Objective: This article aims to highlight the rehabilitation of a geriatric patient with an orofacial cheek defect by an extraoral silicone prosthesis.
Methodology: Structured extra- and intra-oral examination of tissues coupled with a justified choice of impression materials, techniques, and prosthetic rehabilitation with a high-temperature vulcanizing silicone was done.
Results: The presence of compressible tissues, static appearance of the prosthesis during patient's facial movements, variability in complexion of the skin around the defect, and manipulating heat-vulcanized silicone were the challenges faced during clinical procedures. Read More
Arch Craniofac Surg 2016 Dec 23;17(4):190-197. Epub 2016 Dec 23.
Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
Background: The cheek rotation flap has sufficient blood flow and large flap size and it is also flexible and easy to manipulate. It has been used for reconstruction of defects on cheek, lower eyelid, or medial and lateral canthus. For the large defects on central nose, paramedian forehead flap has been used, but patients were reluctant despite the remaining same skin tone on damaged area because of remaining scars on forehead. Read More
Selayang Hospital, Department of Internal Medicine, Malaysia.
Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. Read More
J Oral Maxillofac Surg 2017 Aug 12. Epub 2017 Aug 12.
Chief, Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida Health, Jacksonville, FL. Electronic address:
Purpose: The cervicofacial (CF) flap is a random-pattern flap that provides excellent match for cheek reconstruction. The design of the CF flap varies between different cheek subunits. In this report, the authors review their experience with this flap and present a guide for flap design for different cheek subunits. Read More
Background: Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. Read More
aDepartment of Stomatology, the First Affiliated Hospital of zhengzhou University, Zhengzhou bDepartment of Stomatology, School of Stomatology, Xinxiang Medical Collage, Xinxiang cDepartment of Stomatology, Nanyang Stomatology Hospital, Nanyang dDepartment of Gastroenterology, the First Affiliated Hospital of zhengzhou University, Zhengzhou, PR China.
Our goal was to describe our experience of the folded radial forearm flap (RFF) flap in through-and-through buccal defect reconstructions.Patients who had received a folded RFF flap for full-thickness cheek defect reconstruction were included. The flap success rate and functional results were evaluated. Read More
Cleveland Clinic, Glickman Urological and Kidney Institute, Department of Urology. Electronic address:
OBJECTIVE To present the use of buccal mucosal graft (BMG) in a salvage robotic laparoscopic pyeloplasty as an alternative in the management of recurrent UPJ obstruction. METHODS We present two patients with recurrent UPJ obstruction who had previously undergone two prior open or robotic pyleoplasties, followed by endoscopic management. Preoperative imaging was obtained prior to surgical repair. Read More
Anteromedial maxillectomy is typically performed in conjunction with low-dose radiotherapy and intraarterial chemotherapy. In doing so, the extent of surgical defects is reduced. However, nasal deviation and oral incompetence may ensue, due to cicatricial contracture of wounds, and may be distressing to these patients. Read More
aDepartment of Plastic and Reconstructive Surgery, Okayama Rosai Hospital bDepartment of Plastic and Reconstructive Surgery, Iwate Medical University, Iwate cDepartment of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Rationale: Tissue augmentation of facial depression deformities can be achieved by volume replacement with autologous fat injection, dermal filler injection, etc. Here, we report a case of tissue augmentation of a facial depression deformity using a pedicled buccal fat pad (BFP).
Patient Concerns: A 64-year-old woman was referred with a chief complaint of facial depression deformity. Read More
Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Science Unit, Health Campus, Kubang Kerian, Malaysia.
Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. Read More
Purpose: Reduction malarplasty is one of the most common esthetic surgical procedures performed in the Asian population. Traditional procedures have several complications, such as bone nonunion, malunion, cheek drooping, and damage to the infraorbital nerve and maxillary sinus. Therefore, a more straightforward and effective method of reducing the width of the midface is needed. Read More
Department of Plastic, Reconstructive and Maxillo-facial Surgery, Henri-Mondor Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Objective: The aim of this study was to describe a technique for midface rejuvenation combining lower blepharoplasty, midcheek lift and autologous fat transfer.
