Forked Paramedian forehead flap combined with nasolabial flap for pre-radiation coverage of exposed maxilla in the Total Rhinectomy patient.

Total rhinectomy is ontologically necessary for large and locally invasive carcinomas of the nasal cavity owing to the complex three-dimensional structure of the nose. Reconstruction options include singular or combined options of local tissue rearrangement, free flap reconstruction, and prosthetic reconstruction which may be delayed in the setting of post-ablative radiation therapy. If significant bony exposure is present prior to radiation, there is a substantial risk of osteoradionecrosis and the ensuing sequalae. In these cases, coverage of the bony defect may be advantageous prior to radiation and final reconstructive treatment. We present a case of a total rhinectomy defect for squamous cell carcinoma in a patient who had significant bony exposure prior to radiation which was resurfaced with a combined forked paramedian flap and nasolabial flap. The patient went on to be treated with a full course of radiation and had planned for a post-treatment nasal prosthesis.

Intraoral nasolabial flap for lower lip augmentation following post-radiation contracture.

The nasolabial flap (NLF) has been reported extensively for reconstruction of various intraoral and extraoral defects resulting from trauma or ablative surgery. However, it has not been described for post-radiation lip augmentation. Herein, we present the case of a 74-year-old female who previously underwent a subtotal glossectomy and free flap reconstruction followed by radiotherapy. While oncologically the patient did well, she developed a significant lower lip contracture which compromised oral intake, denture placement, lip excursion, and psychosocial well-being. The patient underwent release of the scar contracture and a NLF was utilized intraorally to act as a spacer between the gingiva and inner lip mucosa to augment the soft tissue deficit. The patient went on to regain oral intake and placement of her dentures, while reporting significant satisfaction with the post-procedural benefits.

Sucrose replacement in high ratio white layer cakes.

BACKGROUND: Several commercially available alternative sweeteners have potential in reducing the caloric content of baked products. Sugar alcohols and natural sweeteners have similar bulk as sucrose and can replace sucrose directly. High intensity sweeteners have high potency but light weight so bulking agents are often added. This study determined alternative sweeteners and combinations of alternative sweetener and a bulking agent that produced good quality white layer cakes. RESULTS: Cakes made with maltitol were acceptable but erythritol and fructose produced undesirable cakes. Maltodextrin and polydextrose were acceptable bulking agents, producing cakes that were similar to control cakes. The flavor of cakes sweetened with sucralose was acceptable but those with stevia had a disagreeable metallic aftertaste. Cakes made with sucralose plus maltodextrin were preferred over those containing sucralose plus polydextrose. Consumer acceptance of flavor, texture and overall liking of cakes containing maltitol was similar to sucrose and both were preferred over cakes containing maltodextrin plus sucralose. CONCLUSION: Replacing sucrose with maltitol in white layer cakes reduced the caloric content by 16% with no loss in quality. © 2016 Society of Chemical Industry.