Aesthetic Deformity Research Articles

Changes in nasal aesthetics following nasal bone manipulation

Nasal bone fractures are the commonest type of bony facial injury causing aesthetic deformity. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose, by comparing pre- and post-treatment nasal aesthetics. Thirty-two patients (26 men and 6 women) underwent aesthetic assessment prior to treatment of the injury by closed nasal manipulation, 7 to 10 days after the initial injury. Standard facial aesthetic photographic assessments were performed prior to and following manipulation. Assessment involved measurement of standard nasal aesthetic parameters. In the nasal trauma cohort, the main anomalies in nasal aesthetics were nasal deviation and differences in the nasal aesthetic profile. Nasal fracture manipulation successfully reduced deviation from an average of 35 degrees pre-manipulation to an average of 9 degrees post-manipulation.

Late Reconstruction of the Complex Orbital Fractures With Computer-Aided Design and Computer-Aided Manufacturing Technique

To construct three-dimensional (3D) imaging and computer generated models of complex orbital fractures, and develop a Computer-Aided Design/Computer-Aided Manufacture (CAD/CAM) system to help improve the surgical planning of complex orbital fracture and promote its outcome. A prospective study was carried out on 17 patients with unilateral complex orbital fractures from Mar 2003 to Mar 2006 at the Shanghai ninth people's hospital. The utilization of a CAD/CAM technique based on Helical computer tomography data, with stereolithographical (SLA) modelling as intermediate step, enabled surgeons to plan for the surgical progress of osteotomy, movement, reposition, fixation and material implanting. Orbital volume was calculated pre and post-operatively. Orbital fracture reconstruction and globe repositioning was performed and followed up 3-9 months post-treatment. Ocular function and aesthetic deformities such as enophthalmos, diplopia and extraocular motility problems were accessed. The data was processed with SAS 6.17 statistical software. 17 patients with complex orbital fractures underwent successful orbital fracture reconstruction surgery. The deformities of orbit, medial canthus, nose, zygomata, maxillary and frontal bone were well corrected. The volume of reconstructed orbit was approximately symmetrical with respect to the contralateral orbit. Enophthalmos was corrected and diplopia, extraocular movement were improved. CAD/CAM system enables the surgeon to predict reconstructive surgical steps before the operation, and can help to improve the outcome of surgery. This technique may be proved as one of the most useful clinical tools for orbital surgery.

Reverse Homodigital Flap

The objectives in fingertip reconstruction surgery are to preserve functional length and sensibility, prevent neuroma formation and articular stiffness, and minimize aesthetic deformities. The reverse homodigital flap technique, first described by Weeks and Wray in 1973, consists of a single stage procedure that maintains finger length and creates a skin cover similar to the native fingertip, thus avoiding long-term immobilization, maintaining the protective sensibility of the finger, and providing a good aesthetic and functional outcome. The authors attempted to analyze the aesthetic and functional outcomes obtained with the reverse homodigital flap technique for fingertip reconstruction. Twenty-seven patients with 28 distal finger injuries were reconstructed using the reverse homodigital flap in the Hospital del Trabajador de Santiago between January 2001 and December 2003. Clinical records were analyzed for tabulation of data regarding: age, sex, injury mechanism, affected finger, donor-site closure, flap laterality, surgical time, and complications. The follow-up ended in May 2004, when ROM, sensibility, and aesthetic satisfaction were evaluated. In all patients, the flap remained vital and no necrosis was found. There where 5 cases of superficial infection and venous congestion, treated with frequent dressing changes, antibiotics, and i.v. Dextran 40 in the cases of venous congestion. Most patients reached an S3 or S3 + sensibility, according to BMRC. ROM was good or excellent in 90% of the patients (ROM>#x2009;90%); the aesthetic outcome, on a 0–10 scale, obtained an average of 8 points, and was considered good. The authors believe that the use of the reverse homodigital flap for fingertip reconstruction is an excellent solution, as it avoids finger amputation, allows a good fingertip skin coverage, avoids long-term immobilization, conserves the protective sensibility of the finger, and allows a good functional and aesthetic outcome.

