Epithetic treatment of facial defects]

The author deals with the aetiology and location of facial defects treated prosthetically during 1974-1975. Treatment methods currently used at the Rostock University Clinic and Policlinic of Stomatology are presented with special regard to constructions developed in this clinic. The importance of the choice of an appropriate material and of the possibility of secure anchoring is pointed to. In spite of certain disadvantages which should not be underrated, facial prostheses have proved useful for temporary treatment and also for definite treatment     

Hemiforehead flap for reconstruction of composite facial defects

Composite defects overlap 2 or more facial units. It is difficult to reconstruct composite defects with adequate shape, color, and texture. Because it is non-hair bearing, is relatively thin, and has a color and texture similar to that of the rest of the face, the skin of the forehead possesses excellent characteristics for nasal reconstruction and repair of other facial areas. The authors developed an extended thin forehead flap (hemiforehead flap) that includes half of the total forehead skin and is based on supratrochlear vessels. In the patient reported here, a hemiforehead flap was used to reconstruct composite defects of the lower lid, cheek, nose, and upper lip. Acceptable aesthetic and functional results were achieved. This flap may serve as an alternative for reconstruction of composite facial defects.     

A boxing technique for making moulages of facial defects

A technique using irreversible hydrocolloid in conjunction with conventional boxing method is described for making impressions of facial defects. The technique improves control of impression material without causing distortion of soft tissue adjacent to facial defects.     

面部软组织评价方法在唇裂患者中的应用

本文总结唇裂术后面部软组织畸形的发生原因和评估方法。唇裂术后面部软组织畸形具有普遍性,但是发生的程度不同,其中以鼻、唇畸形为代表。唇裂术后鼻、唇畸形的评估对唇裂首次术式的选择及以后的二期整复具有指导意义。     

Reconstruction of bone and soft tissue in extensive facial defects

Autogenous iliac and rib grafts are used for the reconstruction of the maxilla and the mandible. Immobilization is assured by use of internal rigid fixation with reconstruction plates or lag screws; in the maxilla, miniplates may be used as well. An immediate reconstruction of chin defects is undertaken with a rib graft. For other defects of the mandible and maxilla, secondary reconstruction via an extraoral approach, without incision of the oral mucosa, is recommended to reduce the danger of infection as much as possible. Defects in facial soft tissue must be closed with local or distant flaps before bone transplantation is begun.     

Long-term outcomes of craniofacial implants for the restoration of facial defects

The aim of this study was to evaluate the long-term survival of craniofacial implants and prostheses and to identify factors associated with failure in a cohort of patients. A 25-year retrospective analysis was conducted at Royal Melbourne Hospital. Data included demographic characteristics, age, site and cause of the deformity, and number and survival of implants. Odds ratios were calculated and event-to-time Kaplan–Meier analyses performed. One hundred and ten patients were included (341 implants); their mean age was 46.2 years. The overall implant survival rate was 79.5% (mean follow-up 10.6 years). Temporal implants had the highest success rate (97.0%), followed by nasal implants (87.5%) and orbital implants (63.3%); differences were statistically significant (P < 0.0001 and P = 0.033, respectively). Kaplan–Meier analyses to determine long-term implant and prosthesis survival found temporal implants had the highest prosthetic (P < 0.0001) and implant survival (P < 0.0001). Patients with congenital deformities demonstrated the highest success rate. Radiotherapy was found to increase the risk of implant failure (P = 0.02). Craniofacial implant-retained prostheses are a reliable and effective option for the restoration of facial defects, with good long-term success rates. Orbital implants and those placed post oncological surgery have a higher failure rate.     

Eyelid grafting as a preprosthetic measure for restoring facial defects

Prosthetic restoration of a facial defect involving the loss of an eye and associated orbital tissues may be restricted by incorrect orientation of the prosthesis if the reconstructed tissue bed is uniform and without distinctive orbital landmarks. A surgically grafted eyelid is useful in this situation. The lower eyelid graft serves to provide an anatomical guide with which to position the ocular component of the orbital prosthesis in relation to its established visual axis. This assists the subsequent orientation of the adjoining tissue portion of the orbital prosthesis, contributing to a well-positioned and cosmetically pleasing result.     

Bilateral interdigitated Pacman flap for round and oval facial defects

Background

Skin texture and color are important considerations during the reconstruction of facial defects, and anatomical borders should be preserved. Therefore, a local flap is a better option. In these cases, the authors repaired facial defects using a bilateral interdigitated VY flap.

Maxillofacial prosthetic principles in the surgical planning for facial defects

In many localities, particularly in larger medical centers, presurgical communication and planning is increasing because the prosthodontist is becoming a more active member of the oncology, trauma, and cleft palate teams. Individuals involved both directly or indirectly in maxillofacial prosthetic therapy should be cognizant of the situations and solutions discussed in this article. In this way the prosthodontist and surgeon will be able to provide a better consultancy and rehabilitation service for their patients.     

Cerebellar involvement in midline facial defects with ocular hypertelorism.

OBJECTIVE: Twenty-four patients were evaluated to better characterize neurological and neuroradiological aspects of midline facial defects with ocular hypertelorism. METHODS: After a clinical genetics evaluation, the individuals were divided into two groups: 12 isolated cases (group 1) and 12 associated with multiple congenital anomalies (group 2). The investigation protocol included medical and family history, as well as dysmorphological, neurological, and neuroradiological evaluations by magnetic resonance imaging or computed tomography scan. RESULTS: Because there was no significant difference concerning the neurological aspects of groups 1 and 2, they were analyzed together. Mild hypotonia (24 of 24), abnormalities in cranial shape (24 of 24), cranial nerves (19 of 24), motor coordination (18 of 24), dynamic equilibrium (14 of 24), and language problems (8 of 24) were noted. Measurements of the posterior fossa showed hypoplastic cerebellar vermis (8 of 17), the cerebellum at lower normality limits (5 of 17), and signs of cerebellar hypoplasia (3 of 7). CONCLUSION: This study clearly demonstrates the presence of structural and functional neurological abnormalities related to midline facial defects with ocular hypertelorism, as well as involvement of the cerebellum. It provides a basis for future investigation of midline facial defects with ocular hypertelorism and should be considered during planning of rehabilitation treatment.     

Bone replacement grafts for the treatment of periodontal intrabony defects

Bone replacement grafts, including autogenous grafts from intraoral donor sites, allografts, xenografts, and alloplastic bone substitutes, are the most widely used treatment modalities for the regeneration of periodontal osseous defects. Studies suggest a favorable clinical outcome with the use of these materials in terms of improvements in periodontal probing depths, probing attachment gains, and bone fill. In terms of bone fill, most studies report more than 50% resolution of intrabony defects when treated with bone replacement grafts. However, histologic evidence of periodontal regeneration, including new bone, periodontal ligament, and cementum, has been reported only for autogenous bone grafts and demineralized freeze-dried bone allografts.