The Innovator of Electrosurgery Hemostasis has been a major risk in the surgical field, causing Halsted to preach for the need for better control of bleeding to improve the morbidity and mortality many surgeons faced at the time. This problem, while combated by suturing methods for many, remained an issue in the neurosurgical field. Dr. Cushing sought out the help of William Bovie, leading to the creation of electrosurgery. This invention changed the way surgery could be performed and remains to be a mainstay in the operating room and countless other procedures, withstanding the test of time and proving its importance in the surgical world. Address correspondence and reprint requests to Katie Marrero, MD, 1045 Baytowne Drive, Apt 11, Champaign IL 61822; E-mail: Marrero.ka@gmail.com Received 16 April, 2019 Accepted 4 June, 2019 The authors report no conflicts of interest © 2019 by Mutaz B. Habal, MD.

Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction: Analysis of Frequency, Preoperative Complaints, and Benefit From Surgery No abstract available

Review of “An Economic Evaluation of the National Surgical Quality Improvement Program (NSQIP) in Alberta, Canada” by Thanh NX et al in Ann Surg 269: 866–872, 2019 No abstract available

Review of “Surgical Consultation as Social Process” by Clapp JT in Ann Surg 269: 446–452, 2019 No abstract available

Duraplasty Using Autologous Fascia Lata and Latissimus Dorsi Free Flap for Chronic CSF Leak Cerebrospinal fluid (CSF) leak is a common complication after cranial surgery. Therefore, after neurosurgical procedures it is crucial to obtain a dural repair that is complete and watertight. There are many techniques that have been described attempting to achieve this goal. However, there are complicating factors (eg, poor tissue viability, need for future radiation, comorbidities, infection, size of the dural defect, multiple operations) that may require a more comprehensive approach to achieve an optimal healing environment. The authors present a technique that uses a muscle free flap to vascularize an autologous fascia lata graft, preserving the viability of the graft and reinforcing its healing ability. The authors applied this technique to a single patient with chronic CSF leak from poor tissue healing after treatments for recurrent medulloblastoma. After harvesting a fascia lata graft with appropriate size, the graft was sutured into the dural defect in a watertight fashion. A latissimus dorsi muscle free flap was harvested and anastomosed to a saphenous vein Corlett loop/AV fistula to the facial artery. The flap was than sutured to the graft. A drain was left in place and a skin graft was applied to the muscle flap. At 8 months follow-up the patient was able to continue with her treatment and has had a stable repair without leak or breakdown. The authors present an algorithm to facilitate dural repair selection. Duraplasty using autologous fascia lata reinforced with a free muscle flap is an effective technique to control chronic CSF leaks, especially when the dura is poorly vascularized and less viable. Address correspondence and reprint requests to Stephan Barrientos, MD, University of Nebraska Medical Center, Division of Plastic and Reconstructive Surgery, 983270 Nebraska Medical Center, Omaha NE 68198-3270; E-mail: barrientoss07@yahoo.com Received 11 April, 2019 Accepted 19 May, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Incidence of Pneumothorax Experienced After Orthognathic Surgery The purpose of this study is to evaluate the frequency of pneumothorax following orthognathic surgery and describe its clinical presentation. A retrospective analysis of a hospital database was carried out on consecutive patients with normal presurgical clinical assessment, laboratory findings, and chest X-ray who underwent orthognathic surgery from January 2007 to September 2018 in the Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Two patients (0.038%), 1 male (age 20 years) and 1 female (age 32 years), complained of respiratory difficulty and chest pain and were clearly diagnosed with postoperative pneumothorax by radiographic chest X-rays from a sample of 5229 consecutive patients during the study period. Intercostal drainage under local anesthesia was performed immediately and the treatment effects for both patients were satisfactory. The present study findings indicate that although orthognathic surgeries can be safely performed in patients with craniofacial anomalies, some unexpected complications such as pneumothorax may occur. Therefore, accurate postoperative follow-up must be done in every patient to monitor possible clinical complications. Patients who experience respiratory difficulty and postoperative chest pain may have pneumothorax, and once it is diagnosed, treatment should be promptly carried out to eliminate further severe sequelae. Address correspondence and reprint requests to Xudong Wang, DDS, MD, and Lei Zhang, DDS, PhD, Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 200011, People's Republic of China; E-mail: xudongwang70@hotmail.com; oral66@126.com Received 26 April, 2019 Accepted 11 May, 2019 KL and TZ contributed equally to this work. This project was supported in part by the Three-Year Plan for Clinical Skill and Innovation Ability Training in Shanghai Municipal Level Hospitals (grant no. 16CR3019A), the Clinical Research Program of the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (grant no. JYLJ006), the Interdisciplinary Program of Shanghai Jiao Tong University (project number YG2017ZD03), and the Shanghai Science and Technology Committee (project no. 18410712000). The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Endonasal Endoscopic Management of Pterigopalatine Fossa Hydatid Cyst Hydatid cyst (echinococcosis) is an infectious disease caused mainly by Echinococcus granulosus, a parasite transmitted by dogs and encountered 1st in the liver and then in the lungs. Involvement in the head and neck region is uncommon, and pterygopalatine fossa disease resulting from hydatid cyst is extremely rare, with only 4 reported patients. In this report, the authors present a patient with exophthalmus caused by a primary hydatid cyst and involving the pterygopalatine fossa which treated only with endoscopic endonasal approach. Address correspondence and reprint requests to Muhammet Fatih Gökmen, MD, Darende Hulusi Efendi Hospital, Zaviye District, Haci Hulusi Efendi, Street No 22, 44700 Darende, Malatya, Turkey; E-mail: mfatihgokmen@gmail.com Received 28 April, 2019 Accepted 11 May, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