Stahl Syndrome in Clinical Practice

Stahl syndrome, known also as "Satiro's ear", is a deformation of the auricle described in the nineteeth century by Stahl who included it in a classification of various deformities of ear:-Helix transversus spleniformis-Crus anthelicis trifurcata-Crus superior turgidumAt present Stahl's ear is included in the second group for the abnonnal cartilaginous pleat which extends from the Crus anthelix to the edge of elix deforming in this way the regular curvature of ear and amplifying the triangular hole. It's frequently associated to other aesthetic deformities of the auricle itself and above all among oriental peoples; the pathogenetic origin of this deformation has to be connected with an hereditary, familial character confirmed by the diffusion of this deformation among the members of the same family, reaching its highest expression in identical twins where its manifestation is about at seventy-five percent. Besides the hereditary-familial hypothesis, we find a second hypothesis according to which the cartilaginous deformity is connected with an altered growth of an instrinsic muscle of ear, the transverse muscle [1,4]. The solution of the problem is surgical, through the Chongcet technique [9], modified and applied in the post-operating using particular remedies.

Temporomandibular Disorders Due to Improper Surgical Treatment of Mandibular Fracture

A case of mandibular fracture surgically consolidated in a wrong position resulting in craniomandibular disorders is reported. The inadequate surgical alignment of the healed bony segments caused a malocclusion. This changed the original neuromuscular system such that compensatory mechanisms began to change the whole balance of the organism. The patient presented a mandibular crossbite, an asymmetry of the face, and extensive alteration of muscular, articular, and postural function. The bony malunion and malocclusion were treated using an interdisciplinary surgical-orthodontic treatment for correcting functional disorders and aesthetic deformity. Electromyography and computerized mandibular scanning were used to evaluate improvement of the muscular activity, during rest and function, and of the mandibular kinesiology. Timing of surgical treatment and adequate fixation and immobilization of fracture segments are very important to avoid complications such as infection, delayed union, nonunion, malunion, skeletal discrepancies, nerve injury, and (rarely) ankylosis. The surgical approach should be based on the general criteria of traumatologic therapy, restoring the original bone shape and the right occlusal relations as soon as possible.

Otto W. Madelung and the Recognition of Madelung’s Deformity

Madelung's deformity is an uncommon congenital condition of the wrist usually seen in adolescent girls. It first was documented in the 1800s and is characterized by a shortened radius that curves ulnarly and volarly, a prominent ulna head that projects dorsally from the wrist, and a triangular arrangement of the carpal bones. It is mostly an aesthetic deformity although functional problems and pain may prompt surgeons to undertake a variety of corrective surgical procedures with varying degrees of success. This challenging condition is encountered rarely in a hand surgeon's practice. Even more obscure than the condition is the physician it is named after: Otto Wilhelm Madelung, a distinguished and successful German surgeon who lived at the turn of the century. This article provides a historical perspective on the person and the condition that is still an enigma a century later.

Rhytidectomy and Parotidectomy Combined in the Same Patient

Until now, aesthetic goals in parotid surgery have seldom been addressed because oncologic concerns have largely overshadowed aesthetic issues for patients with parotid masses. Fortunately, the majority of parotid masses are benign pleomorphic adenomas that rarely recur, leaving a large group of patients healthy after their parotid surgery, with some desiring aesthetic improvement in their facial appearance. Traditional parotidectomy incisions leave a visible scar on the neck as well as a visible hollow in the retromandibular region, which can extend onto the cheek. A rhytidectomy approach to the parotid gland allows for a more concealed, aesthetically appealing scar while maintaining good visibility and access to the parotid gland. By performing bilateral sub-SMAS (superficial musculoaponeurotic system) rhytidectomy after a parotidectomy, facial symmetry and balance is enhanced, and these aesthetic deformities can be minimized. The SMAS flap can help to fill the hollow and form a tissue barrier over the resected gland to prevent gustatory sweating. Finally, the incision scarring is minimized with a rhytidectomy-type approach. Two cases are reported in which patients underwent both rhytidectomy and parotidectomy. In the one case, the procedures were performed in the same surgical setting. In the other case, they were performed in a delayed fashion. These cases exemplify the possibility of addressing facial aesthetic goals of rejuvenation in a patient requiring parotid resection.

