Surgical and prosthetic considerations to rehabilitate an ocular defect using extraoral implants: a clinical report.

This clinical report shows the use of extraoral implants to rehabilitate an ocular defect, focusing the surgical and prosthetic procedures. Using local anesthesia and a surgical template obtained from the diagnostic wax ocular pattern, two cylinder dental implants were strategically placed in the lateral aspect of the right infraorbital region. Four months later, an acrylic framework including two spherical magnets was made using plastic UCLA abutments. After casting laboratory steps, a customized silicon prosthetic appliance was fabricated from the diagnostic wax ocular pattern and attached to the Co-Cr framework, observing its profile and seating aspects. The patient was satisfied with the treatment result, due to the retention, esthetics, and adhesive-free method to anchor his ocular prostheses.

The figure-of-eight radix nasi flap for medial canthal defects.

Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars.

A comparative study on superior auricular artery island flaps with various pedicles for repair of periorbital defects.

Superior auricular artery (SAA) island flaps elevated from the retroauricular region have perfect color, thickness, and texture match with facial skin. In this article, reconstruction of periorbital defects with SAA island flaps is presented. Flaps were categorized into three types because they were elevated on three different pedicles. A type 1 flap was a superficial temporal vessel pedicled SAA island flap with antegrade blood flow. A type 2 flap was a reverse flow SAA island flap based on the frontal branch of the superficial temporal artery (STA). A type 3 flap was a reverse flow SAA island flap based on the parietal branch of STA. Fourteen patients (9 females and 5 males) aged between 31 years and 74 years were treated with these flaps. Two patients with lower eyelid, two patients with upper eyelid, three patients with malar, two patients with infraorbital, one patient with lateral canthal upper eyelid, and four patients with forehead defects underwent surgical intervention. Sizes of the flaps varied between 3x6 cm and 8x6 cm. Venous congestion was observed in all patients in the early postoperative period and lasted for 5 to 9 (mean, 6.6) days in type 1 flap, 5 to 9 (mean, 6.7) days in type 2 flap, and 2 to 5 (mean, 3.6) days in type 3 flap. Apart from distal necrosis of 1x1 cm in one patient and superficial dermal sloughing in two patients, no complications were encountered. Aesthetically and functionally successful results with minimal donor site morbidity were obtained in all patients during the 2 to 22 (mean 10.8) month follow-up period.

[Reconstruction of complex tissue loss of the medial canthus]. / Reconstruction des pertes de substance complexes du canthus interne.

The medial canthus is an anatomic and surgical entity. Reconstruction after cancerological resection is complex. The purpose of this article is to report a reconstruction technique for massive loss of tissue of the medial canthus which was applied in 2 patients with 2 years follow-up. Anatomic reconstruction was achieved. Each element of the canthus was restored: skin using Mustardé temporojugal and frontal flaps, conjunctive using a palatine mucosal graft, lacrimal canal using conjuctivo-rhinostomy, the medial canthal ligament using a fascia lata graft and transnasal canthopexia. Both patients developed an ectropion which required revision surgery. At 2 years, the functional outcome is good. Reconstruction allowed adapted social life and the cancer was controlled successfully.

Retalho miotarsoconjuntival nas reconstruçöes da pálpebra inferior / Myo-tarsal-conjunctival flap for the inferior eyelid reconstructions

Os autores apresentam a sua experiência nas reconstruçöes da pálpebra inferior com o retalho miotarsoconjuntival. As aplicaçöes foram para a correçäo de deformidades causadas por ressecçäo de carcinomas basocelulares. Essas deformidades foram muito variadas na suas posiçöes anatômicas, indo do ligamento cantal interno ao ligamento cantal externo. Säo demonstrados 50 casos com um acompanhamento que variou de seis meses a sete anos. Até o momento, apenas duas complicaçöes foram notadas com relaçäo à área doadora. O resultado estético e funcional mostrou-se superior quando comparado ao das outras técnicas conhecidas

Retalhos triangulares de pele com pedículo subcutâneo central na reconstrução da pálpebra inferior / Triangular skin-flaps with central subcutaneous pedicle in reconstruction of the inferior eyelid

Foram estudados 54 pacientes atendidos, consecutivamente, no Serviço de Cirurgia Plástica do Hospital Santa Isabel de Clínicas e no Hospital Escola da Universidade de Taubaté, no período de 12-09-1984 a 21-06-89, durante o qual foram realizadas 55 reconstruções de pálpebra inferior com retalho triangular de pedículo subcutâneo central. Nos 39 casos em que foi feita apenas a ressecção da pele palpebral, a reconstrução realizou-se com retalho triangular. Nos 16 outros casos, em que a ressecção incluiu o tarso e a mucosa conjuntival, foi feito, além do retalho triangular, o enxerto condromucoso de septo nasal. Em quatro pacientes foi realizada, também, a reconstrução do rebordo ciliar com enxerto do supercílio oposto. Obtivemos resultados caracterizados como BOM em 94,54 por cento, REGULAR em 3,63 por cento e MAU em apenas um paciente. As complicações observadas, de modo geral, não interferiram no resultado final. O método proposto permite realizar desde reconstruções mais simples até as mais complexas, em diferentes localizações da pálpebra. A técnica é de simples execução e pode ser realizada sob anestesia local. Observamos que a mucosa e a cartilagem do septo nasal, enxertadas, substituem o tarso e a conjuntiva palpebral, na avaliação macroscópica. Para reconstruções de áreas mais extensas, podemos associar o retalho triangular com retalhos de outras regiões. Em pacientes idosos, para diminuir a possibilidade de ectrópio, tanto o retalho triangular quanto o enxerto condromucoso devem ter dimensões um pouco menores do que a área ressecada. Além dos bons resultados funcionais obtivemos, também, bons resultados estéticos, pois utilizamos pele da vizinhança e, em alguns casos, complementamos com reconstrução do rebordo ciliar.