RESUMO
One of the greatest challenges in orbital reconstruction is to obtain adequate orbital volume and globe projection after traumatic injury. Autologous bone graft has been considered the gold standard for orbital floor reconstruction, but the harvesting yields many possible complications, such as donor site morbidity. Bone resorption is a frequent problem that can lead to insufficient volume after graft placement. There is a theoretically lower resorption rate of skull bone grafts, even though the exact amount is not known yet. This study is the first to evaluate bone volume and density changes of calvarial split bone grafts after orbital floor reconstruction with a 2-year follow-up. Bone volume and density of calvarial split grafts were determined using computed tomography scans and the software program RadiAnt Dicom Viewer in a total of 10 patients with orbital floor fracture reconstruction. Computed tomography scans taken immediately after surgery (T0) and after a postoperative period of 2 years (T1) were evaluated. The authors found a mean bone volume reduction of 34.25% after 2 years. Bone density was still high after 2 years (over 850 HU), with a mean reduction of 8%. Based on these findings, calvarial split bone grafts represent the ideal reconstruction material for orbital floor fractures.
RESUMO
La acondroplasia es una enfermedad genética rara que representa la forma más común de enanismo de extremidades cortas. Existen pocos casos reportados de gigantomastia y subsecuente cirugía mamaria en esta población. Presentamos el caso de una paciente con acondroplasia, gigantomastia y medialización de pezón que requirió mamoplastia reductora y reposición de complejo areola pezón (CAP). Se utilizó la técnica de T invertida con pedículo inferior. La planeación quirúrgica y el correcto marcaje en pacientes acondroplásicos son pasos importantes para una cirugía exitosa teniendo en cuenta que las referencias anatómicas habituales no son guías confiables para un posicionamiento ideal de la mama en el tórax o del CAP en la mama. (AU)
Achondroplasia is a rare genetic disease representing the most common form of short-limb dwarfism, and there are a few case reports of gigantomastia and subsequent breast surgery in this patient population. We present the case of a patient with achondroplasia, gigantomastia and nipple medialization who required a reduction mammaplasty and reposition of the nipple areola complex (NAC). An inverted T technique with an inferior pedicle was used. Surgical planning and correct marking in achondroplasic patients are important steps for a successful surgery considering that common anatomical landmarks are not a reliable guide for ideally positioning the breast on the thoracic wall or the NAC on the breast. (AU)
