Surgical Correction of Facial Deformities Varghese Mani
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1Surgical Correction of Facial Deformities2
3Surgical Correction of Facial Deformities
Editor Varghese Mani MDS Professor and Head Department of Oral and Maxillofacial Surgery and Principal Mar Baselios Dental College, Kothamangalam Kerala, India
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Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Surgical Correction of Facial Deformities
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2010
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The memory of My parents Mr MV Mani and Mrs Achamma Mani who have been my leading lights6
7Contributors 9Foreword
During the past three decades, the pioneering work of Dr Varghese Mani has greatly enhanced and inspired the work of other maxillofacial and plastic surgeons in India.
In 1806, Sir Charles Bell wrote a series of essays under the title of “The Anatomy of Expression” which in truth was a detailed study of the muscles of the face and its bearing on facial expression and the shades of human emotion. Bell's work fascinated both artists and surgeons but most of all the surgical artists who called themselves plastic or reconstructive surgeons. In their enthusiasm many of these men forgot that behind the complex play of muscle and soft tissue, there lay the bony foundations of the face. Great artists like Leonardo da Vinci realized this before we surgeons did.
These artists talked about a face with a good bony structure and taught that only a face with a good bony structure stood the ravages of time. The so-called pretty face without a good bony foundation disappears like the mist, with the first flush of youth.
Years ago, Dr Varghese Mani came to see me work on clefts. Working with him, I began to understand the foundations of the face, I realized how much the soft tissues depended upon a sound foundation and how important it was to build from the bottom that my results began to improve by leaps and bounds. As a result, and for the first time, very late in life, I matured into a true cleft surgeon.
You can imagine then how thrilled I was when Dr Varghese Mani asked me to write a foreword to his book. It gives me an opportunity to acknowledge his influence in teaching me that a good face lies in its bony structure.
To work adequately on the face, a plastic surgeon must be something of a maxillofacial surgeon and vice versa, am I suggesting that in the near future these two disciplines will merge? I would not be too surprised if they do.
Surgical Correction of Facial Deformities is not just another textbook of Maxillofacial Surgery. The first chapter “Evolution of Face and Beauty Through Time” sets the tone to this remarkable volume wherein has gone a life-time of single-minded devotion to the healing of all the internal scars that external deformities can cause. In the chapter on “Surgical Treatment” the author has poured out his vast experience on the correction of these complex deformities of the face giving it a very personal touch. In the second chapter, “Etiology of Facial Deformities” the author touches on the psychological aspects of deformities, an important feature of this sort of work he says, “It has been observed that good looking and attractive people are more successful, intelligent and skilled than unattractive people“. This on its face value seems absurd, but if you go to the next line the author says “An unattractive person is usually seen as less intelligent and socially awkward by his peers and associates. They gradually consider themselves as thus and become so”. This is exceptional insight into human psychology—shows how people become what they think they are. The chapter on “Troubleshooting in Orthognathic Surgery” is not only meant for the novice surgeon. It stresses the need for sound knowledge of the anatomy of the area, good planning, careful execution and meticulous postoperative care. It touches on the fundamentals of all good surgery, never forgetting that any operation is an insult to the system and the advantages must always outweigh the price that is paid.
This book is a labor of love and I am told by the author that it has taken 3 years in gestation. It has the touch of a master which the author truly is.
HS Adenwalla
Emeritus Professor of Surgery
Head of the Department of Plastic and Reconstructive and Burns Surgery
Head of the Charles Pinto Centre for Cleft Lip, Palate and Craniofacial Anomalies
Jubilee Mission Medical College and Research Institute
Trichur (Kerala), India10
The importance of face is eloquently expressed in the maxim ‘Face is the index of the mind’. Great philosophers, artists, scientists and architects of the past like Plato, da Vinci, Michelangelo, Phidias and others, have realized the importance of beauty and its relation to function. Recent researches indicate that beautiful people are often more successful in life (may be due to the higher level of self confidence); though this is not always true. A study by the author, on the proportion of the facial structures in lieu of evolution, indicates that, by each advancement, the hominid species, gets closer to the ‘Golden / Divine proportion’. To reach perfection in proportion (beauty), we, Homo sapiens, may take another one million years of evolution through two more advanced species, provided, we do not face the wrath of nature, leading to our extinction.
Surgical correction of facial deformities has achieved a status of its own as a specialty of Maxillofacial and Plastic Surgery. Conceived as a textbook for residents and aspiring young surgeons, this could be useful to the practicing surgeons as well, who would like to hone their skills in orthognathic and facial esthetic surgery.
I am delighted and privileged that Dr HS Adenwalla, a world renowned cleft lip and palate surgeon, has contributed two chapters on cleft lip and palate, in this book. He being my mentor, philosopher and guide, has penned the foreword as well. My gratitude to him is boundless.
The predecessor to this book, ‘Orthognathic Surgery- Esthetic Surgery of the Face’, published by Jaypee Brothers Medical Publishers in 1995, was well received by practitioners, faculty and students. However, the fast and ever-expanding technological and scientific advancements made this book a little vapid, and demanded something more than a mere revised edition of it. This conviction, along with nudging from fellow surgeons, pressure from students and request from the publisher, made me venture into the writing of this new textbook, Surgical Correction of Facial Deformities.
The first chapter of this book, “Evolution of Face and Beauty Through Time”, is the result of a pet research project of mine. I am grateful to my co-authors, Dr Eldho T Paul and Mr KS Harish Kumar, for their invaluable help in preparing this chapter.
I express my sincere gratitude to all the contributors. No effort has been spared in making this book as informative and up-to-date as possible.
May I present this book to the fraternity.
Varghese Mani12
I am immensely grateful to Dr HS Adenwalla, a world renowned cleft lip and palate surgeon, who is my mentor, philosopher, guide and friend. He has not only contributed two chapters, but also written the foreword, which has added value to this book.
The contributors were magnanimous to respond positively to my request to author some of the chapters. I place on record my sincere gratitude to them.
Dr George Eipe, a senior colleague has reviewed the entire text and has given timely advice. My gratitude to him is beyond words. My thanks are due to my beloved wife, Mini, for giving me moral support and helping me in this project.
My confidential assistant Mr KP Vinod, and office staff Mr Jerry Jose, Mr Ebin Elias and Mr Basil T Varghese were helpful in typewriting the text and drawing the diagrams. I acknowledge the help rendered by my colleagues, Dr Bobby John, Dr Vinod Sankar, Dr Arun George, Dr Tojan Chacko, Dr Ranjith Kumar P, Dr Anthony George, Dr Giju George, Dr Eldho T Paul and Dr Sajad Salam, and my students, Dr Abie Paulose, Dr Mathew James, Dr Chancy U, Dr Jalaja KP, Dr Manu Johns, Dr Roshna M Bava, Dr Remya Kareem and Mr Abin Varghese in preparing the case reports and compiling the references. I put on record my gratitude to the management of Mar Beselios Dental College and the Secretary, Mr Salim Cherian, and Administrator, Mr Mathew Varghese, for supporting me in this project. Many others have helped me directly and indirectly in the preparation of this book. My thanks are due to them as well.
Most important is my gratitude to Jaypee Brothers Medical Publishers, a leading firm of medical publishers in the continent, for publishing this book in a beautiful format.