain the questionable results of eyebrow surgery.

Impaction of the third molar is relatively frequent in oral and maxillofacial surgery, and its removal is a usual operation with mostly unremarkable outcome. We report a case of bleeding that occurred after a left upper third molar extraction, which necessitated in emergency an angiography with embolization.

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.

Background: The most important predictor of early mortality in patients with HIV-associated cryptococcal meningitis is mental status at presentation; patients who present with altered mental status have up to 25% mortality. Historically, cerebrospinal fluid (CSF) diversion in HIV-negative patients with cryptococcal meningitis and signs of elevated intracranial pressure (ICP) has improved survival. In an effort to affect survival and morbidity rates in patients with HIV-associated cryptococcal meningitis, we have initiated aggressive management of elevated ICP in patients with focal neurologic deficits, mental obtundation, or both., Methods: We identified 10 patients with HIV-associated cryptococcal meningitis who presented with symptoms consistent with elevated ICP, including headache, mental obtundation, papilledema, and cranial nerve palsies. Elevated opening pressure was defined as > 20 cm CSF during lumbar puncture. In patients with elevated opening pressures who had focal neurologic deficits or mental status changes refractory to serial lumbar puncture, management consisted of immediate placement of lumbar drains for continuous drainage of CSF to maintain normal ICP (10 cm CSF). Patients with persistent elevations of spinal neuraxis pressure following lumbar drainage underwent placement of lumbar peritoneal shunts., Results: All patients returned to their baseline level of consciousness following normalization of ICP. Two patients were weaned from lumbar drainage. Eight patients eventually required placement of lumbar peritoneal shunts for persistently elevated ICP despite successful antifungal therapy. Follow-up ranged from 1 to 15 months. One shunt infection occurred, one lumbar peritoneal shunt was converted to a ventriculoperitoneal shunt, and one shunt was removed., Conclusions: Elevated ICP in patients with HIV-associated cryptococcal meningitis is a significant source of morbidity and mortality. The use of lumbar drainage and selective placement of lumbar peritoneal shunts in the management of elevated ICP in patients with HIV-associated cryptococcal meningitis can ameliorate the sequelae of elevated ICP.

The effects of acute anxiety on food intake and preferences were investigated in 12 men awaiting surgery for hernia. Their lunch intake was measured on the day prior to surgery and again after recovery, one month later. Their anxiety was rated on both test days as well as the palatability of the foods they selected and ingested ad libitum. Anxiety was significantly higher on the day before surgery than on control day. However, no hyperphagia appeared and food selection was not systematically disturbed. Protein, lipid, and carbohydrate ratios in the test meals were not affected by the level of stress. The present results are at variance with some, but not all, studies of food intake under stress in animals and humans. Among other factors (nature of stressor, intensity of anxiety, sex of the subjects), culturally determined eating habits could contribute to the discrepancies observed.