Arthroscopic biceps tendon tenodesis: the anchorage technical note

Treatment of long head biceps (LHB) tendon pathology has become an area of renewed interest and debate among orthopaedic surgeons in recent years. The background of this manuscript is a description of biceps tenodesis which ensure continual dynamic action of the tendon which depresses the head and impedes lateral translation. A new technique has been developed in order to treat LHB tendon irreversible structural abnormalities associated with cuff rotator lesions. This technique entails the construction of a biological anchor between the LHB and supraspinatus and/or infraspinatus tendons according to arthroscopic findings. The rationale, although not supported by biomechanical studies is to obtain a triple, biomechanical effect. The first of these biomechanical effects which we try to promote through the procedure of transposition is the elimination of the deviation and oblique angle which occurs as the LHB completes its intra-articular course prior to reaching the bicipital groove. Furthermore, we have found this technique extremely useful in the presence of large ruptures of the rotator cuff with muscle retraction. The most common complication associated to this particular method, observed in less than 3%, is failed biological fixation which manifests as subsidence of the tenodesis and consequent descent of the tendon with evident aesthetic deformity.

Ostéites des os de la face

Various aetiologies have been identified for the inflammatory diseases of facial bones. They are often infectious (mainly dental, traumatic, tumoural, post-radiotherapy, …), but sometimes they may seem primitive (primary chronic osteomyelitis). In such cases, they occur either individually or in a context of plurifocal diseases. Recently, cases of osteomyelitis have been observed, occurring during diphosphonate-based therapies by an unknown process. The main clinical sign is pain, with frequently local swelling, trismus, halitosis and Vincent's sign in mandibular chronic features. Rigorous assessment is necessary to the diagnosis and to avoid errors of treatment. Imaging characteristic aspects (on conventional radiography, CT scanning, MRI) are osteolysis, periostal osteogenesis, sequestra, and sclerosis in primary chronic conditions. Scintigraphy may reveal the disease very early, but lacks specificity to accurately determine lesions localization. Haemogram, sedimentation rate and CRP are variable, but quite useful to assess evolution. Results of bacterial analysis are highly variable, and have to be analysed with some cautious. Diagnostic biopsy is often mandatory. Infectious spontaneous evolution may early result in local, regional, or general extension. Secondary, spontaneous fracture, delayed consolidation, or chronic evolution may occur. Finally, late in the disease, pseudarthrosis can occur, as well as neoplastic transformation, recurrence or sequelae (loss of substance, functional troubles by retraction of masticator muscles or temporo-mandibular ankylosis, aesthetic deformation with facial atrophy or hypertrophy). In infectious conditions, treatment associates antibiotherapy, which has to be used cautiously, sometimes hyperbaric oxygen therapy, and, if necessary, surgical treatment of the cause and of the infection (decortication, interruptive resection). In chronic conditions, this protocol is frequently followed by recurrences, so the use of diphosphonates as well as 14 or 15 carbon atoms macrolids is suggested. No recommendation exists yet for those osteomyelites occurring during diphosphonate therapy. Oral hygiene is the best prevention.

Preservation of the Superficial Lobe for Deep-Lobe Parotid Tumors: A Better Aesthetic Outcome

Deep-lobe parotid tumors are relatively uncommon. Most of these tumors present as external masses. They can also present in the oral cavity or oropharynx. Magnetic resonance imaging and ultrasound-guided fine-needle aspiration for biopsy and cytology have made it possible to establish a definitive diagnosis and identify the exact location of the tumor in almost all cases before surgery. Traditionally, deep-lobe tumors have been managed by a formal superficial parotidectomy and identification and preservation of the facial nerve, followed by removal of the deep lobe that contains the tumor Superficialparotidectomy is associated in most cases with periauricular depression secondary to a loss of volume, leading to variable aesthetic deformities. A complete parotidectomy is more likely to be associated with a larger aesthetic deficit secondary to a greater loss of tissue volume. The incidence of gustatory sweating is high after superficial parotidectomy, particularly in the early postoperative period. We hypothesize that if the superficial lobe is preserved, there is less likelihood of gustatory sweating because of the interposition of tissue between the skin and the cut ends of the secretomotor fibers. Approximately 80% of parotid tissue volume is made up of the superficial lobe, and therefore preservation of the superficial lobe should be associated with less postparotidectomy depression. Therefore, we decided to preserve the superficial lobe of the gland for deep-lobe tumors. Nine patients underwent deep-lobe parotidectomy with preservation of the superficial lobe over a 6-year period. Patients were studied prospectively with regard to technical difficulty, complications, and cosmetic outcome. Follow-up ranged from 12 months to 6 years. We did not experience any undue technical difficulty, and there were no cases of facial weakness. One patient developed gustatory sweating, which almost completely resolved over a 2-year period. There were no cases of post parotidectomy depression, and both patients and surgeons were satisfied with the cosmetic appearance. We present our technique and experience.

