Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip.

PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Flattening of the orbital lower eyelid fat as a long-term outcome after surgical treatment of orbital floor fractures.

Our aim was to report the incidence of asymmetry of the lower eyelid (that manifests itself as flattening of the eyelid fat) as a long-term complication of the surgical approach of unilateral fractures of the orbital floor. We retrospectively reviewed the aesthetic appearance of the lower eyelid in 43 patients after repair of such fractures. Long-term asymmetry seen as asymmetrical flattening of the eyelid fat was evaluated and graded qualitatively as mild, moderate, and severe. We studied its relations to the surgical approach, patient's age and sex, and postoperative time; 20 of the 43 had flattening of the lower eyelid fat. There were significantly more patients with flattening of the fat after a transconjunctival approach than after transcutaneous ones (p=0.03). We found a statistical likelihood of the development of flattening of the fat when patients were between 40 and 60 years old at the time of operation (p=0.006). Increasing age at the time of the study was related to increased severity (p=0.0019), with the greatest significance over 55 years old (p=0.006). We found no relation to patients' sex, or duration of operation. To our knowledge this is the first time that flattening of the eyelid fat has been described as a long-term complication after a particular approach to orbital floor fractures. The transconjunctival incision was more likely to be associated with this long-term outcome. Patients over 40 years old are also at risk of developing flattening, and this is more severe when the patient is over 55. A short follow-up period is not sufficient for the evaluation of the aesthetic outcome of traditional approaches to fractures of the orbital floor in the lower eyelid.

Role of culture of postoperative drainage fluid in the prediction of infection of the surgical site after major oncological operations of the head and neck.

Infection of the surgical site after major oncological operations of the head and neck increases mortality and morbidity. The aim of this prospective pilot study was to assess the efficacy of culturing the exudate from the drain after cervical neck dissection to see if it predicted such infection. We studied 40/112 patients with squamous cell cancer of the head and neck who were treated during the last two years and met our inclusion criteria. Six patients developed infections (15%). Reconstruction with pedicled rather than local or microvascular flaps, duration of operation of over 7 hours, the presence of a tracheostomy, and bilateral neck dissection were considered risk factors (p=0.01). Culture of drainage fluid on postoperative day 3 that grew no pathogens predicted that the site would not become infected, with a negative predictive value of 96%.

Submandibular swelling as the first manifestation of giant cell arteritis. Report of a case.

Giant cell arteritis is a systemic disease with a broad range of clinical signs and symptoms. Although the most frequently involved vessel is the superficial temporal artery, other arteries can be affected. Vasculitic changes in the facial artery usually present as jaw claudication. A report of a case of giant cell arteritis is presented in which facial artery involvement first manifested itself clinically as a submandibular mass. This is a very rare and atypical form of clinical presentation.

Actinomycotic ulcer of the oral mucosa: an unusual presentation of oral actinomycosis.

Although the oral mucosa is often the site of entry of actinomyces into the deeper tissues, actinomycosis in the oral mucosa is extremely rare. Actinomycotic lesions are usually described as either single or multiple abscesses or indurated masses with hard fibrous walls and soft central loculations. Actinomyces israelii is the principal cause of human actinomycosis. We present a rare case of actinomycosis caused by Actinomyces odontolyticus; it presented primarily as a long-standing ulcer of the oral mucosa mimicking a squamous cell carcinoma.

Carbon dioxide laser vermilionectomy for actinic cheilitis.

Actinic cheilitis is a premalignant condition of the lower lip that requires treatment. Several methods have been advocated to manage this disease. In this study, 19 cases of actinic cheilitis were treated by carbon dioxide (CO2) laser vermilionectomy with good results. Because it has the advantages of both scalpel vermilionectomy and laser vaporization of the vermilion, CO2 laser vermilionectomy is proposed as a good method of treating actinic cheilitis.

Reconstruction of the scaphoid fossa of the ear after tumour resection with a retroauricular flap.

A retroauricular flap to reconstruct scaphoid fossa defects is presented. It is an easy, quick and aesthetic flap for this purpose.

Adult rhabdomyoma in the masticatory area. New case presentation and review of the literature.

Adult rhabdomyoma is a rare neoplasm of mesenchymal origin which represents approximately 2% of tumors with skeletal muscle differentiation. There are only about 100 cases reported in the literature. It is a benign tumor occurring most frequently in the head and neck region, which affects predominantly male population of a mean age ranging from 54 to 60. The purpose of this article is to present a new case of adult rhabdomyoma located in the masticatory area, arising as a slow-growing mass bulging in the left-side jugal mucosa and temporal region. The most common location for adult rhabdomyoma is the pharyngeal cavity. This type of tumor appears as a solitary mass, though occasionally may be multifocal. This tumor being of low occurrence, correct diagnosis can prevent aggressive surgery.