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Maintenance of nasal airway in rhinoplasty: role of spreader grafts
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Abstracts
Maintenance of nasal airway in rhinoplasty: role of spreader grafts T. Fattahi University of Florida College of Medicine, Department of Oral-Maxillofacial and Head & Neck Surgery, Jacksonville, FL, USA Background: Rhinoplasty is an exceedingly popular procedure worldwide. One of the most critical component of rhinoplasty is the maintenance of airflow. Objectives: The role of spreader grafts and other types of grafting will be evaluated as they relate and impact airflow during rhinoplasty. Methods: Indications, surgical technique and specific grafting techniques will be evaluated in a cohort of patients undergoing rhinoplasty. Findings/conclusion: Appropriate and precise placement of spreader grafts and other types of grafting materials will enhance the functionality of the nose and maintain airflow.
4. Cross-face sural graft for overstimulation, prophylactic treatment, or as main treatment in cases of facial paralysis with less than 3 months of duration. 5. Microvascular muscle transfers for long-standing facial paralysis 6. Temporal muscle elongation for long-standing facial paralysis not suitable for microvascular techniques Clinical cases representative of each group will be shown. The main goal of a Facial Paralysis Unit is to offer every medical and surgical option to each particular patient with facial paralysis. The decision should be individualized considering the characteristics of each case as well as the patient’s preference. http://dx.doi.org/10.1016/j.ijom.2015.08.933 Medication related osteo necrosis of the jaws (MRONJ) myths busted A. Goss 1,2
http://dx.doi.org/10.1016/j.ijom.2015.08.931
1 2
Improvement in the microsurgical reconstruction R. Fernandes University of Florida College of Medicine, Jacksonville, USA Today, more than ever, our patients’ expectations have changed significantly from previous years. No longer are they satisfied with a ‘successful’ reconstruction. The vast majority of patients expect to have a reconstruction that restores their function and delivers a near normal pre-disease esthetic. This presentation will highlight various approaches, adjunctive techniques and an overall philosophy to predictably deliver a pleasing reconstruction for our patients. http://dx.doi.org/10.1016/j.ijom.2015.08.932 Facial reanimation: where do we stand in 2015? T. González-Otero ∗ , M.J. Morán, J. González Martin-Moro, J. Gui˜nales, E. Gómez, M. Burgue˜no Department of Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain The aim of this paper is to present our experience in the surgical treatment of patients with both short-term and long-term facial paralysis on the basis of a 12-year old Facial Paralysis Unit Different surgical options will be discussed depending on the duration of the paralysis, the aetiology, the patient’s preference, and the presence of viable nerve and muscles. The outcome, pros and cons, and surgical tips of each technique will be emphasized. Surgical techniques will be divided in the following groups: 1. Nerve grafts from the mastoid portion of the facial nerve to distal extratemporal branches in tumours involving the stylomastoid foramen 2. Hypoglossal-facial with hemi-end to end anastomosis to the intratemporal facial nerve with or without cross-face sural grafts (in one or two stages) 3. Masseter-facial with direct anastomosis to the intratemporal facial nerve or with great auricular jump graft, with or without cross-face facial sural grafts (in one or two stages)
The University of Adelaide, Adelaide, Australia Royal Adelaide Hospital, Adelaide, Australia
Myths abound around the nature, incidence, causes and management of MRONJ. This will be appraised and confirmed or busted. http://dx.doi.org/10.1016/j.ijom.2015.08.934 Skeletal management of craniofacial microsomia A.A.C. Heggie Department of Plastic & Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Australia Craniofacial microsomia (CFM) may present with features ranging from a mild unilateral mandibular hypoplasia to gross facial asymmetry involving hypoplasia of the temporozygomatico-orbital complex, masticatory muscles and mandibular condyle/ramus unit together with cranial nerve palsies. While the advent of mandibular distraction was initially recommended for this condition, many units are re-evaluating this approach although in selected patients (eg. infants with OSA) distraction may be indicated. Costo-chondral grafting to establish a more functional ramus/condyle unit remains our preferred reconstruction for the medially-placed (Kaban) Type IIB and Type III cases. However, the combination of inherited skeletal patterns and unpredictable graft growth can make the final skeletal deformity a major surgical challenge for correction. The records of patients who underwent costo-chondral grafting over the past 17 years and who then reached skeletal maturity were retrieved. Of the 13 cases identified, all required orthognathic surgery (bimaxillary – 9 mandible – 4, genioplasty – 12). In several patients, difficulties were encountered in the sagittal section of the previous ramus/body graft site due to the altered anatomy. The neurovascular bundle is at considerable risk as its path varies considerably and is usually encased within cortical bone. Levelling of the occlusal plane in extreme cases may be unstable due to difficulty in overcoming muscular forces during mandibular repositioning. The magnitude of chin repositioning is much greater than may be anticipated as the soft tissue drape follows only in a most reduced hard to soft tissue ratio. Cases illustrating the final skeletal correction will be
Abstracts
Maintenance of nasal airway in rhinoplasty: role of spreader grafts T. Fattahi University of Florida College of Medicine, Department of Oral-Maxillofacial and Head & Neck Surgery, Jacksonville, FL, USA Background: Rhinoplasty is an exceedingly popular procedure worldwide. One of the most critical component of rhinoplasty is the maintenance of airflow. Objectives: The role of spreader grafts and other types of grafting will be evaluated as they relate and impact airflow during rhinoplasty. Methods: Indications, surgical technique and specific grafting techniques will be evaluated in a cohort of patients undergoing rhinoplasty. Findings/conclusion: Appropriate and precise placement of spreader grafts and other types of grafting materials will enhance the functionality of the nose and maintain airflow.
