Orbital Observation Chart: Significant in Orbital Fractures or Not? Purpose: The study was conducted to assess the efficacy of orbital chart in detecting postoperative complications of orbital fractures. Materials and Methods: A retrospective study was conducted in the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2011 to December 2016. It included all the patients with orbital fractures who underwent surgical intervention for reduction of the fracture in the study. We recorded data for the type of fracture, type of intervention, and orbital and ocular changes. Orbital changes measured and charted for 5 parameters which were: pain, proptosis, visual acuity, size of the pupil, and pupillary reaction to direct light reflex. Results: Two hundred thirty-six patients with orbital fractures underwent surgical intervention during these 5 years. The prevailing type of fracture for which they required orbital intervention remains zygomatic complex fractures (69%). The treatment protocol depended on the pattern and displacement of fracture and age of the patient. Pain was the most common symptom among these parameters (15.7%). Conclusion: Orbital chart monitoring represents a straightforward and effective method to detect any complications after surgical management of orbital fractures. Address correspondence and reprint requests to Rajarshi Ghosh, ITS Dental College and Hospital, Delhi-Meerut Road, Asalat Nagar, Uttar Pradesh 201206, India; E-mail: rgeverywhere3788@gmail.com Received 1 March, 2019 Accepted 18 August, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.

Early Pediatric Nasal Reconstruction Utilizing the Tagliacozzi Flap The Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were required to position the medial arm fasciocutaneous flap over the nasal construct. The arm was immobilized for 3 weeks to allow for vascularization of the recipient bed. The child successfully tolerated the splint. She has improved breathing and nasal contour. Address correspondence and reprint requests to Alex A. Kane, MD, Children's Medical Center, 1935 Medical District Dr., Dallas, TX 75235 Received 6 June, 2019 Accepted 13 August, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Effect of Eyelid Involvement in the Reconstruction of Medial Canthal Defects Following Tumor Excision: Retraction No abstract available

Logistic Regression Analysis of Risk Factors for Intracranial Infection After Multiple Traumatic Craniotomy and Preventive Measures Background and Objective: The aim of this study was to study the risk factors of intracranial infection after traumatic craniotomy in multiple trauma to provide references for clinical prevention and control of intracranial infection. Methods: A total of 34 multiple trauma patients treated with craniotomy and complicated with intracranial infection from February 2012 to December 2016 in the department of neurosurgery of our hospital were selected as infection group, and 60 multiple trauma patients who had not been infected after craniotomy during the same period were selected as control group. Related risk factors were screened by univariate analysis at first and analyzed by Logistic regression. Results: Of the 34 patients in the infection group, 13 cases were cured, 21 cases improved, whereas in the control group, 15 cases were cured and 45 cases improved. There was no significant difference in prognosis between the 2 groups (P > 0.05). Univariate analysis showed that surgical approach, surgical duration, postoperative cerebrospinal fluid leakage, and external drainage were important factors for intracranial infection after craniotomy (P < 0.05). Further Logistic regression analysis showed that postoperative external drainage, cerebrospinal fluid leakage, surgical time, and posterior fossa approaches were independent risk factors for intracranial infection after craniotomy. Conclusion: High attention should be paid to the risk factors of intracranial infection after craniotomy such as postoperative cerebrospinal fluid leakage, external drainage, surgical duration and approach, and taking effective preventive measures to reduce the incidence of intracranial infection after craniotomy in patients with multiple traumatic injuries. Address correspondence and reprint requests to Dong Liu, Department of Otorhinolaryngology head and neck surgery, Jiaozhou People's Hospital, Qingdao, Shandong Province 266300, China; E-mail: wueshru328438@163.com Received 14 February, 2018 Accepted 19 July, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

