Long-term radiological findings following reconstruction of the condyle with fibular free flaps.

AIM: Fibular bone grafts are considered as one of the best choices for reconstruction of the condyle. However, little data are available on bone remodelling after such reconstruction. The purpose of this study was to evaluate the long-term radiological outcome. PATIENTS AND METHODS: Eleven patients underwent condylar reconstruction with a free fibular transplant. In all cases the end of the fibular graft was placed into the glenoid fossa under the intact temporomandibular joint (TMJ) disc. Evaluation consisted of digital width and length measurement of the end of the fibula on panorex studies. RESULTS: Remodelling of the end of the neocondyle was found and consisted of rounding off and narrowing of the end of the transplant. CONCLUSION: The most likely explanation for these changes is the fact that the TMJ disc was preserved.

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.

Functional and esthetic rhinoplasty.

Rhinoplasty is performed to improve the appearance of the nose. However, conventional procedures may result in impairment of nasal breathing. The purpose of this article is to describe a "functional and esthetic" rhinoplasty technique designed to avoid adverse effects on ventilation by preserving the structure of the nasal vault. The main indication for this technique is treatment of cyphotic or tension nose. Since this procedure does not correct nasal obstruction due to septo-turbinal abnormalities and narrow nasal fossa, turbinoplasty must be performed concurrently if necessary. Our series of >1000 cases over a 15-year period demonstrates that this conservative rhinoplasty technique prevents most functional complications associated with conventional procedures and often improves ventilation. Immediate and long-term cosmetic outcome is excellent with a natural-looking appearance and fewer tip revisions.