1/9. Necrotizing infection of the face secondary to intranasal impaction of "crack" cocaine."Crack" is a crystalline form of cocaine that is readily available and sold in the form of small granules. The authors report a unique case of forced intranasal impaction of crack cocaine with subsequent extensive necrosis of the nose and upper lip accompanied by a necrotizing infection of the subcutaneous soft tissue of the cheeks, forehead, and temporal regions. The treatment of extensive facial necrosis resulting from infection and ischemia centers around the early diagnosis of the infectious process, prompt and aggressive surgical debridement, and the administration of broad-spectrum antibiotics.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/9. Bilateral congenital choanal atresia and absence of respiratory distress.Bilateral congenital choanal atresia is considered a lethal congenital malformation in an obligatory nasal breathing neonate. Described herein are two cases of bilateral choanal atresia associated with craniofacial anomalies who did not present respiratory distress in the neonatal period. Our first patient had a complete unilateral cleft lip which facilitated oropharyngeal respiration. The second patient presented wory distress in the neonatal period by providing an oropharyngeal airway.- - - - - - - - - - ranking = 100.50152169252keywords = breathing (Clic here for more details about this article) |
3/9. The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty.We suggest that it is possible to correct the stigmata of the post-traumatic nasal deformity by means of an upper buccal sulcus approach alone. This approach is demonstrated in a series of ten cadaveric subjects for the correction of nasal skeletal deviation or bossing. Furthermore, the technique, which avoids internal nasal scarring and violation of the internal nasal valve, has been successfully employed in four patients with a minimum of 9 months follow-up. We suggest that it is possible to conserve the internal nasal valve and avoid problems of nasal tip retractions using this approach in selected cases.- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
4/9. Surgical correction of the long face syndrome.The combined efforts of different specialists are needed for the successful treatment of patients with the long face syndrome. Both surgeons and orthodontists who recognize their own capabilities and limitations must combine their skills to achieve the best possible occlusion and facial esthetics. The surgical and orthodontic plan of therapy is designed to correct the patient's dentofacial deformity. Surgical reduction of facial height and proper alignment of the teeth by orthodontic means are common denominators of successful treatment. By properly planned and executed Le Fort I maxillary osteotomies, the vertical dimensions of the face can be shortened to improve the esthetic balance between the nose, upper lip, teeth, and chin and achieve lip competency. Variable open-bite and nonopen-bite maxillary deformities in forty adults with the long face syndrome were corrected by Le Fort I osteotomy and orthodontic treatment. The technical problems encountered in planning and executing treatment are discussed and illustrated by selected case reports.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/9. Ocular abnormalities in the median cleft face syndrome.An 8-month-old infant boy with median facial cleft syndrome had eyelid coloboma, symblepharon, and a cytic mass in the left upper eyelid. The mass proved to be an ectatic cornea containing a large cystic lens. Maldevelopment of the entire anterior segment of the eye was also present, although the posterior globe was well formed. We postulate that an area of localized abnormal mesodermal differentiation and fusion at the 17- to 20-mm stage of development served as a common mechanism for all the defects noted.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
6/9. Upper lip flap for reconstruction of a full-thickness ala nasi defect.Aesthetic reconstruction of full-thickness ala nasi defects has always been a challenge to the surgeon. Although several techniques are available, none has proved to be ideal. In this paper we describe a flap from the upper lip for reconstruction of defects involving the alar base and full-thickness defects of ala nasi. A flap based on the columella-labial junction is rotated upward for reconstruction of the alar base or ala nasi. The donor site of the flap can be closed primarily. When ala reconstruction is indicated, an upper lip flap forms the inner lining of the nostril, and a skin graft is applied over it for skin coverage. With this flap, an appropriately positioned ala with natural contours may be reconstructed in one stage.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
7/9. Enhancement of the burned nasal tip with the use of upper lip scar flaps.Maximal aesthetic improvement for the patient with burns deserves the same considerations as does functional restoration. The use of burn scars as vascularized flaps is a prime example in which these goals may be simultaneously achieved with an added bonus of salvaging tissues that would otherwise be discarded. Several cases involving revision of commonly encountered perioral scars demonstrate the effectiveness of burn scar flaps in the correction of concomitant nasal deformities, and thus reemphasize this useful principle.- - - - - - - - - - ranking = 4keywords = upper (Clic here for more details about this article) |
8/9. Endoscopic manifestations of Wegener disease.The diagnostic criteria for upper airway necrotizing diseases such as Wegener's granulomatosis (WG) are well defined. However, the differentiation with other diseases of unknown aetiology remains difficult. Establishing an early diagnosis and prompt treatment is very important to minimize loss of function and cosmetic deformity. In the last fifteen years, we observed and treated eight cases of WG. In six patients, WG appeared primarily in the nose area. One patient presented primarily middle ear and secondary nose involvement, whereas in one case, the inner ear was affected too. One patient did not present nasal involvement although the middle ear and several cranial nerves were involved. For these patients, the pathognomonic diagnosis had not been confirmed by biopsy at the early stage and we introduced an immunosuppressive therapy on the basis of clinical and histological findings only. For the eight patients, the treatment stopped the disease process but for one patient, we abandoned drugs because of side effects. Finally, only four of the cases only had a pathognomonic histological diagnosis of WG. In four cases, serologically anticytoplasmic antibodies against neutrophil granulocytes (Anca) were observed early. Both clinical and histological findings and determination of these antibodies give the possibility to solve difficulties in WG differential diagnosis.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
9/9. Limits for the use of forehead flaps for small and extensive midface reconstructions including septum/columella reconstructions.I describe six selected cases of challenging reconstructions in the midface including a small deepithelialised and tunnelled flap for volume-replacement and conjunctiva-reconstruction in the orbit and a case of septum/columella reconstruction with a tunnelled paramedian forehead flap. Big flaps for extensive complex reconstructions in the midface (cheek, lip, and nose) emphasis the efficiency of the flaps. In extensive reconstructions the paramedian forehead might primarily be used for lining. Indian forehead flaps should be dissected to the base in the upper eyelid to increase their strength and for greater versatility. The base can be de-epithelialised without threatening its viability. This procedure allows the flap to be tunnelled and increases the mobility of the flap. Long flaps can even be folded without delay.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |