Prophylactic Midface Lift in Midfacial Trauma

2017 ◽  
Vol 33 (03) ◽  
pp. 347-351
Author(s):  
Ryan Brown ◽  
Kirk Lozada ◽  
Eli Gordin ◽  
Yadranko Ducic ◽  
Sameep Kadakia

AbstractThe objective was to review our favorable experience in the use of prophylactic midface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures.

2005 ◽  
Vol 132 (3) ◽  
pp. 373-380 ◽  
Author(s):  
Jesse E. Smith ◽  
Yadranko Ducic ◽  
Robert Adelson

OBJECTIVE: To determine the efficacy of temporalis muscle flap reconstruction of various defects of the oropharynx, nasopharynx, and base of tongue. STUDY DESIGN: Retrospective chart review of a consecutive series of 24 patients who underwent a total of 26 temporalis flaps (2 bilateral) by the senior author (Y.D.) from September 1997 to August 2003 for reconstruction of defects of the oropharynx, nasopharynx, and base of tongue. METHODS: Variables and outcomes that were examined included defect location, size, adjunctive therapy, complications, and ability to tolerate oral intake at follow-up. RESULTS: There was no evidence of flap failure in our series of patients. There were 2 cases of minor flap loss related to early prosthetic rehabilitation. Two cases of transient frontal nerve paralysis were noted. A 30.8% rate of complication (all minor) was noted in this study. At a mean follow-up of 12 months, 54.2% of patients were tolerating a full diet, 37.5% were tolerating most of their nutrition by mouth, and 8.3% were g-tube dependent. CONCLUSION: The temporalis muscle flap represents an excellent alternative in reconstruction of otherwise difficult-to-reconstruct defects of the nasopharynx, oropharynx, and base of tongue. Donor site aesthetics are well accepted by patients with primary hydroxyapatite cement cranioplasty with or without secondary lipotransfer.


2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.


2019 ◽  
Vol 9 ◽  
pp. 59-64
Author(s):  
Ramesh Agrawal ◽  
Dolly P. Patel ◽  
Bhagyashree B. Desai

The current paper depicts the challenges faced during the treatment of a complicated case of mandibular condylar head fracture, facial asymmetry, and centric relation-centric occlusion (CR-CO) discrepancy along with Class III malocclusion. A 20-year-old female reported with the chief complaint of difficulty in chewing and concern with her appearance due to deviated jaw and had a history of trauma over chin region. The clinical and radiographic examination revealed significant facial asymmetry with long face, right-sided deviation of the mandible, fractured condyle, CR-CO discrepancy, cross- bite with Class III malocclusion, and a missing mandibular single incisor along with non-vital 21 and 22. She was treated with 0.022 MBT appliance along with guiding plane for CR-CO correction followed by asymmetric bilateral sagittal split osteotomy and differential set back on the right and left sides and finally rigid fixation. A good facial profile and functional occlusion were achieved and non-vital 21 and 22 were esthetically rehabilitated with PFM crowns. The stability of surgical as well as orthodontic corrections was excellent and appreciable in the records obtained 2-year post-treatment. When faced with mutilated malocclusion, with multiple problems, sequential correction of functional malocclusion with dental decompensation followed by skeletal correction with surgical approach has yielded a appreciable facial correction with good stability showing 2-year post-treatment follow-up.


2010 ◽  
Vol 16 (3) ◽  
pp. 96-102
Author(s):  
V. V. Klyuchevsky ◽  
Hassan Ben El Hafi

From 2005 to 2009 we treated 112 patients with fractures of distal segment of the humerus, 83 (74,10%) of them were injured when falling from the height of its own growth, 8 (7,14%) - in an accident, 6 (5,35%) - a fall from a height, 13 (11,6%) - in sports, and two - as a result of violent acts. In 97 (87%) cases the fractures were closed, in 15 (13%) - open. 19 patients were treated conservatively and 93 - operatively. Functional results were evaluated using the Mayo elbow performance score (MEPS) in 78,37% of patients. Results of the conservative method: excellent and good - 46,66%, and in all patients with type A without displacement - in 100%. The fair results - in 33% and the poor in 20% - with type В and C. The results of operative treatment: excellent and good - 90,41%, the fair results - in 9,58%, no poor results. Initial prevent the oedema and bleeding into joints and soft tissues, adequate rigid fixation of fractures with the maximal restoration of the elbow joint congruent without additional immobilization and early active mobilization is essential to prevent the elbow stiffness and achieve a good outcomes.


Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 78-87 ◽  
Author(s):  
Wolfhard Caspar ◽  
Bayard Campbell ◽  
Dragos D. Barbier ◽  
Ralf Kretschmmer ◽  
Yechiel Gotfried

Abstract The outcome in 119 patients who were operated on with a conventional standard lumbar discectomy procedure was retrospectively compared with that in 299 patients who were operated on with a microsurgical discectomy technique developed in Homburg/Saar, Federal Republic of Germany by the senior author (W.C.). All patients in this consecutive series had “virgin” lumbar radiculopathy evaluated and operated upon by two experienced surgeons at one institution. Determination of the final outcome was made objectively by an impartial third party using identical criteria for both groups, and with a patient self-evaluation form. The study looked at various pertinent aspects of the treatment course and at final outcome. The results in the microsurgical group were significantly favorable: fewer levels were explored; there was less operative blood loss and a decreased incidence of deep venous thrombosis, urinary tract infections, pulmonary emboli, and bladder catheterization; the time to full ambulation, discharge, and return to work was faster; and there was a decrease in change of occupation and a greater percentage of satisfactory final outcomes, as measured both objectively and subjectively. A description of the microsurgical technique used in this study, which differs significantly from existing microdiscectomy techniques, is presented. The authors conclude that the microsurgical discectomy technique presented in this study is a safe and effective approach to the treatment of lumbar radiculopathy.


2013 ◽  
Vol 84 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Jae-Kyu Lee ◽  
Pil-Kyo Jung ◽  
Cheol-Hyun Moon

ABSTRACT Objective: To investigate discrepancies in results of facial asymmetry analysis using different cone beam computed tomography (CBCT) image reorientation methods and the effectiveness of soft tissue as a reorientation reference for analysis of facial asymmetry. Materials and Methods: An asymmetric group of 30 patients with 4 mm or more of chin point (menton [Me]) deviation and a symmetric group of 30 patients with less than 4 mm of deviation of Me were chosen as study subjects. Three orientation methods were used to calculate and compare Me deviation values of the 60 subjects. Two methods used only skeletal landmarks for reference, and one method included the soft tissue landmarks around the eye. Preferences of an expert group for the facial midline as determined by each reorientation method were also examined. Results: The examinations showed significant discrepancies in Me deviation values between the three reorientation methods. The expert group showed the greatest preference for the facial midline reorientation method that incorporated soft tissue landmarks of the eye. Conclusions: These study findings suggest that the inclusion of soft tissue landmarks, especially those around the eyes, is effective for three-dimensional CBCT image reorientation for facial asymmetry analysis.


2019 ◽  
Vol 35 (03) ◽  
pp. 230-238
Author(s):  
Adrian A. Ong ◽  
David A. Sherris

AbstractBotulinum toxin is integral to the practice of facial plastic surgery. Since it was approved by the U.S. Food and Drug Administration for the temporary improvement of glabellar rhytids in 2002, botulinum toxin has achieved a growing number of off-label clinical applications. These include the management of facial rhytids, brow ptosis, excessive gingival display, masseteric hypertrophy, platysmal banding, facial nerve paralysis, hypertrophic scars, and keloids. Many forms of botulinum toxin have been developed, and their safety and efficacy have been thoroughly established. This article will review the aesthetic and functional uses of botulinum toxin as it relates to the field of facial plastic and reconstructive surgery. In addition, the authors will discuss the suggested quantity of units per injection site based on onabotulinumtoxinA.


2020 ◽  
Vol 40 (7) ◽  
pp. 711-718
Author(s):  
Melekber Çavuş Özkan ◽  
Fatma Yeşil ◽  
İnci Bayramiçli ◽  
Mehmet Bayramiçli

Abstract Background Soft tissue thickness (STT) is a major factor affecting the outcome in rhinoplasty. However, limited information is found in the literature on the age- and gender-related variations of the nasal STT. Objectives The purpose of this study was to measure STT at various landmarks over the nasal framework and compare the age- and gender-related differences. Methods STT measurements were made at 11 landmarks in 325 patients by employing magnetic resonance imaging. Patients were divided into subgroups to compare the STT differences between female and male and between the age groups as young, middle age, and elderly. Results Soft tissue was thickest at the nasion and thinnest at the rhinion. The soft tissue coverage was significantly thicker in the male population at the supratip, tip, nasal bones, upper lateral cartilages, and alar lobules, whereas it is thicker in females at the rhinion. Average thickness of the soft tissues over the entire nasal framework increases with age except the rhinion. Conclusions The STT is variable over different parts of the osteocartilaginous framework. Gender and age influence the STT. The soft tissue is thicker at the distal half of the nose in male patients, and these areas become gradually thicker with age, whereas the soft tissue over the midvault becomes thinner. Increasing age presents a particular challenge to achieve predictable results in rhinoplasty, and an understanding of the soft tissue envelope allows for improved aesthetic outcome. Level of Evidence 2


