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P.007 Recontouring of the aged face
134 Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1 nasal septum on 15 patients of 100 autorhinoplasty was carried out. In case of skin-cartilage deformation on 21 patients of 100 combined method was carried out. Conclusions: The most preferable method of rhinoplasty for patients with inborn deformations is allochondrotransplantation.
P.005 Giant congenital facial hemangioma: Surgical reconstruction in multiple sessions B. Duarte Ruiz1 , F. De As´ıs Riba Garc´ıa1 , M. Cuesta Gil1 , C. Navarro Vila2 . 1 Department of Oral Maxillofacial Surgery, Hospital of Ciudad Real, Spain; 2 Department of Oral Maxillofacial Surgery, Hospital Gregorio Mara˜no´ n, Madrid, Spain Hemangiomas are the most common tumour of infancy and childhood affecting approximately 2.6% of infants by the age of 1 year. They are characterized by presentation at birth or shortly thereafter, and a rapid proliferative phase over the first 12 months. These lesions occur mainly in head and neck district and are preponderant in females. Hemangiomas typically appear during the first 9–10 months of life as an erythematous lesion characterized by an initially rapid growth, followed by spontaneous involution characterized by a decrease in tumour size and colour change from bright red to grey. This involutional process continues over the next 5 to 7 years. In cavernous haemangiomas, this involution can be incomplete. The management of hemangiomas depends on several factors such as age of patient, location, size and growth phase of the tumour. Surgical excision is indicated in small size lesion when can be easily excized, in the treatment of residual hemangiomas after pharmacological therapy or after involution phase and in presence of facial hemangiomas causing functional disturbance or serious psychological distress. We report a case of a giant involuting cavernous hemangioma of left side of the face. Even with a complete involution, signs of the hemangioma persist in the form of fibrosis with lossing of facial muscle activity and facial deformity. Surgical treatment performed in multiple sessions, we have permitted to achieve excellent results with a minimal morbidity.
P.006 Pseudo-xanthoma elasticum, a case report H. Akram, W. Gillingham, L. Cheng. Department of Oral and Maxillofacial Surgery, The Homerton University Hospital, UK Introduction and Objectives: Pseudo-xanthoma elasticum (PXE) or Gronblad-Strandberg-Touraine’s syndrome is a rare congenital connective tissue disorder resulting in skin, ocular, cardiocvascular and gastrointestinal complications. Our objective is to describe the characteristic and presentation of this disease giving special attention to the role of the craniofacial surgeon in managing the skin complications that can commonly affect the neck region with a multidisciplinary approach. Material and Method: We report a case of PXE in a 44 year old Afro-Caribbean woman who presented with redundant, loose and excessive wrinkling of the skin in the neck region, developed between 12 and 14 of age. Her identical twin had the same problem. She had no other skin lesions or no ocular, cardiovascular or gastrointestinal symptoms. Results: A CT scan of the neck showed no abnormality apart from excessive wrinkling and thickening of the skin. A submental skin biopsy showed irregular, curled, mildly basophilic elastic fibres diffusely distributed in the reticular dermis. The fibres stain with elastic Van Gieson and Von Kossa. She was referred to a cardiologist and an ophthalmologist for further assessment of PXE complications.
