11/65. Total soft-tissue reconstruction of the middle and lower face with multiple simultaneous free flaps in a pediatric patient.A 2-year-old boy sustained a massive facial soft-tissue wound secondary to a dog attack. Essentially all the soft tissues of the face were absent, including innervation and intraoral lining. We describe the reconstruction of this defect with five simultaneous free tissue transfers. To our knowledge, this is the first report of five simultaneous free flaps in any patient.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
12/65. Intubating LMA guided awake fibreoptic intubation in severe maxillo-facial injury.PURPOSE: To describe control of the airway in a patient with severe maxillo-facial injury using intubating laryngeal mask guided awake fibreoptic intubation. CLINICAL FEATURES: A 110 kg man presented with a severe facial injury due to a horse kick. Local examination showed a large transverse gaping laceration just beneath the nose, exposing the lower nasal cavities through to the posterior nasopharynx. It was planned to perform a surgical tracheostomy before surgical fixation of the maxilla and nasal bones. Considering the patient's weight, short neck and difficulty in lying flat, surgical tracheostomy under general anesthesia was considered the best option. Under topical anesthesia, an intubating laryngeal mask was introduced followed by a fibreoptic bronchscope. The endotracheal tube was threaded over the bronchoscope and airway control achieved. CONCLUSIONS: The use of an intubating laryngeal mask avoids the need for manipulation of the head and neck and acts as a 'shield' for the fibreoptic bronchoscope from surrounding blood in patients with maxillo-facial injury. The use of the fibreoptic bronchoscope ensures intubation under vision.- - - - - - - - - - ranking = 0.25keywords = lower (Clic here for more details about this article) |
13/65. Self-inflicted gunshot wounds of the lower half of the face: the evolution toward early reconstruction.The self-inflicted gunshot wound of the lower half of the face traditionally has been treated by multistaged and prolonged reconstructive maneuvers that often left significant and uncorrectable secondary deformities. Modern cranio-maxillofacial methods for reduction and rigid fixation of the facial skeleton, using immediate autogenous bone grafts when required, also has been efficacious for the acute management of these severe gunshot injuries. These methods can reduce the previously expected morbidity. Today's improved outcomes also are a consequence of the use of more reliable regional flaps and microsurgical techniques, which permit the early and simultaneous restoration of bone and soft tissue loss once all devitalized tissues have been adequately debrided.- - - - - - - - - - ranking = 1.25keywords = lower (Clic here for more details about this article) |
14/65. Teeth grinding, tongue and lip biting in a 24-month-old boy with meningococcal septicaemia. Report of a case.This paper describes the management of a 24-month-old boy who presented with self-inflicted trauma to his lower lip and tongue, and teeth grinding, 21 days after developing meningococcal septicaemia. A decision to observe and prescribe palliative therapy was made. Extraction of the lower right deciduous canine, which had become non-vital, possibly due to bruxism, was carried out.- - - - - - - - - - ranking = 0.5keywords = lower (Clic here for more details about this article) |
15/65. Facial reconstruction using a combined flap of the subscapular axis simultaneously including separate medial and lateral scapular vascularized bone grafts.With the better understanding of the blood supply to the scapula, combined flaps of the lateral scapula along with the latissimus dorsi and/or serratus anterior are well known. The medial border of the scapula, in this respect, has been underused. The authors present a case report in which a conjoined combined free flap consisting of four free tissue transfers based on the subscapular axis was used in simultaneous reconstruction of a gunshot wound to the face. This included a medial scapular osteofasciocutaneous flap for the mandible, a lateral scapular osseous flap for the anterior maxilla, a serratus anterior muscle flap for the cheek, and a separate latissimus dorsi musculocutaneous flap for the forehead. This flap was successful and provides another alternative to the resolution of complex problems needing multiple areas of both soft-tissue coverage and vascularized bone graft.- - - - - - - - - - ranking = 3.8767026627556keywords = mandible (Clic here for more details about this article) |
