A Hollow Tridimensional Silicone Template for Microtia Reconstruction and Postoperative Scar Compression.

Microtia poses a great challenge in auricular reconstruction, due to a great number of anatomical details on the anterior aspect, and its tridimensional shape. Numerous techniques have been described in an attempt to optimize results. We have designed a hollow tridimensional silicon template to serve as an intrasurgical guide for ear's anatomy, size and projection, according to the normal side, which allows better results of auricular reconstruction. It also can be used as a customized post-operative compression method. We believe it could be a valuable tool for microtia reconstruction surgery. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Unusual Mandibular Distraction Complication in Two Neonatal Pierre Robin Sequence Patients.

ABSTRACT: The Pierre Robin sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and airway obstruction. Conservative management in Pierre Robin sequence consists of nasogastric tube feeding and positioning of the neonate (prone or lateral position) that facilitates the anterior position of the tongue or the application of continuous positive nasal pressure. In case of failure of this treatment, emergency tracheostomy and/or mandibular distraction must be performed.Mandibular distraction is a standard technique used by craniofacial surgeons to achieve an anteroposterior horizontal lengthening of the mandibular body, correcting the posterior position of the base of the tongue and thus retropharyngeal enlargement of the airway.The authors present 2 clinical cases of hypertrophy of the sublingual salivary glands with the use of mandibular distractors in SPR patients with severe airway obstruction.

Distracción osteogénica del maxilar y manejo ortodóncico integral en paciente con síndrome de Pfeiffer. Reporte de caso / Maxillary osteogenic distraction and comprehensive orthodontic treatment in a patient with Pfeiffer syndrome. A case report

Síndrome de Pfeiffer es una craneosinostosis de herencia autosómica dominante, cuyas manifestaciones clínicas son tanto a nivel cráneofacial como en extremidades superiores e inferiores. El tratamiento para estos pacientes debe ser efectuado por un equipo multi-disciplinario y representa un gran desafío para los profesionales de la salud. El objetivo de este artículo es exponer el caso de una paciente adolescente diagnosticada con síndrome de Pfeiffer, que presentaba hipoplasia maxilar severa, maloclusión de Clase III y overjet negativo; tratada con distracción osteogénica usando dispositivo RED (rigid external distractor) asociado a aparatología ortodóncica fija. Los resultados cumplieron con las expectativas terapéuticas y estéticas de la paciente, mostrando estabilidad en la evaluación 20 meses post tratamiento. Palabras clave: Acrocefalosindactilia; Ortodoncia; Osteogénesis por distracción; Hueso maxilar (fuente: DeCS BIREME).

Pfeiffer ́s syndrome is an autosomal dominantly inherited craniosynostosis, its clinical features are both at craniofacial level and upper and lower limbs. The treatment must be carried out by a multidisciplinary team and represents a great challenge for health profes-sionals. The aim of this article is to present the case of a teenage patient diagnosed with Pfeiffer ́s syndrome, who had severe maxillary hypoplasia, class III malocclusion and negative overjet; treated by osteogenic distraction with a RED (rigid external distractor) associated with fixed orthodontic appliances. The results reached the patient's therapeutic and esthetic expectations and showed stability at 20 months posttreatment. Keywords: Acrocephalosyndactylia; Orthodontics; Distraction osteogenesis; Maxilla (source: MeSH NLM).

Craniofacial Microsomia: Orthodontic Surgical Treatment of Growing Patients.

Craniofacial microsomia covers a set of morphogenetic anomalies that affect structures arising from the first and second brachial arches. Due to the vast phenotypic variation and complexity of the malformation, a global treatment that is coordinated by a multidisciplinary team is imperative. Herein, the authors describe 3 clinical patients and discuss the different therapies used according to the type of microsomia present. It was concluded that early and integrated treatment, which considers all the affected and potentially affected soft and hard tissue, is needed, and that patients must be monitored until they have finished growing.

Anteriorly Based Galeo-Pericranial Frontalis Flap: A Novel Application in Secondary Rhinoplasty With Atrophic Skin.

