面颊部扩张皮瓣的设计和转移

目的探讨利用扩张皮瓣修复面颊不同部位皮肤缺损的扩张皮瓣设计。方法269例面颊部血管瘤、瘢痕、色素痣患者,依不同的皮肤缺损位置,在邻近部位放置大小适度的1~3个50~400ml容积的扩张器,扩张充分后采用推进皮瓣法、旋转推进皮瓣法和易位皮瓣法修复。结果269例中共形成305个扩张皮瓣,利用推进皮瓣121个,旋转推进皮瓣145个,易位皮瓣39个;共出现并发症52例,分别为扩张皮瓣远端血运障碍、血肿形成、感染、注水壶渗漏、扩张器外露、睑外翻和包囊挛缩,这些并发症基本未影响最终的手术效果,术后面颊部形态正常。结论我们提出的扩张皮瓣的设计和转移原则,对于面颊部的皮肤缺损组织扩张术治疗有非常重要的参考价值。     

Resection and augmentation of Bichat's fat pad in facial contouring

Summary The Bichat's fat pad (Corpus adiposum buccae) is of great significance in facial contouring. Resection of major parts of this fat pad results in hollow cheeks and in accentuation of the zygoma. On the other hand, hypoplasia or shrinkage of this fat pad can be augmented by means of silicone implants for improved aesthetic results.     

Cirugía reconstructiva de la región cigomática-medial de la mejilla: Presentación de 5 casos

The cheek is the largest anatomical subunit of the face. It is a bilateral structure and symmetry must therefore be preserved. Peripherally it is related to important natural orifices whose location must also be maintained during surgical reconstructions. This is particularly important in the medial zygomatic subunit, whose delicate junction with the lower eyelid means that care must be taken to avoid ectropion. We present 5 options for the reconstruction of surgical defects secondary to the excision of tumors in this region.     

Craniofacial penetration by a wooden stick

IntroductionPenetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity.Case summaryWe describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3 cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain.DiscussionPenetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.     

Augmentation of Cheek Bone Contour Using Malar Osteotomy

Patients with a narrow face have often a defect in expansion of the maxillary–malar complex. A malar osteotomy, separating the malar–zygomatic complex from the orbit and the maxilla, allows an anterolateral cheek projection when performing an external rotation. This technique changes facial contour and improves facial aesthetics. During the past 5 years, 18 malar osteotomies have been performed; the external rotation was stabilized with interposed coral graft in six patients and with interposed bone graft fixed by a miniplate or with a stainless steel wire in 12 patients. Simultaneously septoplasty was performed in five patients, rhinoplasty in 13 patients, and genioplasty in two patients. Six patients had a face and neck lift, one patient had a forehead lift, and one patient had onlay iliac crest bone graft to treat atrophic maxillary alveolar ridges prior to implant placement. Stability was defined after 1 year follow-up. The increase in projection was correlated to the size of the graft. At least 5 mm were necessary to have cheek modification. Mucous inflammation, maxillary sinusitis, and relapse were observed with the use of interposed coral graft, but no complications were observed with bone graft. Malar osteotomy is a simple and safe procedure; it allows an anterolateral cheek projection and seems to be effective for treating transverse midface deficiency. Presented at the XVI^th congress of ISAPS, Istanbul, Turkey, 26–29 May 2002     

逆行性面动脉-颏下岛状肌皮瓣在颊面部组织缺损中的应用

目的探讨分析逆行性面动脉-颏下岛状肌皮瓣在颊面部组织缺损中的应用。方法随机选取我院近三年来收治的颊面部组织缺损患者38例,按照患者所采用的手术修复方式将患者分为实验组与对照组,实验组患者采用逆行性面动脉-颏下岛状肌皮瓣进行移位修复,而对照组患者采用胸大肌皮瓣进行移位修复。术后进行为期一年随访,比较两组患者治疗情况以及感染发生率以及日常生活功能恢复情况。结果经过对患者进行为期一年的随访发现,对照组患者治疗失败3例,有2例患者复发,最终治疗有效率（73.68%）明显低于实验组患者（100.00%）,同时实验组患者进食（100.00%）、语言（100.00%）以及其他功能（100.00%）恢复情况分别明显优于对照组患者（73.68%）、（68.42%）、（73.68%）,P〈0.05,差异具有统计学意义。结论逆行性面动脉-颏下岛状肌皮瓣在颊面部组织缺损中治疗效果显著,同时复发率极低,安全性较高,值得在临床推广。     

Substitution Urethroplasty with Closure Versus Nonclosure of the Buccal Mucosa Graft Harvest Site: A Randomized Controlled Trial with a Detailed Analysis of Oral Pain and Morbidity

Background

Optimal surgical management of the buccal mucosa harvest site in patients with urethral stricture disease during buccal mucosa graft urethroplasty (BMGU) remains controversial.

CD44v6和p63在颊部鳞状细胞癌中的表达及其临床意义

 【摘要】　目的　研究颊部鳞状细胞癌（BSCC）中 CD44v6和p63蛋白表达与BSCC发生、发展、侵袭、转移的关系。方法　应用免疫组织化学SP法检测52例 BSCC、10例颊部非典型增生和10例正常黏膜组织中CD44v6和p63蛋白表达水平,结合临床、病理特征进行分析。结果　在颊黏膜正常组织、非典型增生组织、 BSCC 组织中CD44v6阳性表达率逐渐下降,分别为90.0 %（9／10）、80.0 %（8／10）和55.8 %（29／52）,且表达层次渐少,p63阳性表达率逐渐升高,分别为30.0 %（3／10）、40.0 %（4／10）和90.4 %（47／52）,且表达差异均有统计学意义（P＜0.05）。CD44v6、p63 与BSCC患者性别、年龄、T分期、病理分级无关（P＞0.05）。CD44v6与BSCC侵袭方式、淋巴结转移有关（P＜0.05）,p63与BSCC淋巴结转移无关（P＞0.05）。结论　CD44v6、p63都参与了调控BSCC的发生、发展。CD44v6可能作为检测BSCC的标志物及判断其预后的检测指标。p63可能是一种癌基因,可作为检测BSCC的标志物。CD44v6和p63二者作用可能无联系。     

The use of lingual mucosal graft in adult anterior urethroplasty: surgical steps and short-term outcome

OBJECTIVES: Investigate the tolerability, safety, and efficacy of using the lingual mucosal graft (LMG) for anterior urethroplasty. METHODS: Ten patients (average age, 41 yr) underwent substitution urethroplasty LMG. Harvesting the graft from the tongue was performed by either the oral surgeon or the urologist. In five patients with penile urethral strictures, the grafts were placed on the dorsal urethral surface as a "dorsal inlay." In five patients with bulbar urethral strictures, the grafts were used as a "dorsal inlay" (3 cases) or "ventral onlay" (2 cases). The average follow-up was 5 mo (range: 3-12 mo). RESULTS: Nine cases (90%) were successful and one (10%) was a failure. Three patients who underwent bulbar urethroplasty showed prior failed repair using buccal mucosal grafts harvested from a single cheek (1 case), from both cheeks (1 case), or from the lip (1 case). The length of the lingual grafts was 4-6cm (mean: 4.5cm) with a width of 2.5cm. No patient developed early or late postoperative complications on the harvest site related to the tongue surgery. No difference was observed in patients in whom the graft harvesting was performed by the oral surgeon compared to the patients in whom the procedure was performed by the urologist. CONCLUSIONS: The surgical technique for harvesting a graft from the tongue is simple and safe. The tongue may be the best alternative donor site to the lip when a thin graft is required for urethroplasty or when the cheek harvesting is not possible.