Diagnosis of thyroid multinodular goiter using diffraction-enhanced imaging

Diffraction-enhanced images (DEI) have been obtained using two silicon crystals. A first channel-cut silicon crystal using the Si(3 3 3) reflection is employed to reduce the divergence of the pre-monochromated Si(1 1 1) beam of the light line to 60 microradian (12 arcsec). A second channel-cut Si(3 3 3) crystal was used as a Bragg analyzer to obtain bright and dark field images by changing its angular position. This technique is ideally suited for soft-tissue imaging or objects with the same absorption coefficient interfaces. DEI was developed at the XRD-2 beamline at the Brazilian Synchrotron (LNLS) in Campinas—Brazil. Feasibility tests on acquired images, which allow the diagnosis of thyroid nodular goiter, were performed. This disease is ordinary. The tissue developed on the cervical area causes compression of the nearby structures and undesirable aesthetic deformities with worldwide distribution. DEI of the tissues were taken to observe their morphology and to compare with the microscopic analysis (histopathological). This technique allows cutting sections a hundred times thicker than conventional histological techniques allowing a complete vision of the disease morphology. DEI show details not clearly seen with conventional techniques.

An aesthetic deformity: Madelung's disease

Madelung's disease, also known as benign symmetric lipomatosis, multiple symmetrical lipomatosis or Lanois–Bensaude syndrome, consists of growth of fatty masses predominantly on the face, neck, shoulders, upper thorax and arms. These painless and symmetrical fatty deposits can cause important aesthetic changes in these patients. Middle-aged males are more commonly affected, with an increased prevalence in the Mediterranean area. Currently, the incidence in Italy is 1 in 25 000 males. The aetiology of Madelung's disease remains unknown, although≈60% of affected patients are clinically overweight and there is an intimate association with chronic alcohol abuse. We report an unusual case of Madelung's disease in a 52-year-old male. The fatty deposits were completely resected by means of surgical lipectomy. The patient remains well and disease-free after 12 months of postoperative follow-up.

The Thoracodorsal Artery Perforator-Scapular Osteocutaneous (TDAP-SOC) Flap for Reconstruction of Palatal and Maxillary Defects

Despite technical advances over the past 3 decades, subtotal, total, and extended total maxillectomy defects remain challenging reconstructive problems. In particular, postoncologic resection of the maxilla results in complex 3-dimensional defects of the midface, which cause severe functional and esthetic deformities. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and maxilla is especially challenging because it requires reconstitution of the facial buttresses, occlusion, replacement of bony hard palate, and the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue-bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. Osteocutaneous and osteomuscular flaps such originating from the scapular, iliac, peroneal, and radial vascular systems have been attempted with good success. We devised an osteocutaneous flap based on the scapular vascular system, which provided bone and soft tissue to successfully reconstruct the palate and maxilla in 2 patients. The skin paddle received its blood supply from the major perforating vessels of the thoracodorsal artery, and the scapular bone was nourished by the angular vessels. Although free tissue transfer using thoracodorsal perforator flaps has been described, this flap has not been previously reported in the literature as an osteocutaneous tissue transfer. With the use of rigid fixation, excellent results have been obtained with this technique for palatal and maxillary reconstruction.

