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The temporalis muscle flap revisited on its centennial: Advantages, newer uses, and disadvantages
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New mini-osteotomy of the infraorbital nerve in bony decompression for endocrine orbitopathy
No full textEndocrine orbitopathy is a systemic complex disease that involves the orbital contents. The symptoms are exophthalmos and correlated. The surgical techniques used to correct this condition can be fat decompression by the Olivari technique, 3-wall bony decompression, or the combination of these 2 surgical strategies, the ancillary procedure. Fat decompression is indicated when the intraconal and extraconal fat tissue is increased, whereas bony decompression is used in the presence of extraocular muscle involvement, associated with a normal quantity of intraconal-extraconal fat. Surgical techniques include the transconjunctival approach and ostectomy of the medial wall (when possible through endoscopy), orbital floor, and lateral wall of the orbit.Complications of this type of intervention are often represented by sensitivity disorders of the second branch of the trigeminal nerve, compressed by the intraorbital contents when they prolapse into the sinus. Possible sensitivity disorders are paresthesia, anesthesia, hypoaesthesia, dysesthesia, and hyperesthesia.The innovation introduced by the first author in 2007 consists of a mini ostectomy around the infraorbital foramen with removal of bone fragment. This determines relaxation of the nerve and makes easier the descent toward the sinus, allowing a larger expansion of the orbit contents. The absence of compression significantly reduces the sensitive complications. After treatment of the basic disease, surgical indications should be given according to the Werner classification. Fat decompression with the coronal approach is almost entirely abandoned for the transconjunctival approach, which allows adequate exposure of the lower orbit.The use of mini ostectomy of the infraorbital foramen combined with a 3-wall bony expansion showed a significant reduction of sensitive complications that often cause patient discomfort
Total facial rehabilitation: The evolving concept of reconstructive surgery
No full textTotal facial rehabilitation requires an understanding of the contributing components of the so-called aging face syndrome. This syndrome may be due to atrophy of the jaws or may result from ablative surgery for cancer. The aging face requires correction of every anatomic component (i.e., facial skeleton, dentoalveolar processes, and soft tissue). The surgical armamentarium includes maxillofacial osteotomies, autogenous bone grafts, biomaterials, internal rigid fixation, and other ancillary procedures. The introduction of osseointegrated implants has allowed the surgeon to use a stable base on which a prosthesis can be built with functional and aesthetic long-lasting results. Last, but not least, repositioning of the facial mask is the "final touch" for these complex reconstructive procedures. The concept of total facial rehabilitation may be considered an evolution of reconstructive surgery. Surgical strategies, new technologies, as well as clinical cases will be presented
Dismantling and reassembling of the facial skeleton in tumor surgery of the craniomaxillofacial area. History, surgical anatomy, and notes of surgical technique: Part 1
No full textIn recent years, access osteotomies have been suggested to reach areas of the craniofacial skeleton that hitherto would not have been easily resectable. Some techniques of disassembling of the facial skeleton have been described in the past. In some cases, however, when the bony fragments were not pedicled to the soft tissue, reabsorption was noted. For this reason, new dismantling techniques with adequate blood supply to the bony fragments have been developed. Apart from the maxillo cheek flap, other composite flaps have been described. These flaps may be combined if necessary in selected cases. An overview of the surgical anatomy and surgical strategies will be presented. These reported techniques may be considered a major step forward in the treatment of deeply localized tumors in the craniomaxillofacial area
Use of the microsystem in craniomaxillofacial surgery: Preliminary report
No full textThe last few years have been astonishing technological advances in craniomaxillofacial surgery, with particular regard to the introduction of internal rigid fixation. This technique has allowed craniomaxillofacial surgeons to achieve more precise preoperative planning and use of modern techniques of fixation during surgery. As a result, rigid internal fixation has become popular and currently represents a keystone in maxillofacial surgery for trauma, deformities, orthognathic surgery, as well as reconstruction procedures following tumor resection. We review a 2-year experience with the use of microsystem in 45 patients
The use of the temporalis muscle flap in facial and craniofacial reconstructive surgery. A review of 182 cases
No full textThe authors report on their 16-year experience of reconstruction with the temporalis myofascial flap in 182 cases. All aspects of reconstructive cranio-maxillofacial surgery are covered: trauma, deformities, tumours, TMJ ankylosis, facial paralysis. The temporalis myofascial flap was used both as a single and as a composite flap with cranial bone, coronoid process or skin island. Major complications were not observed. On the basis of their experience, the authors confirm the reliability, versatility and reproducibility of the use of this flap. This is due both to its rich blood supply and to its proximity to the reconstruction site. It is suggested that the use of the temporalis muscle flap should be taken into consideration before deciding on more extensive reconstructive procedures
Osteoma of the frontoethmoidal sinuses: craniofacial resection and reconstructive strategy.
