How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience.

Fractures of the mandibular condyle are common and account for 25-35% of all mandibular fractures reported in the literature. Even with the development of a consensus on the preference for open reduction and internal fixation of these fractures, the clinician is still faced with a dilemma concerning the optimal approach to the ramus-condyle unit. Limited access and injury to the facial nerve are the most common problems. The most commonly used extraoral approaches are the submandibular, retromandibular and preauricular methods. In this study, we propose a modified cosmetic preauricular incision with a short end in the neck, to improve the transmasseteric anteroparotid (TMAP) approach previously described by Wilson et al. in 2005. We retrospectively analysed 13 patients treated in our department for mandibular condylar fractures. Post-operative complications, occlusal status, interincisal opening and joint tenderness were evaluated at 3 months after surgery. The wider skin incision described here provides a convenient approach for open reduction and rigid internal fixation, and good results were obtained. The follow-up ranged from 6 to 40 months.

Reconstruction of nasal skin cancer defects with local flaps.

Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma.

PURPOSE: The transconjunctival, subciliary, subtarsal, and subpalpebral approaches for accessing the infraorbital rim and orbital floor have both advantages and disadvantages. The most common complications include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, and frank ectropion. MATERIALS AND PATIENTS: From 2000 to 2007, we treated 29 patients with lower eyelid malposition after surgery to manage the floor and infraorbital trauma (22 subciliary approaches, five transconjunctival approaches and lateral canthotomies, and two transconjunctival approaches). To correct lower eyelid malposition, we applied the tarsal strip technique in all patients. RESULTS: Twenty-five patients had scleral show and four patients had ectropion: three were previous treated using transconjunctival access and one using subciliary access. Twenty-six patients obtained satisfactory correction of eyelid malposition in a single-step surgical procedure, while three patients required a second surgical step to correct the remaining scleral show. Good aesthetic and functional results were achieved in all cases. CONCLUSIONS: All approaches to the infraorbital rim or orbital floor have the potential for postoperative sequelae. The tarsal strip technique is a relatively simple technique that oral and maxillofacial surgeons can use to manage lower lid malposition, such as scleral show and ectropion.

Temporal myofascial flap in reconstructive surgery of the oral cavity.

AIM: The temporal myofascial flap is a simple, rapid and reliable surgical method for immediate reconstruction of facial defects: indications in the light of modern anatomical knowledge and personal experience, with the accent on achieving an appropriate access route without damaging the facial nerve. METHODS: Our series covers the period from January 1999 to December 2004, during which time myofascial flaps of temporal muscle were used for immediate reconstruction in 20 surgical oncological cases involving the face and neck. RESULTS: Postoperative progress was regular; no lesions of the facial nerve were observed, nor any cases of flap necrosis, including partial. Epithelialisation could already be observed as early as 15 days postsurgery without skin grafting being employed. CONCLUSIONS: Application of a Medpor prosthesis eliminates the only negative outcome from the aesthetic standpoint, related to harvesting the muscle from the fossa.

Treatment of lower lip cancer: an experience of 48 cases.

The article reports results obtained in 48 cases of lower lip cancer. Tumor classified as T1 or T2, requiring a resection up to 60% of the lower lip, were treated with the stair-case technique. Nine patients were treated with the bilateral symmetrical stair-case technique since their lesions were located medially, while 23 were treated with the bilateral method using two asymmetrical flaps because their lesions were in paramedian position but larger than 2 cm. Ten patients required a unilateral flap. The cases classified as T3, in which the lesion required resection of more than 60% of the lip, were treated with the Bernard-Freeman-Fries technique.

The staircase technique for treatment of cancer of the lower lip: a report of 36 cases.

PURPOSE: This article reports the authors' experience with treatment of lower lip cancer using the staircase technique. PATIENTS AND METHODS: Thirty-six patients with stage T1 or T2 cancers of the lower lip were treated. RESULTS: No recurrences were observed during a 6- to 32-month follow-up. All patients showed excellent aesthetic results and no microstomia. CONCLUSIONS: The staircase technique can be used to close defects of up to two thirds of the lower lip. Two bilateral symmetric flaps are used for median defects; 2 bilateral asymmetric flaps are used for paramedian defects greater than 20 mm; and only 1 contralateral flap is required for paramedian defects up to 20 mm.