ABSTRACT
Se describe en este artículo, la experiencia y la evolución en la forma de realizar rinoplastias por parte de los autores. Comenzamos nuestro entrenamiento en rinoplastia estética en la ciudad de México con el Dr. Ortiz Monasterio, y aprendimos una rinoplastia básica (5) que se aplica a todos los pacientes. En los pacientes de origen caucásico se obtienen unos fantásticos resultados simplemente con la rinoplastia básica, pero los pacientes cuya característica es tener una nariz mestiza, necesitan injertos de cartílago en punta nasal y en el ángulo columelo labial, para dar angularidad a una piel gruesa y lograr sensación de refinamiento (camuflaje). Posteriormente hemos evolucionado en nuestra forma de entender la nariz pasando de la visión clásica desde un punto de vista estático a una nueva visión dinámica, desarrollando técnicas para permitir la rotación cefálica de la punta nasal y disminuir el descenso de ésta al hablar o sonreír (AU)
In this paper the authors experience in rhinoplasty is described, and their evolution in the way of performing it. Our training in aesthetic rhinoplasty started in Mexico D.F. with Dr. Ortiz Monasterio, and we learnt a basic rhinoplasty that is applied to every patient. In patients with a Caucasian origin excellent results are obtained with this technique, but in patients with an ethnic nose cartilage grafts are needed in the nasal tip and in the lip-columela angle in order to give sharper angles to the thicker skin. This way a sensation of refining is obtained (camouflage). Our way of understanding the nose has evolved from a classic, static vision to a new, dynamic one. We have developed surgical techniques to obtain cephalic rotation of the nasal tip and diminish the downward tilt during speaking or smiling (AU)
Subject(s)
Humans , Female , Young Adult , Adult , Rhinoplasty/methods , Rhinoplasty/trends , Rhinoplasty , Dissection/methods , Dissection/trends , Osteotomy/methods , Osteotomy/trends , Osteotomy , Surgical Flaps/surgery , Surgical FlapsABSTRACT
La elongación mandibular en pacientes con microsomía hemifacial mediante distracción progresiva es un procedimiento simple y seguro, respaldado en la actualidad por una muy amplia experiencia de más de una década. Se obtine crecimiento vertical y sagital así como rotación de la mandíbula hacia la línea media. Estos cambios producen alteraciones de la oclusión dentaria fácilmente corregibles ortodóncicamente en los niños, pero capaces de originar problemas importantes en el adulto. Para evitar esto llevamos a cabo la corticotomia mandibular simultaneamente con una osteotomia LeFort I en una serie de 24 pacientes con dentición permanente. Posteriormente se practica fijación interdentaria y se procede a la distracción mandibular, logrando en todos los casos la horizontalización del plano oclusar y la corrección de la simetría facial (AU)
Subject(s)
Adolescent , Adult , Female , Male , Middle Aged , Humans , Osteogenesis, Distraction/methods , Palatal Expansion Technique , Osteotomy, Le Fort/methods , Facial Asymmetry/surgery , Maxilla/surgery , Treatment OutcomeABSTRACT
Mandibular elongation by gradual distraction in patients with hemifacial microsomia is a simple and effective procedure to correct facial asymmetry. The two-pin system joined by a softer distracting screw achieves elongation in vertical and sagittal directions as well as medial rotation. The changes in mandibular shape result in changes in dental occlusion. These are minimal in children because of the rapid growth of the maxilla and can be corrected easily with minor orthodontic work. Mandibular distraction in adults with hemifacial microsomia, who usually have stable dental occlusion, produces good aesthetic results but also severe alterations in the occlusion requiring complex orthodontic treatment over a long period. To avoid this problem, an incomplete Le Fort I osteotomy is done simultaneously with the mandibular corticotomy. Intermaxillary fixation is done on the fifth postoperative day, and distraction is initiated. In a series of seven patients, the maxilla was distracted simultaneously with the mandible, preserving the preexisting stable occlusion. Preoperative deviation of the occlusal plane from the horizontal varied from 12 to 18 degrees. The plane became horizontal in four patients, and deviation of 2 degrees persisted in three. The distance from the inferior orbital rim to the occlusal plane on the affected side was increased in all patients, achieving 100 percent correction (compared with the normal side) in four patients and 95, 96, and 97 percent in the other three.