One-Step Triple-Layer Reconstruction of an Exposed Calvarium in a Radiated Tinea Capitis Patient Full-thickness large scalp defects with underlying exposed calvarium pose a significant reconstructive challenge. Traditional reconstructive techniques are usually not an option in patients with irradiated scalp with thin skin and reduced laxity. Dermal substitutes-based reconstruction techniques have been described in recent years. A common approach is the staged methodology, with the initial application of skin substitute followed by a split-thickness skin graft few weeks later; however, this method involves a prolonged period of local wound management prior to skin grafting and is often associated with complications that interfere with wound healing. This report describes a single-stage triple-layer technique for the reconstruction of a large scalp defect with exposed bone in a patient with a history of radiation treatment, using 3 turnover pericranial flaps in conjunction with a Matriderm dermal substitute and split-thickness skin graft. This immediate multilayered reconstruction provides a long-lasting structural and aesthetic outcome, with minimal donor site morbidity and reduced complications. Address correspondence and reprint requests to Tamir Shay, MD, 39 Ze’ev Jabotinsky St, Petach Tikva 4941492, Israel; E-mail: yotamir@clalit.org.il Received 20 March, 2019 Accepted 9 May, 2019 TS and LH-S have equal contribution to the manuscript. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Use of Stock Titanium Mesh Plates in Cranioplasty Craniofacial surgeons are often confronted with major defects of the calvarium. These most commonly are post-traumatic but could also be consequent upon neurosurgical procedures, infection, or tumor removal. There are several options available to reconstruct these defects including autogenous, heterogeneous, and alloplastic material. The goal is to have a method that is easy, cost-effective, with minimal complications, and long-lasting. In our unit we review 100 cases of the use of stock titanium mesh during a 5-year period. Complications occurred in 5 patients (5%) with 3 exposures, 1 late seroma and 1 case requiring repositioning of the plate following trauma. None of the patients required removal of the plate. Address correspondence and reprint requests to Professor Anil Madaree, FRCS(Eng), FCS(Plast)(SA), Department of Plastic Surgery, Inkosi Albert Luthuli Central Hospital, Private Bag X03, Mayville, Durban 4058, South Africa; E-mail: madaree@ukzn.ac.za Received 15 October, 2018 Accepted 13 May, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Morphological Eyelids Changing After Orthognathic Surgery in Long-Face Syndrome Purpose: The aim of the authors study is to demonstrate the soft tissues changes in the eyelid–brow area (ELBA) in patients with long-face syndrome after LeFort I osteotomy and impaction movements. Materials and Methods: To perform this study the authors have analyzed retrospectively orthognathic patients with at least 1 years of completely follow-up. The inclusion criteria were: long-face syndrome according to Farkas’ studies and vertical maxillary shortening movement without considering whether movements have been made in the other 2 planes of space (sagittal and horizontal). Orthognathic patients in which the maxillary impaction movement did not correlate to the long-face syndrome represented the control group. In this group too the authors did not consider if other movements were performed. Size and shape of the eyelid and the eyebrow was assessed on the frontal patients photos calibrated on the three-dimensional soft tissue volume imported from cone beam computed tomography. Two reference lines were taken: a horizontal line from the nasal point passing through both medial canthal angles and a perpendicular line through the pupil centre bilaterally. Then the measures were taken. The same operator (A.C.) took all of the measurements. In both groups, the preoperative measures were then compared with the postoperative ones. Then the soft tissue changes in both groups were compared. Results: The results demonstrate different reaction of the ELBA after orthognathic surgery. The ELBA's position changes in long-face patients in a higher position after maxillary impaction. The authors did not obtain the same results in patients who do not have long-face syndrome. Conclusions: Repositioning skeletal bases in patients with long face causes a change in the ELBA's morphology. Address correspondence and reprint requests to Giulia Amodeo, MD, Via Francesco Saverio Nitti 9, 00191 Rome, Italy; E-mail: gamodeo@live.it Received 3 September, 2018 Accepted 13 May, 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.