Assuntos
Endoscopia , Assimetria Facial/cirurgia , Músculos Faciais/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/complicações , Ritidoplastia/métodos , Idoso , Assimetria Facial/etiologia , Músculos Faciais/anatomia & histologia , Nervo Facial/anatomia & histologia , Feminino , Testa/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Superiorly based flaps with bilevel undermining for the reconstruction of nasal tip and supratip defects have not been utilized to this point for reconstruction of this cosmetic subunit. OBJECTIVE: The purpose of this presentation is to describe a new flap for the reconstruction of nasal tip and supratip defects and to introduce a new method of undermining-bilevel undermining-in the raising of these flaps. METHODS: In this presentation we demonstrate (diagrammatically and with fresh cadaver dissection) the methods of preparing, raising, and preforming this new flap. We further introduce and describe the concept of bilevel undermining. RESULTS: We describe the first author's 4-year experience in the development of this flap. We show clinical representative cases with pre- and postoperative results. CONCLUSIONS: Superiorly based myocutaneous island pedicle flaps with bilevel undermining, a new method of nasal tip and supratip reconstruction, yields excellent functional and cosmetic results. Bilevel undermining is a new and valuable method of achieving greater tissue mobility in muscle-based flaps.
Assuntos
Rinoplastia/métodos , Retalhos Cirúrgicos , Angiografia , Humanos , Microcirurgia/métodos , Cirurgia de Mohs , Neoplasias Nasais/cirurgia , Complicações Pós-Operatórias/etiologia , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do TratamentoRESUMO
An intimate knowledge of the anatomy of the face is essential to the aesthetic surgeon. It is this knowledge that ultimately improves results and minimizes complications. The major morbidity associated with brow lifts is trauma to the temporal branch of the facial nerve. The general course of this nerve has been well documented, but exact details are still lacking. This anatomic study was designed to further elucidate its path. Dissections were performed on each side of 10 fresh cadaver heads. These dissections revealed a consistent relationship between the temporal branch of the facial nerve and the sentinel vein. The sentinel vein is reliably located and preoperatively easily defines the "zone of caution", enabling the surgeon to operate rapidly and with confidence until the zone is reached, at which time the dissection is slower as the vein is approached. In the patient in whom the sentinel vein is not easily visualized externally, it may be identified through fixed skeletal landmarks.