No full textFrontoethmoidal involvement by benign tumors may lead to aesthetic and functional sequelae. The key for removal of such lesions is a proper planned craniofacial approach based on the preoperative evaluation. If total extirpation requires resection of part of the forehead or orbit, immediate reconstruction is mandatory. In recent years, craniofacial techniques and strategies have become popular. Among these are the use of split cranial bone, rotation of skull bones, the use of galeal-pericranial flaps, and the introduction of internal rigid fixation. We present a case of frontoethmoidal osteoma treated with a combined craniofacial approach. For the reconstruction, modern principles of craniofacial surgery have been applied
Neurofibromatosis of the orbit and skull base
No full textVon Recklinghausen's disease is characterized by multiple neurofibromas, pigmentations, and pachydermatoceles of the skin depending on the disorder of the neural crest derivative. We report on a 25-year-old patient suffering from neurofibromatosis localized in the cranio-orbital region, whose main problem was a pulsating right exophthalmos caused by herniation of the frontotemporal lobe through a defect of the greater wing of the sphenoid. The lesion was approached through a combined route (i.e., transfrontally and transfacially [upper eyelid incision]). Surgical strategy and associated problems are discussed
Treatment of macroglossia in Beckwith-Wiedemann syndrome
No full textA case of macroglossia caused by Beckwith Wiedemann syndrome is reported. Beckwith-Wiedemann Syndrome is an overgrowth disorder characterized by a constellation of congenital anomalies. The most common manifestations are omphalocele, macroglossia, gigantism, and visceromegaly. When the tongue reaches a huge dimension, clinical symptoms are represented by dysphagia, alterations in speech, difficulty in chewing, obstruction of the upper airways, and psychologic consequences derived from the patient's physical appearance. The authors describe the surgical strategy performed in the reported case
Palpebral ptosis: Clinical classification, differential diagnosis, and surgical guidelines: An overview
No full textPalpebral ptosis indicates the abnormal drooping of the upper lid, caused by partial or total reduction in levator muscle function. It may be caused by various pathologies, both congenital and acquired. Based on a review of the available literature and on our own clinical experience, a classification is proposed as well as a differential diagnosis between ptosis and pseudoptosis. Some basic surgical guidelines related to age of onset and etiopathogenesis are drawn. Ptosis is divided into neurogenic, myogenic, aponeurotic, and mechanical. The aim of surgery is two fold: functional, to correct the limit in the visual field; and also aesthetic. From January 2000 to January 2004, 42 patients were referred and treated at the Unit of Cranio-Maxillofacial Surgery-Centre for Orbital Pathology and Surgery, Hospital and University, Ferrara, Italy. Of these, 12 cases were congenital and 30 acquired (13 were monolateral and 29 bilateral, for a total of 71 cases). The most widely used surgical techniques were levator muscle recession and frontalis suspension. In congenital forms, these techniques were often associated with techniques to correct oculo-muscular imbalance (i.e., strabismus).Seventy-one upper eyelids were treated, 5 of which were mild, 35 moderate, and 31 severe. Regarding levator muscle function, 60 were fair and 11 poor.Surgical treatment followed the indications and timing with good morphologic and aesthetic results. Complications included two cases of hypocorrection, two asymmetries, and two cases of hypercorrection. Surgical treatment of palpebral ptosis is complex and requires precise diagnosis and indications for surgery related to clinical examination and pathogenesis. Even if these indications are strictly followed, in some cases, the outcomes are unpredictable
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