Methods: All patients who underwent a midface rejuvenation procedure performed by the same surgeon and using a classic subciliary blepharoplasty surgical approach were identified. The technique combined three distinct procedures: lower blepharoplasty with use of a transposition flap of orbital adipose tissue in the medial and central compartment to reduce the subpalpebral bags and attenuate the palpebrojugual sulcus; midcheek lift in the preperiosteal plane with trans-osseous fixation exerting traction on the soft tissues of the cheek along several vectors; autologous fat transfer to offset the loss of volume in the target area. Read More
Facial Plast Surg Clin North Am 2017 Aug;25(3):443-461
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA. Electronic address:
Successful reconstruction of the cheek following excision for cutaneous malignancy requires careful consideration of defect location, size, and depth in relation to the anatomic properties of the affected cheek unit. Various reconstructive options are available to the surgeon, ranging from simple excisions to complex cervicofacial advancements to meet the needs for functional and aesthetically pleasing reconstructive outcomes. The surgeon must prevent distortion of mobile structures, such as the eyelid, nose, and lips; respect aesthetic subunits; and avoid blunting natural creases. Read More
Background And Objectives: A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units.
Material And Methods: This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. Read More
Background: Autologous free fat graft outcomes are not always predictable, and variables that can potentially influence fat graft retention are still not well understood or investigated. The purposes of this study were to assess fat graft retention in the management of craniofacial contour deformities and to identify possible predictive factors of this retention.
Methods: A prospective analysis was conducted using consecutive patients with unilateral craniofacial contour deformities who underwent autologous free fat grafting between 2012 and 2015. Read More
The current concepts in the aesthetic and functional reconstruction of complex oromandibular defects are presented with a case of a patient with self-inflicted gunshot wound to the face. The patient presented with a 6 cm composite mandibular defect; the buccomandibular and suborbital aesthetic zones of the cheek along with the mucosa lining, and the ipsilateral facial musculature were missing. A rapid prototyping model of the facial skeleton was used to assist in preoperative planning. Read More
Lower lid blepharoplasty is one of the most complex procedures performed by plastic surgeons and may cause significant long-term sequelae, including inadequate aesthetic outcomes if not performed with a thorough understanding of anatomy and proper technique. The authors' practice is consistently evolving to deliver the highest quality results for their patients. The purpose of this article is to introduce an additional sixth step to the lower lid blepharoplasty procedure involving the targeted injection of fractionated fat to better blend the lid-cheek junction. Read More
San Diego, Calif. From the Division of Plastic Surgery, University of California, San Diego; and FACES+ Plastic Surgery, Dermatology, Skin and Laser Center.
The buccal space, with its fat pad, is a valuable, overlooked target in facial rejuvenation procedures. The authors identified a specific group of patients who have normal or prominent malar projection in the presence of atrophy of the buccal fat pad, with or without prominent gonial angles. Eight of 24 prospectively studied patients (Biomedical Research Institute of America) who had fat grafts and face lifts received an average of 2. Read More
Roseau, Commonwealth of Dominica; Salzburg, Austria; Leipzig and Munich, Germany; Sacramento, Calif.; and Albany and New York, N.Y. From the Department of Anatomy, Ross University School of Medicine; the Institute of Anatomy and the Departments of Radiology and Oral and Maxillofacial Surgery, Paracelsus Medical University Salzburg & Nuremberg; the Institute of Anatomy, University of Leipzig, Faculty of Medicine; Facial Plastic and Reconstructive Surgery, University of California Davis Medical Center; Division of Plastic Surgery, Albany Medical Center; the Department of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians University; and private practice.
Background: Anatomical knowledge of the facial vasculature is crucial for successful plastic, reconstructive, and minimally invasive procedures of the face. Whereas the majority of previous investigations focused on facial arteries, the precise course, variability, and relationship with adjacent structures of the facial vein have been widely neglected.
Methods: Seventy-two fresh frozen human cephalic cadavers (32 male and 40 female cadavers; mean age, 75. Read More
Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colo.; and Division of Plastic Surgery, Departments of Surgery and Otolaryngology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
Multiple, simultaneous skin cancers of the face are common. This is the first description of reconstructing discontinuous facial defects (i.e. Read More
*Department of Maxillofacial Surgery, Azienda Ospedaliera San Paolo †Department of Maxillofacial Surgery, Fondazione IRCCS Ca' Grande Ospedale Maggiore, Milan, Italy.
