A series of 155 malignant craniofacial tumors referred to a specialized craniofacial center for surgical treatment are presented. One quarter of these were primary and three quarters recurrent. The statistics of long-term follow-up are presented, and it is concluded that this type of surgery for these difficult problems is worthwhile. The increasing experience gained from operating on and following up these patients is presented.

Adolescent↗

PubMedDate not supplied

A craniofacial approach to advanced recurrent cancer of the central face.

Recurrent penetrating midface cancer results from basal cell carcinoma, squamous cell carcinoma, adenocystic carcinoma, and chondrogenic and osteogenic sarcoma. In the past, surgical resection frequently resulted in meningitis. A combined neurosurgical and plastic surgical craniofacial approach has been used for total resection of these lesions. The floor of the anterior cranial fossa has been reconstructed with an extended glabellar flap incorporating a forehead Z-plasty. Over the past 2-and-a-half years, 10 patients have been operated on successfully. Five cases with a follow-up of over 2 years are presented.

Aged↗

PubMedDate not supplied

Treatment of tumors involving the anterior cranial fossa.

The potential for a tumor of the upper face, either malignant or nonmalignant, to involve the anterior cranial base is often not appreciated. This leads to inadequate preoperative investigation and to surgery performed by the head and neck surgeon without the help of the neurosurgeon. In this way, complete tumor resection may be compromised or delayed. Neither of these situations is desirable. If the potential for anterior cranial fossa invasion is recognized, there should be prior consultation with the neurosurgeon and a combined operative procedure. Exposure of these lesions has considerably improved with experience in congenital craniofacial deformities: this will allow en bloc resection of most pathologies. Immediate reconstruction after resection of nonmalignant tumors is advocated, but in aggressive--particularly in recurrent--malignancies, delayed reconstruction is advised. Careful combined follow-up with frequent blind biopsies should be carried out as indicated.

Adult↗

PubMedDate not supplied

Breast reconstruction following removal of silicone implants: a new technique.

We present a new technique for breast reconstruction following removal of silicone breast implants. The technique uses locally available tissue to provide a soft and natural-appearing breast. The twin objectives of mastopexy and breast augmentation are achieved in one step. Immediate and long-term results have been very satisfactory.

Adult↗

PubMedDate not supplied

Advances in craniofacial tumor surgery.

The use of craniofacial surgical techniques has stimulated the development of new approaches to the excision of skull base tumors. Experience gained from operating on 200 skull base tumors (45 nonmalignant and 155 malignant) is presented. The cranial base area is subdivided into specific areas, and surgical approaches have been devised. In addition, the use of vascularized tissue such as the galea, temporalis fascia, temporalis muscle, or free vascularized tissue transfer has prevented the complication of infection so frequently seen as a cause for morbidity and mortality in the past. In this series, there were no major infections. The variety of pathology seen in this area is considerable. Therefore, in a series such as this operated on by a single surgeon, only trends can be observed. We suggest that with experience, surgery in this area is safe, and the long-term survival of this mixture of tumors (primary, recurrent, carcinomas, and sarcomas) is between 40% and 50%, and, therefore, makes excisional procedures worthwhile.

Cranial Fossa, Posterior↗

PubMedDate not supplied

A successful long-term method of fat grafting: recontouring of a large subcutaneous postradiation thigh defect with autologous fat transplantation.

A method of harvesting fat with intact cells using a veterinary needle and a fine needle aspiration device is described. Viable fat cells are obtained in large amounts. A large subcutaneous postradiation thigh defect was reconstructed with harvested fat placed subcutaneously in various sessions. A good, but not perfect, reconstruction was obtained. This case indicates that viable fat cells can be transplanted and can survive even in the adverse environment of a postradiation defect.

Adipose Tissue↗

PubMedDate not supplied

Simultaneous facelift and carbon dioxide laser resurfacing: a safe technique?

A modified facelifting technique with simultaneous carbon dioxide laser resurfacing makes for improved quality of the overlying skin, which enhances the effect of repositioning of the deep facial structures. Concerns have been expressed with regard to complications which may occur when this approach to facelifting is used. This paper presents guidelines which, if observed, allow this procedure to be performed safely in terms of laser skin injury. Over 100 patients have been treated using this combined technique, frequently with the addition of further ancillary procedures. Patient follow-up ranged from 1 to 36 months and showed none of the feared complications to have occurred. This combined approach has improved the results achieved previously by either technique used on its own. In addition, it saves time for both patient and surgeon, and apart from redness, the postoperative recovery period is similar. This technique requires patient education and a postoperative team effort by surgeon, nurse, and aesthetician. Experience has shown that this is a safe procedure which can produce good results with the proper pre- and postoperative management.

Aged↗

PubMedDate not supplied

The volume limitation of the galeal temporalis flap in facial augmentation.

Galeal temporalis flaps based on the superficial temporal vessels have been used for facial augmentation and can be extended to the contralateral side beyond the midline in order to achieve maximum volume. In five patients, the volumes of extended galeal flaps were measured intraoperatively using a water displacement method. The calculated volume varied between 28 and 38 cm3. Experience with this flap showed satisfactory results with no complications; therefore, it is concluded that the extended galeal temporalis flap may be a first choice in the correction of facial soft tissue deficits less than 40 cm3. Clinical cases are presented.

Adult↗