Correction of paralytic lagophthalmos.

INTRODUCTION: Bell's palsy causes lagophthalmos of the involved eyelids. Secondary to the atonicity of the eyelids, xerophthalmia, conjunctivitis and epiphora develops. There are dynamic (muscle transfers) and static (gold weights, tarsorrhaphy) approaches to alleviate these problems. The GOALS of this study are to present a technical note for a surgical method for lengthening the retracted upper eyelid with autogenous temporalis fascia and elevation of the lower eyelid with transplantation of autogenous morselized conchal cartilage graft via standard blepharoplasty incisions. MATERIAL AND METHODS: The proposed technique is illustrated in details with an example of a patient with paralytic lagophtalmos. The 4 years follow up of the case operated by this technique shows a stable occlusion of the eyelids with a lowering of the upper eyelid and elevation of the lower eyelid margin. CONCLUSION: If the paralysis is complete this technique will not accomplish adequate relieve of symptoms. In this cases re-animation of the eyelids with either temporalis muscle transfers or free micro neurovascular muscle transfers are indicated.

External fixation of unstable, "flail" nasal fractures.

Nasal bone fractures are the most common among facial fractures. Usually these are adequately treated with closed reduction and internal and/or external stabilization with splints. However, there are clinical situations where the nasal bones are severely displaced, the nasal septum fractured and displaced, or there are external drape lacerations which preclude the use of nasal splints. If the nasal bones are reducible but unstable we consider them "flail" and in this case transmucosal, endonasal Kirschner wires are used for dorsal support until sufficient healing occurs. The technique is simple, quick, and predictable and causes minimal discomfort to the patients.

Mandibular ramus/coronoid process grafts in maxillofacial reconstructive surgery.

PURPOSE: To evaluate the utility of autogenous extended mandibular ramus and coronoid process bone grafts for maxillofacial reconstructive surgery. PATIENTS AND METHODS: Twelve patients aged 23 to 76 years (mean, 52) who underwent extended ramus/coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or iatrogenic nasal deformity. All patients had either unilateral or bilateral combined coronoid process-mandibular ramus bone grafts for their reconstruction. There was 1 nasal reconstruction, 2 unilateral mandibles, 1 bilateral mandible, 4 unilateral maxillas, 1 unilateral maxilla and mandible combined, and 1 bilateral maxilla and mandible combined. RESULTS: The procedure was considered a success when the patient's deformities were reconstructed ad integrum and when there were no failures of the dental implants placed in the augmented areas as of the longest follow-up. All patients were successfully reconstructed. There was 1 infection at a donor site that resolved with local care and oral antibiotics. All but 1 of the maxillary and mandibular alveolar augmentations underwent endosteal implant placement approximately 4 to 6 months following grafting. The nasal reconstruction restored normal function and symmetry. CONCLUSION: Using both the coronoid process of the mandible and the mandibular ramus as a source for autogenous bone graft can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Craniofacial fibrous dysplasia. conservative surgical management. Review of literature and report of a case.

The present study presents a case of craniofacial fibrous dysplasia attenuating the orbit and the nasal airway, which was treated by conservative surgical approaches. Nasal and orbital decompression, and facial recontouring were performed simultaneously. This was done via a transconjunctival and transcaruncular approaches with a lateral canthotomy, which provided access to the four walls of the orbit, midface and the lateral nasal wall. The reduction of the turbinates was done through a standard turbinectomy approach and the nasal decompression was done via intercartilaginous access and a full transfixion incision and nasal degloving. The bulk of the lesion was removed with chisels, gauges, and rotary instruments. The orbital debulking extended to the orbital apex, which was not involved by the fibrous dysplasia. Approximately 200 mg of dysplastic bone was removed. The functional and aesthetic results were good. The symptoms of chronic conjunctivitis and nasal obstruction have been alleviated and there is no deterioration of his condition. The symptoms of anosmia have also disappeared. Conservative surgical treatment of craniofacial dysplasia in adults with stable disease is recommended.

Maxillary sinus augmentation with deproteinated bovine bone and platelet rich plasma with simultaneous insertion of endosseous implants.

PURPOSE: To investigate the clinical applicability of using deproteinated bovine bone mixed with autologous platelet rich plasma (PRP) in human maxillary sinus augmentations in severely resorbed posterior maxillary alveolar processes with simultaneous insertion of endosseous dental implants. MATERIALS AND METHODS: Fifteen patients with less than 5 mm of residual alveolar bone height in the posterior maxillary alveolus underwent a total of 24 maxillary sinus augmentations. Seventy endosseous implants were inserted simultaneously in the grafted sinuses. The implants were uncovered and loaded 4 months after insertion and the sinus augmentation. An osseous biopsy specimen was obtained from the augmented maxillary sinus in 1 patient. In 3 patients, computed tomography scans of the grafted maxillae were obtained and the bone density quantified and compared with native bone density using SIMPlant 7 (Columbia Scientific, Columbia, MD) software 4 months postoperatively. RESULTS: Although a total of 5 implants in 4 patients were lost, this did not result in the loss of any of the restorations, for an overall success rate of 92.9 %. Follow-up for patients in this study after insertion of the permanent restoration was between 6 and 36 months. The bone biopsy from the patients showed evidence of viable new bone formation in close approximation to the xenograft. The bone density of the grafted bone was similar or exceeded the bone density of the surrounding native maxillary bone. CONCLUSION: Based on our clinical experience, we believe that the use of platelet rich plasma in combination with deproteinated bovine bone is effective for maxillary sinus augmentation with simultaneous insertion of endosseous dental implants in severely resorbed posterior maxillae.