Abstracts, EACFMS XVIII Congress She underwent a bilateral neck skin lift with platysmoplasty and excision of excessive skin. Conclusions: Surgical treatment such as Platysmoplasty is of great value in improving the quality of life in patients with PXE. Patients will have better self-esteem and confidence as a result of improved body image. P.007 Recontouring of the aged face N. Nadjmi, J. Defranq, G. Van Hemelen, H. Vercruysse. Department of Cranio-Maxillo-Facial Surgery, Eeuwfeestkliniek, Antwerp, Belgium Introduction and Objectives: The evaluation of the ageing process of the face is complex and multifactorial. The soft tissue problems that a maxillofacial surgeon is encountered in rejuvenating of the face are: 1. the dermal component in relation to the intrinsic and extrinsic facial ageing (dermal elastosis), 2. sleep and expression lines, 3. photodamage, 4. descending of the facial fat, with jowling and deep nasolabial fold as the result, 5. increase or decrease of the facial fat during the ageing process. Material and Methods: Each individual patient shows different degree of the above-mentioned problems at the time of consultation for facial rejuvenation. The specific need of each patient lies on the basis of the correction of the mentioned ageing components. Our experience in facial recontouring with Extended SMAS Facelift in combination with Endoscopic Brow lifting is presented. Results: The above-mentioned procedure has been used in our department for the last 6 years in more than 70 patients with consistent results. No major complications occurred except a postoperative haematoma in one patient, which healed uneventfully after drainage. Conclusions: Utilizing extended SMAS technique enables the aesthetic surgeon to deal with the challenging reconstruction of the aged face, without compromising the natural facial appearance. P.008 Autogenous cartilage grafts and rhinoplasty: A retrospective study V. Terenzi, V. Pellacchia, S. Buonaccorsi, A. Leonardi. Department of Maxillo-Facial Surgery, Sant’Andrea Hospital, II Faculty of Medicine, University of Rome “La Sapienza”, Italy Introduction and Objectives: Most common situations requiring cartilage grafts in rhinoplasty are secondary rhinoplasty cases and important post-traumatic and congenital nasal deformity, but cartilage grafts can be used also to camouflage slight irregularities in the tip and dorsum. Materials and Methods: From March 2003 to July 2005, a total of 132 patients underwent rhinoplasty at the Maxillo-Facial Department of Sant’Andrea Hospital; among them, 83 cases required cartilage graft augmentation. The donor grafts averaged 89.8% nasal cartilage and 10.2% conchal cartilage; recipient sites averaged 39.5% in the tip, 63% in the dorsum and 18.5% in the columella. All interventations were executed by the same surgeon by a closed approach. Results: Functional and aesthetic result was considered satisfactory in all cases. In no cases resorption or infection of the grafts, or morbidity at the donor site have been observed. Conclusions: Autogenous cartilage grafting, obtained after rhinoplasty or from auricolar or septal harvesting, has demon-
P.005 Giant congenital facial hemangioma: Surgical reconstruction in multiple sessions B. Duarte Ruiz1 , F. De As´ıs Riba Garc´ıa1 , M. Cuesta Gil1 , C. Navarro Vila2 . 1 Department of Oral Maxillofacial Surgery, Hospital of Ciudad Real, Spain; 2 Department of Oral Maxillofacial Surgery, Hospital Gregorio Mara˜no´ n, Madrid, Spain Hemangiomas are the most common tumour of infancy and childhood affecting approximately 2.6% of infants by the age of 1 year. They are characterized by presentation at birth or shortly thereafter, and a rapid proliferative phase over the first 12 months. These lesions occur mainly in head and neck district and are preponderant in females. Hemangiomas typically appear during the first 9–10 months of life as an erythematous lesion characterized by an initially rapid growth, followed by spontaneous involution characterized by a decrease in tumour size and colour change from bright red to grey. This involutional process continues over the next 5 to 7 years. In cavernous haemangiomas, this involution can be incomplete. The management of hemangiomas depends on several factors such as age of patient, location, size and growth phase of the tumour. Surgical excision is indicated in small size lesion when can be easily excized, in the treatment of residual hemangiomas after pharmacological therapy or after involution phase and in presence of facial hemangiomas causing functional disturbance or serious psychological distress. We report a case of a giant involuting cavernous hemangioma of left side of the face. Even with a complete involution, signs of the hemangioma persist in the form of fibrosis with lossing of facial muscle activity and facial deformity. Surgical treatment performed in multiple sessions, we have permitted to achieve excellent results with a minimal morbidity.