2017 ◽  
Vol 11 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Cesar de Cesar Netto ◽  
Augusto César Monteiro ◽  
Rômulo Ballarin Albino ◽  
...  

Phalangeal fractures of the toes represent common injuries of the forefoot. In the hallux, most fractures occur at the distal phalanx and frequently result from a direct crushing type of injury. Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation, hindering gait and weightbearing. The aim of this study was to present an option of operative approach in the treatment of displaced interphalangeal joint fractures of the hallux, along the medial border of the extensor hallucis longus tendon. It is our understanding that this approach minimizes injury to the soft tissue envelope, allowing a rigid fixation and early weightbearing and range of motion. Levels of Evidence: Level V: Expert opinion


Iron-rich octahedral crystals have been described by the senior author in the gut caeca cells of the amphipod Stegocephaloides christianiensis . The present investigation revealed their presence in other species in the family Stegocephalidae ( Bathystegocephalus inflatus , Euandania ingens , Parandania boecki , Stegocephaloides auratus , S. vanhojfeni , Stegocephalus inflatus , Phippsiella spp. and Parandaniexis sp. (cf. mirabilis ). Crystals were not found in Andaniopsis nordlandica , T etradeion crassum or Andaniexis abyssi , although the latter gave a tissue reaction for iron. Fe cells contain only a single crystal each in all species and crystals consistently increased in size proximally in each caecum. The most distal region of the caecum was devoid of crystals. Detailed work was confined to Stegocephaloides christianiensis , Stegocephalus inflatus and Parandaniexis sp. (cf. mirabilis ). Caecum ultrastructure of S. christianiensis is described: two cell facies (R /F and B cells) are distinguishable. R /F cells (=Fe cells) are columnar, with a terminal brush-border of long microvilli. Lipid globules, glycogen, Fe crystals and Ca granules are found in these cells. B-cells have a luminal border of short, stubby microvilli with an apical complex of membrane-bound vesicles of varying degrees of coalescence. The composition of the Fe crystals has been described using X -ray microprobe analysis. Strong Fe peaks were revealed together with minor peaks for Si, P, S, Cl, K, Ca, Cu and Zn. These elements were identified in the surrounding cytoplasm also. Crystal composition is homogeneous with no separate core. The crystal consists of hexagonally arranged, electron dense cores of 5.8 + 0.3 nm diameter at intercore distances of 10.5 ± 0.5 nm, 7.5 + 0.5 nm and 9.5 + 0.5 nm. Wide angle electron diffraction analysis of the cores gave four rings with d spacings of 0.250, 0.223, 0.191 and 0.145 nm (all + 0.003 nm). On these bases the substance of the crystals is identified as ferritin. Ferritin crystals are voided in the faeces of Stegocephaloides christianiensis , suggesting a role in iron excretion, perhaps as part of a body content regulation process. The content of iron in S. christianiensis and a variety of other inshore Amphipoda has been investigated using atomic absorption spectrophotometry. Iron content was non-linearly related to body dry mass in S. christianiensis and cannot simply be explained as a consequence of surface adsorption. Iron levels in S. christianiensis were higher than in many other species investigated. The morphology of the mouthparts of S. christianiensis has been investigated using scanning electron microscopy. Analyses of fresh stomach contents revealed cnidarian nematocysts which corresponded in size and form with those from Adamsia carciniopados , Pennatula phosphorea and Hydractinia echinata . Behavioural observations on live S. christianiensis suggested that Pennatula was a likely prey item. Investigations of a range of Cnidaria and of a few known predators of cnidarians ( Pycnogonum , Hyperia ) confirmed that the discharged acontia of Adamsia and the soft tissues of Pennatula contained unusually high concentrations of iron. It is proposed that the production and expulsion of ferritin crystals by S. christianiensis and other cnidarian-consuming species in the family Stegocephalidae represents an iron regulation system in animals experiencing a dietary iron challenge.


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