ABSTRACT
BACKGROUND AND OBJECTIVES: Providing thin, well-vascularized lining flaps is still the most elusive achievement in corrective nasal surgery. The purpose of this article is to reexamine some of the principles of correction. METHODS AND MATERIALS: To demonstrate the importance of releasing or sectioning nasal lining, the authors review the principles of lengthening the nose, illustrated with seven clinical cases from their surgical experience and a detailed 12-drawing presentation of the surgical approach by Tessier--the senior surgeon. RESULTS AND/OR CONCLUSIONS: The nose is the center of the face and a major determinant of facial appearance. The short nose has been one of the more difficult conditions to treat in rhinoplastic surgery. To optimize the result, procedures developed from experience in craniofacial surgery should be combined with the existing methods, developed primarily by rhinoplastic surgery and confined to the nasal tip.
Subject(s)
Nose/surgery , Adolescent , Adult , Bone Transplantation , Ethmoid Bone/injuries , Female , Frontal Bone/injuries , Humans , Male , Maxilla/abnormalities , Maxilla/surgery , Maxillary Fractures/surgery , Nasal Bone/abnormalities , Nasal Bone/surgery , Nasal Mucosa/surgery , Nose/abnormalities , Nose/injuries , Nose Deformities, Acquired/surgery , Orbital Fractures/surgery , Plastic Surgery Procedures , Rhinoplasty , Skull Fractures/surgery , Surgical FlapsABSTRACT
Six patients with Crouzon's syndrome who were operated on by Dr. Paul Tessier between 1966 and 1976 were reviewed for long-term follow-up. Cephalometric study with superimposition was not possible because the radiographs were taken in different places according to different standards. However, it is interesting to observe the 10- to 17-year soft tissue follow-up of these patients.
Subject(s)
Craniofacial Dysostosis/surgery , Facial Bones/surgery , Adolescent , Adult , Cartilage/anatomy & histology , Cartilage/surgery , Child , Craniofacial Dysostosis/pathology , Craniofacial Dysostosis/physiopathology , Female , Follow-Up Studies , Humans , Maxilla/anatomy & histology , Maxilla/growth & development , Maxilla/surgery , Nasal Bone/anatomy & histology , Nasal Bone/growth & development , Nasal Bone/surgery , RhinoplastyABSTRACT
A rapid survey of eight cases with orbital hypertelorism did not reveal any evident change in maxillary displacement during facial growth following resection of nasal septum and medial displacement of orbital cavities. Accurate analysis of four cases according to the Ricketts long-term growth forecast showed a reduction of growth in the region of anterior nasal spine and only in the posteroanterior direction. This is not necessarily due to the absence of nasal septum. These patients have such severe deformities and the surgical procedure is so extensive that many factors can be responsible for deficient premaxillary growth. Further studies are needed, particularly in patients who, since 1975, have had the same operative method, but without septal resection, to know whether this more conservative procedure has changed the posteroanterior growth of the premaxilla. However, a nasal bone graft has a good prognosis, even when performed in children.
Subject(s)
Bone Diseases, Developmental/surgery , Hypertelorism/surgery , Maxilla/growth & development , Nasal Septum/surgery , Bone Transplantation , Cephalometry , Child , Child, Preschool , Female , Humans , Hypertelorism/pathology , Hypertelorism/physiopathology , Male , Maxillofacial Development , Orbit/surgery , Rhinoplasty/methodsABSTRACT
A new procedure is proposed for correction of the malformations of severe cases of Treacher Collins syndrome in the areas of the maxilla, mandible, and orbit. The operation essentially consists of a rotation of the midfacial segment around a transverse axis at the frontonasal angle. The midface is rotated forward anteriorly and downward posteriorly. It is stabilized by cranial grafts impinged into the temporal bone and the maxilla. The mandible is lengthened either by V shape osteotomy or bone grafting of the ramus. The mandible is fixed in an overjet class III dental occlusion. A posterior bite wafer is maintained for 2 months. The construction of the orbital cavity is completed with cranial bone grafts. The Tessier integral procedure for Treacher Collins syndrome has been done in one stage in six patients and in two stages in five patients. Sufficient data were available for analysis of only four patients.
Subject(s)
Bone Transplantation , Facial Bones/surgery , Mandibulofacial Dysostosis/surgery , Osteotomy/methods , Adolescent , Child , Female , Humans , Male , Mandible/surgery , Maxilla/surgery , Orbit/surgery , Zygoma/surgeryABSTRACT
Dry skulls from patients with Crouzon syndrome or orbital neurofibromatosis were studied using three-dimensional reconstruction of computed tomography data. The images were compared with one another and with the actual skulls. It was concluded that the use of dry skulls is helpful in pointing out errors of inclusion or exclusion. Thinner sections permit more accurate representation. Since reconstructed data do not appear to be significantly enhanced by using overlapping sections, radiation can be reduced by using abutting sections.