4. Cross-face sural graft for overstimulation, prophylactic treatment, or as main treatment in cases of facial paralysis with less than 3 months of duration. 5. Microvascular muscle transfers for long-standing facial paralysis 6. Temporal muscle elongation for long-standing facial paralysis not suitable for microvascular techniques Clinical cases representative of each group will be shown. The main goal of a Facial Paralysis Unit is to offer every medical and surgical option to each particular patient with facial paralysis. The decision should be individualized considering the characteristics of each case as well as the patient’s preference. http://dx.doi.org/10.1016/j.ijom.2015.08.933 Medication related osteo necrosis of the jaws (MRONJ) myths busted A. Goss 1,2
http://dx.doi.org/10.1016/j.ijom.2015.08.931
1 2
Improvement in the microsurgical reconstruction R. Fernandes University of Florida College of Medicine, Jacksonville, USA Today, more than ever, our patients’ expectations have changed significantly from previous years. No longer are they satisfied with a ‘successful’ reconstruction. The vast majority of patients expect to have a reconstruction that restores their function and delivers a near normal pre-disease esthetic. This presentation will highlight various approaches, adjunctive techniques and an overall philosophy to predictably deliver a pleasing reconstruction for our patients. http://dx.doi.org/10.1016/j.ijom.2015.08.932 Facial reanimation: where do we stand in 2015? T. González-Otero ∗ , M.J. Morán, J. González Martin-Moro, J. Gui˜nales, E. Gómez, M. Burgue˜no Department of Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain The aim of this paper is to present our experience in the surgical treatment of patients with both short-term and long-term facial paralysis on the basis of a 12-year old Facial Paralysis Unit Different surgical options will be discussed depending on the duration of the paralysis, the aetiology, the patient’s preference, and the presence of viable nerve and muscles. The outcome, pros and cons, and surgical tips of each technique will be emphasized. Surgical techniques will be divided in the following groups: 1. Nerve grafts from the mastoid portion of the facial nerve to distal extratemporal branches in tumours involving the stylomastoid foramen 2. Hypoglossal-facial with hemi-end to end anastomosis to the intratemporal facial nerve with or without cross-face sural grafts (in one or two stages) 3. Masseter-facial with direct anastomosis to the intratemporal facial nerve or with great auricular jump graft, with or without cross-face facial sural grafts (in one or two stages)
The University of Adelaide, Adelaide, Australia Royal Adelaide Hospital, Adelaide, Australia
Myths abound around the nature, incidence, causes and management of MRONJ. This will be appraised and confirmed or busted. http://dx.doi.org/10.1016/j.ijom.2015.08.934 Skeletal management of craniofacial microsomia A.A.C. Heggie Department of Plastic & Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Australia Craniofacial microsomia (CFM) may present with features ranging from a mild unilateral mandibular hypoplasia to gross facial asymmetry involving hypoplasia of the temporozygomatico-orbital complex, masticatory muscles and mandibular condyle/ramus unit together with cranial nerve palsies. While the advent of mandibular distraction was initially recommended for this condition, many units are re-evaluating this approach although in selected patients (eg. infants with OSA) distraction may be indicated. Costo-chondral grafting to establish a more functional ramus/condyle unit remains our preferred reconstruction for the medially-placed (Kaban) Type IIB and Type III cases. However, the combination of inherited skeletal patterns and unpredictable graft growth can make the final skeletal deformity a major surgical challenge for correction. The records of patients who underwent costo-chondral grafting over the past 17 years and who then reached skeletal maturity were retrieved. Of the 13 cases identified, all required orthognathic surgery (bimaxillary – 9 mandible – 4, genioplasty – 12). In several patients, difficulties were encountered in the sagittal section of the previous ramus/body graft site due to the altered anatomy. The neurovascular bundle is at considerable risk as its path varies considerably and is usually encased within cortical bone. Levelling of the occlusal plane in extreme cases may be unstable due to difficulty in overcoming muscular forces during mandibular repositioning. The magnitude of chin repositioning is much greater than may be anticipated as the soft tissue drape follows only in a most reduced hard to soft tissue ratio. Cases illustrating the final skeletal correction will be