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PubMed2004

Reconstruction of the temporomandibular joint by the transfer of the free vascularised second metatarsal.

We present our experience of a series of patients who presented for salvage reconstruction of the temporomandibular joint (TMJ) for relief of pain. Reconstruction was achieved by transfer of the free vascularised second metatarsal. This technique has been used for a total of seven TMJ reconstructions in five patients. We describe the surgical anatomy, technique and results during the last 18 years. One joint failed but the other six surviving joints continue to provide adequate pain-free function. We advocate this technique for autogenous salvage reconstruction in joints that have been previously operated on unsuccessfully.

Adolescent↗
PubMed2005

Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects.

We evaluated the effectiveness of the buccal fat pad as a pedicled flap for intraoral reconstruction after partial maxillectomy for neoplastic disease in 24 patients, and subsequently, in providing support for a denture. In all patients the buccal fat pad was covered with a split-skin graft and an acrylic plate. There was complete healing of the buccal fat pad flap within 6 weeks in 18 patients with no major complications, and minimal effects on speech and eating. In six cases there was partial dehiscence of the flap, which healed spontaneously in one patient and was repaired with local flaps in two others. There were no cases of complete breakdown of the flap. Eight patients so far have been rehabilitated with small dentures. In conclusion, the buccal fat pad flap is a simple, quick, and reliable method of reconstruction of small to medium-sized posterior maxillary alveolar defects.

Adipose Tissue↗
PubMed2006

Reconstruction of the upper lip and philtrum.

The procedure used to repair upper lip defects depends on various factors: size and location of the defect, the conditions of neighbouring tissues, and the aetiology of the deformity. A single-stage procedure rarely gives a satisfactory cosmetic outcome in patients who have also lost the philtrum or a philtral crease. Here, we describe a single-step procedure for the reconstruction of the upper lip and philtrum that resulted in a good aesthetic appearance.

Adult↗
PubMed2006

Intramuscular gluteal augmentation technique.

Gluteal augmentation with the intramuscular approach produces very good aesthetic results and, when properly performed, has a low incidence of complications. Using the intramuscular tissue plane ensures that implants are naturally positioned. In addition, larger implants may be used than with the submuscular technique, which many patients request. Of all possible gluteal implant placement options, the intramuscular position provides the greatest amount of implant coverage and pads the implant with muscle tissue above and below as well as along the inferior edge.

Buttocks↗
PubMed2006

Otoplasty technique: how I do it.

This article describes the combined conchal cartilage resection and mattress suture technique for the treatment of protruding ears. It is a reproducible, versatile, and safe procedure. The technique improves the protrusion, symmetry, and form of the ear by addressing the poorly developed or absent antihelical fold and the abnormally large concha. It has been used for many years and has produced consistently good long-term results.

Cosmetic Techniques↗
PubMed2006

Analysis in otoplasty.

The normal auricle has a well-recognized shape, and significant deviation from "normal" is immediately evident. In particular, prominent ears are readily apparent and are a relatively frequent cause of patient concern. Correction of the outstanding ear requires a careful understanding of the discrete elements that compose the normal ear. Careful anatomic analysis to determine the precise cause allows appropriate preoperative planning for the correction of a protruding ear.

Cosmetic Techniques↗
PubMed2004

Total lower lip functional reconstruction with a prefabricated gracilis muscle free flap.

Total lower lip reconstruction was performed in an 18-month-old boy following a dog bite. In order to obtain an optimal functional result and to avoid any additional facial scarring, a prefabricated gracilis muscle free flap was used in a two-stage procedure. Firstly, the muscle was delayed on its main pedicle, a 'tendinous' strip was inserted along its free border and a silicone sheet was slid under its predicted intraoral side. At the time of reconstruction, the neomucosal lining obtained in this way reconstituted the labial vestibule. Furthermore, the muscle, reinnervated by the mandibular branch of the facial nerve, was also put under minimal tension and suspended between the two modioli using the 'tendon' graft. This allowed both lip occlusion and normal speech development to be restored without any impairment of mandibular growth during a 4-year follow-up.

Animals↗
PubMed2005

Intraoperative imaging of zygomaticomaxillary complex fractures using a 3D C-arm system.