BACKGROUND: Nasomaxillary dysplasia (Binder syndrome) and cleft are congenital malformations of the midface. Ideally, the nasal deformity is treated from childhood. This approach leads to the need for several surgeries and revisions until full growth is reached. As a result of multiples procedures, the skin over the nasal dorsum sometimes becomes thin, atrophic and could be strongly attached to underlying grafts. For this setting of patients when another rhinoplasty is required, it becomes a technical challenge. The authors describe their experience in complex secondary rhinoplasty performed in patients with thin atrophic skin using the anteriorly based galeo-pericranial frontalis flap (GPFF) to improve the quality of the covering soft tissue along the whole nose skeleton area. RESULTS: Since 2013, 3 female patients; 2 of them with Binder syndrome and 1 cleft lip/palate patient (average 18 years) with previous rhinoplasty (3-6 procedures) are subjected to secondary rhinoplasty using GPFF turning it over the osteochondral nasal framework. Postoperative follow-up was 3 to 18 months. There were no viability complications of the dorsum skin flap in the immediate postoperative period. At long-term follow-up, a visible improvement of local skin conditions and restoration of the nasal contour was achieved. CONCLUSIONS: The anteriorly based GPFF is a well-vascularized versatile flap used extensively in anterior cranial fossa surgery and frontal sinus trauma. Given its known and constant vascular anatomy, this flap is adapted to a new application in complex secondary rhinoplasty, in the presence of atrophic skin with good aesthetic outcomes.

Salival fistulae: a rare complication after microtic ear reconstruction.

Parotid fistulae are a very infrequent complication after ear reconstruction in microtia when the local conditions are favorable. We report 2 cases of salival fistulae after microtic ear reconstruction. Timing of the diagnosis is important to decide the treatment. We recommend conservative management by restricted citric diet in early postoperative salival fistulae and Botox injections in the case that it persists.

Retroauricular island flap as an innovation for microtia ear reconstruction.

The use of a local island flap, designed with retroauricular skin, is an excellent, simple, and reproducible innovation to the classic microtia ear reconstruction, allowing adequate coverage of the cartilage framework, specifically of the conchal area, sparing tense skin closure, reducing skin suffering and necrosis, with a better aesthetic result achieving the naturally depressed concha aspect. The flap design and surgical technique is described. This flap was used in 13 consecutive microtia ear reconstructions in our unit, no complications were encountered, and aesthetic results were excellent.

Combining the Cutting and Mulliken methods for primary repair of the bilateral cleft lip nose.

BACKGROUND: Since 1990, primary bilateral cleft nasal reconstruction has been focused on placing the lower lateral cartilages into normal anatomical position. Of the four major techniques in this class, the Cutting (i.e., retrograde) method and the Mulliken method have been most successful. The retrograde method makes no external nasal incisions, but requires either preoperative or postoperative nasal molding to achieve maximum benefit. Mulliken's technique does not require molding, but leaves the footplates of the medial crura in the depression above the projecting premaxilla associated with the diminutive anterior nasal spine. Leaving the footplates in place also prevents adequate approximation of the alar bases. In this article, the two methods are combined to achieve the benefits of both. METHODS: We report our experience with the retrograde nasal approach associated with marginal rim incisions (Mulliken method) in a series of 25 consecutive bilateral cleft lip cases simultaneous with lip repair. We performed a retrograde approach through membranous septum incisions elevating a prolabial-columellar flap. To facilitate alar cartilage manipulation we added bilateral marginal rim incisions. Nasal width, columella length and width, tip projection, and nasolabial angle were analyzed after a minimum of 2 years after surgery. These were compared with a normal, age-matched, control group. We also examined nostril symmetry and marginal nostril scars. RESULTS: Columellar length was not statistically significantly different from that of the control group (p = 0.122442). Nasal width, columellar width, tip projection, and nasolabial angle were all significantly greater in the cleft group than normal (p < 0.001). No hypertrophied scars were found associated with the marginal rim scar. CONCLUSIONS: Adding the Mulliken approach allows alar cartilage manipulation to be performed more easily than when using the retrograde approach alone. Tip projection and alar base narrowing are facilitated using the combined technique rather than the Mulliken approach alone. Prolabial flap manipulation is safe using this combined approach, even in cases with a severely projected premaxilla. We believe that the combined approach is safe and yields better long-term results than either technique alone.