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Nasal reconstruction is considered the historic foundation of facial plastic surgery, and the forehead flap remains the workhorse of repair. To recreate both the aesthetic contour and function of the nose, all anatomic layers must be addressed—covering, lining, and structural support. This article reviews the noteworthy history underlying the development of the paramedian forehead flap as the primary tool in reconstruction of large nasal defects while highlighting its implications on modern nasal repair. Current developments in the use of 2-staged paramedian forehead flap reconstruction are examined and a modern technique is presented.

Introduction Facial paralysis (FP) has many functional consequences with a large impact on daily life. Although an association with FP and depression has been observed and described in the literature, there are currently no large-scale studies to further validate this correlation. Our goal was to determine whether patients with FP become depressed at a higher rate compared with matched controls. Methods We performed a retrospective cohort study using MarketScan Commercial Claims and Encounters Database by Truven Health. From the database, all inpatient and outpatient claims with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for FP and depression between 2005 and 2013 were extracted. Patients younger than 18 years were categorized as children and those 18 years or older as adults. Patients were subcategorized as having a history of depression if a diagnosis of depression preceding a diagnosis of FP was noted. We matched each patient to a control in the MarketScan database based on age, sex, and state of residence. We compared rates of depression between these patients and matched controls using conditional logistic regression. The method of Kaplan and Meier was used to estimate cumulative incidence curves of depression by each group. Results Approximately 57,941 patients were identified with International Classification of Diseases, Ninth Revision, codes for FP. Among children and adult patients without a diagnosis of depression before the index date for FP, 6.4% (285) and 9.7% (4733), respectively, had a diagnosis of depression within 2 years of the diagnosis of FP. Matched controls showed depression rates within 2 years of 3.9% for children (P < 0.001) and 6.1% for adults (P < 0.001). Conclusions The present study adds to the current body of knowledge on FP and depression given its large sample size and analysis of adult and pediatric populations over 2 years. Indeed, we found that depression rates were significantly increased in both adults and children as compared with matched controls. Our results suggest a need for long-term depression screening in patients with FP.

Objectives/Hypothesis Evaluate bone resorption in free fibular grafts and document resorption behavior as compared to dentulous and edentulous autochthonous mandibular bone. Study Design Retrospective Chart review. Methods Postoperative computed tomography images were used to evaluate fibular graft resorption rates and corresponding sites of the dentulous or edentulous mandible. Bone height, width, and cortical thickness were measured. Results Eighteen patients underwent fibula free flap reconstruction following resection of a primary head and neck cancer. Mandibular defects were classified using Jewer's classification. The average interval loss of osseous height was 0.23 ± 0.09 mm/yr for fibula flap, 0.55 ± 0.13 mm/yr for dentulous native mandible, and 0.98 ± 0.41 mm/yr in edentulous native mandible. Change in osseous width was 0.19 ± 0.08 mm/yr, 0.55 ± 0.33 mm/yr, and 0.73 ± 0.15 mm/yr, respectively. Rate of superior cortical resorption was 0.33 ± 0.34 mm/yr, 0.35 ± 0.13 mm/yr, and 0.53 ± 0.11 mm/yr in fibula flap, dentulous, and edentulous mandible, respectively. Inferior cortical resorption rates were quantified as 0.30 ± 0.11 mm/yr, 0.35 ± 0.08 mm/yr, and 0.51 ± 0.08 mm/yr. Conclusions Fibula free flap reconstruction of the mandible provides excellent functional results and allows for stable outcomes. Bone resorption is significantly lower in fibular graft compared with both edentulous and dentulous mandible. Edentulous bone displays significantly increased rates of atrophy in comparison to the dentulous mandible. This may have implications with regard to long‐term viability of both the fibular flap and native mandible. The role of dental restoration on overall osseous stability warrants further research. Level of Evidence 4 Laryngoscope, 129:1113–1116, 2019

Fractures of the frontal sinus occur from extreme forces and are often associated with other injuries. Management of frontal sinus fractures is variable and dependent on involvement of the anterior table, posterior table, and frontal outflow tract. Severe complications can developed from poorly managed fractures, such as meningitis, mucocele, mucopyocele, and brain abscess. Surgeons should be aware of appropriate management and surgical techniques for addressing frontal sinus fractures. Herein, we review the presentation and management of frontal sinus fractures, including conservative, endoscopic, and open surgical techniques.