RESUMO
The basic techniques of nerve reconstruction surgery for facial nerve palsy are end-to-end nerve suture and end-to-side nerve suture. The latter has the epineural window method and the partial neurectomy/neurotomy method for the treatment of "side" nerves. Hypoglossal-facial nerve cross-link graft is a method of nerve reconstruction in which the hypoglossal and facial nerves are bridged by autologous nerve transposition with end-to-side nerve suture. It has been shown to be effective in treating the sequelae of established facial nerve palsy, but there are some issues that prevent the achievement of stable results.
Assuntos
Nervo Facial , Paralisia Facial , Anastomose Cirúrgica/métodos , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Humanos , Nervo Hipoglosso/cirurgia , Procedimentos Neurocirúrgicos/métodosRESUMO
BACKGROUND: Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. METHODS: A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. RESULTS: The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (nâ=â2), Bell palsy (nâ=â3), congenital conditions (nâ=â2), brain infarction (nâ=â1), Ramsay Hunt syndrome (nâ=â1), and malignant parotid lymphoma (nâ=â1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10âmm. CONCLUSION: The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.
Assuntos
Cicatriz/prevenção & controle , Paralisia Facial/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Sorriso , Músculo Temporal/cirurgia , Adulto , Idoso , Criança , Estética , Paralisia Facial/etiologia , Feminino , Seguimentos , Humanos , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
Hereditary skin laxity is a rare condition, some cases of which are also referred to as cutis laxa, and those involving facial skin are considered a target for treatment by plastic surgery as patients present with an aged face, which can reduce their quality of life. In some of these patients, the facial nerve and muscles may be affected, and cause weakness of mimetic muscles. We performed one-stage bilateral lengthening temporalis myoplasty reanimation, followed by lower facial contouring with partial lower lip excision and hammock-shaped fascia grafting in two patients with hereditary facial skin laxity coexisting with facial palsy. The patient was a 63-year-old woman with hereditary gelsolin amyloidosis and a 64-year-old man who was diagnosed with oculopharyngeal muscular dystrophy. Postoperatively, a symmetrical facial contour was achieved in repose, and smiling with and without biting was possible. To our knowledge, there are no reports of dynamic smile reconstruction for facial weakness in patients with hereditary facial skin laxity. Although these patients may experience progressive loss of function of the trigeminal nerve and its innervating muscles, the static suspension effect of lengthening temporalis myoplasty can be expected to continue even if the temporal muscles lose their function in the future. We believe that, with careful patient selection, dynamic reconstruction is an option for progressive facial paralysis. In this article, we present the chronological history of two patients who underwent multiple plastic surgery procedures and discuss the importance of the role of plastic surgery in improving the quality of life under these conditions.
RESUMO
The free groin flap results in less donor-site morbidity than other skin flaps and is suitable for use in children and adolescents. However, the vascular pedicle is relatively short and vessel diameter is small, which makes vascular anastomosis technically difficult. To overcome this limitation, we harvested vein and arterial grafts from the flap elevation area without placing additional skin incisions. Use of short (2-3 cm) vein/arterial grafts greatly simplified flap insetting and vascular anastomosis. This procedure may expand the indications for free groin flap transfer.
RESUMO
Liposarcomas are one of the most common soft-tissue sarcomas and commonly arise in the deep soft tissues of the extremities and retroperitoneum; however, the occurrence of liposarcomas in the foot or ankle is exceedingly rare. In this article, we present a 52-year-old man with round cell liposarcoma arising in the left foot. This tumor presented unusual manifestations of secondary osseous involvement in the metatarsal and tarsal bones of the left foot and solitary lymph node metastasis at the para-aortic region. Magnetic resonance imaging (MRI) and [(18)F]-fluoro-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) evaluation was considered to be useful for tumor grading and staging in this case.
Assuntos
Neoplasias Ósseas/secundário , Lipossarcoma/secundário , Imageamento por Ressonância Magnética , Ossos do Metatarso/patologia , Tomografia por Emissão de Pósitrons , Neoplasias de Tecidos Moles/patologia , Ossos do Tarso/patologia , Aorta Abdominal/patologia , Neoplasias Ósseas/diagnóstico , Fluordesoxiglucose F18 , Pé/patologia , Humanos , Lipossarcoma/diagnóstico , Lipossarcoma Mixoide/secundário , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/métodos , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Neoplasias de Tecidos Moles/diagnósticoRESUMO
Proliferating pilomatricoma is a histopathological entity that was proposed by Kaddu et al. in 1997. Proliferating pilomatricoma represents a distinctive histopathological entity; it should be differentiated from other benign and malignant neoplasms with features of hair matrix differentiation. Kaddu reported that an incompletely excised proliferating pilomatricoma may have a greater potential for local recurrence, because histopathologically it showed variable nuclear atypia and several mitotic figures. We report two patients with proliferating pilomatricoma and describe their clinical and pathological features.