After preclinical studies and evaluation of radiation exposures, intraoperative three-dimensional (3D) C-arm based imaging is now available for the facial skeleton. Fourteen patients admitted for surgical treatment of zygomaticomaxillary complex (ZMC) fractures were included in the study. Preoperative diagnostics and surgical treatment were performed as usual. Intraoperatively, after open reduction, a cone-beam computed tomography (CBCT) dataset was generated using the SIREMOBIL Iso-C3D (Siemens Medical Solutions, Erlangen, Germany). After DICOM-import in eFilm Workstation axial, coronal and sagittal reconstructions were evaluated by five examiners with the help of six defined criteria. In our study, secondary reconstructions were available after 6 min, excluding the time needed for the evaluation of the images. Especially the positioning of the isocentre of the SIREMOBIL Iso-C3D proved to be uncomplicated. Because of the size of the datasets, assessment of the symmetry of the malar projection proved difficult. Best scoring results were found regarding the visualization of the fragment position, bony anchorage of the screws and the fitting of the plates. Remarkable was the low level of metal artefacts in primary and secondary reconstructions. In conclusion, our results demonstrate intraoperative CBCT using the SIREMOBIL Iso-C3D suitable for assessment of postoperative results following ZMC reduction.

Adult↗
PubMed2005

Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction.

OBJECTIVE: To evaluate the potential indications of thyroid alar cartilage (TAC) graft in the paediatric laryngotracheal reconstruction (LTR) population based on observations obtained in a case series of 27 consecutive infants referred to our tertiary care center. METHODS: Thyroid alar cartilage grafting was performed for limited Myer grade II and grade III subglottic stenosis requiring a single-stage laryngoplasty and for laryngeal enlargement after translaryngotracheal resection of endolaryngeal tumors. The evolution of the grafted area was evaluated prospectively during endoscopic follow-up. RESULTS: Twenty-five patients (92.5%) were successfully extubated after a mean of 5.1 days. No perioperative or postoperative complications were observed. The mean duration of graft harvesting was 7.7 min. Follow-up of the grafted area revealed one case of partial necrosis without prolapse into the lumen. The mean duration of graft epithelialization was 18.1 days (range: 12-30 days). Development of granulation tissue was observed in eight patients (32%) with a mean duration of granulation tissue persistence of 61.5 days (range: 7-155 days). Endoscopic follow-up did not demonstrate any pharyngolaryngeal asymmetry or feeding difficulties. CONCLUSION: This study demonstrated that the use of thyroid alar cartilage grafting is feasible for pediatric laryngotracheal reconstruction. The indications of thyroid alar cartilage graft should be reserved for moderated subglottic stenosis. The use of TAC reduced the operative time and cosmetic sequelae significantly. The healing of the grafted area was similar to those obtained with other types of graft. The TAC removal did not induce laryngeal deformation but longer follow-up is necessary to confirm this.

Adolescent↗
PubMed2005

Anterolateral thigh flaps for reconstruction of head and neck defects.

PURPOSE: This article presents our clinical experience with head and neck reconstruction using a free anterolateral thigh (ALT) flap and describes the morbidity of the donor site. MATERIALS AND METHODS: From October 2001 to October 2003, 20 free ALT flaps were transferred for reconstructing soft tissue defects of the head and neck. The age and gender of the patients, the site of the primary tumor, tumor stage, previous operative condition, types of associated operation, results of flap transfer, donor site morbidity, and clinical course were analyzed. RESULTS: Of 20 cases, 19 free flaps were successfully performed. The success rate was 95%. The size of the ALT flaps ranged from 6 to 10 cm in width and 9 to 20 cm in length (54 to 200 cm2 in area). Sixteen of the 20 donor sites were closed primarily, whereas 4 cases required a split-thickness skin graft to cover the donor site. Complications and morbidity of the donor site were minimal. CONCLUSION: The ALT flap has some advantages over other free flaps, including a long pedicle with a suitable diameter for anastomoses, the availability of different tissues with large amounts of skin, the ease of closing the donor site, and the ability for 2 teams to simultaneously perform the operation.

Adult↗
PubMed2004

Effects of a surgical treatment of congenital cervicovaginal agenesia.