Comparison of the Radial Forearm Flap and the Thinned Anterolateral Thigh Cutaneous Flap for Reconstruction of Tongue Defects: An Evaluation of Donor-Site Morbidity

The radial forearm flap is commonly used for reconstruction of tongue defects following tumor extirpation. This flap is easy to harvest and offers thin tissue with large-caliber vessels. However, its use leaves behind a conspicuous aesthetic deformity in the forearm and requires the sacrifice of a major artery of that limb, the radial artery. The anterolateral thigh cutaneous flap has found clinical applications in the reconstruction of soft-tissue defects requiring thin tissue. More recently, in a thinned form, the anterolateral thigh flap has been used for reconstructing defects of the tongue with functional results equivalent to that of the radial forearm flap. For the reconstruction of tongue defects, these two flaps could provide similar soft-tissue coverage, but they seem to result in different donor-site appearances. The donor site is closed primarily, leaving only a linear scar that is inconspicuous with normal clothing, and no functional deficit is left behind in the thigh. Thus, for the supply of flaps for tongue defects, a comparison between the radial forearm flap and the anterolateral thigh flap donor sites is provided in this study. Between December of 2000 and August of 2002, 41 patients who underwent reconstruction of defects of the tongue using either a radial forearm flap or an anterolateral thigh flap were evaluated. The focus was on the evaluation of the functional and aesthetic outcome of the donor site after harvesting these flaps for the purpose of reconstructing either total or partial tongue defects. Finally, a comparison was performed between the donor sites of the two flaps. The disadvantages of the radial forearm flap include the conspicuous unattractive scar in the forearm region, pain, numbness, and the sacrifice of a major artery of the limb. In some patients, the donor-site scar of the forearm acted as a social stigma, preventing these patients from leading a normal life. In contrast, the anterolateral thigh cutaneous flap, after thinning, achieved the same results in reconstructing defects of the tongue without the associated donor-site morbidity. Most importantly, the donor site in the thigh could be closed primarily in almost all patients without any functional deficit. The thinned anterolateral thigh cutaneous flap is a viable substitute for the radial forearm flap when reconstructing defects of the tongue. The results achieved are similar to those of the radial forearm flap, and the donor-site morbidity is significantly decreased.

Surgical Extrusion Technique for Clinical Crown Lengthening: Report of Three Cases

Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths < or = 3 mm around the teeth at all sites, without bleeding on probing. The teeth functioned normally, with near-normal mobility. Radiographs showed normal periodontal contour consistent with new bone formation in the periapical area. Radiographic analysis did not show any evidence of root or crestal bone resorption or endodontic problems. The technique presented could constitute an alternative surgical approach to performing crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

Subcutaneous dissection of soft tissues in aesthetic surgery

Recent years seem to have been witnessing a steadily increasing demand for aesthetic operations to be performed with the possibly minimum risk for human health. Along with it, they are required to be least traumatic, with neither cuts, nor subsequent cicatrices, as well as to have a short-term rehabilitation postoperative period. In order to obtain a better cosmetic therapeutic outcome in patients with aesthetic deformities of the face and body, we hereby offer a new surgical technique – subcutaneous dissection of soft tissues without external cuts. The operations in which this method is used are as follows:

Endoscopic surgery for fibrous dysplasia of the sinonasal tract in pediatric patients

Fibrous dysplasia (FD) is a non-neoplastic, expansile lesion of unknown origin. In about one-fourth of cases this disorder affects the head and neck area, where the mandible and maxilla are the most frequently involved sites. Its localization to the ethmoid is a rare event. Since the disease slowly progresses, its management is delayed until significant clinical symptoms or non-well-tolerated aesthetic deformities are present. When required, surgery is the treatment of choice. Several external procedures have been used to manage the lesion, but recently, more conservative transnasal approaches have been proposed. We report the history of a 6-year-old boy with fibrous dysplasia of the ethmoid labyrinth that underwent successful transnasal endoscopic removal. Furthermore, an analysis of the literature is presented with particular emphasis on clinical picture, diagnosis, and treatment of this rare illness.

A cheap technical solution for cranioplasty treatments

Skull defects are treated by cranioplasty techniques, which are required to protect underlying brain, correct major aesthetic deformities, or both. This research is a part of our research project in ASEAN countries to investigate (i) the methods for design and manufacturing of cranioplasty implants, and (ii) the feasible technical solutions of minimizing the implant cost based on available production and biomaterial technologies in the region. In this paper, solutions for design and manufacturing of standardized implant templates (SDT) are presented. SDT are made based on the reverse engineering and rapid tooling techniques. With the use of SDT, surgeons have flexible options in preparing the implant both pre and intra operatively, and the operation time is minimized. In addition, the skills required to prepare an implant from SDT are not highly required. The cost for cranioplasty treatments by using SDT is acceptable for ASEAN region.

