Reduction malarplasty with a new L-shaped osteotomy through an intraoral approach: retrospective study of 418 cases.

BACKGROUND: Oriental people usually have a wide midface and a prominent zygoma. Reduction malarplasty is one of the most frequently requested procedures for improvement of the facial contour in the Orient. Some methods involve coronal or preauricular incision for osteotomy, but this increases the likelihood of skin scars and injury to facial nerves, and increases the duration of surgery. Some methods involve an intraoral approach but cannot control the degree of reduction or the precision of interosseous fixation with the designed osteotomy lines. The authors designed an L-shaped osteotomy for malar prominence reduction through an intraoral approach to overcome these shortcomings. METHODS: The authors reviewed 418 patients who underwent an L-shaped osteotomy for malar reduction performed in their department between 1997 and 2007. Follow-up was from 6 to 60 months (average, 12 months). The authors analyzed the rate of complications and evaluated the therapeutic efficacy of their method. RESULTS: Four hundred two patients (96.2 percent) were satisfied. Only 16 patients (3.8 percent) with late complications were dissatisfied. Late postoperative complications focused mainly on asymmetry and cheek drooping. CONCLUSION: The new L-shaped osteotomy for correction of prominent zygoma is an ideal method, with the advantages of simpler manipulation, fewer complications, better outcome, shorter operative duration, no skin scars, and integrity of the structural characteristics of the zygoma.

Rhinoplasty in Chinese: management of lower dorsum and bulbous nasal tip.

BACKGROUND: Bulbous nasal tips and lower dorsa are common facial features in Chinese people, and surgery to reshape these is frequently requested. The use of silicone implants in rhinoplasty has been widely used in China for many years, but is not suitable for patients seeking Caucasian tip shapes. The creation of an excessively high tip supported only by a silicone implant inevitably leads to implant extrusion. Although many rhinoplasty techniques have been used in Caucasian patients, there is currently no suitable method for Chinese patients, whose anatomy differs from that of Caucasians. The present study was aimed to investigate the clinical outcome of a novel method of rhinoplasty in Chinese people. METHODS: Eighty patients underwent rhinoplasty using our method between 2002 and 2006. We classified the patients into three types, according to the distance between tip defining points, and used different techniques accordingly. Furthermore, an innovative cartilage carving method and a tip fibro-fatty tissue flap were designed and combined with traditional techniques, such as insertion of silicone implant, cartilage grafts, suture techniques and cephalic trimming to reshape the nasal contours. The followup period was 10 - 60 months (average, 21 months). RESULTS: Remarkable modifications in nasal contours were achieved. No complications developed in any of the 80 patients. Seventy-eight patients were satisfied with the results. The outcomes remained unchanged over time. CONCLUSION: Our method is effective and suitable for the treatment of Chinese patients with lower dorsa and bulbous nasal tips.

The anatomy and application of the postauricular fascia flap in auricular reconstruction for congenital microtia.

BACKGROUND: The various layers of the scalp are widely used in reconstructive procedures. The technique used for soft tissue coverage seems to influence the framework extrusion rate in auricular reconstruction. We have investigated the role of the postauricular fascial flap in providing ample, thin neurovascular cover to facilitate ear reconstruction in congenital microtia. METHODS: Following postauricular cutaneous tissue expansion, the postauricular neurovascular fascia flap was raised to partially cover the projected three-dimensional autogenous cartilage framework. A suction drain was placed in the pocket to allow the skin to coapt to the framework and a split-thickness skin graft was applied to complete coverage. RESULTS: At final assessment, the aesthetic results were analysed subjectively. Four hundred and thirty-eight ears underwent total ear reconstruction in 428 patients using the postauricular fascial flap technique. None of the reconstructions failed, and all patients were satisfied with the results. CONCLUSIONS: The use of a postauricular fascial flap and skin graft enhances safety and provides better vascularisation of the underlying cartilage.

[vrk1 gene mutation test in two Chinese pedigrees of the first and second branchial arch syndrome].

OBJECTIVE: To explore the role of vrk1 gene in two Chinese pedigrees of the first and second branchial arch syndrome. METHOD: Sixty members in 2 Chinese pedigrees were recruited. The exon 2 -13 were analyzed by polymerase chain reaction and direct sequencing. RESULT: We found a new SNP in proband of Shandong pedigree. CONCLUSION: vrk1 gene mutation can be excluded in 2 Chinese pedigrees of the first and second branchial arch syndrome.