RESUMO
Fortunately, traumatic total amputations of the nose are rare, especially in children. Their reconstructions generally require several operative steps, most often associating cartilaginous grafts (rib and/or concha), a free radial antebrachial flap for mucosal reconstruction and a frontal flap for the skin covering. These are therefore long and complex procedures requiring a trained surgical team and maximum patient adherence to their treatment plan. The clinical case described is that of an 11-year-old child presenting a sub-total amputation of the nose and having undergone reconstruction with skin expansion of the frontal flap due to a horizontal frontal scar of unknown origin and a particularly low hair implantation.
Assuntos
Amputação Traumática , Neoplasias Nasais , Rinoplastia , Amputação Cirúrgica , Amputação Traumática/cirurgia , Criança , Testa/cirurgia , Humanos , Nariz/cirurgia , Neoplasias Nasais/cirurgia , Retalhos CirúrgicosRESUMO
As a very challenging surgery, primary rhinoplasty can lead to secondary. After a primary, patient's concerns can sometimes be pretty easy to fix (remaining bump), but may some other request long and very difficult surgeries (short nose). This article describes the most common reasons of secondary rhinoplasties and provides, for each of them, a surgical treatment.
Assuntos
Nariz/anormalidades , Nariz/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Rinoplastia/métodos , Humanos , Reoperação/métodosRESUMO
BACKGROUND: Keloids are benign fibro-proliferative skin lesions that very rarely occur on the soles. Because of their rarity, the diagnosis of plantar keloids can be difficult. We describe the clinical and histopathological characteristics of eight plantar keloids. METHODS: All patients presenting with plantar keloids between 2005 and 2012 in our Dermatology unit were retrospectively included. Diagnosis was definitely established by re-reading of pathological slides in all cases. Clinical characteristics, histopathological features, treatments given and their results were collected. RESULTS: Six patients were included. Five patients had a single plantar keloid and one had three lesions. They all were of African descent. Only one patient remembered of a previous injury at the site of the keloid. Three patients presented with associated extra-plantar keloids. In four patients, the diagnosis of keloid was not initially suspected clinically or histologically. Re-reading of the clinical photographs showed that the eight plantar keloids shared common morphological features, leading to a distinctive clinical picture, defined by a hardened lesion of rounded or polycyclic shape, with a pink surface crossed by keratotic furrows and the presence of a hyperkeratotic rim. Concerning pathological features, typical hyalinized collagen can be missing and deep fibrosis should not rule out the diagnosis of keloid. Intralesional injection of triamcinolone acetonide and orthopaedic shoes were useful. All patients who had surgical excision presented recurrence. CONCLUSION: The knowledge of the clinical features of plantar keloids is helpful to the diagnosis. There is no well-established treatment, but supportive measures are important.
Assuntos
Aminoquinolinas/administração & dosagem , Colchicina/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos/métodos , Dermatoses do Pé/diagnóstico , Queloide/diagnóstico , Triancinolona/administração & dosagem , Adjuvantes Imunológicos/administração & dosagem , Adulto , Biópsia , Vias de Administração de Medicamentos , Feminino , Seguimentos , Dermatoses do Pé/terapia , Órtoses do Pé , Glucocorticoides/administração & dosagem , Supressores da Gota/administração & dosagem , Humanos , Imiquimode , Queloide/terapia , Ceratolíticos/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The submental island flap is a precious tool in reconstructive surgery. It was described by Martin in 1993, inspired by platysma flaps. In our days, we can find many reliable techniques for this procedure. We reviewed the main studies of the literature that described a total of 528 patients. The rate of partial necrosis was 5.1%, complete necrosis 1.7%, and reversible lesions of the marginal mandibular branch of the facial nerve 1.1%. His versatility makes this flap appropriate for the reconstruction of every part of the face: cheeks, nose, forehead, moustache, beard, and hairs. It can also be used de-epidermised with very good results, for the reconstruction of the buccal cavity, the tongue, the roof of the mouth, the larynx, and the proximal part of the esophagus. The SMAP (Submentalis Artery Perforator flap) is an alternative flap that provides even better cosmetic results. The development of indocyanine green and infrared cameras will allow in a close future to decrease the postoperative complications.
Assuntos
Face/cirurgia , Retalhos Cirúrgicos , Face/irrigação sanguínea , Humanos , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos/irrigação sanguíneaRESUMO
Nowadays, cartilage grafts are widely used in secondary as well as primary rhinoplasty. Even if their fixation is often easier and more precise using an open approach, most of them can also be positioned with a close approach. In this article, the authors describe various cartilage donor sites. For each of them, they describe benefits, inconveniences, harvesting techniques and preferred indications. Cartilage can be harvested on the septum, ear and ribs. For the authors, septal cartilage is often the best material but can be insufficient or totally missing (especially in secondary rhinoplasty). In such cases, concha cartilage is a good material for tip and alar grafts because of its pliability and convexity whereas rib cartilage, which is stiffer and thicker, will provide good supporting grafts. Described more recently, diced cartilage wrapped in fascia (DCF) can be a very good option for dorsal onlay graft, avoiding irregularities of conchal cartilage and risk of rib cartilage's twisting.
