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PURPOSE: This article describes the use of a large-pore polyethylene implant for mandibular angle augmentation. PATIENTS AND METHODS: Patients with severe facial deformities who had previously undergone multiple surgical procedures and were now seeking esthetic improvement were included in this series. Their deficient mandibular angles and reduced ramus height were corrected with polyethylene implants appropriately sculptured and fixed to the mandible through extraoral incisions that preexisted in most patients. The surgical technique is described, and four representative cases are presented that illustrate the changes in facial contour and esthetics. RESULTS: Postoperative appearance was considered very satisfactory, and the patients' esthetic expectations were met to a great extent. The mandibular angle was well outlined, and facial contour and proportions were enhanced. CONCLUSION: This surgical procedure is recommended for mandibular angle augmentation when proper indications are strictly observed and surgical steps are accurately followed.

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Numerous studies have shown the presence of estrogen receptors and a mediated effect of estrogen through these receptors in the articular cartilage of various species, including humans. Because temporomandibular joint (TMJ) symptoms are more prevalent among women, this study was performed to investigate the presence of estrogen and progesterone receptors in the human TMJ. Seven TMJ disc specimens obtained from women with TMJ symptoms with documented internal derangement were analyzed for the presence of these receptors. These were compared with another group of 15 TMJ discs removed from men and women with no TMJ symptoms undergoing skull base surgery who had extirpation of the TMJ for access to the skull base. Detection of these receptors was done by an immunohistochemical technique using mouse monoclonal antibody. The results showed the presence of these receptors in both symptomatic and asymptomatic men and women. Although these receptors were found in more of the women with TMJ symptoms than the other two groups, due to the small number of the specimens studies no definitive conclusions as to the correlation between female sex hormones and TMJ symptoms could be drawn. However it was concluded that the TMJ disc is, at least in some men and women, potentially a female sex hormone target tissue.

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A patient with severe orbital facial trauma with complete dislocation of the globe into the maxillary antrum is presented. Reconstruction of the defect with autogenous bone restored globe position and maintained the visual and ocular-rotary function of the eye.

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The treatment of facial pain disorders has become a multifaceted discipline that involves numerous scientific fields. Diagnostic and treatment modalities may be beneficial to the patient but at times may also complicate the problem and compromise the outcome. We present an interesting case of left trigeminal neuralgia complicated by unassociated lingual nerve dysesthesia.

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Multiple surgical approaches to the orbits with the use of the eyelids have been used. The orbital rim incision fell into disfavor because of esthetic considerations. A subciliary approach supplemented by the lateral brow incision is currently the most popular method of approach to the orbital rim. It provides adequate access to the orbit, but it is not without inherent complications, such as unfavorable scarring, ectropion, and entropion. This article describes an alternate approach to the orbit by means of a transconjunctival incision with lateral canthotomy.

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A transfacial approach for infraorbital nerve exploration and maxillary surgery has been developed, allowing for good visual access as far posteriorly as the foramen rotundum and anterior maxillary region. This allows for infraorbital osteotomies, peripheral nerve grafting, neurolysis procedures, or combined maxillofacial-neurosurgical procedures with gasserian ganglion exploration and/or grafting. The procedure affords maximum surgical accessibility with good postoperative healing and minimal concerns about potential oral contamination.

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A modified version of the Le Fort I maxillary osteotomy is described. The esthetic and anatomic basis, the surgical technique, and possible complications are discussed and two representative cases are shown. This technique has been used to treat 38 patients with various degrees of combined maxillary-zygomatic deficiency in the last 3 years. Based on this experience, it is concluded that this procedure provides a predictable esthetic result and excellent skeletal stability with few intraoperative and postoperative complications. Furthermore, the need for simultaneous bone grafting or alloplastic implants, as in the conventional Le Fort I, is virtually eliminated using this osteotomy.

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The buccinator myomucosal island pedicle flap is a useful means of introducing relatively large amounts of vascularized mucosa into the oral cavity. Using cadaver dissections and clinical cases, the anatomy and clinical relevance of this tissue are defined. Emphasis is placed on the technical caveats and pitfalls of the procedure.

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