Facial Reconstructive Controversies

Mark K. Wax, MD, FACS, FRCS(C), Editor

The field of Facial Plastic and Reconstructive Surgery continues to expand on many different fronts. Teaching in this area of surgical expertise has become a fundamental part of all residency programs. The knowledge base of Facial Plastics comprises up to 20% of the Otolaryngology requirements of the certifying exam. Not only do most Otolaryngologists utilize the knowledge that has been taught by the facial plastic surgeons but also they use the skills learned in their residency on a day-to-day basis. Whether it is for the pediatric patient who needs a cleft revised, or the otology patient who needs tissue rearrangement to cover a cochlear implant, facial plastic surgery is a fundamental part of patient care in the many subspecialties of Otolaryngology. With the integration of facial plastic and reconstructive surgery into the armamentarium of most Otolaryngologists has come a burgeoning in the knowledge of what once were rare fields in Facial Plastic Reconstructive Surgery. This in turn has led to the expansion of knowledge and technical approaches to many areas of facial plastic and reconstructive surgery that were only practiced by a few in academic centers.

The facial plastic reconstructive surgeon is now faced with an array of management tools that can be offered to patients. Along with this has come interest in evidence-based medicine. Not only is the number of publications concerning evidence-based medicine in the field increasing but also textbooks, such as a recent Facial Plastic Surgery Clinics of North America , was dedicated to the subject of evidence-based medicine in facial plastic reconstructive surgery.

A review of the literature in this area reveals that more and more authors are not only reviewing their own results but also analyzing and comparing, on an evidence-based method, what are some of the benefits or drawbacks to current management paradigms of a broad variety of diseases. With this has come the natural development of controversy. In each of many different areas, some more common than others, there are topics in the management of the patient that are not well defined. The maturing of the specialty has seen a critical analysis of the pros and cons of many techniques and foundations of knowledge.

This issue of Facial Plastic Surgery Clinics of North America has asked a number of experts in various subspecialties to analyze the controversial areas in their area of expertise. By discussing the pros, cons, and future directions, we will continue to learn what is the best option for the treatment of our patients. We also should be able to discuss and discover when different options offer the same outcomes. It has been a pleasure to work with such esteemed experts on such a controversial project.

I can only end by acknowledging the leaders in the field of facial plastic and reconstructive surgery who have always examine their outcomes and results and sought to improve patient care. Continuing evaluation of outcomes is essential to maintaining the best possible practices for our patients. The field is strong and will only continue to grow as younger surgeons are taught by such exemplary professionals.

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