CURRENT LITERATURE 801

ating fibers appears less after delayed repair. Clinically, the authors recommend exploration and repair of a damaged lingual nerve after 3 months if there is no evidence of pro- gressive recovery.-R.E. ALEXANDER

Reprint requests to Dr Smith: Department of Oral and Maxillofacial Surgery, University of Sheffield, School of Clinical Dentistry, Clare- mont Crescent, Sheffield St0 2TA, United Kingdom.

Endoscopic Forehead Lift: Aesthetics and Analysis. Dan- iel RK, Tirkanitis B. Clin Plast Surg 22:605, 1995

An extensive review of the literature combined with an on- going analysis of aesthetic patients shows that two aesthetic characteristics of forehead rejuvenation are evident. First, the aesthetics can be derived from the following five sources: classical art, make-up artists, current fashion models, anthro- pometric measurements on attractive individuals, and youth- ful versus aging changes. Second, the analysis often has the following progression: eyebrow level, eyebrow shape, periorbital esthetics, and forehead aesthetics. Facial type and eyebrow shape are important. The triad of browlift, anchor blepharoplasty, and lateral canthoplasty provide the maxi- mum improvement for the eyes. Normative values of the eyes provide anatomic standards. Patients seeking forehead lifts are usually younger patients who want their eyes opened, middle-aged patients seeking correction of the aging periorbital area, and older patients seeking total facial rejuve- nation. Traditionally, the goals of the forehead lift are to correct eyebrow ptosis, alleviate palpebral redundancy, elim- inate glabella frown lines, reduce transverse forehead lines, and minimize transverse radix lines. Eyebrow ptosis is pres- ent when the eyebrow is less than 10 mm above the eyelid margin, or the eyebrow falls below the supraorbital rim. Palpebral redundancy refers to pretarsal show, crease line definition, infrabrow heaviness, and lateral hooding. During the consultation it is tempting to divide the “etchings” of the forehead into three categories that the patient can understand. They are skin lines, permanent wrinkles, and dynamic folds. Surgical planning essentially consists of setting the objective and deciding on the surgical techniques to obtain these goals. -R.H. HAUG

Reprint request to Dr Daniel: 4114 Avocado Ave, Newport Beach, CA 92660.

Sialadenosis of the Salivary Glands. Pape SA, MacLeod RI, McLean NR. Br J Plast Surg 48419, 1995

Sialadenosis has been defined as a noninflammatory dis- ease causing recurrent bilateral swelling of the salivary glands, particularly the parotid, which may be painful. The etiology may be related to peripheral neuropathy of the auto- nomic nerve supply. The etiology in 50% of cases is related to endocrine abnormalities such as drugs, alcohol abuse, malnutrition, and diabetes. This study reviewed seven pa- tients with biopsy proven Sialadenosis. There were four male and three female patients between the ages of 21 and 67 (mean 46.7) years at presentation. Duration before presenta- tion ranged from 6 months to 2 years. Five of the seven had a history of excessive alcohol use, but none were diabetic. All routine laboratory analyses were normal except for 2 patients having elevated gamma glutaryltransaminase. Sialography, fine needle aspiration, and computed tomogra- phy (CT) scans were performed and were adequate for diag- nosis in four of seven patients. Three patients required open biopsy for diagnosis. Histologically the biopsy shows acinar diameter of 50 to 70 pm with a normal range of 30 to 40

pm Sialography is not as beneficial for diagnosis as CT, which will show fatty degeneration and prominent septa and fibrosis. Treatment options are currently li.mited and tym- panic neurectomy has been shown to have poor long-term results. Oral pilocarpine is a recent treatment modality that may show promise; however, further study is required. Sur- gery is an option reserved for those patients who desire cosmetic correction.-G.T. LYNAM

Reprint requests to Mrs Pape: Department of Plastic and Recon- structive Surgery, Newcastle General Hospital, Newcastle upon Tyne NF.4 6BE United Kingdom.

Brain Edema and Neurological Status With Rapid Infu- sion of Lactated Ringers or 5% Dextrose Solution Fol- lowing Head Trauma. Feldman Z, Zachari S, Reichenthal E, et al. J Neurosurg 83: 1060, 1995

