Plastic bullet injuries of the face and jaws

The plastic bullet or plastic baton round was introduced as an anti-riot weapon in 1976. It has evolved from the rubber bullet and wooden baton round. During the recent unrest in South Africa the plastic bullet was used in riot control. Five cases of facial injury are reported. One involved the middle third of the face and 4 the lower third. In all cases skin lacerations compounded facial fractures. Mandibular fractures ranged from a single displaced body fracture to severe comminuted fractures. The middle-third injury was sufficiently severe to result in blindness of one eye.     

Changes associated with the aging face

The demand for facial plastic surgery has increased dramatically in recent years as persons from all socioeconomic levels and age groups have become interested in facial rejuvenation. As the population ages, the demand for esthetic surgery in the elderly will increase at an even greater rate. Before the surgeon begins to learn specific techniques in facial plastic surgery, he or she should have a thorough understanding of the anatomy of the aging face. Safe and effective esthetic surgery is possible only when the anatomic changes associated with the aging face are appreciated by the surgeon and patient.     

Common birth defects in South African Blacks

The prevalence rates of some of the common birth defects have been ascertained in a Black population in South Africa. The births of 29,633 infants were studied retrospectively from hospital records. The commonest defect was found to be polydactyly (10,4/1,000 births), and the other defects investigated were talipes equinovarus (1,55/1000 births), hydrocephalus (1,3/1,000 births), spina bifida and anencephaly (0,78 and 0,40/1,000 births respectively) and facial clefts (0,30/1,000 births). These rates were compared with those found in other population groups in South Africa and, in some cases, in other African countries and in Negro groups in the USA and Canada.     

Teaching 3D sculpting to facial plastic surgeons

This article describes the authors' course, which takes facial plastic surgeons through specific exercises to demonstrate the esthetic impact of 3D manipulations of the nose and face. The course components are described, which include 3D assessment, exercises in manual dexterity, and improving imagination in sculpting facial and nasal features for the optimal esthetic result and match to a given facial shape. The overlap and relationship between a course in 3D sculpting in facial plastic surgery and current 3D tools for design and image analysis being used for facial plastic surgery are discussed.     

Outcomes instruments in facial plastic surgery

The accurate measurement of patient-related outcomes of facial plastic surgery procedures relies upon the development, standardization, and use of validated, procedure-specific quality of life instruments. Although other fields of medicine and surgery have embraced the use of such instruments for the quantification and measurement of otherwise subjective or qualitative aspects of patient satisfaction, in the fields of both general and facial plastic surgery, little has been done in this realm. The study of outcomes research and the application of outcomes research to facial plastic surgery have already been discussed in this issue. Outcomes research is founded upon the ability to measure in some fashion those aspects of patient satisfaction that have hitherto been ignored or at best poorly quantified in the assessment of the results of a medical or surgical intervention. In facial plastic surgery, particularly cosmetic facial plastic surgery, the overwhelming majority of results are subjective in nature, be they patient related or based upon the surgeon's own personal assessment of outcome. For this reason, the use of validated instruments to quantify and measure these results is of particular importance in facial plastic surgery compared with other fields of medicine where many outcomes are objectively determined, such as mortality. This article outlines the background of the use of quality of life instruments in the field of outcomes research to provide a basic understanding for the application of such tools to the work of facial plastic surgery. Specific instruments that have already been developed and validated are described as well. Finally, future directions are highlighted that may allow the improved measurement of patient satisfaction as the field of outcomes research in facial plastic surgery continues to evolve.     

Microsurgical reconstruction of the smile—contemporary trends

The treatment of facial palsy is a complex and challenging area of plastic surgery. Microsurgical innovation has introduced the modern age of dynamic reconstruction for facial palsy. This review will focus on microsurgical reconstruction for smile restoration in patients with long‐standing facial palsy. The most common donor muscles and nerves will be presented. The advantages and disadvantages of single‐stage versus multi‐stage reconstruction will be discussed. Contemporary trends will be highlighted and the authors' preferred practice outlined. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013     

A professional duty to heal!

The rules of South African law are analysed, especially any possible rules which may impose a duty upon a medical practitioner to heal in cases where the patient refuses treatment. The conclusion is reached that a refusal of medical treatment expressed on behalf of a minor child or an unconscious patient might safely be ignored by a medical practitioner, but that an express refusal by a major patient of full legal capacity should be heeded. It is also concluded that, according to South African law, there rests no legal duty upon a medical practitioner to treat a patient where such treatment--even if necessary to save the patient's life--is refused by the patient himself. Therefore, where the conditions imposed by a Jehovah's Witness preclude a medical practitioner from practising good medicine, he should refuse the case.     

