Trans-tragal incision for improved exposure of diacapitular and condylar neck fractures

The authors present a modification of the preauricular approach that improves the exposure of the condyle whilst reducing diacapitular and condylar neck fractures. The incision is a combination of the hockey-stick and endaural incisions. Its inferior part runs within the ear on the posterior face of the tragus; the tragal cartilage is transected together with the retrotragal skin and included in the anterior skin flap. Between May 2009 and December 2010, 16 patients with diacapitular or condylar neck fractures were treated with this approach. All patients showed good occlusion postoperatively and satisfactory aesthetic results. No infection or cartilage necrosis was observed in this series. This approach improves the exposure of the condylar head during the reduction of diacapitular and condylar neck fractures, ensuring easier internal fixation and good cosmetic results.     

Extended modified postauricular incision of the temporomandibular joint

The traditional postauricular approach to the temporomandibular joint has excellent cosmetic results since the entire incision is concealed in the postauricular flexure. Excellent posterior joint exposure, good lateral joint exposure, and fair anterior joint exposure are obtained. The risk of injury to the facial nerve is decreased. An extended modification of the postauricular incision was developed to overcome some of the disadvantages of the postauricular incision while maintaining its advantages. The incision begins inferiorly in a curvilinear manner, over the mastoid tip and progresses superiorly 3 mm posterior to the postauricular flexure. As it ascends superiorly above the level of the external auditory canal, it progresses posteriorly from the flexure. It then progresses superiorly in a curvilinear fashion in the temporal area slightly superior to the customary superior aspect of the preauricular incision. The dissection is carried to and through the temporalis fascia and periosteum, over the root of the zygomatic arch, and anteriorly after crosscut of the external auditory canal to the parotideomasseteric fascia. Dissection anteriorly deep to these fused structures allows a single flap to the skin. With this anterior dissection, the temporal and zygomatic branches of the facial nerve are protected and contained within the skin-fascia flap. The capsule is thus exposed and further dissection into the joint is described. A representative case presentation demonstrates the extended modified postauricular incision.     

颌下-半颈发际缘切口行全颈淋巴清扫术的探讨

目的本研究首次采用颌下-半颈发际缘切口行单侧和双侧全颈淋巴清扫术，探讨其临床可行性。方法选取中山大学附属口腔医院2006年11月至2007年1月入院的舌癌患者3例，采用颌下，半颈发际缘切口行单侧颈淋巴清扫术。选取2007年1月至11月4例恶性肿瘤患者，采用颌下，半颈发际缘切口行双侧颈淋巴清扫术。单侧颈淋巴清扫术切口由颌下切口及半颈发际缘切口组成，颌下切口位于下颌下2～3cm。并与下颌下缘平行。尽量位于皮纹中，前至对侧颏部，后至乳突尖；然后由乳突尖处转折向下，沿发际缘下行至颈中份处。双侧颈淋巴清扫术则由双侧颌下切口及双侧半颈发际缘切口组成。单侧或双侧颈淋巴清扫术均在颈阔肌深面翻瓣后，合理利用手术拉钩牵引，充分暴露手术空间。术中评估操作的可行性及难易程度，术后观察切口愈合情况及瘢痕大小。结果该切口单侧颈淋巴清扫术中暴露虽然不如类矩形切口，但通过合理牵拉仍能充分暴露术区，完成手术；手术操作有一定难度，需要手术医生具有丰富的颈淋巴清扫术的经验，耗时相对较长。双侧颈淋巴清扫术该切口暴露比平行切口较好，但不如“H”形切口和“T”形切口。然而通过合理牵引拉钩，能充分暴露术区，完成手术。3例单侧和4例双侧颈淋巴清扫术患者术后创口愈合良好，瘢痕较小。结论颌下，半颈发际缘切口行单侧或双侧全颈淋巴清扫术，皮瓣血运好，手术反应小，瘢痕形成少。外形美观。减轻患者心理创伤，有利于提高患者生活质量。适用于年轻的和对美观较为重视的选择性颈淋巴清扫术患者。     

