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Maxillo Mandibular injuries are most common through road traffic accident. The defects and deformities are usually prominent in case of facial injuries. The ultimate aim of recontouring and reconstruction of the facial defect is to achieve the maximum functional as well as esthetic part of the face. Here we present a case of fracture in to multiple fragment of the infra orbital rim, reconstructed with rib graft.
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Objective To observe the effects of a novel type ‘umbrella’ graft in secondary cleft rhinoplasty.Methods 38 secondary cleft patients with moderate to severe nasal deformity that were older than 16 years in our department from September 2013 to March 2016 were received rhinoplasty with novel type ‘umbrella’ graft.Nasal augmentation and piriformaperture filling with autologous rib cartilage was applied in patients with saddle nose or nasal base depression.The appearance and patient's satisfaction were assessed at 6 months after surgery.Results There were no complications such as infection,hematoma and graft exposure in all 38 patients with rhinoplasty.The nasal tip,dorsum,nostril and nasal base were improved significantly 6 months after surgery.Especially the nasal tip and nostril,most of them,became almost normal.The patients' self-evaluation of the appearance and function were satisfying.Conclusions The novel type ‘umbrella’ graft can improve the deformity of cleft nose significantly,especially the appearance of the nose tip and nostril,which is a reliable method.
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Objective To explore the feasibility of treating the microtia aided with the digital technology,harvesting the rib cartilage precisely,and carving fabric the ear framework in more details.Methods From July 2015 to January 2017,22 microtia patients accepted clinical therapy aided with digital technology.Preoperatively,the three-dimensional model of the costal cartilage and ear were made to design the cartilage scaffold fabrication.After the operation,the difference of the three dimensional morphology between the reconstructed ear and the normal ear was measured by digital technology.Results With average 7 months follow up,19 cases were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance.The outcomes were acceptable in 3 cases.There were no postoperative complications related to chest wall deformity or affected normal physical function.Conclusions Digital technology can achieve accurate harvesting and reasonable utilization of autogenous rib cartilage,provide accurate guidance for the sculpture of auricle scaffold and objective evaluation for the three-dimensional structure of the reconstructed ear.
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La posición expuesta de la oreja la hace vulnerable a muchos tipos de lesiones, entre las que se encuentran los traumas. Nuestro propósito es presentar un caso clínico en el que se realizó la reconstrucción de una pérdida parcial del pabellón auricular por trauma. Acude al cuerpo de guardia del Hospital Universitario General Calixto García; un paciente masculino de 42 años refiriendo haber perdido un fragmento de oreja en una riña. Se decide realizar hemostasia y fijación mediante puntos de sutura del pabellón auricular remanente a la región temporal, previa incisión en la zona. A los 3 meses del evento traumático se reevalúa con fines de realizar la planificación preoperatoria reconstructiva. Se decide la realizarla mediante injerto de cartílago costal colocado en forma de bolsillo; en la región temporal. Al mes de esta última intervención quirúrgica se realiza, bajo anestesia local, la liberación de la región auricular, el avance de un colgajo temporal y la colocación de un injerto libre de piel en la cara posterior del área reconstruida. Se observa una excelente evolución posoperatoria. El paciente refirió una gran satisfacción por los resultados estéticos obtenidos. En este caso se empleó una secuencia diagnóstica y terapéutica, según elección de los cirujanos involucrados, ante un defecto traumático parcial del pabellón auricular en sus tercios superior y medio. Este tipo de secuela traumática requirió el empleo de procederes quirúrgicos en varios tiempos operatorios que garantizaran un buen aporte sanguíneo de los tejidos y adecuados resultados estéticos finales(AU)