George Warwick Bampfylde Daniell, 1864-1937

In 1907 Dr G. W. Bampfylde Daniell was the first doctor to be appointed an anaesthetist in a South African hospital. Little is known about his work, but due acknowledgement must be made to his pioneering efforts to place anaesthesia on a sound scientific basis, and to his various contributions towards making the specialty safe and comfortable. During his career in South Africa, he played an active role in the then Cape of Good Hope, Western Branch, of the British Medical Association.     

Plastic surgery and the biometric e-passport: Implications for facial recognition

Abstract

This correspondence comments on the challenges of plastic reconstructive and aesthetic surgery on the facial recognition algorithms employed by biometric passports. The limitations of facial recognition technology in patients who have undergone facial plastic surgery are also discussed. Finally, the advice of the UK HM passport office to people who undergo facial surgery is reported.     

Perioperative antibiotic usage by facial plastic surgeons: national survey results and comparison with evidence-based guidelines

OBJECTIVES: To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines. METHODS: A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines. RESULTS: Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary. CONCLUSIONS: Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.     

Useful tools for prone position: ProneView and OPTI-GARD]

For prone position except for neurosurgery or cervical spinal surgery, head and neck are usually turned sideways on the pillow. This position has a risk of injuries to eyes, nose, lips, ears, or facial nerve and inducing neck pain after surgery. We introduce new tools to avoid these complications from prone position. The ProneView consists of a plastic helmet with a window for eyes, nose and mouth, a sponge to fit the face attached to the helmet, and a mirror to watch eyes, nose and lips. The OPTI-GARD is the glasses made by a sponge with a plastic windows to protect eyes. Using the ProneView and the OPTI-GARD together, patient's neck and head can be kept at neutral position with eyes, nose, lips, and ears being kept free from any pressure. In addition, we can check the position of the face easily by mirror. Therefore, the ProneView and the OPTI-GARD must be useful to decrease injuries to eyes, nose, lips, ears, and facial nerve, and neck pain in prone position.     

Sudden death of a champion athlete. Autopsy findings

We report the autopsy findings after the sudden death of a champion swimmer. The athlete was asymptomatic and had only recently retired from a sport in which he had been the South African captain for 4 years and the national record holder in the 400 m medley event. He died suddenly shortly after returning from a 5 km run. At autopsy there was histological evidence of hypertrophic cardiomyopathy.     

Laparoscopic urology training in South Africa

BACKGROUND AND PURPOSE: Laparoscopic urologic surgery is not widely practiced in South Africa. After presenting a laparoscopic training course, we evaluated how effectively this training translated into clinical practice. SUBJECTS AND METHODS: Invitations to the course were sent to all South African urologists. Ten applicants attended the course, which consisted of dry and in-vivo animal surgery. Two questionnaires were sent out after the course. Questionnaire 1 (at course completion) aimed at identifying the precourse laparoscopic experience and expectations of the trainee. Questionnaire 2 (6 months postcourse) assessed how much laparoscopic surgery the participant had performed since the course. RESULTS: Seventeen percent of all South African urologists responded to the invitation. Prior to the course, 40% of trainees had performed >or=10 laparoscopic cases, 30% had performed <10 cases, and 30% had never performed laparoscopy, whereas 60% expected to be doing one or two cases a month after completing the course. Six months after the course, 60% had performed no laparoscopic cases. Of the three trainees who had never before done laparoscopic procedures, none had started to perform procedures since the course. The commonest procedures performed were varicocelectomy and diagnostic laparoscopy for nonpalpable testis. CONCLUSIONS: A hands-on laparoscopic training course to introduce laparoscopic urology into South African private urology practice has not translated into a satisfactory number of clinical cases being performed. The causes are likely multifactorial but are greatly influenced by social and economic forces. One possible solution may be to offer a mentor-based training program.     