16/65. Prefabricated galeal flap based on superficial temporal and posterior auricular vessels.scalp layers are widely used in reconstructive procedures. The authors used prefabricated galeal flaps based on the superficial temporal or postauricular vessels for ear, cheek, mandible, and cranium reconstructions in three cases. In case 1, synchronous beard and ear reconstructions were accomplished by using the temporoparietal and retroauricular flaps. In case 2, a buccomandibular defect was reconstructed by transposing the supra-auricular and retroauricular galea with prefabricated bone and skin. In case 3, an epidural hematoma in the left frontoparietal area was evacuated after a circular craniectomy. The harvested bone was not put back on the defect area but buried between the periosteal and galeal layers because of brain edema. These layers were raised as an osteogaleoperiosteal flap and transposed onto the defect area after 7 weeks. When used with a prefabrication method, scalp layers offer versatile options for repairing composite defects of the head region. A galeal flap based on the posterior auricular vessels is practical and reliable in reconstructive procedures. The authors suggest that this flap is an option in cases in which the temporoparietal fascia artery or the superficial temporal artery is not available. Prefabrication of the harvested cranial bone inside the adjacent tissues offers several advantages in that a viable bone is provided at the end of the procedure, intervention at a distant area is avoided, the graft is placed on osteogenic tissue (periosteum) that is also transposed onto the defect, and sophisticated procedures such as microsurgical techniques are not needed.- - - - - - - - - - ranking = 3.8767026627556keywords = mandible (Clic here for more details about this article) |
17/65. Iliac crest free flap in oromandibular reconstruction. 13 cases study.Oromandibular reconstruction following oncological resection is particularly challenging. In this past decade, great improvements have been made, in functional and aesthetic terms, following the introduction of composite free flaps. By means of this reconstructive technique, it is, in fact, possible to restore mandibular continuity, and, consequently, the morphology of the lower third of the face; rehabilitate mastication through osteointegrated implants, and optimise the reconstruction of soft tissue, employing the fascio-cutaneous or muscular portion of these flaps. Between January 1995 and January 2001, 70 oromandibular reconstructions employing osseous free flaps were performed in the Department of Maxillo-Facial Surgery of the Ospedale Maggiore in Parma, and in 13 of these the iliac crest free flap was used. Personal experience is described regarding the indications and use of this flap.- - - - - - - - - - ranking = 0.25keywords = lower (Clic here for more details about this article) |
18/65. Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures.Midface fractures, especially if related to traffic accidents, represent a remarkable problem from a surgical, psychological, and social standpoint. In trauma dynamics, the pattern of the fractures can extend to all bony fragments and is often associated with soft tissue injuries and loss of bony structures. This can lead to posttraumatic deformities that greatly influence the patient psychologically and limit his social rehabilitation, sometimes permanently. Panfacial trauma includes midface fractures associated with fractures of other areas (i.e., mandible, frontal bone). Orbits and the nasoethmoidal area are often involved with loss of soft tissue and, in severe cases, loss of orbital contents. We report an unusual complex clinical case representative of this kind of pathological profile in which the guidelines described in the literature were followed in the reconstructive procedure.- - - - - - - - - - ranking = 3.8767026627556keywords = mandible (Clic here for more details about this article) |
19/65. Self-inflicted midline facial gunshot wounds: the case for a combined craniofacial and microvascular team approach.Self-inflicted gunshot wounds to the face are extremely complex and difficult to manage. In the past, these patients have been treated by debridement, hemostasis, and soft tissue closure with reconstruction deferred to a later time. This approach consigned the patient to significant facial contracture and scarring, which is impossible to adequately correct secondarily. As a result of this traditional approach, patients had substantial disfigurement as well as dysfunction. At the Medical College of wisconsin, we have begun an aggressive multispecialty team approach in which the maximum possible reconstruction is performed acutely. This has resulted in superior aesthetic and functional results, and in a substantially lower number of hospitalizations, surgical procedures, and hospital days. This approach includes the spectrum of current plastic surgical techniques including the craniofacial approach using open reduction with accurate miniplate reconstruction and acute bone grafting as well as soft tissue reconstruction and replacement using composite multiple-stacked free tissue transfer. We believe the overall approach provides a superior result and we will continue a program of aggressive and acute intervention.- - - - - - - - - - ranking = 0.25keywords = lower (Clic here for more details about this article) |
20/65. The traumatic bone cyst: review of literature and report of two cases.The traumatic bone cyst, seen by clinicians both physician and dentist alike, is a well recognized yet poorly understood entity whose pathogenesis remains obscure. Generally asymptomatic, this lesion is most often found as an incidental finding on routine radiographic survey. Its diagnosis, however, is important to rule out more significant pathology. A brief review of pertinent literature and two new cases of traumatic bone cyst have been presented, including an infrequently reported case of traumatic bone cysts occurring bilaterally in the mandible.- - - - - - - - - - ranking = 3.8767026627556keywords = mandible (Clic here for more details about this article) |
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