RESUMEN
In the past, lip reconstruction after ablative surgery has been performed by primary closure and more recently by free flap transfer technique. Cheek's skin flap has been used to reconstruct the lower lip cutaneous portion. This study presents a reconstructive method for the vermillion and the lip's cutaneous portion using the Goldstein-Robotti techniques (for the vermillion) and the buccinator flap to reconstruct the cutaneous lip portion and the perioral muscles. This procedure allows a complete reconstruction with a double layer technique for defects of more than one-third of both lips, together or alone, including modiolus, showing satisfactory functionality and aesthetics. The procedure was carried out by splitting the buccinator muscle and elongating the upper and lower buccinator bundles, together or alone. Soft tissue blunt dissection prevented most facial nerves and vessels injuries, ensuring blood supply and an amount of lip sensitivity. Even in the case of facial vessel ligatures after neck dissection, the technique was possible basing the flap pedicle on the internal maxillary artery branches (buccinator) and contralateral facial vessels (orbicularis). We present a case series of six reconstructions of various defects of the upper and lower lips, including the commissure after ablative surgery for squamous cell carcinoma and polymorphous adenocarcinoma. The results showed satisfactory functional and aesthetic outcomes, with similar tissue texture, static and dynamic symmetry achieved for all the patients.
RESUMEN
OBJECTIVE: Scuba diving and freediving are popular activities around the world, and their growth has increased the frequency of related pathology. A good ability to equalize is of paramount importance for diving. This is especially true for freediving, during which dive time is limited to just one breath. Even though equalization disorders are quite common in divers, a scoring system does not exist to date. In this paper we propose a new scoring system for equalization problems of freedivers: the EP score, shorthand for "equalization problems." METHODS: We administered the EP score assessment to 40 Italian freediving spearfishermen who were divided in two groups: Group A comprised 20 freedivers complaining of equalization problems and multiple barotraumas but totally asymptomatic in their everyday lives. These individuals had already received medical treatment and nasal surgery without improvement and then had undergone Eustachian tube balloon dilation. Group B comprised 20 healthy freedivers without any history of equalization disorders. We performed a statistical analysis to evaluate the reliability of this scoring system and to evaluate its usefulness in diagnosis and follow-up. RESULTS: Our data show substantial statistical differences between healthy freedivers and freedivers complaining of equalization disorders (Z-Score = -5.396 at p ⟨ 0.05); data do not show any statistical difference between healthy freedivers and patients successfully treated by Eustachian tube balloon dilation (U-value = 152.5 and Z-Score= -1.271 at p ⟨ 0.05). CONCLUSION: The EP score assessment seems to be a reliable tool to quantify equalization disorders during freediving and to evaluate how the difficulty varies over time and after treatment. Since equalization disorders could be present in different populations, the EP score assessment could be applicable to a wider group.