RESUMO
The birth of rhinoplasty in the West was driven by a great demand for reconstruction of noses destroyed voluntarily or not, post-traumatic or medical. Two men emerge strongly through their work and writings: Gaspare Tagliacozzi for the brachial flap and Joseph Carpue for the frontal flap. Both of them describe a different method but based on the same skin flap principles. But were they really the first? History tells us that other, more anonymous people before them had used these same methods on a large scale but without leaving any conclusive or very significant written trace. The use of flaps or grafts, methods, which are the true pillars of plastic surgery, opened up perspectives much wider than the nose. But history has retained the name of these two men through their writings. If they were not the precursors, they were nevertheless promoters, laying the foundations of modern plastic surgery and promoting the spread of these great principles throughout the world.
Assuntos
Procedimentos de Cirurgia Plástica , Rinoplastia , Cirurgia Plástica , Humanos , Masculino , Nariz/cirurgia , Retalhos CirúrgicosRESUMO
The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.
Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/história , Implantes de Mama/história , Neoplasias da Mama/história , Feminino , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , Humanos , Mamoplastia/métodos , Ilustração Médica , Retalhos Cirúrgicos/históriaRESUMO
AIM OF STUDY: Five cases of the same congenital malformation of the nose, affecting the nasal dorsum and the supra-tip, were supported in our university plastic surgery center. This malformation has not been described in the literature known to the authors. The aim of this study is to analyze this nasal deformity. PATIENTS AND METHODS: Five children presented this congenital deformity between 1994 and 2014. The patients were examined and the malformation precisely described. Genetic and histological examinations were carried on. The diagnosis and treatment of this pathology were discussed. RESULTS: This malformation associated 4 anomalies: hypertrophy of soft tissue of the dorsum located in the middle third of the nasal bridge, deformed alar cartilages turned back downward and outside, advanced support default and median skin brand similar to a scar. These patients showed no other abnormalities of the midline or respiratory disorders. No genetic disorder was found for these five patients, and no histological arguments were found. Three patients were operated, one until adulthood with a satisfying cosmetic result. CONCLUSION: Bibliographic research has not allowed us to make an accurate diagnosis of this malformation that appears to be non-syndromic and to have a genetic origin. Our therapeutic approach became more clear and it now seems legitimate to propose early excision of fat mass to prevent alar deformations, associated with a cortico-cancellous graft, which in our experience grows with age, to support the tip.
Assuntos
Nariz/anormalidades , Nariz/cirurgia , Satisfação do Paciente , Rinoplastia , Retalhos Cirúrgicos , Criança , Feminino , Hospitais Universitários , Humanos , Masculino , Nariz/diagnóstico por imagem , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Rinoplastia/métodos , Resultado do TratamentoRESUMO
AIM OF THE STUDY: We present the case of a patient with Goldenhar syndrome associated with congenital fistula in the middle of philtrum at the upper lip. PATIENTS AND METHODS: The patient was supported from birth for Goldenhar syndrome. Several procedures were performed in childhood to correct a macrostomia and mandibular hypoplasia right. At 14 years old, she has a rhinoplasty to correct a complex nasal malformation. During the procedure, a hole in the upper central incisor inter-space is found. It is extended by a fistula which runs through the front palate towards the vomer rail at the base of the partition. This fistula is blind behind the vomer and can be completely resected. Pathological examination of the resection reveals a squamous lining. RESULTS: The median fistula of the upper lip are extremely rare : less than 30 cases reported in the literature. The unusual run of the fistula and the recent appearance of a pituitary syndrome in this patient makes us look for a continuity between it and Rathke's pocket by computed tomography imaging type. CONCLUSION: The association of Goldenhar syndrome and median congenital fistula of the upper lip was never yet described in the literature. The association with hypopituitarism was suspected with the posterior extension of the malformation, not confirmed by the scanner, but strongly suspected jointly by the neurosurgical and plastic surgery team.
Assuntos
Síndrome de Goldenhar/complicações , Doenças Labiais/congênito , Fístula Bucal/congênito , Adolescente , Feminino , Humanos , Doenças Labiais/cirurgia , Fístula Bucal/cirurgiaRESUMO
The presence of a congenital or acquired cutaneous lesion is a frequent reason for consultation in pediatric plastic surgery unit. The management of these lesions requires a good knowledge of specific diagnoses in children. This step is sometimes difficult because of the multiplicity of possible diagnosis. Some skin tumors may be the external sign of a general disease or an underlying malformation; those can change the overall prognosis and management and require to be properly identified. The decision of surgical excision depends on various criteria, including diagnosis but also the reconstruction possibilities. The timing of surgical treatment depends on the medical emergency of the tumor resection (benign tumor, spontaneously regressive tumor, risk of degeneration into malignancy), on the cosmetic and psychological impact but also on the growth or learning steps in child life. This article first provides an aid in the diagnosis of the most common or more characteristic skin tumors. The algorithm is principally based on the pigmentation aspect of the tumor. The age and conditions of the surgical management are specified for each type of tumor. Cutaneous hemangiomas and vascular malformations, and congenital cysts and fistulas are not reported in this article.
