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Crack Smiles

Stephen G. Rothstein, MD; Paul Gittelman, MD; Mark S. Persky, MD
JAMA. 1991;265(12):1528. doi:10.1001/jama.1991.03460120042026.
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To the Editor.—  A new form of facial trauma is occurring among the drug addict population in New York City. The Department of Otolaryngology at the New York (NY) University Medical Center has treated six patients over the past 6 months with facial lacerations involving the facial nerve and, less frequently, the parotid duct. These injuries were deliberately inflicted by drug pushers or other addicts in order to create a scar to serve as a reminder to others of the punishment that would occur for a "bad deal."The lacerations are linear and clean, inflicted with a razor blade or knife. The injuries extend from the tragus to the oral commissure and are called "half-smile" (if unilateral) or "smile" scars (if bilateral). On the street, they are also known as "life marks."The facial nerve is identified proximal and distal to the injury and reanastomosis is performed with a fine


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