The myomucosal buccinator flap, first described by Bozola in 1989, has become an important tool for intraoral defects reconstruction. In the literature, there is a variety of proposed myomucosal cheek flaps, both pedicled and island, based on the buccal or the facial arteries. From January 2007 to December 2011, the authors used a pedicled buccinator flap based posteriorly on the buccal artery to reconstruct partial lingual defects following tumor resection in 27 patients. Read More
Background: The typical reconstructive option for closing large-sized defects of the distal half of the nose is the paramedian forehead flap. Other alternatives are a melolabial interpolation flap and bilobed or trilobed flaps. The dorsal nasal (Rieger) flap is suitable for closing small-sized defects at this location, especially when they are medially located. Read More
Surgical defects located within 5 mm of the nasal alar margin are at risk for alar elevation or collapse of the external nasal valve during wound healing. To reduce the chance of such complications, free cartilage grafts may be used as part of the reconstruction. However, if the defect is large enough so that the free cartilage graft does not fill most of the defect, wound contraction can still lead to alar displacement. Read More
Background: Oral cavity cancers are fairly common and have propensity to recur locally. Since Pectoralis Major Myocutaneous (PMMC) flap is the most widely used first flap for reconstruction, it is exhausted at the earliest and recurrence poses a formidable challenge for reconstructive surgeon. Present study evaluated the feasibility of contralateral Pectoralis Major Myocutaneous Flap for reconstruction after resection of recurrent tumour. Read More
Simultaneous maxillary and mandibular reconstruction is exceedingly rare. These are complicated cases, requiring consideration of multiple variables: defect components, donor site morbidity, recipient vessels, and so forth. We describe a unique case of secondary maxillary/mandibular reconstruction in a 59-year-old male. Read More
Plast Reconstr Surg Glob Open 2016 Dec 13;4(12):e1160. Epub 2016 Dec 13.
Department of Plastic and Reconstructive Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan; and Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.
Expanded local flaps and skin grafts (expanded/nonexpanded) are a common approach for reconstructing medium (1.5-20 cm) and large (>20 cm) divided nevi of the eyelids. However, this approach does not often provide a satisfactory cosmetic result, particularly in Asian patients, because of different skin types. Read More
Background: Lower eyelid reconstruction after tumor removal is always challenging, and full-thickness defects beyond half of the eyelid length require a flap from a part other than the remaining lower eyelid, such as the temporal area or the cheek.
Objective: We aimed to report our experience of applying Smith-modified Kuhnt-Szymanowski, one of the most popular procedures for paralytic ectropion, for reconstructing oblong full-thickness lower eyelid margin defect.
Materials And Methods: We performed Smith-modified Kuhnt-Szymanowski on 5 cases of oblong full-thickness lower eyelid margin defect after skin cancer removal. Read More
Plast Reconstr Surg Glob Open 2017 Feb 3;5(2):e1226. Epub 2017 Feb 3.
Plastic and Reconstructive Surgery, University of Montreal, Montreal, Quebec, Canada; and Division of Plastic and Reconstructive Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient's unaffected side to allow for perfect fit to the zygomatico-maxillary defect. Read More
Am J Otolaryngol 2017 May - Jun;38(3):351-353. Epub 2017 Jan 18.
Indiana University School of Medicine, Indianapolis, IN, Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address:
Importance: Reconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19year old female, creating a unique defect requiring repair.
Objective: Demonstrate a unique case of severe maxillary degeneration and discuss the associated reconstructive challenges and final repair with a prosthetic implant. Read More
Vascular Birthmark Institute of New York, New York3Department of Otolaryngology, Manhattan Eye, Ear and Throat Hospitals, New York, New York4Department of Otolaryngology, Lenox Hill Hospital, New York, New York.
Importance: The current standard of treatment for infantile hemangiomas (IHs) involves initial observation for regression throughout infancy and childhood, with or without medical management with β-blocker medications. Approximately 50% of the lesions respond almost completely to this regimen. However, the remaining 50% of the lesions, especially established focal IHs of the lip, nose, eyelids, forehead, cheek, and scalp, do not regress completely with this regimen or do so leaving a deformity; among these lesions, early surgical management may result in a superior aesthetic and functional outcome. Read More
Ten years after the first face transplantation, we report the partial loss of this graft. After two episodes of acute rejection (AR) occurred and completely reversed in the first posttransplantation year, at 90 months posttransplantation the patient developed de novo class II donor-specific antibodies, without clinical signs of AR. Some months later, she developed several skin rejection episodes treated with steroid pulses. Read More
Human bite injury to the eyelid is extremely rare and poses a significant challenge in surgical reconstruction. We report an extremely rare case of human bite injury to the eyelid in a 43-year-old male with approximately 60% full thickness loss of the upper eyelid and 80% to 90% full thickness loss of the lower eyelid and its successful reconstruction using the local advancement cheek flap. Read More
Cleveland, Ohio; and Cairo, Egypt From the Departments of Plastic Surgery and Anatomy, Cleveland Clinic; and the Department of Plastic Surgery, Cairo University.
Learning Objectives: After studying this article, the participant should be able to: 1. Define the anatomy of the lower eyelid tarsoligamentous framework and the related periorbital retaining ligaments, and cite their surgical relevance. 2. Read More
*Department of Plastic and Reconstructive Surgery, New York University †Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY.