The exposed position of the ear makes it vulnerable to many types of injuries, including traumas. It is our purpose to present a clinical case in which reconstruction was performed of a partial traumatic auricular loss. A 42-year-old male patient presents at the emergency service of General Calixto García; University Hospital and reports having lost a piece of his ear in a fight. It was decided to perform hemostasis and fixation by stitching the remaining section of the auricle to the temporal region, after making an incision in the area. Three months after the traumatic event re-evaluation was conducted with a view to planning reconstructive surgery. It was decided to carry out the reconstruction placing a pocket-shaped rib cartilage graft in the temporal region. One month after the operation, auricular release, advancement of a temporary flap and placement of a free skin graft on the back of the reconstructed area were performed under local anesthesia. Excellent postoperative evolution was observed. The patient reported great satisfaction with the esthetic results obtained. The case herein presented was based on a diagnostic and therapeutic sequence of actions determined by the surgeons involved with a view to correcting a partial traumatic defect of the upper and middle thirds of the auricle. This type of traumatic sequel required the use of surgical procedures at several operative moments ensuring good blood supply to tissues and appropriate final esthetic results(AU)
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Humans , Male , Adult , Ear Auricle/injuries , Ear Auricle/surgery , Ear Cartilage/transplantation , Surgical Flaps/surgery , Wounds and Injuries/diagnosisABSTRACT
Objective To study the clinical efficacy of autologous cartilage following unilateral cleft lip and palate repair on correction of secondary complex deformity.Methods 17 patients with complex secondary cleft palate were enrolled in this study from December 2004 to December 2014.Correction of nasal and lip deformity and oronasal fistula were achieved at the same time.The therapeutic efficacy was evaluated after follow-up from 3 months to 2 years after operation.Results All 17 patients received satisfactory results,of which 14 patients were satisfied and three cases of general satisfaction.Conclusions Satisfactory results are received by using autologous rib cartilage to repair secondary complex deformity of unilateral cleft lip and palate.
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BACKGROUND: The hemodynamic reactions to psychological stress were different between adult genders. Our aim was to investigate the hypothesis that preoperative cardiovascular responses in children undergoing ear reconstruction surgeries will be different according to gender. METHODS: We obtained data from children, aged 7-16 years, undergoing reconstruction surgeries for microtia during 2005-2009. Number of boys receiving primarily rib cartilage graft (RCG) surgery and secondarily ear elevation procedure was 121 and 83, respectively, and girls 48 and 28, respectively. Preoperative systolic (S), diastolic blood pressure (DBP) and heart rate (HR) on each surgery were compared between genders, and within genders. RESULTS: Boys were younger than girls by one year at first and second admission. Boys showed significantly lower preoperative DBP than girls (mean difference [MD]: -3.7 mmHg, 95%CI: -6.1 to -1.3, P = 0.032) before RCG, whereas significantly higher SBP (MD: 21.5 mmHg, 95%CI: 16.6 to 26.4, P < 0.001), and DBP (MD: 10.2 mmHg, 95%CI: 6.0 to 14.4, P < 0.001) before ear elevation. Comparison between the two surgeries within the same gender indicated that boys demonstrated significantly higher SBP (P < 0.001) and DBP (P < 0.001) before ear elevation than before RCG; however SBP was comparable and DBP was significantly lower (P = 0.035) before ear elevation than before RCG in girls. CONCLUSIONS: Gender impact on the preoperative cardiovascular reactions was evident in children undergoing microtia surgery.
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Adult , Aged , Child , Humans , Blood Pressure , Cartilage , Congenital Abnormalities , Ear , Heart Rate , Hemodynamics , Ribs , Stress, Psychological , TransplantsABSTRACT
Objective To explore the clinical effect of auricle reconstruction with expanded auricle posterior flap on mastoidea and auto rib cartilage bracket for repair of congenital microtia.Methods Twenty-one eligible patients with congenital auricle malformation and defect were recruited into this study and three-stage operation was performed.A 50 ml kidney-shaped expander was implanted at mastoid process area to expand skin in stage Ⅰ surgery,followed by a regular affusion to expand skin for 3 to 4 months.The average total waterflood was (80.51 ± 3.87) ml.The volume remained stable for 1 month,once up to the predetermined amount.In stage Ⅱ surgery autogenous costal cartilage was taken and carved into inverted conch shape.Auricle was reconstructed with the expanded flap to cover the auto rib cartilage bracket.The stage Ⅲ surgery was performed for details dressing of the auricle after 3 months.Results All 21 cases underwent operation successfully.Reconstructed ear auricles were similar to uninjured sides in size and shape.Both doctors and patients were contented with the auricles.Conclusions Expanded auricle posterior flap on mastoidea can cover the auto rib cartilage bracket.Autologous costal cartilage can be carved to four layers cartilage bracket that likes an inverted conch,and followed by realistic postoperative auricular shape and strong three-dimensional sense after operation.
