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Nasal-chin deformity
Oral P r e s e n t a t i o n s / O53. R e c o n s t r u c t i v e S u r g e r y I V the past 15 years. A combination of multiple small or moderate surgical procedures can produce dramatic results for cosmetic rejuvenation. The synergistic utilization of multiple, simultaneous cosmetic procedures can produce cosmetic benefits for the patient that are unrivaled by singular techniques. These surgical combinations address all aspects of facial aging and are safe and effective for most surgeons and patients. [-0--~~
93 References
[1] Epker BN, Stella JP, Fish LC: Dentofacial Deformities: Integrated Orthodontic & Surgical Correction. Year Book Medical Pub; 1998. [2] Peck GC: Techniques in Aesthetic Rhinoplasty. 2nd ed. New York, NY: Thieme-Stratton; 1984. [3] Wolfe SA, Berkowitz S: Plastic Surgery of the Facial Skeleton. Boston, MA: Little, Brown and Company; 1989.
PULL UP SPREADER GRAFT TO A TIP SUPPORT EFFECT
D. Bertossi, L. Chiarini, P.E Nocini. Universita degli Studi di Verona,
Clinica Odontoiatrica e di Chirurgia Maxillo-Facciale, Piazzale L.A. Scuro 10, 37134 Verona, Italy Nasal airway obstruction can be associated to a deviated septum or nasal valve collapse with or without anatomical obstructions (polyps). Furthermore, the architectural defect can involve the aesthetics of the nasal dorsum and tip. The purpose of the Author is a new technique of simultaneous spreader grafting of the nasal vault and the rotation of the tip in the desired position. 10 patients affected by light (4) to severe (6) nasal obstruction were treated from 2001 to 2003 with a new technique of nasal spreading. This technique is performed with an open approach. The upper part of the lateral crus is splitted and rotated medially and therefore inserted in a precise pocket between the nasal septum and the upper lateral. The cartilages are fixed pulling up the nasal domes and tip with PDS 5-0. The dorsal part of the lateral crus can be adjusted with a scalpel creating a supratip break and tip support. Also the spreading gives an anatomically related quantity of cartilage and dorsal enlargement. There is no scarring and no need of cartilage harvesting, all 10 patients had an improvement in nasal airway (scale 1 to 10), 6 patients with a clinical score of 7 and 4 patients with a clinical score of 10. Nobody complained for the open approach scarring and all had a good aesthetic result, with a stable upward rotation of the tip after 2 years. Nor displacement of the sutured cartilagen neither infections or hematoma was observed in 100% of patients, we propose a new technique of nasal spreading that cannot substitute the conventional use of dorsal spreaders, but can be an aid in cases of thin nasal skin associated to a double dome and down-rotated nasal tip.
[-~-2-.'~ NASAL R E C O N S T R U C T I O N W I T H MODIFIED COMPOSITE GRAFT - A SERIES OF FIFTEEN CASES G. Brady, A.R. Patterson, A. Adams, M.R. Telfer. York Hospital
Wigginton Road, York Y031 8HE, United Kingdom Full-thickness defects of the alar margin create a reconstructive challenge. The surgical options available include local flaps, conventional composite grafts and modified composite grafts incorporating a dermal pedicle. We present a description of the technique of the modified composite graft together with a review of its use over a period of eighteen months. A series of fifteen consecutive patients was identified, in which excision of nasal skin cancers had resulted in defects of the alar margin with reconstruction with modified composite grafts. The cases were analysed with regard to adequacy of the reconstruction and complications. The graft take was complete in fourteen of the fifteen cases, resulting in good cosmetic results. There was partial graft failure in the remaining case resulting in slight notching of the alar rim, however, this was minor and required further revision. There were no other complications noted. Take can be slow. Technique of placement into the pocket to be discussed. The modified composite graft allows defects of the alar margin to be reconstructed with a single-stage technique. Our initial results have shown that it is reliable and gives a good cosmetic and functional result.
