The Lip Repositioning Surgery: A Review of the Technique's Evolution

The lip repositioning technique (LRT) is considered a safe and predictable gummy smile (GS) treatment. However, since Rubinstein and Kostianovsky introduced it in 1973, it has undergone several modifications. This article aims to review and provide a historical compilation of LRT evolution to help clinicians understand each technique's description and the rationale for its modifications to treat GS.An electronic search was performed in Medline, Scopus, and Cochrane Library up to May 2021 including the terms “lip repositioning,” “lip repositioning technique,” or “lip repositioning surgery” and studies evaluating or discussing the original LRT's modifications in detail. The search had no language or time restrictions. Additionally, a hand-searching of references of all included articles was performed.Modifications described in the literature include muscle severance, subperiosteal dissection of the gingiva, frenectomies, and the use of adjuvant products. They aim to minimize relapse, morbidity, and improve stability. Discomfort, scar formation, and pain were the most frequent complications reported. The choice to use a modification should be analyzed and customized to the individual patient's needs.

Our Experience with Inverted Papilloma: about 61 Patients

Introduction: Inverted papilloma (IP) is the most common type of Schneiderian papilloma originating from the mucosal lining of the nose and paranasal cavities. It is a semi benign tumor with a high tendency for recurrences and malignant transformation. Management consists of a complete tumoral resection. Objective: to analyze surgical results considering the techniques (open or endoscopic surgery), the rate and time of recurrence. Method: We present herein a cohort of 61 patients treated in the CHU-UCL Godinne between 1998 and 2019. We analyzed the demographic data, the origin of the tumor, the staging, the surgical approach and the outcomes. The patients were classified into two groups: the first one includes 48 patients operated de novo in CHU-UCL Godinne and the second group 13 patients referred to us for revision surgery. Results: We observed 8 recurrences, all groups confounded. The global success rate was 87%. The number of recurrences in the first group was 6 out of 48 and 2 out of 13 in the second group. Following these results we propose an algorithm of treatment depending on the site of attachment of the IP. Conclusion: We confirmed that more extended surgeries such as Caldwell Luc procedure, medial maxillectomy, Draf IIb/III frontal sinusotomy or type III sphenoidotomy give better outcomes than more “limited” and functional surgeries such as Draf I/IIa frontal sinusotomy or middle antrostomy. The latter should be done only for specific and limited extension of the IP in the maxillary sinus. A subperiosteal dissection is mandatory in all cases. Keywords: inverted papilloma; retrospective study; surgery; recurrence

Cerclage Fixation of Navicular Fractures

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Navicular fractures are commonly seen midfoot fractures that can be easily missed and difficult to treat. More severe fractures result from forces that compress the talar head into the navicular causing the navicular to displace radially like staves of a barrel. In a case report from Foot and Ankle International, Naidu and Singh (2005) showed a displaced comminuted intra-articular navicular fracture that was treated innovatively with a cerclage wiring technique. To our knowledge, this is the only published report of a navicular fracture treated with this approach. Since that time the senior author has treated over 25 of these severe fractures with a similar cerclage wiring technique. Over time this technique has evolved and now preferentially involves use of an Arthrex FiberTape cerclage system. Methods: The surgical technique is described as follows. First a small incision is made over the medial pole of the navicular. A lead suture is then passed after subperiosteal dissection along the plantar surface of the navicular and received at a similar incision at the lateral pole. The original technique we employed involved the use of a Dall-Miles cable and cable passer but has been supplanted by the lead suture technique or by using the needle of an Arthrex FiberTape. Once control of the plantar surface is accomplished, subperiosteal dissection is made along the dorsal surface with a Kelly clamp or small periosteal elevator. The lead suture is then delivered to the medial pole which then allows for circumferential control of the fracture fragments. The FiberTape is then passed by pulling the lead suture which delivers the FiberTape circumferentially. This provides indirect reduction by radial compression as it is sequentially tightened. Results: We have performed over 25 cases in a similar manner and in our experience have found this to be the best fixation and reduction technique available (Image 1 & 2). Conclusion: This approach demonstrates a safe, expedient, minimal incision surgical approach that provides optimal fixation of these difficult navicular fractures.