Assuntos
Cartilagem/transplante , Rinoplastia/métodos , Humanos , Septo Nasal/cirurgia , Reoperação , Coleta de Tecidos e Órgãos/métodosRESUMO
Osteotomies are performed to modify the shape of the bony part of the nose, therefore they should not be done systematically. Main indications are correction of deviated nose, narrowing of bony vault and roofing of an open roof after important hump resection. The nose should be very precisely analyzed before osteotomies if the surgeon doesn't want to create deformities such as step, inverted V, pinched nose or saddle nose. When too narrowed, bones can also block the airway and lead to functional problems.
Assuntos
Osso Nasal/cirurgia , Osteotomia/métodos , Rinoplastia/métodos , Humanos , Osso Nasal/anormalidades , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
Suture techniques are widely used and can be very useful and efficient to support the nasal tip and correct its deformities. Nevertheless, they are so powerful that they have to be performed very precisely if the surgeon does not want to create cosmetics as well as functional problems. The authors describe the main tip sutures and their effects, expected or not.
Assuntos
Nariz/anormalidades , Rinoplastia/métodos , Técnicas de Sutura , Estética , Humanos , Cartilagens Nasais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cicatrização/fisiologiaRESUMO
Secondary rhinoplasty is very usual. Some patients are not satisfied by the previous surgery because the result is poor with obvious defaults but, sometimes, the result is good but the patient expects perfection. These two different situations will not lead to the same answer from the surgeon. Techniques of secondary rhinoplasty are the same than primary, but are often more difficult to perform because of scar tissue, retraction and loss of lining. The authors analyse the more frequent deformities in secondary rhinoplasty and the way they fix them.
Assuntos
Estética , Nariz/anormalidades , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Rinoplastia/métodos , Cartilagem/transplante , Humanos , Erros Médicos/prevenção & controle , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia , Osteotomia/métodos , Satisfação do Paciente , Complicações Pós-Operatórias/etiologiaRESUMO
In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach--the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty.
Assuntos
Rinoplastia/métodos , Dissecação/instrumentação , Dissecação/métodos , Humanos , Cartilagens Nasais/cirurgia , Mucosa Nasal/cirurgia , Septo Nasal/anormalidades , Septo Nasal/cirurgia , Rinoplastia/instrumentação , Instrumentos CirúrgicosRESUMO
Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation.
Assuntos
Cuidados Pré-Operatórios/métodos , Rinoplastia/métodos , Cefalometria/métodos , Estética , Humanos , Septo Nasal/anormalidades , Septo Nasal/cirurgia , Doenças Nasais/diagnóstico , Doenças Nasais/cirurgia , Fotografação , Encaminhamento e ConsultaRESUMO
Overprojected tip is a pretty usual request not easy to manage. Preop analysis is crucial in order to evaluate tip support and skin thickness and ability to retract. For example, if the skin is very thick and has poor chance to retract, the surgeon should be very careful in the tip projection decreasing to avoid a skin pollybeak deformity. In such cases, he has to analyze the facial proportions, especially other areas projection (radix, dorsum and chin) and think about augmenting them to balance the profile rather than decreasing tip projection. Correction should always be conducted incrementally, starting with weakening the tip support mechanisms and, only if necessary, continue with alar cartilage interruption. This can be performed on many areas (lateral cruras, domes, medial cruras) and with several techniques (resection or interruption+overlapping).
Assuntos
Estética , Nariz/anormalidades , Rinoplastia/métodos , Cefalometria/métodos , Humanos , Cuidados Pré-Operatórios/métodosRESUMO
The decision to perform nasal resection follows a comprehensive analysis of the aesthetic objective depending on the anatomic and artistic criteria. Fear of leaving visible scars leads many surgeons to hesitate vis-à-vis the indications. However, this surgical technique can be very useful during rhinoplasty. The patient should always be informed preoperatively of the possibility of cutaneous resection of the nostrils and the type of scar than can ensue. It is important to know the foreseeable elements of nasal resection in order to provide a more systematic approach to routine rhinoplasty.