P.006 Pseudo-xanthoma elasticum, a case report H. Akram, W. Gillingham, L. Cheng. Department of Oral and Maxillofacial Surgery, The Homerton University Hospital, UK Introduction and Objectives: Pseudo-xanthoma elasticum (PXE) or Gronblad-Strandberg-Touraine’s syndrome is a rare congenital connective tissue disorder resulting in skin, ocular, cardiocvascular and gastrointestinal complications. Our objective is to describe the characteristic and presentation of this disease giving special attention to the role of the craniofacial surgeon in managing the skin complications that can commonly affect the neck region with a multidisciplinary approach. Material and Method: We report a case of PXE in a 44 year old Afro-Caribbean woman who presented with redundant, loose and excessive wrinkling of the skin in the neck region, developed between 12 and 14 of age. Her identical twin had the same problem. She had no other skin lesions or no ocular, cardiovascular or gastrointestinal symptoms. Results: A CT scan of the neck showed no abnormality apart from excessive wrinkling and thickening of the skin. A submental skin biopsy showed irregular, curled, mildly basophilic elastic fibres diffusely distributed in the reticular dermis. The fibres stain with elastic Van Gieson and Von Kossa. She was referred to a cardiologist and an ophthalmologist for further assessment of PXE complications.
Abstracts, EACFMS XVIII Congress She underwent a bilateral neck skin lift with platysmoplasty and excision of excessive skin. Conclusions: Surgical treatment such as Platysmoplasty is of great value in improving the quality of life in patients with PXE. Patients will have better self-esteem and confidence as a result of improved body image. P.007 Recontouring of the aged face N. Nadjmi, J. Defranq, G. Van Hemelen, H. Vercruysse. Department of Cranio-Maxillo-Facial Surgery, Eeuwfeestkliniek, Antwerp, Belgium Introduction and Objectives: The evaluation of the ageing process of the face is complex and multifactorial. The soft tissue problems that a maxillofacial surgeon is encountered in rejuvenating of the face are: 1. the dermal component in relation to the intrinsic and extrinsic facial ageing (dermal elastosis), 2. sleep and expression lines, 3. photodamage, 4. descending of the facial fat, with jowling and deep nasolabial fold as the result, 5. increase or decrease of the facial fat during the ageing process. Material and Methods: Each individual patient shows different degree of the above-mentioned problems at the time of consultation for facial rejuvenation. The specific need of each patient lies on the basis of the correction of the mentioned ageing components. Our experience in facial recontouring with Extended SMAS Facelift in combination with Endoscopic Brow lifting is presented. Results: The above-mentioned procedure has been used in our department for the last 6 years in more than 70 patients with consistent results. No major complications occurred except a postoperative haematoma in one patient, which healed uneventfully after drainage. Conclusions: Utilizing extended SMAS technique enables the aesthetic surgeon to deal with the challenging reconstruction of the aged face, without compromising the natural facial appearance. P.008 Autogenous cartilage grafts and rhinoplasty: A retrospective study V. Terenzi, V. Pellacchia, S. Buonaccorsi, A. Leonardi. Department of Maxillo-Facial Surgery, Sant’Andrea Hospital, II Faculty of Medicine, University of Rome “La Sapienza”, Italy Introduction and Objectives: Most common situations requiring cartilage grafts in rhinoplasty are secondary rhinoplasty cases and important post-traumatic and congenital nasal deformity, but cartilage grafts can be used also to camouflage slight irregularities in the tip and dorsum. Materials and Methods: From March 2003 to July 2005, a total of 132 patients underwent rhinoplasty at the Maxillo-Facial Department of Sant’Andrea Hospital; among them, 83 cases required cartilage graft augmentation. The donor grafts averaged 89.8% nasal cartilage and 10.2% conchal cartilage; recipient sites averaged 39.5% in the tip, 63% in the dorsum and 18.5% in the columella. All interventations were executed by the same surgeon by a closed approach. Results: Functional and aesthetic result was considered satisfactory in all cases. In no cases resorption or infection of the grafts, or morbidity at the donor site have been observed. Conclusions: Autogenous cartilage grafting, obtained after rhinoplasty or from auricolar or septal harvesting, has demon-