Lipostructure technique in Romberg syndrome.

Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and the cause of this alteration are unknown. Pathogenesis of this syndrome is not clear: some authors refer the atrophy of subcutaneous system to the alteration of sympathetic system, whereas others refer it to an alteration of the nervous system referred to the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association to this health disorder are as follows: trigeminal neuritis, facial, and epilepsy, the last one being the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years, and soon after, it becomes stable. Today, plastic surgery with graft of autogenous fat can be performed after stabilization of the disease. The objective of this work is, through the presentation of a clinical case, suggesting a therapeutic plan formed by 2 sequential treatments: poliglactic acid to obtain skin thickening followed by Coleman technique for reconstructing three-dimensional projection of face contour restoring the superficial density of facial tissues. The results we obtained prove the efficacy of combining these 2 treatments, and the satisfaction of the patient confirms the quality of our results.

Burns: bone-anchored, extra-oral implantology.

Extra-oral implants represent a valid alternative technique in aesthetic reconstruction of the craniofacial district in oncology surgery. Two female patients were selected; they were treated from December 2001 to June 2007 by implanting auricular epithesis. The age range was 27 years. They shared the same diagnosis: burns of the auricle-temporal region. The deformity in the auricle region and the complete absence of the pinna convinced the authors to choose this reconstructive method. Most patients showed a good stability of fixtures, epithesis and perimplants soft tissue, in some cases there has been a delay in the time to healing soft tissue perimplant and only one patient has removed the plant after 5 years cancer recurrence. No complications were observed, including bleeding and infections, in the postsurgery period. No report was made in any case of lesion of the facial nerve having the fixtures being positioned in the back and above the point of emergency.

Hypercondylia: problems in diagnosis and therapeutic indications.

Condylar hyperplasia is a rare disease that alters the anatomy of one of the two condylus of the mandible as a consequence of the abnormal growth of the interested condylus and results in facial asymmetry and functional problems at puberty. Both sexes are affected. Two cases were analyzed, including an active and an inactive nucleus. Histopathologically, two types are distinguished: active and inactive hypercondylia. Diagnosis is usually achieved through clinical and radiographic approach and is utterly important to distinguish the consequent therapeutic approach. Thanks to the development of new diagnostic techniques, it is possible to quantify in advance the risk of skeletal relapse in case of hyperactive nucleus. This study points out the need to identify the type of hyperplasty to treat as active or inactive. Surgery should be based on scintigraphy results to evaluate active center of ossification. Clinical manifestations depend on the date of onset of this pathology and the speed of growth of the anomaly. We underline the importance of a precise diagnosis, clinical and instrumental, to plan the correct treatment achieved through a correct anamnesis, a standardized diagnostic protocol, supported by the indispensable scintigraphy.

Orbital reconstruction: bone-anchored implants.

The authors present their experience on reconstruction by extraoral bone-anchored implants technique, showing two patients from a total of 13, treated for orbital reconstruction. They were selected from 66 patients treated for reconstruction of orbit, ear and nose using this technique by the staff of the Department of Plastic and Reconstructive Surgery of the University of Tor Vergata, Rome, Italy. They underwent orbital emptying due to cancer pathology. Surgical technique is described in detail; its final purpose being positioning of titanium fixtures on the orbital borders, necessary to anchor the silicone epithesis. The advantages and potential limits of this technique are exposed, exposing the important role of patient's compliance. The importance of preliminary study on the patients is also emphasized and includes clinical evaluation and instrumental examination for surgical planning, completed by a photographic study in the three standard projections.Satisfactory aesthetic results were obtained by the use of this technique and the authors believe it may represent a valid option; complementary to more traditional ones, but is a first choice in patients who cannot endure major surgery or in case of failure of traditional techniques.