Management of fluids in hypovolemic, head-injured pa- tients is controversial. Hypertonic saline has been suggested as the optimum solution for resuscitation because it rapidly re-establishes cardiovascular function, maintains normal in- tracranial pressures, and provides plasma expansion with only small volumes. Recent studies have suggested that com- plete resuscitation with hypertonic saline requires larger vol- umes than previously reported and found no advantage over normal saline infusions. However, rapid infusion of 0.25 r&/g of 0.9% (normal) saline over 30 minutes has not been shown to have any effect on electrolyte balance, neurological severity scores, or brain edema. The purposes of this study were to determine whether rapid infusion of a large volume of lactated Ringer’s solution or a smaller-than-usual volume of 5% dextrose solution could be given after closed head trauma without increasing mortality or brain edema, or pro- ducing electrolyte disturbances. Of 142 rats, 24 died immedi- ately after the closed head trauma. The authors randomly assigned the surviving 118 rats to 1 of 15 experimental groups. Selected groups of rats were infused beginning 1 hour after closed head trauma (via a mid-scalp incision) was administered with a standardized impact. Other groups received no closed head trauma, no infusion, or combinations thereof. Animals were killed at 4 and 24 hours. The groups treated with 5% dextrose solution had a significantly higher rate of mortality, but the neurological severity scores were no different than those of the control groups. Rats receiving lactated Ringer’s infusions showed no changes in electro- lytes, no increased brain edema, and plasma osmolality com- pared with nontreatment groups. The authors challenge the traditional recommendation that head-injured patients be subjected to fluid restriction. In this study, large amounts (up to 3 times the rat’s blood volume) of lactated Ringer’s solution had no adverse effects following closed head trauma. Dextrose-containing solutions, on the other hand, should be avoided because a higher mortality rate and tran- sient neurological deterioration can occur with those solu- tions.-R.E. ALEXANDER

Reprint requests to Dr Feldman: Department of Neurosurgery, Bay- lor College of Medicine, 6560 Fannin, Suite #900, Houston, TX 77030.

Fixture Stability and Nerve Function after Transposition and Lateralization of the Inferior Alveolar Nerve and Fixture Installation. Hirsch JM, Branemark PI. Brit J Oral Maxillofac Surg 33:276, 1995

Eighteen patients underwent placement of 63 Brlnemark (Nobelpharma USA, Chicago, IL) implants in the posterior edentulous mandible. A buccal cortical window was re-

CURRENT LITERATURE

moved that was 25 to 30 mm in length, 10 mm in height, posterior to the mental foramen, and exposing the inferior alveolar nerve. The fixtures were placed lingually to the nerve with gentle buccal retraction of the nerve. The goal of using this transposition technique involved the use of longer fixtures, but not the engaging of the lower cortex. If the lower cortex was to be engaged or difficulty was encoun- tered with the transposition, then the exposure was extended anteriorly to include the mental foramen. The incisive branch was cut and the main nerve was lateralized posteriorly. Then the implants were placed. Patients underwent follow-up neu- rological examination resulting in mean full restoration of nerve function at 3.8 weeks for the lateralization group and 5.7 weeks after transposition. The mean healing period be- fore stage II surgery was 5.8 months, 100% integration was obtained for the lateralization group, and 80% stability in the transposition group. Thus, the authors conclude that later- alizing the nerve is the preferred method to transposition during implant placement.-GREG TAYLOR.

Reprint requests to Dr Hirsch: Department of OMFS, University of Goteburg, Gothenburg, Sweden.

The Biplanar Endoscopically Assisted Forehead Lift. Os- lin B, Core GB, Vasconez LO. Clin Plast Surg 22:633, 1995

The biplanar browlift has distinct advantages that, at

times, warrant its use over the use of the pure endoscopic lift or the standard bicoronal lift. Patients with “high” foreheads (greater than 7.0 cm) who may or may not have had previous standard bicoronal forehead lifting are not candidates, be- cause they could not tolerate further recession of their frontal hairline. Patients with very ptotic eyebrows, who would oth- erwise require marked advancement of the forehead skin, are candidates because hairline recession is obviated by this prehairline approach. Patients with deep transverse forehead wrinkles benefit from this procedure because the initial dis- section on top on the frontalis muscle allows for redraping of the forehead skin over the muscle. Additionally, patients with eyebrow asymmetry can have it corrected via this ap- proach. The technique uses a prehairline incision that extends transversely just within the hairline of the scalp. The subcuta- neous elevation is performed for 3.0 to 4.0 cm in between the two frontotemporal lines. Before plication, the subcutaneous elevation is extended in the midline approximately 4.0 cm after which a rent is made in the midline aponeurosis to connect the second plane of dissection, subperiosteally. The subperiosteal dissection continues to the supraorbital rims bilaterally, the periosteum is divided, nerves protected and corrugator muscle avulsed. The procerus muscle is resected and then the frontalis muscle is plicated. The skin is then closed, and a suction drain placed.-R.H. HAUG.

Reprint request to Dr Oslin: UAB Plastic Surgery, 1813 6th Ave S, MEB-524, Birmingham, AL 35284-3295.