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Open rhinoplasty for trauma cases
Oral Presentations / O42. Reconstructive Surgery III flaps (18 patients); reconstruction of alar nose by means of prelaminated submental microvascular flap (1 patient); tongue reconstruction with free microvascular latissimus dorsi flap after subtotal hemiglossectomy (1 patient); jaws reconstruction with onlay, inlay, interpositioning free bone grafts (15 patients) and mandibular reconstruction with free fibular microvascular graft (1 patient). In group with Dermabond skin adhesives it's achieved absolute success in primary closure of skin wounds without necrosis, inflammation or hypertrophic scars.Local infection occured in 2 patients with mandibular bone reconstruction which is controlled by local irrigation and proper antibiotic administration. Partial necrosis occured in patient with alar nose reconstruction but without aesthetic and functional significance. It is possible successful reconstruction of lost tissue with the same or similar tissue with minimal morbidity of donor region applaying above mention methods and techniques.
I-6-~
A NEW APPROACH FOR RECONSTRUCTION OF THE ORAL COMMISSURE
T. Bar, A. Zagury, O. Nahlieli. The Department of Oral and Maxillofacial
Surgery, Ashkelon, Israel Reconstruction of the oral commissure is a challenging procedure for the oral and maxillofacial surgeon. Both esthetic and functional problems are to be solved in order to achieve a satisfactory result. Many types of restorations were discussed in the literature such as folded forehead flap, pectoralis major flap, modified Eastlander flap or "over-and-out technique, etc". We proposed a modified procedure for the reconstruction of the oral commissure which is a one stage procedure, with both functional and esthetic good results. A 70 years old man was diagnosed with a squamous cell carcinoma of the right buccal mucosa infiltrating via the oral commissure to the outer skin. The TNM staging was T4NOM0. He underwent resection of the tumor with healthy margins (according to frozen section) and a modified right neck dissection. The reconstruction of the oral commissure was done at the same surgery with the use of upper and lower flaps obtained from the upper and lower lips respectively. The uppermost part of the flaps was sutured to the modiolus, thus obtaining some function. Radiotherapy was done 6 weeks later Both functional and esthetic results were satisfactory, obtaining complete oral competence and normal, symmetric oral commissure resembling in height and contour to the contra lateral healthy side. 18 months later he is doing well without evidence of disease. Nowadays the use of distant flaps such as free microvascular flaps or pedicled is highly abundant, these kinds of restorations give better esthetic and functional results; however they are not without complications and a higher morbidity rate. Some times we as surgeons must not forget the simpler and less morbid ways of reconstruction even in a challenging area such as the oral commissure. We proposed an easy and a simple reconstructive procedure which is a one stage, local and less morbid procedure
F
RETROSPECTIVE STUDY ON THE 0RECONSTRUCTION 4 • OFCLINICAL A PENETRATED NASAL DEFECTS WITH NASOLABIAL SKIN FLAP PEDICLED ON THE INFRAORBITAL VESSELS
L.-J. Li, H.-W. Zhao, M. Tong, B. Han, H. Liu. Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, China The purpose of this study is to evaluate the treatment effects of nasal defect reconstruction used by the nasolabial skin flap pedicled on the infraorbital vessels. 16 cases had been received nasal defect reconstruction with nasolabial skin flap pedicled on the infraorbital vessels through the subcutaneous tunnel within recent 4 years. All of the 16 flaps were viable, the maximum area of which was 5.0×2.5cm. The color and texture of the flaps were similar to that of surrounding skin in recipient site. Thermal sensation and tactile sensation were proved to be existing in all the 16 flaps. The scar of donor site was occulted and the contour of nose was not changed after operation. The nasolabial skin flap pedicled on the infraorbital vessels has many distinct advantages and is confirmed to be one of the optimal methods for defects reconstruction as an adjacent axial flap.
