1,721,009 research outputs found
The role of maxillary osteotomy in the treatment of arhinia
No full textPurpose: Arhinia is a very rare malformation, and only 41 cases are described in the literature. Given its rarity, there is no standardized surgical protocol. This article describes our preferred treatment, which underlines the importance of maxillary osteotomy for obtaining satisfactory results. Methods: We observed 3 girls with arhinia, 2 of whom were treated by a 2-step surgical protocol. During the first phase, the patients underwent maxillary osteotomy with the creation of a new epithelium-lined nasal cavity. A skin expander was also placed in the forehead. During the second step, an external nose was created in both patients from the expanded forehead flap with local perinasal flaps and costochondral grafts. Results: Both reconstructions were viable and esthetically acceptable. No internal nose restenosis was observed. Conclusions: On the basis of our experience, maxillary osteotomy should be considered part of an integrated approach in treating arhinia
Deep-planes lift associated with free flap surgery for facial reanimation
No full textBetween April 1999 and April 2008, 37 patients with long-standing facial paralysis underwent a one-stage facial reanimation with neuromuscular free flaps: 28 patients (group A) underwent flap transposition only; 9 patients (group B) underwent a deep-planes lift (DPL) composed of the superficial muscoloaponeurotic system + parotid fascia at the time of facial reanimation. The postoperative and final results were compared between groups A and B, following the classification of Terzis and Noah (1997). Before the onset of contraction, only group B patients (100%) showed good or moderate symmetry at rest, while none of the patients of group A had a symmetric face.
The respective final results for patients in groups A and B who already showed the onset of flap contraction were excellent in 28.6% and 44.5%, good in 42.9% and 33.3%, moderate in 10.7% and 22.2%, and fair or poor and fair in 17.8% and 0% of patients, respectively. The DPL allows immediate symmetry of the face at rest and contributes to upgrading the final static and dynamic results in facial reanimation with free muscular flaps
Upper eyelid reconstruction with forehead galeal flap
No full textIntroduction: Upper lid reconstruction depends on the size of the defect, and a general consensus holds that partial-thickness defects can be reconstructed using simple or composite grafts. Full-thickness defects involving up to 30% of the upper lid are repaired easily by direct suturing with or without upper lid sliding flaps. When defects affect more than 50-70% of the upper lid, complex reconstruction is needed. Traditionally, this devolves upon lower lid flaps, as in the Cutler-Beard and Mustardé techniques. These methods share intrinsic disadvantages, such as donor site morbidity and the need for two surgical sessions to detach the flap pedicle. To our knowledge, upper lid reconstruction with a grafted forehead galeal-pericranial flap has not been previously reported. This proves to be an excellent reconstructive option for extensive upper lip defects. Moreover, it has many advantages over other reconstruction techniques, such as technical ease and very low donor site morbidity. Furthermore, it is a single-stage procedure. We present our experience with five extensive upper lid reconstructions using galeal-pericranial forehead grafted flaps. Materials and methods: Five patients needed major upper lid reconstruction, which consisted of a galeal-pericranial forehead flap grafted with oral mucosa and retroauricular skin. Four of them had had the lid removed surgically for oncological reasons, while one patient suffered from orbital-periorbital fasciitis. Results: All of the flaps and grafts survived. The functional and morphological results were satisfying, and no complications were noted. Conclusions: The forehead galeal-pericranial flap appears to be an excellent instrument for upper lid reconstruction. Compared to other techniques, it has the advantages of simplicity and very minimal donor site morbidity. Moreover, it does not necessitate a two-stage surgical procedure
Functional disturbances of the inferior alveolar nerve following sagittal osteotomy of the ramus mandibulae: preventive surgical technic
No full textPermanent functional disturbances of the inferior alveolar nerve after sagittal osteotomy of the ramus of the mandible form an increasingly common feature of the reported series. Reference is made to earlier experimental research in a description of a preliminary series in which this complication was avoided by cleaving the two cortical substances with a thin cement spatula used as a scalpel. The results were extremely encouraging. There were no reports of permanent functional disturbances of the alveolar nerve, while the incidence of temporary defects was also reduced
Reconstructive possibilities in oncological surgery of the lips
No full textThe authors face the problem of the treatment of tumours of the lip. First of all they express their own opinion about the choice between surgery and radiotherapy, specifying the reasons why they prefer in some cases one therapy and in others the other one. When they use surgical treatment, it is their duty to look not only at the oncological result, but to take care of the functional and aesthetic point of view. So, after the operation, it is very important to ensure complete lip closure without microstomia, with a good mobility and sensibility and an appearance as normal as possible. Beyond these aims we must comply with the aesthetic demands, as we work on the patient's face. So the reconstruction must be performed immediatly after the surgical removal and when it is possible, by means of local flaps. Actually the reparation performed with these kind of flaps simulates fairly well the original lip and often the scars are hidden in the natural lines of the face. In order to describe the different procedures used in the surgical treatment of these tumours, the authors classify these in: tumours of the lower lip; tumours of the vermillion; tumours of the labial commissure and tumours of the upper lip. Furthermore, for the neoplasms of upper and lower lip, they consider the extension of surgical removal (less than 1/3 of total lip length; from 1/3 to 2/3; more than 2/3). For everyone of these situations they choose and describe the surgical methods which, in their opinion, are most suitable to yield the best functional and aesthetic results
Craniofacial growth in patients with unilateral cleft lip and palate: an intercentre study
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Cephalometric evaluation of posterior airway space in unilateral cleft lip and palate patients
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