The Gladiator's Tears: Epiphora From Ancient Rome This article examines the clinical presentation of epiphora in Ancient Rome through the historico-medical analysis of the literary evidence provided by the verses by the poet Juvenal in his Satire VI. A gladiator's ophthalmological problem is interpreted as epiphora caused by traumatic injuries to the craniofacial region, compatible with those described in the paleopathological literature. This analysis also focuses on the history of epiphora in antiquity and its treatment. Address correspondence and reprint requests to Michael E. Habicht, Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland; E-mail: michael.habicht@iem.uzh.ch Received 6 July, 2019 Accepted 9 July, 2019 FMG and MEH contributed equally to this work. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Bicanalicular Lacerations: Clinical Characteristics and Surgical Outcomes With a New Bicanalicular Silicone Stent Background: Bicanalicular lacerations are relatively rare and more of a surgical challenge in clinical practice. The purpose of this study is to evaluate the clinical characteristics and surgical outcomes of bicanalicular lacerations with a new bicanalicular silicone stent at a tertiary eye care center. Methods: All patients who underwent bicanalicular lacerations repair from January 2013 and December 2018 were retrospectively reviewed. Data collected for each patient included patient demographics, affected sides, cause of injuries, the timing of management, associated ocular injuries, the timing of stent removal, duration of follow-up and the outcomes of the surgical repair with a new bicanalicular silicone stent. Results: Thirty-six patients with bicanalicular lacerations met the inclusion criteria and were enrolled in the study. The mean age of the patients was 43.8 years old (range: 2–73years). Of the 36 patients, 33 (91.7%) were males and 3 (8.3%) were females. The right eye was injured in 17 patients (47.2%). All patients underwent surgical intervention within 24 hours. The most common cause of bicanalicular lacerations was electric bicycles accidents (7 patients, 19.4%), and followed by motor vehicle accidents (6 patients, 16.7%), blunt objects (6 patients, 16.7%), fights (6 patients, 16.7%), falls (3 patients, 12%), dog bites (2 patients, 5.6%), hook injuries (2 patients, 5.6%), broken glass (2 patients, 5.6%), and sharp objects (2 patients, 5.6%). The most common associated ocular injuries were orbital fracture (61.1%), followed by lid lacerations and open globe injuries. The functional success rate was 86.1%. The average interval between the surgery and the stent removal was 13.8 weeks (range: 8–20 weeks). All the stents were removed successfully without any difficulty in the outpatient department. The follow-up after stent removal ranged from 2 to 12 months (mean: 5.1months). Conclusions: Bicanalicular lacerations involvement occured in 6.8% of all canalicular lacerations. The most common cause of bicanalicular lacerations was electric bicycles accidents and the most common associated ocular injuries was orbital fracture in North China. The new bicanalicular silicone stent achieved good functional success (86.1%) in the management of bicanalicular lacerations. Address correspondence and reprint requests to Shaolei Han, MD, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, No. 399, Quanbei East Street, Xingtai, Hebei 054000, China; E-mail: hanshaolei06@163.com Received 20 July, 2019 Accepted 17 August, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.

Treatment of Traumatic Depressed Compound Skull Fractures Background: A skull fracture widely occurs in patients with traumatic brain injury, leading to intracranial hematoma, brain contusion, and intracranial infection. It also influences the prognosis and death of patients. This study aimed to discuss cases of patients with comminuted skull fractures. Methods: From October 2015 to December 2018, 38 patients with comminuted skull fractures were admitted to the hospital. All patients underwent three-dimensional reconstruction of computed tomography scan images. Digital subtraction angiography or magnetic resonance venography was performed to find out the venous sinus. The clinical findings of the patients were significant regarding gender, age, injury mechanism, location, admission Glasgow Coma Scale (GCS), combined epidural, subdural, cerebral contusion, intracranial pneumatosis, maximum depth of depression, admission to surgery, dural tear, post-operative cerebrospinal fluid leakage, post-operative infection, and Glasgow Outcome Scale (GOS) 3 months after surgery. Results: The incidence of traffic accidents, fall from a height, railway accidents, fall of an object, and chop injury was 60.5%, 18.4%, 13.2%, 5.3%, and 2.6%, respectively. Intra-operative dural trar negatively correlated with epidural hematoma, cerebral contusion, and subdural hematoma. Also, post-operative infection negatively correlated with intracranial pneumatosis, depth of fracture depression, and pre-operative cerebrospinal fluid leakage. No correlation was found between contusion, subdural hematoma, intracranial pneumatosis, depth of fracture depression, and post-operative infection. The GOS score positively correlated with age, pre-operative cerebrospinal fluid leakage, and admission GCS score. Conclusions: A perfect pre-operative examination is a key to successful surgery. Further studies should be conducted to find out more effective treatments for traumatic comminuted skull fractures. Address correspondence and reprint requests to Xiaochun Jiang, Wannan Medical College, Department of Neurosurgery, Yi-Ji Shan Hospital, Zheshan West Road on the 2nd.,Wuhu, Anhui, China; E-mail: jiangxiaochun2001@hotmail.com Received 23 July, 2019 Accepted 17 August, 2019 XS and QW are the co-first authors. This study was funded by the priority of research funds of Wannan Medical College (Grant No. WK2017ZF04), the teaching quality and teaching reform project of Wannan Medical College (Grant No. 2018jyxm58) and the Collegiate Major Natural Science Research Projects (Grant Nos. KJ2018ZD027 and KJ2017A267), Anhui Province, China. The authors have no conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.