Prevention and management of positioning errors in Le Fort I osteotomies

Positioning errors during maxillary surgery can produce unfavorable outcomes, including malocclusion and esthetic deformities. Positioning errors occur for a number of reasons, including during the work-up and during the surgical phases of treatment.If the records obtained are inaccurate, the position of the maxilla will also be inaccurate. The mounting of the models on the articulator is often a source of inaccuracy. For instance, if the interocclusal registration is not accurate, the relationship of one model to the other will be improper. Model surgery on these models will therefore lead to inaccurate information. Splints made on them will produce inaccurate positioning of the maxilla during surgery.Another source of inaccuracy is in the positioning of the maxillary model during model surgery for a bimaxillary surgery. If this step is not done accurately, one will produce an unfavorable position of the maxilla during surgery. The inaccuracy will be compounded in a bimaxillary case because the mandible will also be inaccurately positioned.Another source of inaccuracy in positioning the maxilla comes during the surgical procedure. If the mandibular condyles are not properly seated during repositioning, a malocclusion will result once the patient awakens from surgery and the muscles become tonic. Another source of inaccuracy during the surgical procedure comes from using reference points to vertically position the maxilla that provide false information.This lecture will provide examples of these inaccuracies and demonstrate what can be done to prevent and manage them.ReferencesEllis E: Accuracy of model surgery: Evaluation of an old technique and introduction of a new one. J Oral Maxillofac Surg 48:1161Ellis E, Tharanon W, Gambrell K: A study on the accuracy of facebow transfer: Effect of surgical prediction and postsurgical result. J Oral Maxillofac Surg 50:562, 1992Ellis E: Bimaxillary surgery using an interim splint to reposition the maxilla. J Oral Maxillofac Surg 57:53, 1999 Positioning errors during maxillary surgery can produce unfavorable outcomes, including malocclusion and esthetic deformities. Positioning errors occur for a number of reasons, including during the work-up and during the surgical phases of treatment. If the records obtained are inaccurate, the position of the maxilla will also be inaccurate. The mounting of the models on the articulator is often a source of inaccuracy. For instance, if the interocclusal registration is not accurate, the relationship of one model to the other will be improper. Model surgery on these models will therefore lead to inaccurate information. Splints made on them will produce inaccurate positioning of the maxilla during surgery. Another source of inaccuracy is in the positioning of the maxillary model during model surgery for a bimaxillary surgery. If this step is not done accurately, one will produce an unfavorable position of the maxilla during surgery. The inaccuracy will be compounded in a bimaxillary case because the mandible will also be inaccurately positioned. Another source of inaccuracy in positioning the maxilla comes during the surgical procedure. If the mandibular condyles are not properly seated during repositioning, a malocclusion will result once the patient awakens from surgery and the muscles become tonic. Another source of inaccuracy during the surgical procedure comes from using reference points to vertically position the maxilla that provide false information. This lecture will provide examples of these inaccuracies and demonstrate what can be done to prevent and manage them. References Ellis E: Accuracy of model surgery: Evaluation of an old technique and introduction of a new one. J Oral Maxillofac Surg 48:1161 Ellis E, Tharanon W, Gambrell K: A study on the accuracy of facebow transfer: Effect of surgical prediction and postsurgical result. J Oral Maxillofac Surg 50:562, 1992 Ellis E: Bimaxillary surgery using an interim splint to reposition the maxilla. J Oral Maxillofac Surg 57:53, 1999

Oral functional outcome after intraoral reconstruction with nasolabial flaps

In this study, the functional and aesthetic outcome of patients with nasolabial flaps in the floor of the mouth was examined. Sixteen patients underwent reconstruction of the floor of the mouth with 19 nasolabial flaps after resection of a squamous cell carcinoma. Eight patients received postoperative radiotherapy. The patients were questioned concerning oral disabilities. Speech, mastication, deglutition, oral continence and the aesthetic result were evaluated. Two-point discrimination, temperature sensation and blunt-sharp discrimination of the intraoral flaps were tested. Speech and the wearing of dentures were hardly affected. Consumption of solid foods caused moderate problems in half of the patients. No sensibility problems were found. The aesthetic deformity was minimal. The use of nasolabial flaps in patients with limited defects of the anterior floor of the mouth after tumor resection showed adequate functional and aesthetic results.