Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip.

PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Frontal sinus obliteration after trauma: analysis of bone regeneration for two selected methods.

We present a prospective randomized experimental study comparing bone regeneration obtained in 60 post-traumatic frontal sinuses obliterated with either calvarial bone dust (n=30, group I) or calvarial bone and demineralized bone matrix (DBM; n=30, group II). Radiological follow-up included high-resolution computed tomography with quantitative micro-density analysis in Hounsfield units (HU), together with a volumetric evaluation of the ossification at 6 and 24 months after surgical treatment. Epidemiological information and potential drawbacks were analysed. Bone volume and density data (HU) for the regenerated areas were subjected to statistical analysis at 6 and 24 months for both groups. Results were compared with reference values obtained from frontal and temporal bone in every patient. Complications developed for 10% of operated sinuses. The resulting bone formation (HU) in group I patients was significantly better than that obtained in group II. Ossification progressed in a statistically significant manner in both groups when compared at 6 and 24 months postoperatively. The use of DBM as a biomaterial associated with calvarial bone dust for sinus obliteration shows long-term safe results, similar to autogenous bone, but with a lower final bone density.

[Subcranial approach. Technical aspects and application in craneofacial traumatic pathology]. / Abordaje subcraneal. Consideraciones técnicas y aplicaciones en patología traumática craneofacial.

UNLABELLED: INTRODUCTION. Suitable approach to anterior cranial base is mandatory to get global satisfactory surgical outcomes. In the beginning it depends on the exactly anatomical position into the cranial fossa and tridimensional spread. Surgical approach implies the evaluation of the patient status, reconstructive options and surgical team experience. Subcranial approach is a safe surgical option in the treatment of frontal traumatic pathology. It allows adequate management of frontal sinus and its obliteration with easy radiologic follow-up. OBJECTIVES. To analyse subcranial approach as a treatment option in traumatic pathology of the anterior cranial base and to present our review of subcranial approach. Valuation of surgical technical aspects. and related complications. MATERIAL AND METHODS. Retrospective analysis of 50 patients operated (subcranial approach) from January 2004 to December 2009 by Maxillofacial and Neurosurgery Department, University Hospital 12 de Octubre, Madrid. 34 patients presented craniofacial trauma or postraumatic sequela and 16 patients presented craniofacial tumours. Oncological cases offers experience to discuss surgical aspects. Results are related to traumatic pathology and sequela. Main items review were surgical technique including materials used for frontal sinus obliteration, associated traumatic pathology, hospital stay and complication rates. RESULTS. No perioperatory mortality was found. Patients´ age ranged 15-76 years. 22 were male and 12 female. Description of frontal fractures involved. Frontal sinus obliteration was made with calvarian bone dust. Morbidity rates was 29% in posttraumatic patients. Mean hospital stay was 13 days. CONCLUSIONS: Subcranial approach to anterior cranial base is a safe and reliable treatment option to the pathology of this area. It allows outstanding exposure of the nasal cavity, orbits, ethmoidal cells-sphenoid sinus and great access to anterior fossa without frontal lobe retraction.

Abordaje subcraneal. Consideraciones técnicas y aplicaciones en patología traumática craneofacial / Subcranial approach. Technical aspects and application in craneofacial traumatic pathology

Introducción. La elección del abordaje más adecuado a la base craneal en cada caso es esencial para la obtención de resultados quirúrgicos globales satisfactorios. Inicialmente dependerá de la localización anatómica exacta de la lesión dentro de la base craneal y de su extensión tridimensional, así como de la naturaleza de la misma. Las opciones posibles deben ser depuradas finalmente en función del status global del paciente, planificación reconstructiva y experiencia del equipo quirúrgico. El abordaje subcraneal es una opción terapéutica segura en el tratamiento de la patología traumática frontal. Permite el manejo adecuado del seno frontal y su obliteración si es precisa, favoreciendo el seguimiento radiológico del mismo. Objetivos. Validar el abordaje subcraneal como vía adecuada de acceso en patología traumática de la base craneal anterior. Revisión de nuestra serie clínica. Valoración de aspectos técnicos quirúrgicos. Análisis de complicaciones. Material y métodos. Estudio retrospectivo de 50 pacientes intervenidos desde Enero de 2004 hasta Diciembre 2009 por el Servicio de Cirugía Maxilofacialy Servicio de Neurocirugía del Hospital Universitario 12 de Octubre (Madrid) mediante abordaje subcraneal. 34 pacientes presentaban traumatismos cráneo faciales o secuelas postraumáticas y 16 pacientes presentaban patología oncológica. Se enumeran los casos oncológicos como base de experiencia para la descripción de los aspectos técnicos. La casuística descrita se refiere a la patología traumática y sus secuelas. Los principales parámetros analizados fueron la técnica quirúrgica incluyendo el material de relleno para la obliteración del seno frontal, patología traumática asociada, estancia hospitalaria y tasa de complicaciones. Resultados. No existió mortalidad intra-postoperatoria inmediata. La edad varía entre los 15-76 años siendo 22 varones y 12 mujeres. Se describe el tipo de fracturas frontales (..) (AU)

Introduction. Suitable approach to anterior cranial base is mandatory to get global satisfactory surgical outcomes. In the beginning it depends on the exactly anatomical position into the cranial fossa and tridimensional spread. Surgical approach implies the evaluation of the patient status, reconstructive options and surgicalteam experience. Subcranial approach is a safe surgicaloption in the treatment of frontal traumatic pathology. It allows adequate management of frontal sinus and its obliteration with easy radiologic follow-up. Objectives. To analyse subcranial approach as atreatment option in traumatic pathology of the anteriorcranial base and to present our review of subcranial approach. Valuation of surgical technical aspects. andrelated complications. Material and methods. Retrospective analysis of 50 patients operated (subcranial approach) from January 2004 to December 2009 by Maxillofacial and (..) (AU)