Assuntos
Neoplasias Cutâneas/cirurgia , Algoritmos , Criança , Humanos , Neoplasias Cutâneas/patologiaRESUMO
Skin expansion is a difficult and long process in which can occur more or less serious complications. Overall complications rates describe in the literature vary between 13 and 37%. We can categorize them in major complications, which can lead to a failure maybe even an aggravation of the anterior status, and in minor complications that do not compromise the expansion process but can alter it. The main major complications are infection, skin suffering and necrosis which can lead to prosthesis exposition, leaks and technical problems with equipment dysfunctions that may cause difficulties or a failure of the inflations. The main minor complications are hematomas, seromas, valve or tube exposition, pains with paraesthesias caused by neighbouring organs compression, pathologic and unsightly scares and can lead to an important psychological impact. These complications can be due to a precarious skin's state, a material dysfunction or unpredictable technical problems but also by an inappropriate preoperative indication or planning. The emerging of a complication, however, is not synonymous to a failure of the procedure; a satisfactory reconstruction may still be obtained in 75% of all cases. The purpose of this article is to help to identify the situations at risk of complications in order to prevent, detect and treat them early.
Assuntos
Expansão de Tecido/efeitos adversos , Algoritmos , Criança , Humanos , Necrose , Pele/patologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapiaRESUMO
INTRODUCTION: Ortho dontico-surgical coverage of alveolar crack is essential in reason of its repercussions on facial growth and implementation of children's teeth set. We proposed to realize a premature gingivo periosto plastic surgery from 4 years old by osseous substitute to lower age of alveolar cracks closure and decrease the morbidity of patients. PATIENTS AND METHODS: We conducted a retrospective study over one year (January, 2012 to December, 2012), with six months postoperatively outcomes, on 23 cases of gingivo periosto plastic sugary with osseous substitute type glass by bone transplant at infantile plastic surgery service of Timone - Children teaching hospital of Marseille, France. RESULTS: We held 23 patients. Seventeen children, 12 boys and 5 girls presented unilateral cracks. Twenty patients required a quantity of glass bone under 1cc for the narrow cracks. Prevalence of the mucous cracks was low (4 cases on 23). Technique of gingivo periosto plastic surgery with osseous substitute is simple and our results are globally satisfactory. We observed less morbidity of the operating site. CONCLUSION: The first results of this study showed that gingivo periosto plastic surgery with osseous substitute glass bone is a simple, reliable and reproducible technique, with promising results. Reduction of site's morbidity by osseous transplant, accessibility of glass bone cost and simplicity of surgical gesture justified adoption of this technique.
Assuntos
Processo Alveolar/cirurgia , Substitutos Ósseos/uso terapêutico , Procedimentos Cirúrgicos Bucais/métodos , Processo Alveolar/anormalidades , Criança , Pré-Escolar , Feminino , Gengiva/cirurgia , Humanos , Masculino , Periósteo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Estudos RetrospectivosRESUMO
Palpebral malformations can be isolated or associated with a craniofacial disorder. Their assessment is based on clinical examination; additional investigations are mainly done to characterize craniofacial syndromes. In case of extrapalpebral lesions or complex craniofacial pathology, genetic testing must be performed. Some isolated malformations will only need a simple follow-up; others must have specific treatment, undertaken following a precise timing, taking into account child and anatomical structures' growth and the possible consequences of the malformation on the eye and child's sight (degree of urgency). When dealing with these malformations, there are two main risks to be taken into consideration: corneal irritation due to lagophtalmos and amblyopia owing to visual axis obstruction, anisometropia or strabismus.