053. Reconstructive Surgery IV
References
[1] Boccieri A. Subtotal reconstruction of the nasal septum using a conchal reshaped graft. Ann Plast Surg. 2004 Aug;53(2):118-25. [2] Andre RF, Paun SH, Vuyk HD. Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum. Arch Facial Plast Surg. 2004 Jan-Feb;6(1):36-40. [3] Toriumi DM, Josen J, Weinberger M, Tardy ME Jr. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg. 1997 Aug;123(8):802-8. [4] Tardy ME Jr. Graduated sculpture refinement of the nasal tip. Facial Plast Surg Clin North Am. 2004 Feb;12(1):51-80. [-~-~"~
NASA L-C HI N DEFORMITY
S. Benarroch Mahfoda. Medical Department, Tota/sa/ud Medical &
Dental Clinic, Madrid, Spain Determine the frequency of appearance of Nasal- Chin Deformity and type of nasal and chin anomaly most commonly related to each other Three hundred and forty four patients (293 females and 51 males) that had facial plastic surgery over a 10 year period were reviewed retrospectively, aged 15-50; the population studied consisted of various ethnic groups. All the patients underwent a complete facial analysis in order to diagnose disharmonies. The procedures included in this study were: genioplasty, rhinoplasty, and combination of both. Patients were classified into 3 categories based on the surgical procedure performed, as follows: Group I: Isolated rhinoplasty, Group I1: Isolated genioplasty, Group II1: Rhinoplasty + Genioplasty. The surgical technique for all the categories included, closed rhinoplasty and horizontal osteotomy of the chin. Of the 344 adults including in the study 27.1% were diagnosed with Nasal Chin deformity, 92.9% were caucasian, 88.5% were 15 to 30 years old, 85.6% were females, the deformities which were most frequently fund associated to each other were nasal hump (85.1%) and anterior deficiency of the chin (93.6%) Nasal and chin deformity had been studied separately. The results of this study indicate that the Nasal-Chin Deformity have a statistically significant relation. Clinical consideration and surgical correction of this disharmony provide consistent, long-term aesthetic improvement.
F05•
FIBULAR OSTEOCUTANEOUS FREE FLAP APPLICATION ON A R E C U R R E D M A N D I B U L A R C A R C I N O M A WITH
OSTEORADIONECROSlS U.K. Kim, W.H. Ha, J.U. Hong, T.K. Kwon, "KD. Kim, J.H. Byun, S.H. Shin, I.K. Chung. Dept. of Oral and Maxillofacial Surgery, College of Dentistry,
Pusan National University, Busan, South Korea Radiation therapy and surgery are established treatments for malignancies in the head and neck region. One of the worst clinical scenarios of the radiation therapy is the development of osteoradionecrosis (ORN). A fibular free flap among various free flaps has been used successfully for reconstruction of mandible involved with ORN or cancer. We will review literature cases of ORN with cancer and discuss our abnormal case with recurred cancer on ORN site. 59-year-old man having the pain, ulcerative lesion on mandible was transferred from the other department. He had a medical history with partial glossectomy and 5600cGy adjuvant radiation on oral cavity for tongue cancer treatment about 13 years ago. The pathology report confirmed the wound as recurred squamous cell carcinoma on mandible. Conventional radiography showed local destructive bony lesion under the soft ulcerative lesion, but MR image revealed ORN on the half of mandible with a bulbous carcinogenic mass. The lesion was considered as recurred carcinoma with ORN on mandible. We performed the composite mandibular resection, neck dissection, and a fibular osteocutaneous free flap surgery for reconstruction of mandible, cheek, floor of mouth simultaneously. The Patient with recurred oral cancer on ORN mandible has showed good oral functions like swallowing, esthetics without any recurred signs after free fibular composite osteocutaneous flap reconstruction so far since 2 years ago. The recurred carcinoma lesion on ORN involved mandible would be well healed if the surgeon meticulously would evaluate the lesion status and treat with optimal free vascularized flaps. References
[1] Duncan MJ, Manktelow RT, Zuker RM, et al: Mandibular reconstruction in the radiated patient: The role of osteocutaenous free tissue transfers, Plastic and Reconstr Surg 76:829, 1985.
