Objective anthropometric analysis of eyelid reconstruction procedures

Before undergoing facial tumour resection and reconstruction, especially of the eyelids, patients are worried about their postoperative appearance. “Eye-balling” of postoperative results may not be sufficient to adequately judge surgical results. Reference anthropometric measurements for the eyelids are available.We present an evaluation of a series of tumour resection and reconstructive procedures of the eyelids on standardized photographs based on reference anthropometric data. 51 patients underwent eyelid reconstruction with different established techniques after resection of local eyelid tumours. Analysis included intercanthal width, biocular width, eye fissure width, eye fissure height, lid sulcus height, upper lid height, upper iris coverage, lower iris coverage, position of cornea to palpebra inferior, scleral show, ectropion, and canthal tilt. We clearly differentiated between resections including eyelid margin or not.Time (p = 0.04) and surgery (p = 0.03) showed a significant association with decreased values of lower eyelid coverage. Resection of the eyelid margin showed no significant influence on the values investigated.In all the patients analysed the indices were reproducible and reliable. Not surprisingly an association between surgery and lower eyelid retraction was found. Resection of the eyelid margin does not seem to cause a greater risk of eyelid deformity. The standard measurements described are accurate and objective to evaluate postoperative results.     

应用CAD/CAM重建下颌骨:手术结果分析

该文旨在分析虚拟外科在下颌骨重建手术中的精确性。对8例采用非血管化髂骨瓣和游离腓骨肌皮瓣进行下颌骨重建的患者进行回顾分析。上颌骨CT扫描数据输入软件,指导下颌骨切除,外科导航下颌骨重建钛板的位置。术后CT与     

上颌骨功能性修复中骨性支柱重建的生物力学分析

目的：建立以腓骨重建上颌骨的三维有限元模型,进行生物力学分析,研究骨性支柱重建在上颌骨功能性修复中的作用。方法：应用MedGraphics、Unigraphics和Ansys8．0软件建立4种腓骨重建上颌骨的三维有限元模型,于双侧后牙区垂直加载,研究上颌骨的应力分布。结果：建立了上颌骨Brown 3类缺损的3段式腓骨、2段式腓骨＋重建钛板、2段式腓骨＋钛网和2段式腓骨＋颧种植体重建的三维有限元模型。3段式腓骨重建的应力分布图和应力矢量图与正常上颌骨最为接近．应力分布比较均匀。另3种应力主要位于重建侧上颌骨,并集中于重建结构转折和颧种植体植入颧骨处。结论：有效的上颌骨骨性支柱重建,能使重建后的上颌骨处于比较合理的应力分布状态,更接近于正常的上颌骨．     

Gastro-omental free flaps in oral and oropharyngeal reconstruction:surgical anatomy, complications, outcomes

Free gastro-omental flaps can be used to reconstruct defects in the oral cavity after ablative cancer surgery. The omentum can provide as much bulk as required. The generous gastro-omental pedicle allows mobility. The gastric mucosal lining has the advantage that it produces mucus, does not carry hair follicles and is not prone to troublesome desquamation. This paper reviews the surgical anatomy of free gastro-omental flaps and presents a series of eight cases in which these flaps were used for oral and oropharyngeal reconstruction.     

Evaluation of accuracy and sensory outcomes of mandibular reconstruction using computer-assisted surgical simulation

Purpose

To introduce a modified protocol for mandibular reconstruction and evaluate the protocol using a standardized assessment method.

Measuring surgical outcomes in congenital craniofacial surgery: an objective approach

Assessment of surgical outcome in congenital craniofacial malformations is necessary to evaluate treatment efficiency since the results of early surgery are influenced by surgical technique and timing. Available outcome measurements all have their limitations, especially for application in congenital craniofacial malformations. Therefore a new outcome measurement was developed, in which each facial unit is scored in a standardized way. For each facial unit, deformities of shape or contour, malposition and soft tissue involvement were evaluated, besides scoring for specific congenital malformations of that area. The final result was tested on pre- and postoperative photographs of patients with rare facial clefts and reliability and validity were demonstrated. The new developed instrument showed the ability to provide quantification of outcome. Because of its properties it can serve as an instrument to compare outcome between techniques, surgeons and centers in a more objective and standardized way.     