79
FG-•'•
FUNCTIONAL AND CLINICAL RESULTS OF 3-WALL ORBITAL DECOMPRESSION
G. Santler 1 , H. K~rcher 1 , A. Langmann 2. 1Department of OralMaxillofacial Surgery, University Dental Clinic, Graz; 20phthalmologic Clinic, University Clinics, Graz, Austria Auto antibodies reacting with ocular muscles and orbital fat causing inflammatory reactions in Graves' orbitopathy may lead to double vision, exophthalmia, corneal lesions, optic nerve compression and increased ocular pressure. In this study the influence of 3-wall orbital decompression in Graves' disease on globe position, function and clinical activity are described. In the time between October 2002 until August 2003 six patients (5 female, 1 male) with Graves' orbitopathy underwent 3-wall orbital decompression. The ages varied from 17 to 72 years. Utilising a transconjunctival approach with lateral canthotomy the entire lateral orbital wall was osteotomised and transpositioned into a lateral and anterior position. To avoid steps the osteotomy lines were running into the cranial and caudal orbital rim. Fixation was achieved by means of microplate osteosythesis. Orbital floor and medial orbital wall were osteotomised and displaced via the same approach. To avoid overprojection of the lateral orbital rim the modification comprises a reshaping of the lateral outer curvature. All patients underwent clinical examinations before and after decompression including Hertel ophthalmometry, Werner classification and clinical activity score (CAS). Reduction of exophthalmos could be demonstrated in all patients with a mean value of 7.8mm. But not only Hertel measurements became near to normal but also clinical activity of Graves disease could be reduced. The compression of the optic nerve could be released with visual recovery in both cases. Near to all values of both Werner and CAS classification were improved and most of them became normal. Only a low number of complications were found. No iatrogenic visual loss and no additional diplopic images had to be detected, whereas patients with pre-existing diplopia showed no improvement of this symptom. One haematoma and one protracted swelling could be managed conservatively. The modified 3-wall orbital decompression, according the original technique described by Tessier in 1969, is an effective and safe therapy of exophthalmos. The best results could be achieved after having taped the full potential of conservative treatment modalities. Only in cases were the eyesight is endangered, because of optic nerve compression or corneal ulceration early interventions become necessary.
I
OPEN RHINOPLASTY O • 1FOR TRAUMA CASES
J. Gonzalez-Lagunas, J.A. Hueto, G. Raspall. Department of Oral and
Maxillofacial Surgery Hospital Universitari Vail d'Hebron Barcelona, Spain Nasal bone fractures are the most common fractures of the facial skeleton. Frequently patientes are treated without inadequate preoperative assesment, being closed manipulation an insufficient procedure for definitive treatment. We present our experience in the management of these patients with the open rhinoplasty approach. We have studied twentyfour consecutive patients affected by simple nasal trauma. In 17 cases enough data were available for study. In all patients, a rim incision combined with a transcollumelar incision was performed. Procedures performed and registered included septoplasty, osteotomies, bone grafting,cartilage grafting and other ancillary techniques A 1 to 3 male to female relationship was observed, with an average age of 29.5 yrs. Nine patients had received previous surgery/manipulationof the nose. Thirteen patients were operated through an open approach. Surgery was performed 2-20 months after trauma, and no special problem was found in the early cases. No technique specific sequela was observed and no complaint about healing of the external scar was registered. Only one patient asked for revision surgery. Problems of the traumatic nose include complex osseocartilaginous defects, alteration of soft tissue planes and the loss of potentially donor areas for cartilage Open rhinoplasty allows directs vision and complete exposure of the fractures sequelae. In selected patientes, earlier treatment of the defect is possible
I-6-~
A NEW APPROACH FOR RECONSTRUCTION OF THE ORAL COMMISSURE
T. Bar, A. Zagury, O. Nahlieli. The Department of Oral and Maxillofacial
Surgery, Ashkelon, Israel Reconstruction of the oral commissure is a challenging procedure for the oral and maxillofacial surgeon. Both esthetic and functional problems are to be solved in order to achieve a satisfactory result. Many types of restorations were discussed in the literature such as folded forehead flap, pectoralis major flap, modified Eastlander flap or "over-and-out technique, etc". We proposed a modified procedure for the reconstruction of the oral commissure which is a one stage procedure, with both functional and esthetic good results. A 70 years old man was diagnosed with a squamous cell carcinoma of the right buccal mucosa infiltrating via the oral commissure to the outer skin. The TNM staging was T4NOM0. He underwent resection of the tumor with healthy margins (according to frozen section) and a modified right neck dissection. The reconstruction of the oral commissure was done at the same surgery with the use of upper and lower flaps obtained from the upper and lower lips respectively. The uppermost part of the flaps was sutured to the modiolus, thus obtaining some function. Radiotherapy was done 6 weeks later Both functional and esthetic results were satisfactory, obtaining complete oral competence and normal, symmetric oral commissure resembling in height and contour to the contra lateral healthy side. 18 months later he is doing well without evidence of disease. Nowadays the use of distant flaps such as free microvascular flaps or pedicled is highly abundant, these kinds of restorations give better esthetic and functional results; however they are not without complications and a higher morbidity rate. Some times we as surgeons must not forget the simpler and less morbid ways of reconstruction even in a challenging area such as the oral commissure. We proposed an easy and a simple reconstructive procedure which is a one stage, local and less morbid procedure
F
RETROSPECTIVE STUDY ON THE 0RECONSTRUCTION 4 • OFCLINICAL A PENETRATED NASAL DEFECTS WITH NASOLABIAL SKIN FLAP PEDICLED ON THE INFRAORBITAL VESSELS
L.-J. Li, H.-W. Zhao, M. Tong, B. Han, H. Liu. Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, China The purpose of this study is to evaluate the treatment effects of nasal defect reconstruction used by the nasolabial skin flap pedicled on the infraorbital vessels. 16 cases had been received nasal defect reconstruction with nasolabial skin flap pedicled on the infraorbital vessels through the subcutaneous tunnel within recent 4 years. All of the 16 flaps were viable, the maximum area of which was 5.0×2.5cm. The color and texture of the flaps were similar to that of surrounding skin in recipient site. Thermal sensation and tactile sensation were proved to be existing in all the 16 flaps. The scar of donor site was occulted and the contour of nose was not changed after operation. The nasolabial skin flap pedicled on the infraorbital vessels has many distinct advantages and is confirmed to be one of the optimal methods for defects reconstruction as an adjacent axial flap.
