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Management of parotid sialocele after facial trauma creating a transoral salivary fistula: two case reports
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21st ICOMS 2013 - Abstracts: Oral Papers
T30.OR001
T30.OR003 Structured rhinoplasty using costal cartilage
T30.Rhinoplasty Planning of the nose shape in one-stage orthognathic and rhinoseptoplasty surgery A. Glushko 1,∗ , A. Drobyshev 1 , L. Pavluk-Pavluchenko 2 , K. Kurakin 1 , K. Lonskaya 1 1 Moscow 2
State University of Medicine and Dentistry, Russia Peoples’ Friendship University of Russia, Russia
Overview: In the modern world it is becoming more actual surgical treatment of patients with dentofacial anomalies, consisting in carrying out one-stage orthognathic surgery and rhinoseptoplasty. In this case, preoperative planning of the future nose shape has a number of features and complexity. Objective: To identify the features and estimate the predictability of the preoperative planning of the nose shape in case of one-stage surgery. Materials and methods: There were 21 patients (women 16–45) with different classes of malocclusion, who underwent one-stage orthognathic surgery and rhinoseptoplasty. Orthognathic protocol was consisted of the Le Fort I osteotomy, BSSO and genioplasty in case of necessity and rhinoseptoplasty was made by ‘close’ surgery protocol. Computer simulation of the future nose shape was made. Pre-surgical, on stage of planning, intra-surgical (after orthognathic and before rhinoseptoplasty) and post-surgical photos were made. All data regarding nose shape were correlated and analyzed. Results: In all 21 patients intraoperative nose deformation was marked. Improvement of the nose shape was found in 2 patient, and was required a small correction. In 7 patients there were significant change of the nose shape that was connected with severe malocclusion and facial asymmetry. A slight changes of the nose shape were marked in 12 patients. Changes of the nose shape were as type of worsening of an existing deformation or the change of one deformation type to another. After the orthognathic surgery in 3 patients the nose shape was changed from the ‘hump’ to ‘saddle’ type due to significant shift of nasal septum. In 18 patients changes varied within the range of available deformation. Conclusions: Changes of the nasal structures after orthognathic surgery have a varying severity. Therefore, the pre-surgical planning of the nose shape in patients with malocclusion is a complex task. Key words: rhinoplasty; rhinoseptoplasty; nose surgery; orthognathic surgery; surgical planning
M. Naves ∗ , L. Patrocinio Federal University of Uberlandia, Brazil The nasal reconstruction becomes extremely important in the rehabilitation of disfigured victims. This study aimed to describe the technique of structural rhinoplasty with autologous costal cartilage for nasal reconstruction in patients with saddle nose deformity and evaluate the aesthetic results, functional and patient. A descriptive study was conducted evaluating 10 patients with saddle nose who underwent structural rhinoplasty with costal cartilage graft. The preoperative symptoms were, more common, aesthetic complaints and nasal obstruction (100%), followed by nasal crusting (80%), epistaxis (70%) and nasal whistling (20%). Columellar retraction and asymmetry of the nasal tip were observed in 80% and 90% of patients. In total, 62.5% and 55.5% of patients showed improvement after surgery, respectively. Structural rhinoplasty with costal cartilage grafts permits a good quantity of cartilage in the manufacture of allowing a safe nasal reconstruction of the saddle nose. The use of diced cartilage wrapped with temporal fascia increased the nasal dorsum in patients with saddle nose and showed a lower risk of twisting and allowed a more natural appearance to the nasal dorsum with satisfactory result. The septal L-strut reconstruction was essential in structuring the nose leading to good functional outcome, improvement of nasal patency. http://dx.doi.org/10.1016/j.ijom.2013.07.619 T31.OR001
T31. Salivary Glands – Surgery Management of parotid sialocele after facial trauma creating a transoral salivary fistula: two case reports J. Argando˜na 1,2,∗ , T. Donoso 1 , O. Gahona 3,4 , L. Araya 3 , Y. Arévalo 3 1 Oral
and Maxillofacial Surgery, San Borja Arriaran Hospital, Santiago, Chile Oral and Maxillofacial Department, Faculty of Dentistry, Finis Terrae University, Santiago, Chile Oral Surgery Specialty Program, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Finis Terrae University, Santiago, Chile 4 Stomatological Medicine and Pain Clinic, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Finis Terrae University, Santiago, Chile 2
http://dx.doi.org/10.1016/j.ijom.2013.07.617 T30.OR002 Outpatient rhinoplasty under local tumescent anaesthesia: technical note and initial experience R. Jimenez Bellinga 1,∗ , A. Lopez Davis 2 , J. Giner Diaz 2 , J. Ruiz Cruz 3 1 2 3
Rino Estetica, Maxillofacial Surgeon, Private Practice, Madrid, Spain Maxillofacial Surgeon, Private Practice, Madrid, Spain Navarra University Clinic, Department of Oral and Maxillofacial Surgery, Pamplona, Spain
