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A new method of columella lengthening for correction of cleft lip nose deformity
84 Journal of Cranio-Maxillofacial Surgery Excessive face height due to skeletal open bite can be corrected by elevation of the maxilla with or without adjunctive mandibular osteotomies. Superior repositioning via total maxillary osteotomy has proven to be very stable as shown in our study. We present 20 patients, the average follow-up span of which is 5 years, the oldest cases having been treated more than 10 years ago and the most recent cases more than 2 years ago. Long-term stability is obtained provided that precise preoperative planning and accurate surgical rules are observed.
Spontaneous Regeneration of Mandibular Condyles in a Sickle Cell Patient - Report of an Unusual Case Ogunlewe 0., Akinwande J.
Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria This paper reports a case of spontaneous regeneration of mandibular condyles that occurred in a 13 year old Nigerian patient with sickle cell disease, following total mandibulectomy for a case of ameloblastoma. The spontaneous regeneration of the mandible was noticed two months after surgery and by 1 year there was regeneration of the entire mandible with well-shaped condyles.
The Furlow Method for Primary Veloplasty in Two-Stage Palatoplasty Ohashi 0., Ono K.
Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Niigata, Japan Palatal repair using the Furlow double opposing Z-plasty was performed in 31 patients with soft palate cleft between 1990--1994. Speech results were very encouraging, since 91% of 22 patients who were old enough to permit speech evaluation showed vocal resonance without evidence of hypernasality and nasal escape. In an attempt to improve speech results, this clinical experience led us to use the Furlow method for primary veloplasty in two-stage palatoplasty, which has been employed in our clinic since 1983. Compared with the Perko technique which has been done so far, there seem to be a number of worthwhile advantages to this operation, with few disadvantages or complications. Besides lengthening the soft palate, the Furlow procedure lifts up the velum, which should narrow nasopharyngeal space. It provides a reorientation of the levator muscle with a reconstruction of the levator sling, placing the muscles in an overlapped position, which theoretically should provide a more competent oronasal sphincter than an end-to-end approximation. The amount of dissection around the muscle bundles is less because the muscles are left attached to the mucosa on one surface. This should reduce fibrosis. With the Z-plasties, a straight midline scar in the soft palate is avoided, which should reduce postoperative shortening in the anteroposterior direction. In this presentation, experience with the Furlow method for primary veloplasty in twostage palatoplasty is reported.
A New Method of Columella Lengthening for Correction of Cleft Lip Nose Deformity
A new technique for colnmella lengthening in the secondary correction of cleft lip nose deformity is presented. Open rhinoplasty is applied according to Rethi's method, but rim incision on the affected side is made on the outer skin a little above the nostril rim in order to lengthen upper columella; in unilateral case, rim incision on the affected side is made to the same height of the healthy rim and in bilateral case, both sides of rim incisions are made on the outer skin above the nostril rim. Reflecting nose tip skin by this incision, malpositioned alar cartilage(s) is exposed and repositioned to fix to the surrounding tissues. If the corrected cartilage is not adequately supported, a small cartilaginous strut taken from the lower part of the nasal septum is used to fix medial crura of the corrected alar cartilage to the anterior edge of the nasal septum. When the nasal tip skin is redraped, skin is usually insufficient to cover the base of columella due to the improved nasal projection. Therefore, an inferiorly based small pedicle flap is made from rim skin below the incision and is rotated medially into the raw area of the columella base. In bilateral case, bipedicled flaps from both sides can be used to cover the relatively large skin deficit.
Treatment of the Cranio-Maxillofacial Malignant Turnouts
Olshanskiy V.., Chissov V., Sdvizhcov A., Reshetov L, Cherekaev V.. P.A. Hertzen Cancer Research Institute, Moscow, Russia We observed 170 patients with malignant tumours of the nose, paranasal and ethmoidal sinuses. In 28 cases there was tumour invasion into the skull base. Epithelial cancer was discovered in 26 cases, including transitional cell variant in 2 cases. Nonepithelial tumours were seen in 2 cases. In these groups we performed combined treatment. Radiotherapy and surgical excision was the basic method. Surgical stage consisted of approach, tumour excision and reconstruction of the defect. We used 3 types of approach. In 16 cases, we used transfacial access; in these cases intracranial tumour invasion was limited. Forehead intracranial access was performed in 9 cases when tumour penetration into anterior skull base was wide. In cases with larger tumours we used combined access. Excision phase consisted from coagulation and remove of the tumours mass. On visual control resected the walls of the operative cavity. Orbit exenteration was performed where needed. The last stage performed was postoperative defect reconstruction. Defects of the dura mater were covered by autogenous fascium. Defects of the face were reconstructed with local tissues, island and free microsurgical flaps. In 14 cases we used fasciocutaneous flaps from forearm, parascapular region and forehead, in 12 cases musculocutaneous flaps (m. latissimus dorsi, m. serratus anterior) including 7 observation with split ribs. Complication rate was 30%. There was no postoperative mortality. We observed 3-years survival in 61.5%, 5-years, 32.1%.
Reconstruction of Composite Maxilllary Defects using the Osteomyocutaneous Radial Forearm Flap
Olstad O.A., Skjelbred P., Lyberg T.
Ohishi M., Nakamura N., Yoshikawa H., Goto K., Honda Y.