The bicoronal flap (craniofacial access): an audit of morbidity and a proposed surgical modification in male pattern baldness

Maxillofacial surgeons have used the bicoronal flap for nearly three decades to gain access to the craniofacial skeleton. A retrospective analysis of 68 bicoronal flaps done over a five-year period showed that our incidence of permanent morbidity was low. Although 24 patients (35%) experienced some form of sensory abnormality immediately after the operation, this persisted for longer than two years in only one. Complete motor recovery occurred by one year in all 15 patients (22%) who developed postoperative frontalis weakness. Three patients developed male pattern baldness postoperatively, which resulted in exposure of the scar and poor cosmesis. This prompted a cadaveric study in which we assessed the feasibility of modifying the position of the standard bicoronal incision in people who are prone to hair loss. The pivotal point of the bicoronal flap was found to lie at its most inferior aspect. By extending the incision into the skin crease in front of the lobe of the ear it was possible to adjust the anteroposterior position of the bicoronal incision without limiting access to the facial skeleton. We therefore advocate occipitally placed incisions with preauricular extensions in patients who are prone to male pattern baldness.     

Vertical platysma myocutaneous flap reconstruction for oral defects using three different incision designs: experience with 68 cases

This study evaluated the effects of three different incision designs for the vertical platysma myocutaneous flap (VPMF): apron, MacFee, and T-shaped. This flap was used for the reconstruction of intraoral defects following cancer ablation in selected patients. Sixty-eight cases of VPMF reconstruction were assessed: the apron incision was used in 28, MacFee incision in 22, and T-shaped incision in 18. With regard to postoperative outcomes, there were 26 cases of flap survival and two of partial necrosis with the apron incision; 20 of survival and two of partial necrosis with the MacFee incision; 15 of survival and three of partial necrosis with the T-shaped incision. Success rates were 92.9%, 90.9% and 83.3%, respectively, for VPMF with the apron, MacFee, and T-shaped incisions. A wound healing disturbance in the neck was seen in three cases of VPMF with the apron incision and one case with the MacFee incision. The MacFee incision had the best aesthetic effect, and the postoperative neck scar was more obvious for the T-shaped incision. It is recommended that VPMF with the MacFee or apron incision be used for the reconstruction of larger buccal mucosa and floor of the mouth defects, while VPMF with the T-shaped incision should be used for smaller intraoral defects, especially tongue defects of the lateral surface.     

隐蔽切口入路内镜辅助颈部肿物切除效果初探

目的探索评价颌面部隐蔽切口入路内镜辅助下颈部良性肿瘤切除的新术式。方法选取2018年1月至2019年8月于山东大学齐鲁医院口腔颌面外科就诊的颈部良性肿瘤患者17例(颏下区3例,下颌下区2例,腮腺后下极9例,胸锁乳突肌上区1例,胸锁乳突肌中区1例,胸锁乳突肌下区1例)。术前行CT检查,评价肿瘤大小、边界、形态、性质,根据肿瘤所在区域设计不同部位隐蔽切口,颏下区及下颌下区肿物选用口内前庭沟入路,腮腺后下极及胸锁乳突肌区肿物选用耳后隐蔽小切口入路。术中采用自制的"口腔手术用造腔装置"辅助牵拉完成颈部"造腔",内镜辅助下将肿物完整摘除,术后每3个月定期随访。结果所有手术均按预期完成,术后3个月复查时,视觉模拟量表平均为9.3分,患者对切口设计及手术整体效果均表示满意,术后1~15个月随访均未见复发。结论采用隐蔽切口入路内镜辅助颈部良性肿物切除是一种切口不明显、具有良好美容效果的手术方法。     

Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery

AIM: The purpose of the present study was to describe and evaluate a new incision technique: the papilla base incision. METHODOLOGY: Twenty healthy patients referred for surgical treatment of persisting apical periodontitis, who were free of periodontal disease and had intact interdental papillae were included in the study. The preoperative papilla height was recorded by measuring the distance between the contact point and the most coronal point of the papilla. The papilla base flap, consisting of the papilla base incision and two releasing incisions, was used to expose the bone. The papilla base incision consisted of a shallow first incision at the base of the papilla and a second incision directed to the crestal bone, creating a split thickness flap in the area of the papilla base. Further apically a full thickness flap was raised. Following standard root-end resection and filling, flap closure was achieved with microsurgical sutures. The papilla base incision was sutured with 2-3 interrupted sutures, which were removed 3-5 days after the surgery. The experimental sites were evaluated at the conclusion of the surgery, at suture removal and after 1 month, and compared to the preoperative findings. The healing pattern, complications and postoperative recession were recorded. The experimental sites were observed with a x 3 magnification and graded as to whether a visible scar resulting from the incision could be detected. Twenty experimental sites were analysed. RESULTS: Complete closure of the wound was achieved in all cases after surgery. Except for four patients with delayed healing at suture removal, all other patients displayed rapid healing. No noticeable space was created beneath the contact point area. The change in distance between the reference point and the most coronal point of the papilla comparing the preoperative and the one-month postoperative situation was 0.05 +/- 0.39 mm. The probing depth remained within normal limits. One month postoperatively, observation of the incision demonstrated: four sites with a visible incision line (grade 1), in seven sites the incision defect could be partially detected (grade 2) and nine incisions could not be detected (grade 3). CONCLUSIONS: In patients with healthy marginal periodontal conditions the papilla base incision allows rapid and predictable recession-free healing following marginal surgical exposure of the soft tissues. One month postoperatively the majority of the incisions were completely or partially invisible. Long-term healing will be studied.     

游离腓肠内侧动脉穿支皮瓣修复头颈部缺损的初步研究

目的 探讨游离腓肠内侧动脉穿支皮瓣在头颈部缺损修复中的应用.方法 2010年4月至2011年1月16例患者头颈部肿瘤切除后拟用游离腓肠内侧动脉穿支皮瓣修复组织缺损,术前采用超声多普勒血流仪或彩色多普勒超声检测穿支血管,设计皮瓣,术中记录皮瓣大小、穿支血管的数目和血管蒂长度,术后观察游离瓣成活情况,随访记录供区愈合情况及评价术后并发症.结果 最终完成游离腓肠内侧动脉穿支皮瓣修复16例,15例皮瓣术后成活,1例术后因静脉危象手术探查后皮瓣部分存活.供区15例直接缝合,1例植皮.15例供区Ⅰ期愈合,1例因术后供区肌肉坏死行清创手术后愈合.14例术后随访3～ 12个月,所有患者供区除因瘢痕致远端皮肤触觉异常外,远期无明显功能障碍.结论 游离腓肠内侧动脉穿支皮瓣供区并发症轻微,适用头颈部中小型缺损修复.     

改良美容切口联合胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用

目的:探究改良美容切口联合胸锁乳突肌瓣在腮腺肿瘤切除术中的应用.方法:选取2016年8月～2020年7月在我院接受腮腺良性肿瘤切除术治疗的104例腮腺良性肿瘤患者,按照随机分组法分为改良美容切口组与联合治疗组,各52例.改良美容切口组选择改良美容切口,联合治疗组选择改良美容切口并采用胸锁乳突肌瓣进行组织缺损区修复.记录...     