OBJECTIVE: Congenital agenesis of the uterine cervix and vagina is one of the rarest congenital defects. The objective of this manuscript is to present our experience and effects of a surgical treatment in five girls with inborn agenesis of the uterine cervix and vagina, who were operated in our clinic. METHOD: The vagina is reconstructed in four stages: (1) formation of vaginal recess; (2) phantomization of vagina; (3) joining of the reconstructed vagina with the uterus; (4) revision and correction of the junction. GnRH analogs were administered to avoid menstrual blood flow into the peritoneal cavity during phantomization. RESULTS: Patency of the uterovaginal junction was maintained with a #6 intubation tube. Normal menstruation was restored in all patients. Atresion of the canal at the uterovaginal junction was disclosed after 3-8 months in three of the patients. Patency was restored with surgical hysteroscope and the canal was mechanically distended. Clinical and ultrasonographic followup in the patients will continue.

Adolescent↗
PubMed2006

Primitive neuroectodermal tumor of the sternum in a child: resection and reconstruction.

Pediatric primary malignancies of the sternum are rare. They represent less than 1% of all bone tumors. Primitive neuroectodermal tumor of the chest wall or Askin's tumor is more often seen in the ribs than in the sternum. Surgical treatment involves resection of the tumor followed by primary reconstruction. We report the case of a 16-year-old adolescent boy who was diagnosed to have primitive neuroectodermal tumor of the sternum and underwent resection with primary reconstruction of the anterior chest wall. We describe for the first time the use of a 2-mm Gore-Tex Dualmesh plus biomaterial (W.L. Gore and Associates, Flagstaff, Ariz) and locking mandibular multiperforated titanium plates with screws (Stryker-Leibinger, Freiburg, Germany) for primary sternal reconstruction in a child. Despite having a wide resection, he did not require postoperative ventilation and had an uncomplicated recovery. The reconstructed chest wall has a normal contour with normal pulmonary physiology.

Adolescent↗
PubMed2005

Investigation of a hybrid method of soft tissue graft fixation for anterior cruciate ligament reconstruction.

To increase knee stability following anterior cruciate ligament (ACL) reconstruction, development of increasingly stronger and stiffer fixation is required. This study assessed the initial pullout force, stiffness of fixation, and failure modes for a novel hybrid fixation method combining periosteal and direct fixation using porcine femoral bone. A soft tissue graft was secured by combining both an interference screw and an EndoButton (Smith and Nephew Endoscopy, Andover, MA). The results were compared with the traditional direct fixation method using a titanium interference screw. Twenty porcine hindlimbs were divided into two groups. Specimens were loaded in line with the bone tunnel on a materials testing machine. Maximum pullout force of the hybrid fixation (588+/-37 N) was significantly greater than with an interference screw alone (516+/-37 N). The stiffness of the hybrid fixation (52.1+/-12.8 N/mm) was similar to that of screw fixation (56.5+/-10.2 N/mm). Graft pullout was predominant for screw fixation, whereas a combination of graft pullout and graft failure was seen for hybrid fixation. These results indicate that initial pullout force of soft tissue grafts can be increased by using the suggested novel hybrid fixation method.

Animals↗
PubMed2005

Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction.

OBJECTIVE: To describe the advantages of using Mimix hydroxyapatite (HA) bone cement in reconstructing a variety of ossicular chain abnormalities. STUDY DESIGN AND SETTING: Case series at a tertiary medical center. RESULTS: Twenty-five cases of HA reconstruction are included in this series (ages 23-74; mean, 47 years). The examples presented include (1) HA as the sole reconstructive material for incus erosion, (2) HA for securing a total or partial ossicular replacement prosthesis, (3) incus augmentation after crimping for revision stapedotomy with incus erosion, (4) HA in primary stapedotomy to fix the crimped prosthesis to an intact incus, and (5) other unique situations. Preoperative and postoperative audiograms were evaluated for 4-tone pure tone average (PTA), speech reception thresholds, word recognition scores, and air-bone gaps (AB gaps). Mean follow-up was 11 months (range 2 to 22 months). The mean PTA improved from 57 dB to 37 dB, whereas the mean AB gaps decreased from 33 dB to 16 dB. There were no cases of infection or extrusion. CONCLUSIONS: Hydroxyapatite bone cement is an excellent adjunct or alternative to ossiculoplasty with preformed prostheses. Easily malleable, rapidly setting, and rapidly hardening, Mimix is particularly well suited for middle ear work. SIGNIFICANCE: Definitive fixation with bone cements during difficult ossicular chain reconstruction may ensure a more enduring successful outcome.

Adult↗