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Objective To discuss the effect of transplanting autogenous rib cartilage in correction of short and upwardly rotated nose.Methods A piece of autogenous rib cartilage was transplanted into the front of nasal septa to lengthen it,leading to the nasal tip moving forwards and correcting the short and upwardly rotated nose.For low nose cases,simultaneous implants was used into the nasal back.Results The nasal tips were prolonged 0.75 cm on average after operation in 56 patients with short and upturned noses.The nasolabial angle and extent of nostril exposure were normal after operation.The operational consequences were fine in 54 patients,while 2 case were not satisfactory.Efficacy was stable during one year follow-up.Conclusions This method is reliable,and it can be recommended in rhinoplasty of patients with short and upwardly rotated nose.
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ObjectiveTo investigate the treatment and prevention of auricle reconstruction complications by Medpor framework and autoallergic rib cartilage framework implantation.Methods A total of 158 microtia were performed ear reconstructive operation,in which postoperative complications happened in 18 cases during January 2003 to June 2011,and studied retrospectively.Results There were three cases of dilator haematoma (incidence rate was 1.90 ％),and they were cured after treatment.There were two dilator infection cases (incidence rate was 1.27 ％).One case was cured after treatment,and another one revealed no effect after treatment and dilator implantation operation was done half a year later.There were thirteen cases of framework plantation exposure and infection after Ⅱ stage operation,in which there were seven rib cartilage framework cases (incidence rate was 5.79 ％),and they were cured after change dressings and operation; there were six Medpor framework cases (incidence rate was 16.22 ％),and the three cases were cured after change dressings and operation,and other three cases revealed no effects after change dressings and so the operation failed.ConclusionsPreoperative percise plan and fine manipulation can decrease the incidence of haematoma.The main reasons of framework exposure include the skin tension,thin skin flap or the effect of external force.On account of the high incidence of framework exposure and difficult treatemnt,it is better to use rib cartilage framework for uricle reconstruction.
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PURPOSE: Microtia is a congenital anomaly resulting from abnormal development of the branchial apparatus. Although significant modification and improvement of operative procedures for the reconstruction of the auricle with a natural appearance have been reported, postoperative complications, such as infection, flap necrosis and deformity, still remain serious problems in patients. Many studies with long-term results have focused mainly on operative procedures for an acceptable auricular shape without consideration of possible complications. METHODS: We conducted a retrospective study on postoperative complications at the recipient sites of 183 patients who underwent auricular reconstruction with autologous rib cartilage grafts from November 1987 to January 2007 at the Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital. Patients were analyzed in terms of the kinds and incidences of complications, and their treatment options. RESULTS: Postoperative complications included wound dehiscence, flap necrosis, infection, hypertrophic scar, auricular deformity and absorption of rib cartilage grafts. The complications occurred in 47 patients with a complication rate of 25.7%. Fourteen patients were successfully managed with conservative treatment. However, surgical treatment was required in 51 reoperations(33 patients) of total 329 operations. CONCLUSION: Postoperative complications at the recipient sites of autologous rib cartilage grafts occurred with relatively high incidences and required long-term treatments and multiple surgeries. The results of this study may provide information on the causes and proper management of postoperative complications as well as safe procedures for the reconstruction of the auricle.