Department of Maxillofacial Surgery, Ullevaal University Hospital, Oslo, Norway
First Department of Oral and MaMllofacial Surgery, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
Defects in the maxilla are usually the result of gunshot injuries or extirpative surgery for malignant neoplasms.
Spontaneous Regeneration of Mandibular Condyles in a Sickle Cell Patient - Report of an Unusual Case Ogunlewe 0., Akinwande J.
Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria This paper reports a case of spontaneous regeneration of mandibular condyles that occurred in a 13 year old Nigerian patient with sickle cell disease, following total mandibulectomy for a case of ameloblastoma. The spontaneous regeneration of the mandible was noticed two months after surgery and by 1 year there was regeneration of the entire mandible with well-shaped condyles.
The Furlow Method for Primary Veloplasty in Two-Stage Palatoplasty Ohashi 0., Ono K.
Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Niigata, Japan Palatal repair using the Furlow double opposing Z-plasty was performed in 31 patients with soft palate cleft between 1990--1994. Speech results were very encouraging, since 91% of 22 patients who were old enough to permit speech evaluation showed vocal resonance without evidence of hypernasality and nasal escape. In an attempt to improve speech results, this clinical experience led us to use the Furlow method for primary veloplasty in two-stage palatoplasty, which has been employed in our clinic since 1983. Compared with the Perko technique which has been done so far, there seem to be a number of worthwhile advantages to this operation, with few disadvantages or complications. Besides lengthening the soft palate, the Furlow procedure lifts up the velum, which should narrow nasopharyngeal space. It provides a reorientation of the levator muscle with a reconstruction of the levator sling, placing the muscles in an overlapped position, which theoretically should provide a more competent oronasal sphincter than an end-to-end approximation. The amount of dissection around the muscle bundles is less because the muscles are left attached to the mucosa on one surface. This should reduce fibrosis. With the Z-plasties, a straight midline scar in the soft palate is avoided, which should reduce postoperative shortening in the anteroposterior direction. In this presentation, experience with the Furlow method for primary veloplasty in twostage palatoplasty is reported.
A New Method of Columella Lengthening for Correction of Cleft Lip Nose Deformity
A new technique for colnmella lengthening in the secondary correction of cleft lip nose deformity is presented. Open rhinoplasty is applied according to Rethi's method, but rim incision on the affected side is made on the outer skin a little above the nostril rim in order to lengthen upper columella; in unilateral case, rim incision on the affected side is made to the same height of the healthy rim and in bilateral case, both sides of rim incisions are made on the outer skin above the nostril rim. Reflecting nose tip skin by this incision, malpositioned alar cartilage(s) is exposed and repositioned to fix to the surrounding tissues. If the corrected cartilage is not adequately supported, a small cartilaginous strut taken from the lower part of the nasal septum is used to fix medial crura of the corrected alar cartilage to the anterior edge of the nasal septum. When the nasal tip skin is redraped, skin is usually insufficient to cover the base of columella due to the improved nasal projection. Therefore, an inferiorly based small pedicle flap is made from rim skin below the incision and is rotated medially into the raw area of the columella base. In bilateral case, bipedicled flaps from both sides can be used to cover the relatively large skin deficit.
Treatment of the Cranio-Maxillofacial Malignant Turnouts
Olshanskiy V.., Chissov V., Sdvizhcov A., Reshetov L, Cherekaev V.. P.A. Hertzen Cancer Research Institute, Moscow, Russia We observed 170 patients with malignant tumours of the nose, paranasal and ethmoidal sinuses. In 28 cases there was tumour invasion into the skull base. Epithelial cancer was discovered in 26 cases, including transitional cell variant in 2 cases. Nonepithelial tumours were seen in 2 cases. In these groups we performed combined treatment. Radiotherapy and surgical excision was the basic method. Surgical stage consisted of approach, tumour excision and reconstruction of the defect. We used 3 types of approach. In 16 cases, we used transfacial access; in these cases intracranial tumour invasion was limited. Forehead intracranial access was performed in 9 cases when tumour penetration into anterior skull base was wide. In cases with larger tumours we used combined access. Excision phase consisted from coagulation and remove of the tumours mass. On visual control resected the walls of the operative cavity. Orbit exenteration was performed where needed. The last stage performed was postoperative defect reconstruction. Defects of the dura mater were covered by autogenous fascium. Defects of the face were reconstructed with local tissues, island and free microsurgical flaps. In 14 cases we used fasciocutaneous flaps from forearm, parascapular region and forehead, in 12 cases musculocutaneous flaps (m. latissimus dorsi, m. serratus anterior) including 7 observation with split ribs. Complication rate was 30%. There was no postoperative mortality. We observed 3-years survival in 61.5%, 5-years, 32.1%.
Reconstruction of Composite Maxilllary Defects using the Osteomyocutaneous Radial Forearm Flap
Olstad O.A., Skjelbred P., Lyberg T.
Ohishi M., Nakamura N., Yoshikawa H., Goto K., Honda Y.
Department of Maxillofacial Surgery, Ullevaal University Hospital, Oslo, Norway
First Department of Oral and MaMllofacial Surgery, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
Defects in the maxilla are usually the result of gunshot injuries or extirpative surgery for malignant neoplasms.