前臂桡侧-掌长肌腱复合瓣在唇颊部缺损修复中的应用

目的：探讨前臂桡侧-掌长肌腱复合瓣在唇颊部缺损修复中的应用价值,并对临床手术经验进行初步总结。方法：应用前臂桡侧-掌长肌腱复合瓣对5例唇颊部缺损患者进行手术修复,掌长肌腱与残余口轮匝肌可共同维持唇颊部形态和功能,对折的前臂皮瓣则可同时修复皮肤与黏膜缺损。术后定期随访,最短随访时间20个月。结果：5例游离复合瓣移植后均获得成活,成活率100％,在术后6个月,复合瓣外观形态较好;术后10-12个月,患者能很好地进行开闭口、咀嚼等运动。结论：前臂桡侧-掌长肌腱复合瓣修复唇颊部缺损,形态和功能均令人满意。     

Association between condylar position changes and functional outcomes after condylar reconstruction by free fibular flap

Clinical Oral Investigations - Stable and appropriate condyle positioning is necessary for maintaining temporomandibular joint function. It is unclear if this position remains stable in patients...     

Lip morphology and area changes associated with surgical correction of mandibular prognathism

Changes in lip morphology and area, measured in two dimensions from standardized lateral head films, were assessed in a series of twenty adults at three times: pre-surgically, 8--14 months post-surgically, and a long-term follow-up at 5--7 years. All individuals received the same, single surgical procedure (Obwegeser sagittal split for correcting mandibular prognathism. Upper and lower lip changes were quantified as millimetres displacement of the lip centroid vertically and horizontally, plus changes in cross-sectional area. Direction and amount of change, its dependency on the amount and kind of surgically induced symphyseal changes, and the intercorrelations among lips and among lip and symphysis variables were statistically evaluated, both univariately and multivariately. Three measures are made of symphysis change: horizontal and vertical repositioning and amount and direction of rotation. Horizontal repositioning primarily affected the lengthening and areal increase of the upper lip. Vertical repositioning had its major influence in the height and cross-sectional area of the lower lip: a superior shift of the mandible made the lower lip shorter, more protrusive and smaller in area; an inferior shift produced an increase in lower lip height with increased area. The third variable, symphyseal rotation, had its greatest influence on the labial-lingual shift of the upper lip's centroid. The long-term follow-up showed little change from the 1 year post-operative conditions; equilibrium of the soft tissue components was then achieved fairly soon after surgery.     

Lip adhesion: an unusual complication of erythema multiforme.

The purpose of this article is to report a case of lip adhesion as a complication of erythema multiforme in an 8-year-old child. This is the second reported case of this complication of oral ulceration associated with erythema multiforme.     

Craniofacial disproportions in Apert's syndrome: an anthropometric study

Twenty craniofacial indices composed of 26 surface measurements taken directly from the head and face were determined in 14 Apert's syndrome patients 18 days to 5 years old (younger subgroup) and 14 patients ages 6 years to 15 years old (older subgroup). All of the patients were North American Caucasians who had undergone early suture release but no facial repair. The indices were compared with those in healthy controls of the same age and sex. The wide intercanthal distance in relation to the narrow soft nose was the most frequent (81.5%) and extensive (17.7% above the maximum normal index value) disproportion. Abnormal indices occurred most often with the combination of one abnormal and one normal measurement (61.0%). All seven of the 16 disproportions seen in both age subgroups increased in frequency nonsignificantly with age: the supernormal cephalic, intercanthal, nasal, and vertical mandibulofacial indices and the subnormal nasofacial, upper face, and jaws' arcs indices. Of the six disproportions that decreased in frequency with age, four changed significantly (the supernormal frontoparietal and frontozygomatic indices and the subnormal mandibulofacial and nasozygomatic indices) and two changed nonsignificantly (the supernormal intercanthoalar and subnormal cheilozygomatic indices). With the exception of two nasal proportions, the extent of the disproportionality decreased in all of the indices that increased with age.     

种植与颌骨功能性重建

颌骨是人体颌面部重要器官之一。因外伤、肿瘤所致的颌骨缺损不仅仅破坏容貌，而且周围重要组织与器官结构破坏、缺失，将给患者的生理和心理带来重大打击，严重影响患者的生存质量。因此，颌骨重建的目的除恢复颌骨的连续性和完整性外，还为义齿承力、固位和行使咀嚼功能创造条件。以前往往因唇颊沟、舌沟变浅或消失、牙槽嵴缺损或低平给常规义齿修复带来困难。20世纪70年代中期，Brainemark等率先将日趋成熟的种植义齿技术引入下颌骨缺损功能重建领域，为真正意义上的颌骨功能重建开辟了一条新的途径。     

Patterns of dysmorphology in Crouzon syndrome: an anthropometric study

Twenty-four craniofacial proportion indices were calculated from 26 surface measurements taken directly from the head and face in 61 patients with Crouzon syndrome, aged 11 days to 32 years. All patients were North American caucasians who had not undergone facial repair. The measurements and proportions were compared with those in healthy controls of the same age and sex. In most patients, the only disproportions present were a wide forehead in relation to the cranial breadth and wide orbital region compared with the face width. The proportions were in the normal range in most cases (71.7%), although many tended toward its extremities. Disproportions were associated most frequently with a combination of abnormal and normal measurements (48.9%); however, a large number (42.4%) involved two normal measurements. Among the normal proportions, most involved two normal measurements, although almost one fourth (22.8%) were associated with one or two abnormal measurements.     