Assuntos
Anormalidades Múltiplas , Anormalidades do Olho/cirurgia , Pálpebras/anormalidades , Procedimentos Cirúrgicos Oftalmológicos , Procedimentos de Cirurgia Plástica , Algoritmos , Criança , Neoplasias Oculares/cirurgia , Humanos , FotografaçãoRESUMO
Dynamic facial reanimation with free muscle or nerve transfers represents the mainstay of facial paralysis treatments particularly for perioral area and smile. These techniques are not always feasible, in such cases we perform a perioral suspension with fascia lata graft. However many teams blame this technique for short-term recurrence of the deformity. We describe in this paper details of our surgical technique, to improve the aesthetic result and stability over time, and the results and complications encountered. Fascia lata graft was sutured beyond the midline to the contralateral healthy lips, after tunneling through upper and lower orbicularis oris. Fascia lata graft was then tunneled through the buccal fat pad, then under the zygomatic arch to the temporal region, where the temporal aponeurosis was incised to make way for the fascia lata graft, which was fixed to the outer face of the temporal aponeurosis, applying slight overcorrection to the oral commissure. From 2003 to 2012, we performed this procedure on 8 patients. Results showed an immediate aesthetic improvement, stable over time. Perioral suspension with fascia lata graft is a surgical alternative when dynamic reanimation is not feasible.
Assuntos
Paralisia Facial/cirurgia , Fascia Lata/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The submental island flap is a precious tool in reconstructive surgery. It was described by Martin in 1993, inspired by platysma flaps. In our days, we can find many reliable techniques for this procedure. We reviewed the main studies of the literature that described a total of 528 patients. The rate of partial necrosis was 5.1%, complete necrosis 1.7%, and reversible lesions of the marginal mandibular branch of the facial nerve 1.1%. His versatility makes this flap appropriate for the reconstruction of every part of the face: cheeks, nose, forehead, moustache, beard, and hairs. It can also be used de-epidermised with very good results, for the reconstruction of the buccal cavity, the tongue, the roof of the mouth, the larynx, and the proximal part of the esophagus. The SMAP (Submentalis Artery Perforator flap) is an alternative flap that provides even better cosmetic results. The development of indocyanine green and infrared cameras will allow in a close future to decrease the postoperative complications.
Assuntos
Face/cirurgia , Retalhos Cirúrgicos , Face/irrigação sanguínea , Humanos , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos/irrigação sanguíneaRESUMO
Facial paralysis prognostic depends on eye lesion. In this pathology, lacrymal and palpebral functions will be modified: bad eye closure and leak of tears secretions. It can leads to corneal complications from keratitis to corneal abcedation and visual dysfonction. This chapter details different procedures and their indications to avoid this kind of complications.
Assuntos
Paralisia Facial/complicações , Paralisia Facial/cirurgia , Úlcera da Córnea/etiologia , Doenças Palpebrais/etiologia , Doenças Palpebrais/cirurgia , Pálpebras/inervação , Pálpebras/cirurgia , Humanos , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/cirurgia , Músculos Oculomotores/inervação , Músculos Oculomotores/cirurgiaRESUMO
In rhinoplasty, satisfying the patient both aesthetically and functionally can be complex. In aesthetic surgery, the rhinoplastician has a reinforced obligation of means. In our experience, the functional outcome of the patient is closely linked to the morphological result. When a rhinoplasty provides the patient with full aesthetic satisfaction, even if he/she has breathing difficulties, there will be very few disputes. In primary rhinoplasty, unsatisfactory results occur in 15%-30% of the cases. While orally informing the patient is paramount, the practitioner must also have written proof of the information via documents given or sent to the various players including the patient. The taking of pre- and postoperative photographs is essential and the surgeon must keep them on file for support in case of conflict.
Assuntos
Estética , Prova Pericial/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Rinoplastia/legislação & jurisprudência , Documentação/normas , França , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Educação de Pacientes como Assunto/legislação & jurisprudência , Satisfação do Paciente , Encaminhamento e Consulta/legislação & jurisprudênciaRESUMO
Observing a morphological alteration of the nasal septum should in no way automatically lead to a septoplasty. Only poorly tolerated septal deviations creating a mechanical nasal obstruction are a surgical indication. This delicate operation requires meticulousness to preserve the muco-perichondrial envelope. The statement follows a rigorous clinical assessment where endoscopy is important because it points out the septal deformities, the size of the inferior turbinates and possible valvate problems. Performing a rhinomanometry and sometimes a CAT scan will complete the preoperative assessment.
Assuntos
Obstrução Nasal/cirurgia , Septo Nasal/anormalidades , Septo Nasal/cirurgia , Rinoplastia/métodos , Endoscopia , Estética , Humanos , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Rinomanometria , Tomografia Computadorizada por Raios XRESUMO
Correction of a twisted or crooked nose can be very complex and require the use of a broad range of surgical techniques. Patient needs are often mixed--aesthetic and functional--particularly in post-trauma cases. The quality of postoperative breathing is therefore as important as correction of the nasal deviation. Extracorporeal septoplasty or spreader grafts are very effective not only in correction of the nasal pyramid deformation, but also in resolution of functional respiratory issues. Reconstruction and proper support of the septum are necessary components for a straight nose. Aesthetic deformation can be difficult to correct owing to the memory of the bone and cartilage. Although minor deformations can be corrected with simple techniques, a more aggressive procedure is often necessary in the most complex cases. Despite attempts to correct deformation thanks to the various techniques described here, a postoperative deviation can persist. Preoperative discussion is very important and enables the surgeon to explain to the patient that it is very difficult to obtain a perfectly straight nose.