Assuntos
Estética , Rinoplastia/métodos , Cefalometria , Cicatriz/prevenção & controle , Humanos , Complicações Pós-Operatórias/prevenção & controleRESUMO
To many surgeons, nasal airway obstruction is synonymous with either septal deviation or inferior turbinate hypertrophy. The role of internal and external nasal valves is often less known by surgeons even if it is crucial in nasal breathing and strongly interrelated with esthetic of the middle third of the nose and alar wall. Therefore, precise examination of the two valves and conservative surgery should help to avoid many functional and esthetic problems.
Assuntos
Estética , Cartilagens Nasais/cirurgia , Obstrução Nasal/cirurgia , Rinoplastia/métodos , Cartilagem/transplante , Humanos , Septo Nasal/cirurgia , Conchas Nasais/cirurgiaRESUMO
Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty.
Assuntos
Nariz/anatomia & histologia , Rinoplastia/métodos , Humanos , Osso Nasal/anatomia & histologia , Osso Nasal/cirurgia , Cartilagens Nasais/anatomia & histologia , Cartilagens Nasais/cirurgia , Mucosa Nasal/anatomia & histologia , Mucosa Nasal/cirurgia , Septo Nasal/anatomia & histologia , Septo Nasal/cirurgia , Seios Paranasais/anatomia & histologia , Seios Paranasais/cirurgiaRESUMO
Nasal lesions, which are often carcinomas, require a histological control of the excision sometimes forcing to postpone the reconstruction source of nasal mutilation disfiguring. Reconstructive procedures have made steady progress and the notion of reconstruction in three planes advocated by Tiersch has been improved in a major way by Millard, Burget and Menick, who added an essential aesthetic dimension. We present our experience in this field by selecting procedures that seem most appropriate and describing the key points of the operating process, which remain the guarantee of both therapeutic and aesthetic success.
Assuntos
Rinoplastia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/lesões , Nariz/cirurgia , Neoplasias Nasais/cirurgia , Retalhos CirúrgicosRESUMO
Hyaluronic acid (HA) is the most used dermal filler. Some complications associated with its use have been described, but most of them are rare and benign. We report an exceptional case of skin necrosis of the tip of the nose, in a 22-year-old patient, after HA injection. The initial appearance may occurred subsequent aesthetic sequels. After necrotic tissue excision, patient was followed in rapid succession. Daily local care has led to wound healing, without any important sequel. This rare complication reminds us that HA injections are not without risk, despite their apparent simplicity of use. Moreover, the case presented confirms the potential healing of the nasal tip, allowing treatment with wound healing, rather than other early invasive procedure.
Assuntos
Técnicas Cosméticas/efeitos adversos , Ácido Hialurônico/efeitos adversos , Nariz/patologia , Pele/patologia , Viscossuplementos/efeitos adversos , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções , Necrose , Viscossuplementos/administração & dosagem , Cicatrização , Adulto JovemRESUMO
In eyelid reconstruction, filling the defect is not sufficient. In young patients, the aim is to obtain a reconstructed eyelid, as normal as possible. In elderly patients, the large amount of available skin and the good quality of scars seem to be favorable. But weakening and stretching of the connective tissue and eyelid structures and deficient production of tears may compromise the functional result. In every case, restoring aspect and function are going together. The purpose of this chapter is to show how different techniques may be used in eyelid reconstruction with good cosmetic result. Different cases are carefully described and illustrated.
Assuntos
Blefaroplastia/métodos , Adulto , Idoso , Estética , Neoplasias Palpebrais/cirurgia , Feminino , Humanos , Masculino , Retalhos CirúrgicosRESUMO
BACKGROUND: Defects involving several aesthetic subunits (ASUs) or lying at the junction of an ASU are challenging and require a complex reconstruction. This study aimed to describe the hemi-tip as a new ASU. MATERIAL AND METHODS: We conducted a retrospective study including patients who underwent a nasal reconstruction for lower nasal pyramid defects according to our modified ASU principle. Patients who suffered from a subtotal alar defect, which also involved <50% of the tip, were reconstructed after excising the remaining tissue of the hemi-tip subunit. An aesthetic evaluation was performed using a patient satisfaction scale and by independent raters. RESULTS: From 2010 to 2014, 21 patients underwent a lower hemi-nose reconstruction. All patients had a full-thickness defect and underwent a reconstruction of the three layers of the nose. Sixty-four percent of our patients were very satisfied, 26% were satisfied, and only 10% were unsatisfied with their nasal tip appearance, with a mean score of 4.4/5. The nasal tip was also rated by independent raters with a mean score of 4.1/5. DISCUSSION: Our results and experience showed that a midline scar between the two hemi-tips is inconspicuous. The majority of the defects involving only one side of the tip would benefit from the hemi-tip ASU reconstruction. CONCLUSION: We have modified the number of ASUs by considering the hemi-tip as a proper subunit.