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Humans , Absorption , Cartilage , Cicatrix, Hypertrophic , Congenital Abnormalities , Ear , Incidence , Necrosis , Postoperative Complications , Retrospective Studies , Ribs , Surgery, Plastic , Surgical Procedures, Operative , TransplantsABSTRACT
Objective To observe the effect of isolating and harvesting the chondrocytes from rabbits rib cartilage with the method of three-step enzymatic digestion, and the biological characteristic of the isolated chondrocytes during cultivation in vitro to evaluate their biological activity. Methods The method of three-step enzymatic digestion was designed that the rib cartilage was digested one by one with 1 g/L trypsin and 1 g/L EDTA, 1 g/L hyaluronidase and 2 g/L collagenaseⅠ in the culture medium to isolate chondrocytes. The harvesting and viability rate of the primary chondrocytes were detected. During the passage cultivation in vitro, the changes of the chondrocyte shape and growth were observed, and the changes of the collagen typeⅠ and Ⅱ and aggrecan in the extracellular matrix were detected. Results ① The extracellular matrix of rib cartilage was completely dissolved by the three-step enzymatic digestion, and the chondrocytes were completely isolated from the solid matrix. The number of the harvested chondrocytes from every gram of wet cartilage was (4 295.7)?10~(4) on average,and their viability rate was 97.2% on average. ②The primary and first passage chondrocytes had triangle or multi-angle shape, and became elliptic shape at the growing confluence with the positive immunohistochemical staining of collagen type Ⅱ and the strong heterochromia to toluidine blue. The content of sulfate glycosaminoglycans(GAG) in the extracellular matrix of the primary passage cells was (80.61?11.40) ?g/cm~(2). The chondrocytes after the third passage gradually became spindle shape with the negative staining of collagen typeⅡ and the weak heterochromia to toluidine blue. The content of sulfate GAG of the fourth passage cells was (44.74?10.18) ?g/cm~(2). Conclusion ① The method of three-step enzymatic digestion can make the extracellular matix of rib cartilage to be completely degraded, and has advantages of the high efficiency of harvesting primary chondrocytes with high cellular viability rate and simple manipulation. ②The primary and first passage chondrocytes have fine biological activity.
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The constricted ear was suggested by Tanzer for the purpose of obviating the confusion involving lop ear, cup ear and prominent ear as defect whose helix turns down, and scapha and fossa triangularis are narrowed. The constricted ear has a spectrum of severity and therefore, requires a graded surgical approach. Tanzer has described the degree of deformities of the constricted ear as falling into three groups. For the correction of constricted ear, there are numerous techniques but we have had difficulties in adopting these techniques in various type. We also describe the various constricted ear as the Tanzer's classification and adopted three methods to each type, banner flap(group I), concha cartilage graft (group II) and rib cartilage graft(group III) for reducing postoperative deformity and confusion in correcting the ear deformities. Constricted ear repairs must be individualized to accomodate each specific deformity. We corrected 22 cases of constricted ear in 20 patients using each optimal method described above according to the degree of deformities. Mild deformities need only reshaping and adjusting of existing tissues, moderate deformities need additional skin and severe deformities require a cartilage graft. For correction of constricted ear, accurate identification of the severity of deformity is essential. The results were satisfactory and we report our experience with relative literatures.
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Humans , Cartilage , Classification , Congenital Abnormalities , Ear , Ribs , Skin , TransplantsABSTRACT
Objective To find a better method to reconstruct total ear in one stage. Methods In the procedure, a compound framework was formed, in which Medpor acted as ear framework and homogenous rib cartilage as helix-framework after being sculptured, then they were vamped together. The formed framework was covered with adjacent skin flap and homogenous skin graft after it had been covered with superficial temporal fascia flap. Results From January 2001 to Augest 2003, 8 cases of congenital microtia or antotia were treated in this way, and all of them obtained satisfactory appearance in auricle. Conclusion The reconstructed ear has a delicate structure and good appearance, and looks and feels as a real one by this new procedure.
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Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.