Results of surgical lengthening of the short nose in the bilateral cleft lip patient.
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Biomedical subjects
Publications and source records attributed to D R Millard.
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A rare acinic cell carcinoma of the soft palate is reported and its potential for recurrence and metastasis discussed. A wide ablation created a speech-crippling defect that was reconstructed with an island flap from the opposite side and a pharyngeal flap for nasal lining and an island flap from the same side for oral cover. Speech is again normal.
The mucoperiosteal island flap, first designed to provide nasal lining during pushback lengthening of a short cleft palate, has been used to assist in reconstruction of large soft palate defects following resection for cancer, to create and maintain patency of the velopharyngeal aperture after stenosis and to maintain patency of the nasal airway after resection of bony choanal atresia.
In cleft palate patients with a protrucing premaxilla, retrusion or collapse, the abnormal alveolar arches require a mouth gag which can be fitted to the individual. This modification of the Dott-Dingman mouth gag allows maximum adjustability and exposure.
A general format has been developed and used for reconstruction of the lower two-thirds of the nose in patients retaining some septum who have a low forehead. The lining above the alae comes from strategic local flaps, while the alar lining and most of the columella are produced by a pair of nasolabial flaps. Support is provided by the residual septum (sometimes advance), and by a later costal chondroperichondrial hinge graft. The cover comes from a "headless" gull-shaped, forehead flap.
A method of breast reconstruction, following a radical mastectomy, used a tubed flap of the tissue usually discarded during an abdominal lipectomy. This places the donor scar in an unnoticeable position. After migration, maneuvers such as denuding portions for insertion and overlap, and using a wrist attachment, have been of benefit in supplying adequate cover for an implant and in recreating an anterior axillary fold. The areola and nipple are obtained from the opposite breast. When indicated, a subcutaneous mastectomy of the opposite breast and insertion of an implant there equalizes the breasts and comforts the patient.
Two cases of nipples placed too high by reduction mammaplasties have been corrected by a combination of maneuvers--including (1) shortening the distance from the nipple to the inframammary line, and (2) repositioning of the areola-nipple component or putting in an implant to make the main projection of the breast directly behind the nipple.
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