93 References
[1] Epker BN, Stella JP, Fish LC: Dentofacial Deformities: Integrated Orthodontic & Surgical Correction. Year Book Medical Pub; 1998. [2] Peck GC: Techniques in Aesthetic Rhinoplasty. 2nd ed. New York, NY: Thieme-Stratton; 1984. [3] Wolfe SA, Berkowitz S: Plastic Surgery of the Facial Skeleton. Boston, MA: Little, Brown and Company; 1989.
PULL UP SPREADER GRAFT TO A TIP SUPPORT EFFECT
D. Bertossi, L. Chiarini, P.E Nocini. Universita degli Studi di Verona,
Clinica Odontoiatrica e di Chirurgia Maxillo-Facciale, Piazzale L.A. Scuro 10, 37134 Verona, Italy Nasal airway obstruction can be associated to a deviated septum or nasal valve collapse with or without anatomical obstructions (polyps). Furthermore, the architectural defect can involve the aesthetics of the nasal dorsum and tip. The purpose of the Author is a new technique of simultaneous spreader grafting of the nasal vault and the rotation of the tip in the desired position. 10 patients affected by light (4) to severe (6) nasal obstruction were treated from 2001 to 2003 with a new technique of nasal spreading. This technique is performed with an open approach. The upper part of the lateral crus is splitted and rotated medially and therefore inserted in a precise pocket between the nasal septum and the upper lateral. The cartilages are fixed pulling up the nasal domes and tip with PDS 5-0. The dorsal part of the lateral crus can be adjusted with a scalpel creating a supratip break and tip support. Also the spreading gives an anatomically related quantity of cartilage and dorsal enlargement. There is no scarring and no need of cartilage harvesting, all 10 patients had an improvement in nasal airway (scale 1 to 10), 6 patients with a clinical score of 7 and 4 patients with a clinical score of 10. Nobody complained for the open approach scarring and all had a good aesthetic result, with a stable upward rotation of the tip after 2 years. Nor displacement of the sutured cartilagen neither infections or hematoma was observed in 100% of patients, we propose a new technique of nasal spreading that cannot substitute the conventional use of dorsal spreaders, but can be an aid in cases of thin nasal skin associated to a double dome and down-rotated nasal tip.
[-~-2-.'~ NASAL R E C O N S T R U C T I O N W I T H MODIFIED COMPOSITE GRAFT - A SERIES OF FIFTEEN CASES G. Brady, A.R. Patterson, A. Adams, M.R. Telfer. York Hospital
Wigginton Road, York Y031 8HE, United Kingdom Full-thickness defects of the alar margin create a reconstructive challenge. The surgical options available include local flaps, conventional composite grafts and modified composite grafts incorporating a dermal pedicle. We present a description of the technique of the modified composite graft together with a review of its use over a period of eighteen months. A series of fifteen consecutive patients was identified, in which excision of nasal skin cancers had resulted in defects of the alar margin with reconstruction with modified composite grafts. The cases were analysed with regard to adequacy of the reconstruction and complications. The graft take was complete in fourteen of the fifteen cases, resulting in good cosmetic results. There was partial graft failure in the remaining case resulting in slight notching of the alar rim, however, this was minor and required further revision. There were no other complications noted. Take can be slow. Technique of placement into the pocket to be discussed. The modified composite graft allows defects of the alar margin to be reconstructed with a single-stage technique. Our initial results have shown that it is reliable and gives a good cosmetic and functional result.