Background: The senior author has previously described a deep-plane cervicofacial hike flap as a workhorse for reconstruction mid-cheek defects. One important modification commonly used involves overcorrection of the defect in order to reduce the incidence of ectropion. This report outlines the senior author's experience in surgical treating complex cheek defects with an overcorrected deep-plane cervicofacial hike flap. Read More
Plast Reconstr Surg Glob Open 2016 Nov 10;4(11):e1100. Epub 2016 Nov 10.
Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nakagami, Okinawa, Japan; and Department of Oral and Maxillofacial Surgery, University of the Ryukyus Hospital, Nakagami, Okinawa, Japan.
Maxillo-mandibular asymmetry has numerous aetiologies: congenital, traumatic, iatrogenic and post-oncologic. Patients with congenital dentofacial malformations are generally submitted to orthognathic surgery and/or additional procedures (genioplasty, alloplastic implants) with satisfactory results. However, despite achieving skeletal symmetry, noticeable facial asymmetry may persist. Read More
Introduction: Skin cancer treatment includes surgical and non-surgical techniques. Among surgical techniques, Mohs micrographic surgery permits a complete evaluation of surgical margins with maximal tissue sparing.
Material And Methods: Retrospective review of dermatology database of skin cancer cases treated with Mohs surgery at University Hospital Dr. Read More
J Plast Reconstr Aesthet Surg 2017 Mar 11;70(3):330-335. Epub 2016 Nov 11.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan. Electronic address:
Background: Defects of the nasal ala and upper lip aesthetic subunits can be challenging to reconstruct when they occur in isolation. When defects incorporate both the subunits, the challenge is compounded as subunit boundaries also require reconstruction, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, we used nasolabial flaps for upper lip reconstruction and a forehead flap for alar reconstruction. Read More
Facial Plast Surg Clin North Am 2017 Feb;25(1):37-43
Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas Health Sciences Center at Houston, 6400 Fannin Street, Houston, TX 77030, USA.
Scars of the cheek resulting from all causes can extol significant psychological toll. The cheek is the largest facial subunit and visually and aesthetically prominent making scars in this region difficult to ignore. An approach to scar management that targets specific characteristics of a scar using a combination of surgical and nonsurgical modalities can significantly improve the appearance of most scars. Read More
Objective: The new lift is a procedure for facial rejuvenation with minimal incision, giving the patient a significant improvement of mid face and neck, with limited dissection and minimal scars. A further "One-stitch" of anchorage to the deep temporal fascia is required to hold tissues. By a minimal surgical access, we get a suitable cheek lift with the improvement of nose-labial folds, mandibular edge and neck contour. Read More
Head neck cancer constitute significant cancer burden and among it carcinoma of oral cavity involving buccal mucosa is most common entity in India. Very often it involves lip commisure. Radical surgery along with radiotherapy still remains treatment of choice. Read More
Immediate reconstruction of orbitomaxillary defects is challenging for head and neck reconstructive surgeons. The primary goals of orbitomaxillary reconstruction are to cover the skin and mucosal defects, fill the defect space, and reconstruct the natural facial contour. This report describes 2 patients who underwent extended orbitomaxillectomy and immediate reconstruction using a combined latissimus dorsi musculocutaneous and scapular angle osseous free flap (LD-SA flap). Read More
Merkel cell carcinoma (MCC) is a highly aggressive cutaneous neuroendocrine tumour that is increasing in incidence. We report a case of a 92-year-old white man on long-term immunosuppression for temporal arteritis who presented with a Merkel cell tumour on his left cheek. A wide local excision was performed and the defect was reconstructed with a full-thickness skin graft. Read More
Associate Professor, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University; Department of Public Health, Chang Gung University, Taoyuan, Taiwan. Electronic address:
Most parotid tumors grow slowly, and sometimes these patients do not request surgical treatment until the tumors become large and affect their appearance. The surgical treatment of these large tumors is usually accompanied by large skin defects after excision, and it is challenging for surgeons to close the defect primarily. This report describes the case of a 68-year-old man with a left parotid gland tumor (largest dimension, 110 mm) and the case of a 79-year-old man with a left parotid gland tumor measuring approximately 77 mm that had existed for decades. Read More
Arteriovenous malformations are uncommon congenital disorders in vascular development. They frequently involve craniofacial structures and result in a morphogenic abnormality with ominous arteriovenous shunting. We present a huge AVM of the upper lip in an 18-year-old patient who was successfully treated by the combination method of presurgical endovascular embolization and complete resection of the lesion. Read More