Assuntos
Doenças do Cabelo/patologia , Neoplasias de Cabeça e Pescoço/patologia , Pilomatrixoma/patologia , Neoplasias Cutâneas/patologia , Feminino , Doenças do Cabelo/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Pilomatrixoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The single-stage technique for cross-face reanimation of the paralyzed face without nerve graft is an improvement over the two-stage procedure because it results in early reinnervation of the transferred muscle and shortens the period of rehabilitation. On the basis of an anatomic investigation, the short head of the biceps femoris muscle with attached lateral intermuscular septum of the thigh was identified as a new candidate for microneurovascular free muscle transfer. The authors performed one-stage transfer of the short head of the biceps femoris muscle with a long motor nerve for reanimation of established facial paralysis in seven patients. The dominant nutrient vessels of the short head were the profunda perforators (second or third) in six patients and the direct branches from the popliteal vessels in one patient. The recipient vessels were the facial vessels in all cases. The length of the motor nerve of the short head ranged from 10 to 16 cm, and it was sutured directly to several zygomatic and buccal branches of the contralateral facial nerve in six patients. One patient required an interpositional nerve graft of 3 cm to reach the suitable facial nerve branches on the intact side. The period required for initial voluntary movement of the transferred muscles ranged from 4 to 10 months after the procedures. The period of postoperative follow-up ranged from 5 to 42 months. Transfer of the vascularized innervated short head of the biceps femoris muscle is thought to be an alternative for one-stage reconstruction of the paralyzed face because of the reliable vascular anatomy of the muscle and because it allows two teams to operate together without the need to reposition the patient. The nerve to the short head of the biceps femoris enters the side opposite the vascular pedicle of the muscle belly, and this unique relationship between the vascular pedicle and the motor nerve is anatomically suitable for one-stage reconstruction of the paralyzed face. As much as to 16 cm of the nerve can be harvested, and the nerve is long enough to reach the contralateral intact facial nerve in almost all cases. The lateral intermuscular septum, which is attached to the short head, provides "anchor/suture-bearing" tissue, allowing reliable fixations to the zygoma and the upper and lower lips to be achieved. In addition, the scar and deformity of the donor site are acceptable, and loss of this muscle does not result in donor-site dysfunction.
Assuntos
Músculos Faciais/cirurgia , Paralisia Facial/cirurgia , Músculo Esquelético/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Paralisia de Bell/complicações , Cadáver , Dissecação/métodos , Músculos Faciais/irrigação sanguínea , Músculos Faciais/inervação , Paralisia Facial/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/inervação , Neuroma Acústico/complicações , Nervos Periféricos/transplante , Técnicas de Sutura , Coxa da Perna/irrigação sanguínea , Coxa da Perna/inervação , Resultado do TratamentoRESUMO
Repair of scalp defects using a superficial temporal fascia pedicle VY advancement scalp flap, which is supplied by superficial temporal vessels, is reported. This method has been used in seven cases of scalp defects, and enables us to provide primary closure of the defects with hair-bearing scalp skin. This method is simple, easy, and reliable.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Couro Cabeludo/cirurgia , Retalhos Cirúrgicos , Idoso , Feminino , Cabelo , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Artérias TemporaisRESUMO
This report describes a simple technique for augmentation rhinoplasty using calcium phosphate cement paste for postoperative and posttraumatic nasal deformities. This biomaterial was used to correct traumatic nasal bone deformity in one patient and for augmentation rhinoplasty after removal of the nasal implant in two patients. These patients were followed for a minimum 6 months and a maximum of 26 months. The esthetic results were satisfactory with no complication. Calcium phosphate cement consisting of alpha-tricalcium phosphate, dicalcium phosphate dibasic, and tetracalcium phosphate monoxide has been used for bone replacement and augmentation because of its good biocompatibility and osteoconductivity. This technique is easy and safe. It seems to be a suitable material for augmentation rhinoplasty in the Orient. Its long-term safety and reliability require proof with longer follow-up periods, however.