Spontaneous Idiopathic Cerebrospinal Fluid Rhinorrhea Cerebrospinal fluid rhinorrhea is described as cerebrospinal fluid flow through the nose due to the abnormal connection of the subarachnoid space and sinonasal cavity. Spontaneous idiopathic rhinorrhea is a rarely seen disease. Besides the patient's clinical presentation detailed radiological evaluation and other invasive procedures must be carried out to confirm the diagnosis. Its treatment is compelling due to high recurrence rates. In the treatment algorithm when conservative treatment modalities had been proven inadequate, surgical repair must follow in order. In this paper the authors present the details of 2 cases of spontaneous rhinorrhoea patients. Address correspondence and reprint requests to Gulden Demirci Otluoglu, MD, Merdivenkoy Mah., E5 üzeri, 23 Nisan Sk. No. 17, 34732 Kadiköy, Istanbul, Turkey; E-mail: guldendemirci@gmail.com Received 23 July, 2019 Accepted 18 August, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Experience of Replantation and Reconstruction in Total Scalp, Partial Forehead, and Ear Avulsions In this study, the authors present the challenges of replantation and management of 2 patients who have total scalp, partial forehead and ear avulsion. A 39-year-old male farmer was admitted to the emergency room with the total scalp, forehead, partial right eyebrow and upper eyelid amputation after his hair was catched by an agricultural machine. Anastomoses of 2 arteries and 2 veins in the occipital region were done first. Anastomosis of the right and left superficial temporal arteries and veins were performed end to end by turning the operating table without moving the head, followed by 1 vein anastomoses in the frontal region. Although anastomotic blood flow was observed by Doppler ultrasonography, there were changes suggesting necrosis in the frontal and both temporoparietal regions and later in the occipital region. Necrotic tissues began to be debrided tangentially from the 10th day. During serial debridement, it was observed that the necrotic tissue includes skin and connective tissue. At the end of the post-operative second month, surgical treatment was completed and 12 months after the surgery, the patient lives with the wig because of hair loss, but the patient is cosmetically satisfied. An 18-year-old female gatherer was admitted to the emergency room with the total scalp, both eyebrows, right upper eyelid and partial right ear avulsion, after her hair was catched by an agricultural machine. Totally, anastomoses of 4 arteries and 3 veins were performed. On the 10th post-operative day, necrotic skin findings appeared and serial debridement were performed and it was revealed that aponeurosis was fully intact. The defect areas of skin and connective tissue were repaired with STSG. Intact partial temporal scalp tissue was present. Scalp replantation should always be considered as the first choice, according to the similar tissue principle of tissue repair in plastic surgery if there is no contraindication. Additionally, performing multiple arterial and vein anastomoses, evaluating the patient position in the post-operative period for anastomosis and hemodynamic follow-up, avoiding aggressive debridement and early reconstruction may give the patient the chance of skin grafting which is the basis of the reconstructive ladder. Address correspondence and reprint requests to Mehmet Emin Cem Yildirim, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine Hospital, Necmettin Erbakan University, 42080, Konya, Turkey; E-mail: dr.cem_yildirim@hotmail.com Received 23 July, 2019 Accepted 18 August, 2019 The authors have no conflicts of interest to disclose. © 2019 by Mutaz B. Habal, MD.

Surgical Treatment for Facial Port Wine Stain by Prefabricated Expanded Cervical Flap Carried by Superficial Temporal Artery Background: Port wine stain (PWS) is a congenital benign vascular malformation. Laser treatment is the main therapy for PWS. But some patients are not sensitive to it, and failed laser treatment will leave scars on face. Hence in this study, the authors used prefabricated flap carried by superficial temporal artery to treat PWS. Methods: Nine patients diagnosed with large-scaled PWS (occupying more than half of the cheek) from January 2008 to December 2017 were selected in the study. One of them did not finish the treatment. Eight patients completed all scheduled treatments. In the first stage, superficial temporal vessels were transferred to the donor site and then an expander was implanted. About 80 to 150 days later, PWS was removed and the prefabricated flap was used to repair the wound. All the 8 patients were followed-up for 10 months to 36 months. Results: Prefabricated flap survived well. All patients are satisfied with the appearance. The color and texture of prefabricated flap is similar to the surroundings. Conclusion: The combination of prefabricated flap and skin soft tissue expander not only extends the scale of flap but also enhances the efficacy of surgical treatment. It is a good candidate to treat PWS. Address correspondence and reprint requests to Yangqun Li, MD, The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba-da-chu Road, Shijingshan District, Beijing 100144, China e-mail: liyangqundoctor@163.com Received 8 January, 2019 Accepted 29 March, 2019 The authors report no conflicts of interest Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.