Biomedical subjects
Publications and source records attributed to D Marchac.
We report a case of an adult mid-face reconstruction for a deformity occurring in infancy, using a Le Fort III advancement first to restore the contour of the skeleton. This was followed by a scalping forehead flap for the nasal reconstruction, and a fleur-de-lis Abbe flap for reconstruction of the lip and nasal vestibule.
We report the experiences in 6 major craniofacial centers, with similar teams but in different parts of the world, in a total of 793 craniofacial operations. The mortality rate was 1.6%. Complications developed in 16.5% of the cases (including infections in 4.4%). This surgery has many potential advantages, not least of which is its psychosocial effects on previously disfigured patients. Certain problems seem inherent, however, for there are not yet any satisfactory solutions to them. Some of the factors that reduce morbidity and improve results include the use of hypotensive anesthesia, a reduction in operating time, rigid stabilization of the mobilized bones at the end of the operation, a diminution in the number of incisions, and extensive antibiotic therapy.
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33 cases of fronto-cranial remodeling by osteotomies are reported by the authors. Since 1973, 19 oxycephalies have been operated according to an original technique based on two principles:--rocking and advancement of the supra-orbital barr, with an easy lateral retention by a Z-bony cut.--transposition of free bone flaps to rebuild a forehead of the appropriate curvature. The good results obtained have encouraged the authors to operate on young children or even babies in order to solve simultaneously the functionnal and the aesthetic problems. Three plagiocephalies, two trigonocephalies have thus been treated, as well as 5 facio-craniostenosis for whom a 2 cm forehead advancement has been done, the following results being very encouraging.
A normal forehead has two parts, shaped differently: (1) the lower part (corresponding to the supraorbital rim and glabellar area) set at a steep angle to the nose; (2) the upper part, sloping gently backward. To reproduce this normal anatomy in cases of cranostenosis affecting the frontal area, we found it essential to mobilize and reshape a supraorbital bar of bone and to transfer a suitable piece of the cranial vault in one piece to make a new upper forehead. By this method we have treated 18 patients with oxycephaly since 1973, with good results. We have also operated on babies with craniostenosis to try to solve simultaneously the functional and the cosmetic problems. In faciocraniostenosis, there are dominant malformations at the base of the skull, but an isolated frontal advancement of two cm has produced gratifying early results.
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Micro-orbitism which follows the very early arrested development of the optic vesicles hinders the fitting of a prosthesis. A total enlargement of the orbit is proposed which restores the normal dimensions and enables facial symmetry to be re-established. The risks and advantages of this procedure are discussed.
The author confines himself to the problems posed by contention after Lefort type III osteotomy. He considers that the posterior iliac crest of the patient may be used to major advantage. Osteosynthesis is essential but it is sometimes possible to avoid maxillo-mandibular block. The results obtained in 18 cases are presented.
In severe cases of microphthalmos or anophthalmos, the bony orbital cavity is often too small to allow one to create a satisfactory socket for a prosthesis. An omnidirectional expansion of the orbit, by osteotomies done in a step-like fashion, allows the creation of a larger bony cavity and improves the symmetry of the face. The risks of the craniotomy and of the mobilization of the free bone pieces are discussed.
The authors present a patient who had aplasia of the right breast associated with absence of the pectoralis muscles and a chest wall deformity. The insertion of combined breast-chest wall implants improved her appearance markedly.
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We present five cases of reconstruction of the orbital walls after destruction by tumours. Treatment is based upon wide exposure through a bicoronal scalp incision and immediate reconstruction with autogenous iliac bone grafts. we do not recommend using foreign materials for reconstructing the orbit.
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