Closed reduction and percutaneous Kirschner wire fixation in the treatment of simple zygoma fractures: orbital volumetric outcomes.

INTRODUCTION: The primary goal of treatment of fractures of the zygoma is the perfect restoration of function and aesthetic appearance. An adequate surgical treatment must combine adequate fracture reduction with the lowest possible morbidity of the surrounding soft tissues. This is the principle that guides the use of closed method for the treatment of simple fractures of the zygomatic bone. For a long-term evaluation, it is necessary to develop a method of volumetric orbitometry using tomography and use it for the evaluation of recent and late outcomes of patients treated with the closed technique. METHODS: We present a study consisting of 3 consecutive phases that aimed to evaluate the orbital volume in late postoperative patients with simple fractures of the zygomatic bone treated with closed reduction. In the first phase, examinations of 21 patients were selected and a method was developed for volumetric orbitometry. This method was tested by 3 averiguadores (certified radiologists). After defining the volumetric method, the second stage was started, when 10 examinations of the patients who had been diagnosed with simple fractures of the zygomatic bone were selected. These examinations were from the patients who underwent conservative treatment and who also had a computed tomographic scan in a maximum period of 7 days postoperatively. In the third phase of the study, we selected 10 other examinations of the patients who had been operated on with the closed method in over 12 months. Orbital volumetry analysis of late results was performed. RESULTS: In the first phase, the method for orbital volumetry by helical computed tomographic scan showed adequate precision and accuracy. Furthermore, it was able to set the possibility of using an orbit control volume at each other. In the second phase, the statistical analysis of the mean orbital volumetry showed that zygomatic fractures alter the orbital volume and that the closed technique is able to restore these volumes. In the third phase, the volumetry of the orbits of the patients with late follow-up of unilateral closed reduction of fractures of the zygoma also showed the maintenance of the results. CONCLUSIONS: The current study was able to develop a reliable method of volumetry and use it to the evaluation of patients in recent and late postoperative period who were treated with closed technique.

Tessier no. 4 facial cleft: evolution of surgical treatment in a large series of patients.

BACKGROUND: : Tessier no. 4 facial cleft is a rare, complex, and challenging craniofacial malformation. The present article aims to describe different clinical features evidenced in 21 cases of this malformation, discussing a 20-year experience with and evolution of its surgical treatment. METHODS: : Some demographic data, clinical features, and reconstructive results were evaluated retrospectively. These patients have been evaluated and treated in three specialized Brazilian craniofacial centers. Nineteen were already operated on, with a mean follow-up of 3.5 years (range, 1 to 20 years). RESULTS: : Sex distribution showed a male prevalence (2:1). The average age of initial treatment was 5.4 years. Four cases were affected on the right side of the face, seven on the left, and 10 bilaterally. Six patients had other rare associated facial clefts, including nos. 5 (three patients), 7, 9, and 10. Cleft upper lip was evidenced in all patients, and maxillary hypoplasia was present in five and maxilla cleft in eight. Lower eyelid coloboma was seen in almost every case (19 patients); 10 of these had medial canthus dystopia. Four patients had amniotic bands in the limbs. Surgical repair was individualized to each patient. Surgical experience gained with these patients allowed the authors to develop some technical modifications, which have improved aesthetic results, camouflaging scars into natural folds and anatomical units, without compromising functional outcomes. CONCLUSIONS: : The great majority of Tessier no. 4 facial clefts can be appropriately treated using local flaps. Classic techniques are extremely useful, but long-term results could be improved if the technical modifications described were adopted.

Combination micrografting and tattooing in the reconstruction of eyebrows of patients with craniofacial clefts.

The absence of an eyebrow, either partial or total, has been observed in patients with craniofacial clefts, such as the Tessier 9 to 13 cleft. Several techniques have been used to improve the appearance of the region, such as island scalp flaps and scalp strip grafting, with limited or marginally satisfactory aesthetic results. The authors report 2 patients with craniofacial clefts in whom a novel technique combining 2 separate surgical approaches, micrografting and tattooing, was used. The use of micrografting with single or double hair units, properly angulated, produces natural-looking and satisfactory results with a minimum of morbidity. Excellent volume and appearance of the eyebrow may be achieved in a single session using this technique. Tattooing performed subsequently over the microimplanted hairs provides the illusion of greater density to the eyebrow, resulting in an appearance closer to normal.