Assuntos
Estética , Deformidades Adquiridas Nasais/cirurgia , Nariz/anormalidades , Rinoplastia/métodos , Cartilagem/transplante , Tomografia Computadorizada de Feixe Cônico , Humanos , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/diagnóstico , Osteotomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , RinomanometriaRESUMO
Most patients who consult a surgeon for rhinoplasty do not want a radical change in their nose. They seek a reduction in the volume of the nasal pyramid and correction of a precise element that they judge to be ungainly--most often an osteocartilaginous hump. The procedure that we qualify as "standard" will eliminate the osteocartilaginous hump, decrease the dimensions of the septum and reduce the size of the alar crus of the alar cartilage. Although the required technical maneuvers are simple, their sequence must be coherent with a few basic rules that are simple but rarely explained in order to avoid defects linked to excessive, or on the contrary, insufficient corrections.
Assuntos
Rinoplastia/métodos , Rinoplastia/normas , Estética , Humanos , Osso Nasal/anormalidades , Osso Nasal/cirurgia , Cartilagens Nasais/anormalidades , Cartilagens Nasais/cirurgia , Nariz/anormalidadesRESUMO
Osteotomies are performed to modify the shape of the bony part of the nose, therefore they should not be done systematically. Main indications are correction of deviated nose, narrowing of bony vault and roofing of an open roof after important hump resection. The nose should be very precisely analyzed before osteotomies if the surgeon doesn't want to create deformities such as step, inverted V, pinched nose or saddle nose. When too narrowed, bones can also block the airway and lead to functional problems.
Assuntos
Osso Nasal/cirurgia , Osteotomia/métodos , Rinoplastia/métodos , Humanos , Osso Nasal/anormalidades , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
Secondary rhinoplasty is very usual. Some patients are not satisfied by the previous surgery because the result is poor with obvious defaults but, sometimes, the result is good but the patient expects perfection. These two different situations will not lead to the same answer from the surgeon. Techniques of secondary rhinoplasty are the same than primary, but are often more difficult to perform because of scar tissue, retraction and loss of lining. The authors analyse the more frequent deformities in secondary rhinoplasty and the way they fix them.
Assuntos
Estética , Nariz/anormalidades , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Rinoplastia/métodos , Cartilagem/transplante , Humanos , Erros Médicos/prevenção & controle , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia , Osteotomia/métodos , Satisfação do Paciente , Complicações Pós-Operatórias/etiologiaRESUMO
In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach--the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty.
Assuntos
Rinoplastia/métodos , Dissecação/instrumentação , Dissecação/métodos , Humanos , Cartilagens Nasais/cirurgia , Mucosa Nasal/cirurgia , Septo Nasal/anormalidades , Septo Nasal/cirurgia , Rinoplastia/instrumentação , Instrumentos CirúrgicosRESUMO
Children noses have special anatomical and functional characteristics. Early interventions performed before the end of the child's growth have been a main topic as they may cause adverse effects on the subsequent development and the function. This chapter describes the characteristics of the nasal pyramid and the septum at different stages of growth. Should one's approach be very cautious in children surgical indications, one should not hesitate opting for the treatment of congenital malposition or acquired when they jeopardize the nasal function. Considering possible procedures and specific conditions within pediatric field are discussed in this chapter.
Assuntos
Nariz/crescimento & desenvolvimento , Rinoplastia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Intervenção Médica Precoce , Humanos , Lactente , Recém-Nascido , Septo Nasal/anormalidades , Septo Nasal/anatomia & histologia , Septo Nasal/crescimento & desenvolvimento , Septo Nasal/cirurgia , Nariz/anormalidades , Nariz/anatomia & histologia , Tomografia Computadorizada por Raios XRESUMO
Harvesting iliac crest bone in children is special because of the presence of a thick cartilage. Constant pressure on the internal iliac fossa, ascends the skin, and moves the abdominal muscles away from the iliac crest. A single incision is then used for cutaneous and subcutaneous dissection. An internal piece of cartilage is then removed and the iliac muscle retracted in order to harvest cortical and spongy bone from the internal side of the iliac crest. That pièce of cartilage is then sutured at its initial place. During the harvesting, the surgeon needs to be careful to preserve the lateral femoral cutaneous nerve.