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Complex acquired orbital anophtalmos
108 Journal of Cranio-Maxillofacial Surgery
Laser Focus in Surgical Photography Smith H. W.
School of Medicine, Columbia University, New York, USA A simple lightweight focusing device is presented for use in the operating room using ruby laser pointers. The focusing system makes it possible for a recruited photographer to use a preset camera system which is directed by the operating surgeon. This system is especially useful in surgical cavities and positions where it is not possible for the photographer to view the area and accurately focus through the camera lens. This system arrangement can be used with most 35 mm single lens reflex cameras which have a ring flash, a power unit and a 50-55 mm macro lens. The use of an automatic exposure mode makes it unnecessary to bracket the exposures. The surgeon may elect to have a camera with either a mechanical or a motorized film advancement.
Immediate Primary Management of Craniofacial Trauma Patients: New Opportunities due to Faster Computed Tomography Scanning Smith A. T.
Department of Maxillofacial Surgery, Royal London Hospital London, UK Historically, the treatment of significant craniofacial injury has of necessity been deferred until life-threatening intracranial injuries have been adequately assessed and managed. Assessment of brain injury in the modern neurosurgical unit relies on clinical evidence and brain imaging. Computed tomography (CT) scanning forms the mainstay of this monitoring of neural tissue. The radiographic parameters and scan settings for imaging brain tissue differ from those for craniofacial bony injury evaluation. This involves resetting the scanner for a second scan sequence. In the severely injured patient with probability of intracranial bleeding or rising intracranial pressure, this delay may be unacceptable and often the definitive bony windows are deferred. Prolonged delay of the bony assessment and thus the primary treatment of craniofacial disruption renders surgery more difficult. Optimal treatment may be impossible and the outcome may be poor quality of repair. New rapid dynamic CT scanning permits rapid imaging of both critical neural tissue and facial bony structures within a time frame less than 25% of that needed previously. The worth of this system was tested on its introduction by the aftermath of the Irish Republican Army (IRA) bomb blast in the London Docklands. Neurosurgeon and Maxillofacial surgeon alike now see CT scans adequate to allow co-ordinated treatment planning, and craniofacial fractures can often be treated at the first operation, via access shared with the neurosurgeon.
Complex Acquired Orbital Anophtalmos SorreI-Dejerine E., Ozun G.
Department of Plastic Cranio-Maxillo-Facial and Burns Surgery, Foch Hospital, Suresnes, France The treatment of post-traumatic or post radiodystrophy orbital anophtalmos is usually complex, with a reconstruction in several stages, usually from the deep to the surface.
Firstly the orbital bone structure should be repaired with osteotomies and/or bone grafts. Then an implant, the bigger the better, is placed in the cavity. The muscles are fixed to it. A conchal cartilage graft is almost always used to protect the implant. The last stages are the reconstruction of the fornix with buccal mucosa graft, the reconstruction of the eyelids with a palatal mucosa graft and local musculo cutaneous flaps. Finally a thin prosthesis is adapted. We present a series of patients illustrating this approach, focusing on the details of each operation. The results are shown.
Advance the Face to Improve It: Different Uses of the Cranial Vault Harvesting Sorrel-Dejerine E., Ozun G.
Department of Plastic Cranio-Maxillo-Facial and Burns Surgery, Foch Hospital, Suresnes, France Advancing the face generally rejuvenates and improves it. Bone is the best material to use, especially that from the cranial vault, as has been popularised by Paul Tessier. The nose is the area of choice to be projected, not only on the dorsum, but also on the base by a special spine graft maintained by a miniplate. Advancing a retruded maxilla or a retruded mandibula, of course, rejuvenates, as advancing a retruded chin associated to a face lift improves the face. Malar bone projection by bone graft or osteotomy is sometimes useful. It is exceptionally necessary to project the forehead. In spite of an osteotomy with a cranial approach which creates a dangerous dead space we prefer simple onlay bone ships, embedded behind a modelled biodegradable plate, to obtain a perfectly smooth frontal bone in an advanced position. We present a series of patients who illustrate different techniques of craniofacial osteotomies and bone grafts. These techniques of reconstructive or aesthetic surgery are detailed and the results shown.
Mandibular Reconstruction with Free Fibular Flap in Surgical Treatment Head and Neck Tumours
Sotosek B., Arnez'~Z. Medical Centre, Department of Maxillo-Facial Surgery, Ljubljana, Slovenia Immediate reconstruction following segmental mandibulectomy is an accepted surgical technique. During the last two years in our department, 13 patients underwent immediate reconstruction with a fibula free flap after segmental surgical excision of the mandible. Nine patients had squamous cell carcinoma of the oral cavity, two ameloblastoma, one adenoid cystic carcinoma and one had osteoradionecrosis of the mandible with pathological fracture. In 8 patients we used osseous free fibular flaps in combination with radial forearm free flaps. In 5 patients we used free osseocutaneus fibular flap. One free flap (fibula) failed in the immediate postoperative period and could not be revascularized. The failed flap was immediately replaced by a reconstruction plate and covered with a radial forearm free flap. Two free fibular flaps failed after radiotherapy, the bone became exposed and was removed without secondary reconstruction. All complications occurred when the mandibular defect included the anterior mandibular arch. In this series, 10 patients had malignant disease; 8 of them are alive and free of disease; Four patients were able to eat a regular
Laser Focus in Surgical Photography Smith H. W.
