Correction of Temporal Hollowing Deformity Using Serratus Anterior Muscle Flap

Temporal hollowing deformity (THD) is a contour irregularity in the frontotemporal region, which results in facial asymmetry in the frontal view. Here, we present our clinical experience of correction of THD using serratus anterior (SA) muscle and fascia free flaps. Between March 2016 and December 2018, 13 patients presenting with THD were treated with SA free flap. The mean age of the patients was 47.8 years. The patients received craniectomy due to subarachnoid hemorrhage, epidural hematoma, or brain tumor. On average, correction of THD was performed 17 months after cranioplasty. The SA flap size ranged from 5 × 5 cm to 10 × 8 cm . The mean operation time was 107.3 minutes. All of the flaps survived without complications. The mean follow-up duration was 20.3 months. For correction of THD, the SA muscle and fascia flap is among the best candidates to permanently restore aesthetic form and symmetry.

Garré's Sclerosing Osteomyelitis with Perimandibular Soft Tissue Inflammation and Fistula

Garré's sclerosing osteomyelitis is a form of chronic osteomyelitis that commonly affects children and young adults. Here, we report one such case of Garré's sclerosing osteomyelitis in a 20-year-old female who presented with facial asymmetry and inability to open mouth. On clinical examination, it was bony hard swelling with trismus. History of infected second molar tooth extraction was present. Computed tomography scan showed thickening and sclerosis of the ramus and condylar process of mandible, on right side, with proliferative periostitis. Magnetic resonance imaging showed soft tissue edema and inflammation, in the form of enlargement of right masseter and pterygoid muscles with intramuscular fluid collection. On the basis of history, clinical signs, and imaging features, diagnosis of Garré's osteomyelitis with fascial space infection was made. To our knowledge, very few cases of Garré's osteomyelitis present with superimposed fascial space infection, as it is otherwise a nonsuppurative condition. Fistula formation is a very rare incidence as it is seen in our case.

Lateral tarsal strip through osteotomies for recurrent ectropion and eyelid laxity correction

Objective to present a surgical technique for treating patients with recurrent ectropion and severe lower eyelid laxity. Methods Lateral tarsal strip and canthal fixation by osteotomy was performed in 6 patients with recurrent ectropion and 1 patient with extreme lower eyelid laxity secondary to an anophthalmic socket. Preoperative and postoperative photographs were evaluated in order to assess the outcomes of the procedure. Patients were followed up 4 weeks, 6 months, 12 months and 24 months of the postoperative period. The initial symptoms of the patients were eye redness, epiphora, foreign body sensation, aesthetic complaints, and facial asymmetry. Symptoms and aesthetic results were assessed by questioning, photographs, and fluorescein and lissamine green stains taken in each visit. Results No postoperative complications were observed. No recurrence episodes were reported during the follow-up period and physical appearance improvement and symptom severity reduction were maintained during the observation. Conclusion Lateral tarsal strip through osteotomies is an effective surgical procedure for treating severe recurrent ectropion cases or lower eyelid laxity and could be considered as an alternative treatment option or even a primary surgical technique in selected difficult cases.

OCULO-AURICULO-VERTEBRAL SPECTRUM ASSOCIATED WITH ABERRANT SUBCLAVIAN ARTERY IN AN INFANT WITH RECURRENT RESPIRATORY DISTRESS

ABSTRACT Objective: To describe an infant with craniofacial microsomia and recurrent respiratory distress associated with aberrant right subclavian artery in order to review its most frequent congenital anomalies and alert the pediatrician to its rarer and more severe complications. Case description: This case report involves an 18-month-old male infant, only son of non-consanguineous parents. At birth, the child presented craniofacial dysmorphisms (facial asymmetry, maxillary and mandibular hypoplasia, macrostomia, grade 3 microtia, and accessory preauricular tag) restricted to the right side of the face. Additional tests showed asymmetric hypoplasia of facial structures and thoracic hemivertebrae. No cytogenetic or cytogenomic abnormalities were identified. The patient progressed to several episodes of respiratory distress, stridor, and nausea, even after undergoing gastrostomy and tracheostomy in the neonatal period. Investigation guided by respiratory symptoms identified compression of the esophagus and trachea by an aberrant right subclavian artery. After surgical correction of this anomaly, the infant has not presented respiratory symptoms and remains under multidisciplinary follow-up, seeking rehabilitation. Comments: Craniofacial microsomia presents a wide phenotypic variability compared to both craniofacial and extracraniofacial malformations. The latter, similarly to the aberrant right subclavian artery, is rarer and associated with morbidity and mortality. The main contribution of this case report was the identification of a rare anomaly, integrating a set of malformations of a relatively common condition, responsible for a very frequent complaint in pediatric care.

Complicações Cirúrgicas em Bichectomia: Revisão de Literatura / Surgical Complications in Bichectomy: Literature Review

A bichectomia é um procedimento cirúrgico em que remove-se a parte correspondente ao coxim adiposo do Bichat, com finalidades estética e funcional. Tal procedimento está cada vez mais popular na Odontologia. Objetivo: Apresentar uma revisão narrativa da literatura sobre complicações associadas às cirurgias de bichectomia. Materiais e Métodos: Foi realizada uma busca de publicações sem restrição em relação ao ano de publicação em que foram realizados, incluído artigos científicos, relatos de caso clínicos, revisões de literatura, estudos descritivos e observacionais e excluindo cartas ao editor, editorias, teses e manografias a partir dos descritores em saúde (DeCS) “anatomia” (anatomy), “bichectomia” (bichectomy), “odontologia” (dentistry). Usando as bases de dados Lilacs, SciELO e Pubmed. Conclusão: Bichectomia é um procedimento estético-funcional, que apresenta riscos de complicações potencialmente graves, destacando-se lesão do ducto de Stenon ou do ramo bucal do nervo facial, que provocam, respectivamente, sialocele, fístulas salivares e paralisia bucal temporária ou definitiva, além de hematomas, assimetria facial e infecções pós-operatórias.---Bichectomy is a surgical procedure in which the part corresponding to the fat pad of Bichat is removed, with aesthetic and functional purposes. Such procedure is increasingly popular in dentistry. Objective: To present a narrative review of the literature on complications associated with bichectomy surgery. Materials and Methods: A search for publications was performed without restriction regarding the year of publication, including scientific articles, clinical case reports, literature reviews, descriptive and observational studies and excluding letters to the editor, editorials, theses and manographies from the health descriptors (DeCS) “anatomy” (anatomy), “bichectomy” (bichectomy), “dentistry” (dentistry). Using Lilacs, SciELO and Pubmed databases. Conclusion: Bichectomy is an aesthetic-functional procedure that presents risks of potentially serious complications, especially damage to the Stenon's duct or the buccal branch of the facial nerve, which cause, respectively, sialocele, salivary fistulas and temporary or permanent buccal paralysis, in addition to bruises, facial asymmetry and postoperative infections.