A型肉毒毒素在美容整形外科的临床应用分析

目的:探讨在美容整形外科使用A型肉毒毒素进行面部除皱的临床效果。方法:选取在我院美容整形外科进行面部除皱治疗的患者共184例,根据面部皱纹情况分为鱼尾纹组(72例)、眉间纹组(53例)、额纹组(42)和混合组(17例),分别采用不同的注射方法及注射剂量对不同部位的皱纹进行处理,观察各组皱纹改善效果,并调查患者的满意度。结果:鱼尾纹组治疗有效率为94.5%,眉间纹组为88.7%,额纹组为95.2%,混合组为76.5%,四个组的满意度分别为94.4%、92.5%、92.9%、88.2%,组间比较无统计学意义(P>0.05)。结论:在面部除皱美容中局部应用A型肉毒毒素,可以显著改善患者的面部皱纹情况,疗效显著,且可提高患者的满意度,值得推广应用。     

Preoperative Identification of Psychiatric Illness in Aesthetic Facial Surgery Patients

The purpose of this study was to evaluate the preoperative use of a two-part standardized assessment program (Prime-MD, Biometrics Research Department, New York State Psychiatric Institute) to objectively detect psychiatric disorders in facial plastic surgery patients, and to compare its use to findings identified by the facial plastic surgeon. Seventy-five new patients requesting aesthetic facial surgery at two academic centers and two private practice locations were evaluated.     

Preoperative assessment of the aging patient

The issues related to preoperative evaluation and facial analysis for patients undergoing facial rejuvenation procedures are discussed in this article. A key component of the preoperative evaluation begins with a thorough understanding of the patient's concerns and desires for improvements. Other components of the evaluation should include a detailed assessment of the patient's medical and psychiatric history, informed consent, and photographic documentation. Additionally, we discuss facial changes associated with aging, paying special attention to some of the differences that occur between male and female patients. Different aesthetic scales and their applications in facial plastic surgery are also presented. Finally, we consider the process of facial analysis in the context of common facial plastic procedures including rhytidectomy, blepharoplasty, browlift, and minimally invasive techniques.     

颜面部整形患者术前情绪状态测评

目的:研究颜面部整形美容患者术前的情绪状态,为术前准备和术后综合治疗提供依据。方法:用焦虑自评量表(SAS)和抑郁自评量表(SDS)对33例整形美容外科受术者进行术前测验,同时用33名正常人作为对照组。结果:手术组SAS 和SDS得分分别为49.75±6.59和54.02±9.79,以SAS和SDS≥50为界值,结果显示得分明显高于对照组。结论:颜面部整形美容患者在术前存在着较明显的焦虑和抑郁情绪反应。     

Psychological issues in patient outcomes

This article provides an overview of the psychological issues of facial plastic surgery patients. It begins with a review of the research on the preoperative psychological characteristics of cosmetic surgery patients. Results from the studies assessing postoperative changes in psychological status are reviewed. The psychological issues of specific patient groups, including adolescents and male patients, are discussed. Individuals who undergo plastic surgical procedures as a result of craniofacial anomalies or facial injuries often face a myriad of psychosocial challenges. These issues are outlined in brief. The article concludes with a discussion of two psychiatric conditions, body dysmorphic disorder and posttraumatic stress disorder, that may be frequently encountered by facial plastic surgeons.     

William Jolly--father of medical science in South Africa

William Jolly graduated in medicine at Edinburgh University in 1906 and became research assistant to Sir Edward Sharpey Schafer. He also mastered various techniques in electrophysiology under Einthoven, graduating D.Sc. in 1911. In 1911 he was appointed first Professor of Physiology and in 1918 first Dean of the Faculty of Medicine at the University of Cape Town. He conducted and stimulated research there and in recognition thereof was awarded an Honorary LI.D. by Edinburgh University and a special allowance from the University of Cape Town. He was President of the Royal Society of South Africa, a trustee of the South African Museum and a member of the National Research Council and Board.     

整形美容修复技术在急诊面部创伤治疗中的应用

探讨在急诊面部创伤患者中采用整形美容修复技术治疗的价值。方法 选取2023年1月-5月 广州医科大学附属第六医院/清远市人民医院急诊诊治的137例面部创伤患者为研究对象，根据入院时间将 其分为对照组（n =69）和观察组（n =68）。对照组予以常规外科修复治疗，观察组予以整形美容修复技术 治疗。比较两组创面愈合优良率、并发症发生率及面部美观程度。结果 观察组创面愈合优良率为89.71%， 高于对照组的75.36%（P ＜0.05）；观察组并发症发生率为7.35%，低于对照组的18.84%（P ＜0.05）；观察 组术后面部总体美观、皮肤颜色及面部对称性评分均高于对照组（P ＜0.05）。结论 在急诊面部创伤患者 中采用整形美容修复技术治疗能够促进创面愈合，改善面部美观度，且具有较高安全性。