School of Medicine, Columbia University, New York, USA A simple lightweight focusing device is presented for use in the operating room using ruby laser pointers. The focusing system makes it possible for a recruited photographer to use a preset camera system which is directed by the operating surgeon. This system is especially useful in surgical cavities and positions where it is not possible for the photographer to view the area and accurately focus through the camera lens. This system arrangement can be used with most 35 mm single lens reflex cameras which have a ring flash, a power unit and a 50-55 mm macro lens. The use of an automatic exposure mode makes it unnecessary to bracket the exposures. The surgeon may elect to have a camera with either a mechanical or a motorized film advancement.
Immediate Primary Management of Craniofacial Trauma Patients: New Opportunities due to Faster Computed Tomography Scanning Smith A. T.
Department of Maxillofacial Surgery, Royal London Hospital London, UK Historically, the treatment of significant craniofacial injury has of necessity been deferred until life-threatening intracranial injuries have been adequately assessed and managed. Assessment of brain injury in the modern neurosurgical unit relies on clinical evidence and brain imaging. Computed tomography (CT) scanning forms the mainstay of this monitoring of neural tissue. The radiographic parameters and scan settings for imaging brain tissue differ from those for craniofacial bony injury evaluation. This involves resetting the scanner for a second scan sequence. In the severely injured patient with probability of intracranial bleeding or rising intracranial pressure, this delay may be unacceptable and often the definitive bony windows are deferred. Prolonged delay of the bony assessment and thus the primary treatment of craniofacial disruption renders surgery more difficult. Optimal treatment may be impossible and the outcome may be poor quality of repair. New rapid dynamic CT scanning permits rapid imaging of both critical neural tissue and facial bony structures within a time frame less than 25% of that needed previously. The worth of this system was tested on its introduction by the aftermath of the Irish Republican Army (IRA) bomb blast in the London Docklands. Neurosurgeon and Maxillofacial surgeon alike now see CT scans adequate to allow co-ordinated treatment planning, and craniofacial fractures can often be treated at the first operation, via access shared with the neurosurgeon.
Complex Acquired Orbital Anophtalmos SorreI-Dejerine E., Ozun G.
Department of Plastic Cranio-Maxillo-Facial and Burns Surgery, Foch Hospital, Suresnes, France The treatment of post-traumatic or post radiodystrophy orbital anophtalmos is usually complex, with a reconstruction in several stages, usually from the deep to the surface.
Firstly the orbital bone structure should be repaired with osteotomies and/or bone grafts. Then an implant, the bigger the better, is placed in the cavity. The muscles are fixed to it. A conchal cartilage graft is almost always used to protect the implant. The last stages are the reconstruction of the fornix with buccal mucosa graft, the reconstruction of the eyelids with a palatal mucosa graft and local musculo cutaneous flaps. Finally a thin prosthesis is adapted. We present a series of patients illustrating this approach, focusing on the details of each operation. The results are shown.
Advance the Face to Improve It: Different Uses of the Cranial Vault Harvesting Sorrel-Dejerine E., Ozun G.
Department of Plastic Cranio-Maxillo-Facial and Burns Surgery, Foch Hospital, Suresnes, France Advancing the face generally rejuvenates and improves it. Bone is the best material to use, especially that from the cranial vault, as has been popularised by Paul Tessier. The nose is the area of choice to be projected, not only on the dorsum, but also on the base by a special spine graft maintained by a miniplate. Advancing a retruded maxilla or a retruded mandibula, of course, rejuvenates, as advancing a retruded chin associated to a face lift improves the face. Malar bone projection by bone graft or osteotomy is sometimes useful. It is exceptionally necessary to project the forehead. In spite of an osteotomy with a cranial approach which creates a dangerous dead space we prefer simple onlay bone ships, embedded behind a modelled biodegradable plate, to obtain a perfectly smooth frontal bone in an advanced position. We present a series of patients who illustrate different techniques of craniofacial osteotomies and bone grafts. These techniques of reconstructive or aesthetic surgery are detailed and the results shown.
Mandibular Reconstruction with Free Fibular Flap in Surgical Treatment Head and Neck Tumours
Sotosek B., Arnez'~Z. Medical Centre, Department of Maxillo-Facial Surgery, Ljubljana, Slovenia Immediate reconstruction following segmental mandibulectomy is an accepted surgical technique. During the last two years in our department, 13 patients underwent immediate reconstruction with a fibula free flap after segmental surgical excision of the mandible. Nine patients had squamous cell carcinoma of the oral cavity, two ameloblastoma, one adenoid cystic carcinoma and one had osteoradionecrosis of the mandible with pathological fracture. In 8 patients we used osseous free fibular flaps in combination with radial forearm free flaps. In 5 patients we used free osseocutaneus fibular flap. One free flap (fibula) failed in the immediate postoperative period and could not be revascularized. The failed flap was immediately replaced by a reconstruction plate and covered with a radial forearm free flap. Two free fibular flaps failed after radiotherapy, the bone became exposed and was removed without secondary reconstruction. All complications occurred when the mandibular defect included the anterior mandibular arch. In this series, 10 patients had malignant disease; 8 of them are alive and free of disease; Four patients were able to eat a regular