Skin and composite grafts

Skin grafts may be used for coverage of facial defects in situations in which alternative methods of reconstruction, such as local flaps, are not an option. They may also be beneficial for patients who wish to avoid or who are not good candidates for more complex reconstruction. Full-thickness skin grafts often have a better color and texture match to adjacent skin when compared to split-thickness grafts; however, split-thickness grafts have lower metabolic demand and increased survival rate. Composite grafts may be very useful in the repair of defects with unique contour and support requirements, such as the nasal ala and eyelid. With all grafts, thoughtful planning and sound surgical technique are critical in achieving the best possible functional and aesthetic result.

Mandibular reconstruction with microvascularized graft after ameloblastoma resection: case series

Ameloblastoma is a locally aggressive and highly infiltrative tumor with a high recurrence rate. Its multicystic form the recommended treatment is resection with a safety margin, which results in significant facial defects with esthetic and functionals repercussions. Microvascular surgery revolutionized the reconstruction of significant defects because these grafting techniques allow a more satisfactory aesthetic and functional restoration. This study aimed to report a series of cases of reconstructions of mandibular defects using microvascularized fibular graft after ameloblastoma resection. Six patients were included in this study, and we collected data related to the surgical procedure, diagnosis, complications and follow-up. The patients were characterized as four women and two men, with a mean age of 23.8 years, with a diagnosis of mandibular ameloblastoma located mainly in the body, angle and mandibular ramus. These patients underwent lesion resection, resulting in defects larger than 5 cm, which justified using a microvascularized fibular graft for its reconstruction. The patients evolved well, with good results and without recurrences or complications in a postoperative follow-up of 2 to 5 years. Ameloblastoma is a lesion that reaches large dimensions and causes excellent cosmetic and functional damage. The microvascularized graft is an alternative in reconstructing significant defects and allows satisfactory morphofunctional reestablishment with minimal complications.

Radiographic Features of Facial Cosmetic Material: Report of Two Cases

Recently, the use of noninvasive facial cosmetic procedures has been widely disseminated. In the face, cosmetic fillers, threads, and implants are used to reduce or delay the effects of aging or adjust facial defects caused by trauma or disease. The dentist or dental specialist may encounter these materials in the radiographic images of their patients. There are few reports in the dental literature describing the radiographic appearance of some materials along with the diseases they mimic. As the procedures and materials advance and evolve, dentists and dental specialists must be aware of their radiographic appearance to avoid errors in diagnosis. This is a report of two cases that include panoramic radiography and CBCT scan. Among these cases, there is an unusual appearance of a cosmetic filler due to a subperiosteal injection method. Moreover, it will discuss common types of cosmetic materials used in the face and their imaginological appearance. This is the key to dentists and dental specialists due to increasing use of facial cosmetic materials and a parallel increase in the use of cone beam CT and chances to encounter such findings.

Interdisciplinary care for newborns with cleft lip and palate in a children's multidisciplinary hospital

Накопленный опыт детской хирургии новорожденных и современные методы диагностики (компьютерная и магнитно-резонансная томография, пренатальная диагностика) позволили изменить существующие сроки коррекции врожденных пороков лица. В статье подробно описана «Система оказания помощи детям с расщелиной губы и нёба в период новорожденности», разработанная и внедренная на кафедре стоматологии детского возраста и ортодонтии Сеченовского университета. Сформулированы необходимые условия для оказания помощи данной категории пациентов и показания к предхирургической подготовке, обоснована тактика лечения, анестезиологического обеспечения у данной категории новорожденных. В работе приведены результаты ранней хирургической коррекции врожденных пороков лица 46 новорожденным с расщелиной губы и нёба. Детей с расщелиной губы и альвеолярного отростка разделили на 2 группы. В первую группу (n = 30) вошли пациенты, у которых диастаз в области альвеолярных отростков составлял 10 мм и менее. В этом случае сразу выполнялась хейлоринопластика. Во вторую группу (n = 16) вошли дети с диастазом альвеолярного отростка верхней челюсти более 10 мм. Этим новорожденным проводилась предхирургическая ортодонтическая подготовка в течение 10-12 дней (установка ортоимплантатов и наложение эластической тяги – цепочки). Критерием готовности к операции являлось достижение ширины диастаза между фрагментами альвеолярного отростка 10 мм и менее. После этого проводилось одномоментное удаление ортоимплантатов и операция – хейлоринопластика. Новорожденным с расщелиной твердого и мягкого нёба (n = 4) выполнялась уранопластика по методике А. А. Мамедова. У всех пациентов достигнуты хорошие эстетические и функциональные результаты. The accumulated experience of pediatric surgery of newborns and diagnostic methods (CT, MRI, prenatal diagnostics) have made it possible to change the existing terms for the correction of congenital facial defects. The article describes in detail «A system of care for children with cleft lip and palate in the neonatal period», developed and implemented at the Department of Pediatric Dentistry and Orthodontics, Sechenov University. The necessary conditions for rendering assistance to this category of patients are described, indications for pre-surgical preparation are formulated, the tactics of treatment, anesthetic management in this category of newborns are substantiated. The article presents the results of early surgical correction of 46 newborns with cleft lip and palate. Children with cleft lip and alveolar bone were divided into 2 groups. The first group (n = 30) included patients whose diastasis in the area of the alveolar processes was 10 mm or less. In this case, cheilorinoplasty was performed immediately. Group 2 (n = 16) included children with alveolar ridge diastasis of the upper jaw of more than 10 mm. This group of newborns underwent pre-surgical orthodontic preparation for 10-12 days, which consisted of installing ortho-implants and applying an elastic traction chain. The criterion for readiness for surgery was the achievement of a diastasis width between the fragments of the alveolar process of 10 mm or less. This was followed by simultaneous removal of ortho-implants and surgery – cheilorinoplasty. Newborns with a cleft of the hard and soft palate (n = 4) underwent uranoplasty according to the method of A. A. Mamedov. All patients received good aesthetic and functional results.

Local Flaps and Grafts

Reconstruction of facial defects is a complex process that when done well can have a significant positive impact on patients’ quality of life. While the variety of specific facial defects and their causes seems endless, it is important to understand that several core tenets in local reconstruction such as facial anatomy and aesthetics, appropriate patient selection, as well as surgical technique can aid in successful repair in most cases. This review contains 17 figures, 1 table and 28 references Key words: Local flap; skin grafts; facial reconstruction; skin cancer

How is the face formed and when it goes wrong: In relation to Cleft Lip/Palate

The normal development of the face relies upon the correct morphogenesis of structures in utero that usually occurs within the first trimester of embryonic life. The face is a very complex structure involving many genes and factors and with it being such a crucial part of life, both physically and aesthetically and therefore mentally, its important for everything to be just right. However, when the normal process doesn’t go to plan this results in dysmorphogenesis, which cleft lip and palate (CLP) is an example of as the lip/palate doesn’t fuse together and the infant is left with a gap. Although the exact cause of CLP is unknown, it is thought to be a mixture of genetics, environment and the teratogens the mothers are exposed to within the environment. This report will demonstrate the normal development of the face for the purpose of understanding how it goes wrong, resulting in CLP. Since there is still a lot to be understood about CLP it will also shed light on recent advances in relating SHH and certain genes as a possible cause for this dysmorphogenesis. The report will also briefly look at the relation of CLP with the genes associated with syndromic and non-syndromic diseases and the different types of CLP. There are many other facial defects that are a result of dysmorphogenesis, however as CLP is one of the most common yet poorly understood facial defect, it will be the main focus of this report.