Assessment of surgical outcomes and oncological safety for submental artery perforator flap reconstruction after ablation of oral cancer

The submental artery perforator flap (SAPF) has been a new option for the intraoral reconstruction of oral squamous cell carcinoma (OSCC) patients in recent years, but its surgical outcomes have not been well assessed. We compared the surgical outcomes and oncological safety of SAPF reconstruction for medium-sized soft-tissue defects after the ablation of primary oral cancer with traditional submental island flaps (SIF) and anterolateral thigh perforator flaps (ALTPF). Fifty-one SAPFs, 30 SIF, and 74 ALTPF were reviewed for the intraoral medium-sized reconstructions after the ablation of oral cancer from our institutional clinical oncological databases. We performed comparative assessments on the variables of surgical outcome and oncological safety among the 3 cohorts. A Kaplan-Meier estimate of survival for each flap was calculated. Operating time was significantly reduced in the SIF and SAPF groups than ALTPF (p = 0.021 and 0.014, respectively). Flap thickness of SAPF was the significantly thinnest (mean 0.5 cm) among three groups. The common complications of donor site for both SAPF and SIF group were incision dehiscence and orocutaneous fistula. There was no significant difference in disease-free survival (DFS) among the 3 groups. However, several OSCC patients with the SIF reconstruction were found to have recurrences with a metastatic lymph node under the flap after the first operation. SAPF could be a versatile choice of the intraoral reconstruction for the medium-sized soft-tissue defects after the ablation of oral cancer.     

Atypical Presentation of an Upper Lip Pleomorphic Adenoma: Case Report

The pleomorphic adenoma (PA) or mixed tumor is the most common neoplasm of the salivary glands, usually presenting with a non-specific clinical manifestation and a diverse histopathological pattern. The region of the lips is the second most common site for minor gland neoplasms. The aim of this paper is to report the case of a 39 year old caucasian woman presenting with a swelling on the right side of the upper lip combined with a history of trauma in the region of the upper right central incisor, eight years ago. The swelling was attributed to the periapical lesion of the upper right central incisor that was observed on the orthopantomography. Intraoperatively the surgeon came upon a nodule of firm consistency in the mucolabial fold. The histopathologic diagnosis of this lesion was benign mixed tumor of salivary gland. This report discusses the deviation in frequency of mixed salivary gland tumor between upper and lower lip, the clinical differential diagnosis, the histopathological pattern and the appropriate treatment.Key words: Pleomorphic Adenoma, Lip, Salivary Glands, Minor     

Clinical application of the functional matrix: mandibular reconstruction and monobloc functional therapy.

A 13-year-old black girl with an extensive ameloblastoma of the mandible required subtotal mandibular resection and immediate reconstruction with use of an autogenous, ipsilateral, corticocancellous graft from the iliac crest and monobic functional therapy. Twenty-seven months later, clinical evaluation showed normal mandibular function and no facial asymmetry. Bony architectural changes after 27 months included reformation of the coronoid process, angular process, and external oblique ridge; preservation of mandibular length and thickness; and maintenance of the alveolar ridge height. The reformation of the coronoid process suggests the importance of the functional matrix (temporalis muscle) in skeletal tissue growth. The monobloc appliance in conjunction with bone grafting is an effective means for transmission of biophysical stimuli and for maintenance of appropriate stress for remodeling of bone in the mandible.     

Surface morphology in Treacher Collins syndrome: an anthropometric study

Between 27 and 65 anthropometric measurements were taken for the head and face of 18 Treacher Collins syndrome patients. The most defective and frequent findings were subnormal facial depth measurements, which increased in disproportionality toward the mandible. Width of the face was more frequently and more severely subnormal than that of the mandible. The orbits were hyperteloric with disproportionately short eye fissures and an antimongoloid inclination. The ears were microtic (more so in width than in length) in 58.8 percent of cases but low-set in only 20 percent. The nose measurements were mostly normal, which explains the "parrot-beak" character of the nose in the presence of a hypoplastic receding chin; the only nose defects were supernormal height and width in the root and subnormal bridge inclination. The most frequently seen striking disproportions were those between the width of the nasal root and the width of the soft nose, followed by the great discrepancy between the markedly narrow face and the usually normal face height.