101/179. Nasal manifestations of yaws. yaws is an infectious, non-venereal disease of the tropical countries, which is caused by treponema pertenue. Gangosa and goundou were seen commonly in cases of yaws in africa, particularly in the early part of this century. After successful WHO mass treatment campaigns, these conditions are rarely seen now. A case of yaws with gangosa, goundou, and a nasopharyngeal carcinoma is presented here for its rarity. ( info) |
102/179. 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. ( info) |
103/179. Median forehead island skin flap for the correction of severely collapsed nose. Five cases of severely collapsed nose as a result of infection were corrected by excision of intranasal scar and lining the intranasal defect with median forehead island skin flaps based on supratrochlear vessels. Simultaneous bone grafting was undertaken to support the reexpanded nose. Clinical experiences are presented. ( info) |
104/179. Clinical application of the free flap based on the cutaneous branch of the acromiothoracic artery. The nasal reconstruction in 8 patients and cheek reconstruction in 1 using a free flap from the deltoid region has been successfully undertaken in our department since August 1987. The flap has a direct cutaneous artery--the acromial artery--as its vascular axis. The experiences and a brief anatomical review of the donor site are reported. ( info) |
105/179. Acoustic rhinometry: evaluation of the nasal cavity with septal deviations, before and after septoplasty. We introduce acoustic rhinometry as a new, objective method to assess the geometry of the nasal cavity. The cross-sectional area of the nasal cavity as a function of distance from the nostrils was obtained. A group of 21 patients with septal deformities was examined with acoustic rhinometry preoperatively and postoperatively. These values were compared with those of 21 normal control subjects. The minimal cross-sectional area (MCA) is located in the anterior part of the nose, and it shifts anteriorly under the effect of decongestion. The preoperative value of MCA is related to the location and severity of the anterior septal deformity. Postoperative smaller MCA found in the opposite side of that narrowed by a severe anterior septal deformity may be explained by the impact of septoplasty without reduction of a hypertrophic turbinate. A highly significant relation between MCA and the subjective feeling of nasal patency, before and after surgery, suggests that MCA is a valuable parameter to express nasal patency. Correction of posterior septal deformities is found to increase significantly the cross-sectional area posteriorly. The effect of decongestion in the postoperative values, however, suggests that the mucosa contributes even more to the cross-sectional area of the posterior part of the nose. Acoustic rhinometry seems very suitable for evaluation of the nasal cavity in cases where septoplasty and turbinoplasty is considered, as well as for the postoperative evaluation. ( info) |
106/179. The chondrocutaneous postauricular free flap. Use of the auriculomastoid region as a donor-site for a microvascular free flap is still not the general consensus. This report presents three patients with composite tissue defects of the face aesthetically reconstructed with a chondrocutaneous postauricular free flap. For its safe surgical application, additional anatomic knowledge was refined with cadaver study. Use of the chondrocutaneous postauricular free flap has some merits. Its dissection is straightforward and safer than when only the cutaneous unit is used. It also offers a more dependable vascularized composite tissue as a one-stage operation. With freedom of design, a variable combined facial defect can be delicately reconstructed. The final aesthetic results obtained were gratifying, and the donor-site deformity was minimal. ( info) |
107/179. A new cocaine abuse complex. Involvement of nose, septum, palate, and pharynx. A new complex of findings caused by cocaine abuse is presented. The complex consists of nasal collapse, septal perforation, palatal retraction, and pharyngeal wall ulceration. The findings and their causes are described. Pathologic evaluation to ensure that a concomitant disease, such as Wegener's granuloma, malignant reticulosis, autoimmune lesion, or various other destructive diseases, was not present was performed on only one patient. Although three patients presented with the findings caused by cocaine abuse, only one patient consented to the biopsy examinations. This case is presented in detail. ( info) |
108/179. The effects of nasomaxillary injury on future facial growth. The appearance of results of injury to the columella, the nasal septum, and the nasal bones, in particular, has been well described. Anomalies of the maxilla and global facial balance secondary to nasomaxillary injury are less well known. Three cases involving children, aged 11, 14, and 17 years, who had suffered nasomaxillary injury at least 8 years earlier as a result of physical beating, were studied with the use of photographs and architectural craniofacial lateral cephalometric radiographic analysis. The architectural craniofacial analysis of Delaire produced a graphic representation of the resultant maxillofacial deformities rather than a description of the deformities in terms of deviation from a statistical mean. Traumatic injury to the nasomaxillary complex provides an experimental model that implicates the role of the cartilaginous nasal septum and local functional conditions in the growth of the nasomaxillary complex. The importance of the functional premaxillary skeletal unit in balanced facial growth allows better understanding of the pathophysiology of malformation of this region. ( info) |
109/179. Nasofacial defect following fibrosarcoma excision and radiotherapy. For initial reconstruction, Dr. Burget suggests that he would have advanced the cheek flap medially toward the nasal septum and, subsequently, reconstructed the missing right half of the nose with a forehead flap and cartilage grafts. Dr. Panje suggested early prosthetic rehabilitation, while Dr. Krause's concepts were similar to Dr. Burget's, with forehead flap nasal reconstruction, after cheek reconstruction to the nasofacial and nasolabial lines with a medially advanced cheek flap. Dr. Panje recommended an immediate maxillary denture prosthesis, as did Dr. Krause (who supplemented this with foam rubber). Dr. Burget placed the prosthesis 3 weeks after tumor ablation. For skin grafts, Drs. Panje and Burget suggested split thickness grafts to all new surfaces to decrease wound contracture, while Dr. Krause used dermis grafts for the same purpose. Other reconstructive methods mentioned were the (1) cervical tubed flap, (2) free scapular flap, (3) Washio flap, (4) tissue expansion, and (5) nasolabial flap. Suggestions for isolated defects included: Lower eyelid--increase internal support by building up the prosthesis; release lower lid from deltopectoral flap and V-Y advancement; support graft or irradiated cartilage (1-2 mm sheet) under orbicularis oculi. Nasal ala--bring present ala down and insert cartilage graft; turn internal skin down and fill the resulting defect with a composite graft. Upper lip--multiple Z-plasty. Retrodisplacement of cheek due to maxillectomy--release buccal scar; skin graft the raw internal surface and build up prosthesis. ( info) |
110/179. Defect of the ala nasi following trigeminal denervation. Case report. Trophic ulceration of the nose is a rare complication occurring in patients with trigeminal anaesthesia. The etiology is not clear, but self-inflicted injuries to an anaesthetic region are considered to play an important part. The authors' experience with three cases indicates that substitution with skin from the affected area of the face will not give a lasting result. It seems probable that only skin with an intact nerve supply can provide a permanent replacement for skin lost in the dystrophic process. This means that a local flap innervated from a non-affected part of the face would offer the best possibility of a permanent cover for these defects. ( info) |