Background and objectives: We present our experience using the technique of tumescent local anaesthetic infiltration for nasal cosmetic surgery including osteotomies and functional surgery in the septum. Materials and methods: We present the technique of tumescent local anaesthetic infiltration step by step, as well as the surgical technique in a serie of 20 cases of cosmetic septorhinoplasty between November 1, 2012 until March 31, 2013. In all cases were performed septoplasty and osteotomies. Discussion: We try to show the adventages of this new technique in our private practice, reducing costs and offering another option to the patient. Every case was successfully performed, without pain or discomfort. Surgical time varied between 45 min and an hour and 35 min. Conclusions: Rhinoplasty performing local tumescent anaesthesia is a perfectly valid option in cases of purely cosmetic surgery of the nose and to correct septal cartilage disorders. It is cheaper and offers the same results than the traditional method. http://dx.doi.org/10.1016/j.ijom.2013.07.618
3
Sharp penetrating trauma of the face, besides causing a cosmetic defect, may also injure deeper anatomic structures. Lacerations in the cheek region may involve branches of the facial nerve, parotid gland or its duct, and vascular structures such as the transverse facial artery. Failure to recognize a parotid duct injury may result in the formation of a sialocele or cutaneous fistula. We describe a simple technique using intravenous tubing for the management of a persistent parotid sialocele. Case reports and technique: We report two cases with left sided swelling of the cheek following a penetrating injury to the same area which had occur 1 month earlier, skin was distended and had a thin friable appearance. Ultrasonography and aspiration of the fluids content confirmed the presence of a sialocele. Each of these cases was treated with surgical drainage using a transoral approach under general anesthesia. Local anesthesia was infiltrated into the buccal mucosa. Intravenous tubing was inserted through the parotid papilla on the first case and towards the back on the second. The free end was sutured to the oral mucosa using non absorbable suture (nylon 4-0) and it was left in place for 3 and 2 months respectively to allow maturation of a new salivary tract directing saliva intraorally. The sialoceles resolved with no recurrence over a follow up period of 1 year on the first case and 2 months on the second. Discussion: Many treatment modalities have been mentioned in the literature. They basically consist of a conservative or a surgical approach. When conservative management fails, or when the viability of the skin is imminently at risk, surgical treatment is indicated. Conclusion: This procedure is quick and easy to perform, has a low morbidity rate and is highly effective. Key words: parotid sialocele; intravenous tubing; salivary fistula http://dx.doi.org/10.1016/j.ijom.2013.07.620
21st ICOMS 2013 - Abstracts: Oral Papers
T30.OR001
T30.OR003 Structured rhinoplasty using costal cartilage
T30.Rhinoplasty Planning of the nose shape in one-stage orthognathic and rhinoseptoplasty surgery A. Glushko 1,∗ , A. Drobyshev 1 , L. Pavluk-Pavluchenko 2 , K. Kurakin 1 , K. Lonskaya 1 1 Moscow 2
State University of Medicine and Dentistry, Russia Peoples’ Friendship University of Russia, Russia
Overview: In the modern world it is becoming more actual surgical treatment of patients with dentofacial anomalies, consisting in carrying out one-stage orthognathic surgery and rhinoseptoplasty. In this case, preoperative planning of the future nose shape has a number of features and complexity. Objective: To identify the features and estimate the predictability of the preoperative planning of the nose shape in case of one-stage surgery. Materials and methods: There were 21 patients (women 16–45) with different classes of malocclusion, who underwent one-stage orthognathic surgery and rhinoseptoplasty. Orthognathic protocol was consisted of the Le Fort I osteotomy, BSSO and genioplasty in case of necessity and rhinoseptoplasty was made by ‘close’ surgery protocol. Computer simulation of the future nose shape was made. Pre-surgical, on stage of planning, intra-surgical (after orthognathic and before rhinoseptoplasty) and post-surgical photos were made. All data regarding nose shape were correlated and analyzed. Results: In all 21 patients intraoperative nose deformation was marked. Improvement of the nose shape was found in 2 patient, and was required a small correction. In 7 patients there were significant change of the nose shape that was connected with severe malocclusion and facial asymmetry. A slight changes of the nose shape were marked in 12 patients. Changes of the nose shape were as type of worsening of an existing deformation or the change of one deformation type to another. After the orthognathic surgery in 3 patients the nose shape was changed from the ‘hump’ to ‘saddle’ type due to significant shift of nasal septum. In 18 patients changes varied within the range of available deformation. Conclusions: Changes of the nasal structures after orthognathic surgery have a varying severity. Therefore, the pre-surgical planning of the nose shape in patients with malocclusion is a complex task. Key words: rhinoplasty; rhinoseptoplasty; nose surgery; orthognathic surgery; surgical planning
M. Naves ∗ , L. Patrocinio Federal University of Uberlandia, Brazil The nasal reconstruction becomes extremely important in the rehabilitation of disfigured victims. This study aimed to describe the technique of structural rhinoplasty with autologous costal cartilage for nasal reconstruction in patients with saddle nose deformity and evaluate the aesthetic results, functional and patient. A descriptive study was conducted evaluating 10 patients with saddle nose who underwent structural rhinoplasty with costal cartilage graft. The preoperative symptoms were, more common, aesthetic complaints and nasal obstruction (100%), followed by nasal crusting (80%), epistaxis (70%) and nasal whistling (20%). Columellar retraction and asymmetry of the nasal tip were observed in 80% and 90% of patients. In total, 62.5% and 55.5% of patients showed improvement after surgery, respectively. Structural rhinoplasty with costal cartilage grafts permits a good quantity of cartilage in the manufacture of allowing a safe nasal reconstruction of the saddle nose. The use of diced cartilage wrapped with temporal fascia increased the nasal dorsum in patients with saddle nose and showed a lower risk of twisting and allowed a more natural appearance to the nasal dorsum with satisfactory result. The septal L-strut reconstruction was essential in structuring the nose leading to good functional outcome, improvement of nasal patency. http://dx.doi.org/10.1016/j.ijom.2013.07.619 T31.OR001
T31. Salivary Glands – Surgery Management of parotid sialocele after facial trauma creating a transoral salivary fistula: two case reports J. Argando˜na 1,2,∗ , T. Donoso 1 , O. Gahona 3,4 , L. Araya 3 , Y. Arévalo 3 1 Oral
and Maxillofacial Surgery, San Borja Arriaran Hospital, Santiago, Chile Oral and Maxillofacial Department, Faculty of Dentistry, Finis Terrae University, Santiago, Chile Oral Surgery Specialty Program, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Finis Terrae University, Santiago, Chile 4 Stomatological Medicine and Pain Clinic, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Finis Terrae University, Santiago, Chile 2
http://dx.doi.org/10.1016/j.ijom.2013.07.617 T30.OR002 Outpatient rhinoplasty under local tumescent anaesthesia: technical note and initial experience R. Jimenez Bellinga 1,∗ , A. Lopez Davis 2 , J. Giner Diaz 2 , J. Ruiz Cruz 3 1 2 3
Rino Estetica, Maxillofacial Surgeon, Private Practice, Madrid, Spain Maxillofacial Surgeon, Private Practice, Madrid, Spain Navarra University Clinic, Department of Oral and Maxillofacial Surgery, Pamplona, Spain
Background and objectives: We present our experience using the technique of tumescent local anaesthetic infiltration for nasal cosmetic surgery including osteotomies and functional surgery in the septum. Materials and methods: We present the technique of tumescent local anaesthetic infiltration step by step, as well as the surgical technique in a serie of 20 cases of cosmetic septorhinoplasty between November 1, 2012 until March 31, 2013. In all cases were performed septoplasty and osteotomies. Discussion: We try to show the adventages of this new technique in our private practice, reducing costs and offering another option to the patient. Every case was successfully performed, without pain or discomfort. Surgical time varied between 45 min and an hour and 35 min. Conclusions: Rhinoplasty performing local tumescent anaesthesia is a perfectly valid option in cases of purely cosmetic surgery of the nose and to correct septal cartilage disorders. It is cheaper and offers the same results than the traditional method. http://dx.doi.org/10.1016/j.ijom.2013.07.618
3
Sharp penetrating trauma of the face, besides causing a cosmetic defect, may also injure deeper anatomic structures. Lacerations in the cheek region may involve branches of the facial nerve, parotid gland or its duct, and vascular structures such as the transverse facial artery. Failure to recognize a parotid duct injury may result in the formation of a sialocele or cutaneous fistula. We describe a simple technique using intravenous tubing for the management of a persistent parotid sialocele. Case reports and technique: We report two cases with left sided swelling of the cheek following a penetrating injury to the same area which had occur 1 month earlier, skin was distended and had a thin friable appearance. Ultrasonography and aspiration of the fluids content confirmed the presence of a sialocele. Each of these cases was treated with surgical drainage using a transoral approach under general anesthesia. Local anesthesia was infiltrated into the buccal mucosa. Intravenous tubing was inserted through the parotid papilla on the first case and towards the back on the second. The free end was sutured to the oral mucosa using non absorbable suture (nylon 4-0) and it was left in place for 3 and 2 months respectively to allow maturation of a new salivary tract directing saliva intraorally. The sialoceles resolved with no recurrence over a follow up period of 1 year on the first case and 2 months on the second. Discussion: Many treatment modalities have been mentioned in the literature. They basically consist of a conservative or a surgical approach. When conservative management fails, or when the viability of the skin is imminently at risk, surgical treatment is indicated. Conclusion: This procedure is quick and easy to perform, has a low morbidity rate and is highly effective. Key words: parotid sialocele; intravenous tubing; salivary fistula http://dx.doi.org/10.1016/j.ijom.2013.07.620