颏部取骨术两种手术切口愈合情况比较

目的总结18例颏部供骨骨移植术中两种软组织切口设计的伤口愈合情况。对其中较理想的供区手术方式进行了介绍。方法18例下颌骨颏部供骨Onlay植骨的患者．8例采用前庭沟切口设计；10例患者采用附着龈切口设计。结果8例前庭沟切口当中，6例一期愈合,2例出现伤口裂开；所有8例患者术后皆形成较为明显的瘢痕。10例附着龈切口患者术后伤口皆一期愈合．且愈合后无明显的瘢痕形成。结论附着龈切口能提供较理想的手术入路并能较好地达到无张力复位组织瓣。     

Facelift approach with a hybrid SMAS rotation advancement flap in parotidectomy for prevention of scars and contour deficiency affecting the neck and sweat secretion of the cheek

Tumors of the parotid gland are generally be removed by the standard external bayonet-shaped incision approach without reconstruction of the parotid bed. The disadvantage of this approach is frequently an obvious scar affecting the neck and a conspicuous hollow contour around the angle of the mandible in addition to a sweat secretion of the cheek (Frey syndrome). To overcome these disadvantages, especially the facial depressed deformity subsequent to parotid surgery, during the last several years, the author has concentrated on facelift incision used in combination with a hybrid SMAS rotation advancement flap. Twelve patients (7 male; 5 female) ranging in age from 32 to 73 years (mean age, 57.8 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine-needle cytology result. Parotidectomy was performed using the modified facelift incision in conjunction with the rotation advancement hybrid SMAS flap. All patients were followed up every 3 months during the first year. During follow-up, the patients were specifically asked about their satisfaction with their postoperative appearance and whether they would consent to the operation again. The vascularized hybrid vicryl mesh/SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy and prevents the gustatory sweating. There are no drawbacks to the use of the modified facelift incision to remove tumors of the parotid gland.     

Modification of MacFee Incision: A Balance Between Cosmesis and Accessibility

Incision design is a critical element of operative planning. Incisions are chosen with the aim of optimizing exposure of relevant neck levels and minimizing morbidity. Various incisions have been proposed over the years but none fulfilled the criterias of ideal incisions. We propose a modification of MacFee s incision which is the balance between cosmesis and exposure.     

Extended approach in head and neck tumors: modified Schobinger incision

Surgical treatment of many tumors of the head and neck require extended approaches. Many cervicotomies have been described in the treatment of head and neck and cervical tumors; careful thought must be made by a surgeon when surgical treatment is planned for an extended tumor.Our purpose is to show the versatility of the modified Schobinger incision. Between 2003 and 2005, 18 patients were operated on at our plastic surgery department; all presented extended cervical tumors of various origins.In all 18 patients, a Schobinger incision as modified by Yoel and Linares was used. The principal modification described by these authors consisted in the extension of the vertical line of incision below the subclavicular area to the nipple-areola complex. Partial necrosis occurred in two (11%) patients; one (1.8%) patient developed a pharyngocervical fistula; in all cases, healing occurred spontaneously.The benefits of this incision are as follows: 1) an unobstructed vision of anatomic landmarks and the more distal surgical elements; 2) increased blood supply for the flap by means of recruitment of new arterial vessels from the first, second, third, and fourth internal mammary perforators; 4) should flap necrosis occur, it will not compromise the coverage of the great vessels of the neck; 5) the flap's excessive mobility permits it to be used in facial areas, thus facilitating their reconstruction. Other advantages of this incision are that it permits access to different areas of the surgical field, that it allows protection of vital anatomic structures in both the pre- and postoperative periods, and that it results in an inconspicuous and aesthetically acceptable final scar.     

Modification of the skin incision to allow versatility in placement of the skin paddle when raising a fibular osteocutaneous flap

A simple modification to the skin incision in raising the fibular osteocutaneous flap allows the skin paddle to be centred on the best available peroraters running through the posterior intercrural septum into the flap. This maximises the success rate for reperfusion of the skin paddle following vascular anastamosis at the recipient site.     

