Salvage of calvarial bone graft using acellular dermal matrix in nasal reconstruction and secondary rhinoplasty for frontonasal dysplasia.

Frontonasal dysplasia is a severe malformation composed of cranial, ophthalmic, nasal, upper lip, and palatal deformities. Reconstruction in these patients requires complex craniofacial efforts. A 19-year-old woman with frontonasal dysplasia was treated at our institution where she had undergone multiple prior reconstructive surgeries including facial bipartition and cantilevered calvarial bone graft for nasal reconstruction. She later presented with a palpable bone graft prominence, associated contour deformity, and an area of overlying paper-thin skin at the nasal tip. Although there was no ulceration, the threat of graft extrusion required immediate attention. The prominent bone graft tip was debrided, and the overlying soft tissue envelope was augmented using acellular dermal matrix. No surgical complication was encountered. The patient had successful salvage of the bone graft and a pleasing aesthetic outcome at 9 months of follow-up. The use of acellular dermal matrix has proven to be beneficial in the correction of nasal contour deformities given its soft, natural appearance, availability, affordability, and safety. Its use also avoids further donor site morbidity. We suggest acellular dermal matrix as a graft material in revision rhinoplasties for cases of acquired nasal contour deformity and threatened bone graft extrusion. This is the first report known to the authors using acellular dermal matrix during staged nasal reconstruction in a patient experiencing frontonasal dysplasia.

Rapidly growing nodular fasciitis in the cheek of an infant: case report of a rare presentation.

OBJECTIVE: Nodular fasciitis is a benign proliferative spindle-cell lesion found in the subcutaneous fascia that presents as a rapidly growing mass with rich cellularity and mitotic activity, leading to it frequently being mistaken for a sarcoma. Histomorphologic features and immunohistochemical profile are useful in proper diagnosis. The treatment is complete excision, and recurrence is uncommon. A rare presentation and treatment of nodular fasciitis in the cheek of an infant is described here. METHODS: The lesion was resected by direct transcutaneous approach, and the skin was closed with 2 layers of purse-string polydioxanone sutures followed by fast-absorbing gut sutures to reapproximate the epidermis. RESULTS: Postoperatively, the patient had a wound dehiscence on the cheek, which healed secondarily with wound care. A small area of palpable tumor unable to be resected remained stable after 4 months of follow-up, and facial nerve function was preserved. CONCLUSIONS: Although infrequent in both children and the oral mucosa, nodular fasciitis should be considered in the differential diagnosis of facial tumors in infants and young children.