79
FG-•'•
FUNCTIONAL AND CLINICAL RESULTS OF 3-WALL ORBITAL DECOMPRESSION
G. Santler 1 , H. K~rcher 1 , A. Langmann 2. 1Department of OralMaxillofacial Surgery, University Dental Clinic, Graz; 20phthalmologic Clinic, University Clinics, Graz, Austria Auto antibodies reacting with ocular muscles and orbital fat causing inflammatory reactions in Graves' orbitopathy may lead to double vision, exophthalmia, corneal lesions, optic nerve compression and increased ocular pressure. In this study the influence of 3-wall orbital decompression in Graves' disease on globe position, function and clinical activity are described. In the time between October 2002 until August 2003 six patients (5 female, 1 male) with Graves' orbitopathy underwent 3-wall orbital decompression. The ages varied from 17 to 72 years. Utilising a transconjunctival approach with lateral canthotomy the entire lateral orbital wall was osteotomised and transpositioned into a lateral and anterior position. To avoid steps the osteotomy lines were running into the cranial and caudal orbital rim. Fixation was achieved by means of microplate osteosythesis. Orbital floor and medial orbital wall were osteotomised and displaced via the same approach. To avoid overprojection of the lateral orbital rim the modification comprises a reshaping of the lateral outer curvature. All patients underwent clinical examinations before and after decompression including Hertel ophthalmometry, Werner classification and clinical activity score (CAS). Reduction of exophthalmos could be demonstrated in all patients with a mean value of 7.8mm. But not only Hertel measurements became near to normal but also clinical activity of Graves disease could be reduced. The compression of the optic nerve could be released with visual recovery in both cases. Near to all values of both Werner and CAS classification were improved and most of them became normal. Only a low number of complications were found. No iatrogenic visual loss and no additional diplopic images had to be detected, whereas patients with pre-existing diplopia showed no improvement of this symptom. One haematoma and one protracted swelling could be managed conservatively. The modified 3-wall orbital decompression, according the original technique described by Tessier in 1969, is an effective and safe therapy of exophthalmos. The best results could be achieved after having taped the full potential of conservative treatment modalities. Only in cases were the eyesight is endangered, because of optic nerve compression or corneal ulceration early interventions become necessary.
I
OPEN RHINOPLASTY O • 1FOR TRAUMA CASES
J. Gonzalez-Lagunas, J.A. Hueto, G. Raspall. Department of Oral and
Maxillofacial Surgery Hospital Universitari Vail d'Hebron Barcelona, Spain Nasal bone fractures are the most common fractures of the facial skeleton. Frequently patientes are treated without inadequate preoperative assesment, being closed manipulation an insufficient procedure for definitive treatment. We present our experience in the management of these patients with the open rhinoplasty approach. We have studied twentyfour consecutive patients affected by simple nasal trauma. In 17 cases enough data were available for study. In all patients, a rim incision combined with a transcollumelar incision was performed. Procedures performed and registered included septoplasty, osteotomies, bone grafting,cartilage grafting and other ancillary techniques A 1 to 3 male to female relationship was observed, with an average age of 29.5 yrs. Nine patients had received previous surgery/manipulationof the nose. Thirteen patients were operated through an open approach. Surgery was performed 2-20 months after trauma, and no special problem was found in the early cases. No technique specific sequela was observed and no complaint about healing of the external scar was registered. Only one patient asked for revision surgery. Problems of the traumatic nose include complex osseocartilaginous defects, alteration of soft tissue planes and the loss of potentially donor areas for cartilage Open rhinoplasty allows directs vision and complete exposure of the fractures sequelae. In selected patientes, earlier treatment of the defect is possible