053. Reconstructive Surgery IV
References
[1] Boccieri A. Subtotal reconstruction of the nasal septum using a conchal reshaped graft. Ann Plast Surg. 2004 Aug;53(2):118-25. [2] Andre RF, Paun SH, Vuyk HD. Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum. Arch Facial Plast Surg. 2004 Jan-Feb;6(1):36-40. [3] Toriumi DM, Josen J, Weinberger M, Tardy ME Jr. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg. 1997 Aug;123(8):802-8. [4] Tardy ME Jr. Graduated sculpture refinement of the nasal tip. Facial Plast Surg Clin North Am. 2004 Feb;12(1):51-80. [-~-~"~
NASA L-C HI N DEFORMITY
S. Benarroch Mahfoda. Medical Department, Tota/sa/ud Medical &
Dental Clinic, Madrid, Spain Determine the frequency of appearance of Nasal- Chin Deformity and type of nasal and chin anomaly most commonly related to each other Three hundred and forty four patients (293 females and 51 males) that had facial plastic surgery over a 10 year period were reviewed retrospectively, aged 15-50; the population studied consisted of various ethnic groups. All the patients underwent a complete facial analysis in order to diagnose disharmonies. The procedures included in this study were: genioplasty, rhinoplasty, and combination of both. Patients were classified into 3 categories based on the surgical procedure performed, as follows: Group I: Isolated rhinoplasty, Group I1: Isolated genioplasty, Group II1: Rhinoplasty + Genioplasty. The surgical technique for all the categories included, closed rhinoplasty and horizontal osteotomy of the chin. Of the 344 adults including in the study 27.1% were diagnosed with Nasal Chin deformity, 92.9% were caucasian, 88.5% were 15 to 30 years old, 85.6% were females, the deformities which were most frequently fund associated to each other were nasal hump (85.1%) and anterior deficiency of the chin (93.6%) Nasal and chin deformity had been studied separately. The results of this study indicate that the Nasal-Chin Deformity have a statistically significant relation. Clinical consideration and surgical correction of this disharmony provide consistent, long-term aesthetic improvement.
F05•
FIBULAR OSTEOCUTANEOUS FREE FLAP APPLICATION ON A R E C U R R E D M A N D I B U L A R C A R C I N O M A WITH
OSTEORADIONECROSlS U.K. Kim, W.H. Ha, J.U. Hong, T.K. Kwon, "KD. Kim, J.H. Byun, S.H. Shin, I.K. Chung. Dept. of Oral and Maxillofacial Surgery, College of Dentistry,
Pusan National University, Busan, South Korea Radiation therapy and surgery are established treatments for malignancies in the head and neck region. One of the worst clinical scenarios of the radiation therapy is the development of osteoradionecrosis (ORN). A fibular free flap among various free flaps has been used successfully for reconstruction of mandible involved with ORN or cancer. We will review literature cases of ORN with cancer and discuss our abnormal case with recurred cancer on ORN site. 59-year-old man having the pain, ulcerative lesion on mandible was transferred from the other department. He had a medical history with partial glossectomy and 5600cGy adjuvant radiation on oral cavity for tongue cancer treatment about 13 years ago. The pathology report confirmed the wound as recurred squamous cell carcinoma on mandible. Conventional radiography showed local destructive bony lesion under the soft ulcerative lesion, but MR image revealed ORN on the half of mandible with a bulbous carcinogenic mass. The lesion was considered as recurred carcinoma with ORN on mandible. We performed the composite mandibular resection, neck dissection, and a fibular osteocutaneous free flap surgery for reconstruction of mandible, cheek, floor of mouth simultaneously. The Patient with recurred oral cancer on ORN mandible has showed good oral functions like swallowing, esthetics without any recurred signs after free fibular composite osteocutaneous flap reconstruction so far since 2 years ago. The recurred carcinoma lesion on ORN involved mandible would be well healed if the surgeon meticulously would evaluate the lesion status and treat with optimal free vascularized flaps. References
[1] Duncan MJ, Manktelow RT, Zuker RM, et al: Mandibular reconstruction in the radiated patient: The role of osteocutaenous free tissue transfers, Plastic and Reconstr Surg 76:829, 1985.