单侧颈淋巴清扫术切口的研究进展

常见单侧颈淋巴清扫术切口包括T形或Y形切口、矩形切口、围裙式切口等.这些颈淋巴清扫术的切口各有其优缺点,临床医生也总在不断尝试和探索新的切口.本文就单侧颈淋巴清扫术切口的进展情况进行综述,探讨各类切口的优缺点,以供临床参考.     

Endodontic flap design: analysis and recommendations for current usage

An endodontic flap design, which may be used as an alternative to the presently described endodontic flaps, is presented. This flap involves a full-thickness dissection with easily recognizable landmarks and straight-line incisions. A beveled horizontal incision is designed to incorporate the maximum amount of facial keratinized tissue into the body of the flap, while leaving the interproximal tissues untouched. The resultant flap is easily replaced with interrupted sutures to the stable interproximal papillae. Healing is rapid, with excellent esthetic results.     

改良式腮腺肿瘤切除术

目的:介绍一种改良式手术切除腮腺肿瘤的方法。方法:采用耳屏前隐蔽的面部除皱术切口及耳后延长入发际的内切口,在嚼肌筋膜下翻瓣;首先解剖暴露面神经总干后,根据肿瘤的位置,选择性解剖面神经颈面干而行腮腺部分切除术,保护腮腺的部分功能;并采用蒂在上方的胸锁乳突肌局部填塞以减少术后畸形。结果:应用改良术式的16例患者中,无1例出现涎瘘及面神经损伤,随访3～6个月无1例出现Frey’s综合征,并且局部凹陷轻微,面容美观。结论:改良式手术方法切口隐蔽,容易操作,不易损伤面神经周围支,术后并发症少,是一种值得推荐的腮腺肿瘤切除术。     

The Use of Bipaddled Submental Flap for Reconstructing Composite Buccal Defect

Reconstruction of full-thickness buccal defect is challenging as two linings need to be addressed. Either two different flaps or double-paddle for one free flaps are necessary for this defect. The prolonged operation might not be tolerated by patients because of advanced age or medical comorbidity. A 77-year-old gentleman, with significant medical comorbidity, presented with a 4.0 × 4.5 cm ulcerative mass due to squamous cell carcinoma arising from the left buccal mucosa. The tumor extended to the left cheek skin. There was no palpable neck node. CT scan did not show any bony erosion or suspicious neck node. Full-thickness resection of the tumour was undertaken. For the full-thickness buccal defect, a bi-paddled pedicled submental flap after de-epithelialization of the flap skin was used for both the cutaneous and mucosal resurfacing. The flap survived completely and patient recovered smoothly. The surgery is simple and operation time is much shorter than free flap reconstruction. This modified utilization of submental flap simplifies the closure of complicated oro-facial wound.     

Flap design and the LeFort III osteotomy: Blood flow investigation

The effect on local blood flow of flap design in a LeFort III osteotomy was examined in this study. The radioactive microsphere technique was used to make serial flow determinations in two groups of macaque monkeys. The use of seven skin and mucosal incisions was compared with a coronal flap procedure. Significant blood flow reductions to the midface segment were measured when a coronal incision was the sole access in performance of the osteotomies. The findings indicate that the multiple incision approach is more biologically sound than the coronal incision approach in the LeFort III osteotomy. Important information about the surgical techniques can be determined from the data and applied to a more successful performance of the LeFort III osteotomy.     

副腮腺肿瘤切除的手术入路

目的探讨副腮腺肿瘤外科治疗的最佳手术入路。方法对笔者近年所做的9例副腮腺肿瘤手术入路分别采用了延长的腮腺切除手术入路;肿瘤表面皮肤纹理的直接手术入路以及耳前发际内的角形切口手术入路三种方法。结果上述3种不同的手术入路在手术损伤大小、切口隐蔽、副腮腺肿瘤的术野显露以及并发症的发生率等方面存在明显差异。结论耳前角形切口应作为副腮腺肿瘤切除的首选手术入路,它具有更好的美容及手术治疗效果．