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Pribaz, Julian J.; Weiss, Denton D.; Mulliken, John B.; Eriksson, Elof
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This article is a review of five patients who underwent reconstruction of nasal and paranasal facial defects with prelaminated forearm free flaps. The defects resulted from thermal injury, gunshot wound, excision of tumor, and arteriovenous malformation (
Yamawaki, Yoshio ; Nishimura, Yoshihiko ; Suzuki, Yoshihisa
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Several authors have demonstrated the importance of medial movement of the lateral pharyngeal wall in velopharyngeal closure upon phonation. However, it remains controversial what muscle is responsible for lateral pharyngeal wall movement and where is the main site of this movement. The purpose of this study was to address the above two unanswered questions. In 22 subjects (12 normal volunteers, 10 patients with cleft palate), lateral pharyngeal wall movement upon phonation was evaluated by using rapid magnetic resonance imaging (MRI). Before rapid MRI, their lateral pharyngeal wall movements were classified into three groups: the poor, moderate, and good, according to the findings of nasopharyngoscopy. Inward displacement of the eustachian tube cartilages upon phonation, which was quantified as distance ratio in the transverse plane of MR images, was compared with nasopharyngoscopic findings. In addition, the level of lateral pharyngeal wall movement was observed in the plane 5 mm lateral to the mid‐sagittal plane of MR images. Inward displacement of the eustachian tube cartilage in the transverse plane of MR images was coincident with medial movement of lateral pharyngeal wall observed by nasopharyngoscopy in all 22 subjects. By using one‐way analysis of variance, a statistically significant correlation was found between nasopharyngoscopic classification and distance ratio. The sagittal plane of MR images revealed that the main site of movement occurred at the level of the hard palate and above. It is concluded that medial movement of the lateral pharyngeal wall consists of inward displacement of the eustachian tube cartilage, which is caused by contraction of the levator veli palatini muscle, and that the primary site of this movement is at the level of the hard palate and above, where the eustachian tube, but not the superior constrictor muscle, exists. (
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Through the author's experience with 1200 cases during a 25‐year period, this article presents technical improvements in ear reconstruction and proposes and discusses possible directions for further technical advancement. This article presents the rationale for the author's current methods of managing total ear repair. Throughout the article, the author stresses and demonstrates cartilage‐sparing techniques that are designed to minimize the amount of cartilage used in a repair to preserve maximum chest wall integrity. This article also presents the latest method of framework fabrication, showing differences in construction between younger and older patients; a new method that constructs a tragus as an integral part of the framework; a method that maintains ear projection with a scalp‐banked cartilage wedge; and a method that solves the always frustrating low hairline by presurgical laser treatment. In addition, the concept of creating autogenous frameworks by tissue engineering is pursued and discussed in practical clinical terms. A survey of 1000 microtia patients indicates that surgically constructed ears remain durable, withstand trauma well, and provide consistent emotional relief and psychological benefits through the repair. (
Chen, Yu‐Ray ; Yeow, Vincent K. L.
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Multiple‐segment osteotomy is defined as an osteotomy that divides the tooth‐bearing arch of the maxilla or mandible into three or more segments. Combining large‐segment orthognathic surgery and unitooth or small‐segment surgery is an effective approach for dealing with a wide range of dentofacial deformities with occlusal problems. The indications for a multiple‐segment osteotomy included dentofacial deformities and malocclusions requiring stable correction within a short overall treatment period. From 1991 to 1997, a total of 85 patients had multiplesegment osteotomy orthognathic procedures performed at Chang Gung Memorial Hospital. The indications for surgery were maxillary protrusion/deformity (31 patients), mandibular prognathism (51 patients), and noncleft maxillary retrusion (three patients). The types of osteotomies performed were Le Fort I, anterior segmental osteotomies of the maxilla or the mandible, palatal split, posterior segment, and unitooth or double‐tooth segments. Follow‐up ranged from 6 months to 7 years; stability was seen in movements, with only three complications (one partial gingival loss and two inferior mental paresthesias). No osteotomized segments were lost. The average overall treatment time was approximately 15 months, including 3 to 6 months of preoperative and 9 to 12 months of postoperative orthodontic treatment. This is at least 6 months shorter than traditional orthognathic surgery. Experience with 85 consecutive patients has shown that the results are good and the procedure is safe, with minimal complications. (
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