Depression Deformity Research Articles

Application of Medpor in restoration of craniofacial contour deformities

Objective To explore the effects of Medpor in surgical treatment of craniofacial de-pressed deformities. Methods Combining with other surgical methods, 37 patients with craniofacial de-pressed deformities were treated with Medpor. Of them, 29 cases of craniofacial depression and defects subjected to trauma, 6 cases were progressive facial hemiatrophy and 2 case were angle of mandible de-formity. All were followed up from three months to four year. Results Facial configurations and func-tions of all the 37 cases were greatly improved after the treatment, without any complication of infection or rejection;patients were all very satisfactory or relatively satisfied with the results. Conclusion Med-por is an ideal implant material to correct the deformity of earaniofacial, and combining with others methods, the treatment of earaniofacial deformity can obtain good results. Key words: Craniofacial bone; Deformity; Defect; Medpor

Face-lift approach combined with a superficial musculoaponeurotic system advancement flap in parotidectomy

A standard bayonet-shaped incision with no reconstruction of the parotid bed is usually used for removal of parotid tumours. Its disadvantages are often an obvious cervical scar, a conspicuous shallow contour around the angle of the mandible, and gustatory sweating. We have studied 17 patients with benign parotid tumours, who were treated by superficial parotidectomy with a combination of a face-lift approach and a superficial musculoaponeurotic system (SMAS) advancement flap. The patients were followed up every 6 months for 3 years. All patients were satisfied with the cosmetic outcome, and the depression deformity was considerably less. This approach prevented gustatory sweating. We think that this approach is simple and a useful tool in parotidectomy.

Secondary Reconstruction of Mandibular Depression Deformity with Pedicled Latissimus Dorsi Myocutaneous Flap

When secondary reconstruction is required in the head and neck region where a primary operation was performed before, it is important to select a flap which is not only suitable for the purpose, but also can be transferred more safely. In the present case, a female patient, 33 years old, complained of depression deformity around the left mandibular region. She had undergone segmental mandibulectomy coupled with radical neck dissection because of adenoid cystic carcinoma of the left submandibular gland 12 years ago. The deformity was thought to be mainly due to the defi ciency of subdermal soft tissue. The insertion of a denuded and folded pedicled latissimus dorsi myocutaneous flap into the submandibular space satisfactorily restored the depressed mandibular contour. The pedicled latissimus dorsi myocutaneous flap can acquire a bulkiness by being folded, whose atrophy is tolerable for a long period, and is safe for secondary reconstruction.

Hemispheric brain volume replacement with free latissimus dorsi flap as first step in skull reconstruction

Large skull defects lead to progressive depression deformities, with resulting neurological deficits. Thus, cranioplasty with various materials is considered the first choice in therapy to restore cerebral function. A 31-year-old female presented with a massive left-sided hemispheric substance defect involving bone and brain tissue. Computed tomography showed a substantial convex defect involving the absence of calvarial bone as well as more than half of the left hemisphere of the brain, with a profound midline shift and a compression of the ventricular system. There was a severe problem due to multiple deep-skin ulcerations at the depression margin, prone to skin perforation with a probability of intracranial infection. In a first step, a free myocutaneous latissimus dorsi flap was transplanted for volume replacement of the hemispheric brain defect, and 4 months later, artificial bone substitute was implanted in order to prevent progressive vault depression deformity. Healing was uneventful, and the patient showed definite neurological improvement postoperatively. Free tissue transfer can be a valuable option in addition to cranioplasty in the treatment of large bony defects of the skull. Besides providing stable coverage for the reconstructed bone or its substitute, it can also serve as a volume replacement.

Pectus excavatum, pectus carinatum and other forms of thoracic deformities

This review article covers the spectrum of congenital thoracic wall deformities along with their historical background. Willital's classification divides these deformities into 11 types - funnel chest (4 types), pigeon chest (4 types), and combination of funnel and pigeon chest, chest wall aplasia and cleft sternum. Records of patients at our center comprised 90% depression deformities, 6% protrusion deformities, 3% combined depression-protrusion deformities and 1% other forms. Mild forms of abnormalities warrant the wait- and-watch approach during the first 4-5 years. The deformities manifest primarily during the pubertal spurt often with rapid progression with subjective complaints like dyspnea, cardiac dysthesia, limited work performance and secondary changes. Operative correction in young adults is more favorable in mild cases. The Willital technique has been the standard technique for the correction of pectus excavatum, pectus carinatum and other combined forms of deformities at our center with excellent long term results. The Nuss procedure and the Pectus Less Invasive Extrapleural Repair (PLIER) technique for pectus excavatum and pectus carinatum have also been described in this article. Surgical correction for Poland's syndrome is reserved for patients with severe aplasia of the ribs with major depression deformity. Sternal defects including various types of ectopia cordis are discussed. Even after surgical correction, there is significant reduction in the total capacity and inspiratory vital capacity of the lungs, probably a result of the decreased compliance of the chest wall. However, the efficiency of breathing at maximal exercise improves significantly after operation.<br>

Secondary Reconstruction of Mandibular Depression Deformity with Pedicled Latissimus Dorsi Myocutaneous Flap

Secondary Reconstruction of Mandibular Depression Deformity with Pedicled Latissimus Dorsi Myocutaneous Flap

Use of deep inferior epigastric artery flaps for reconstruction of the female genitalia.

Free skin grafts have been the most conventional choice for reconstructing the female genital area after excision of malignant tumours. However, some patients have developed scar contractures, or depressed deformities or ectropion of the mucosal membrane of the urethra or vagina. We discuss here the use of deep inferior epigastric artery (DIEA) flaps. Although the method leaves a scar in the abdominal region, it can be hidden by underwear. We have operated on six patients with satisfactory results.

Cranial-bone defects with depression deformity treated with ceramic implants and free-flap transfers

Hydroxyapatite ceramic has many advantages in the treatment of cranial-bone defects. However, for large skull defects with severe depression deformities, it may be risky to use ceramic implants because an extradural dead space will be left and the overlying scalp will have to be closed under tension. In these cases microvascular free-flap transfers are a good solution. We have treated three patients for large skull defects with severe depression deformities after repeated local infections and several operations or irradiation. A latissimus dorsi myocutaneous flap was combined with a serratus anterior muscle flap to fill the extradural space under the ceramic implant in the first patient. A latissimus dorsi muscle flap was inserted under the ceramic implant in an irradiated site and a combined small serratus anterior muscle flap was used as a monitor in the second patient. A latissimus dorsi myocutaneous flap was used to cover the ceramic implant and fill the scalp defect in the third patient. The follow-up periods varied from 12 to 35 months (mean: 20.7 months). The clinical courses of all three patients were uneventful and no flap was lost. The extradural space can be reduced to some extent by making the ceramic implant slightly flatter or thicker, but in patients with severe depression deformities, whose brain expansion cannot be expected, a muscle flap should be transferred into the space.

Eye socket reconstruction with free flaps in patients who have had postoperative radiotherapy

It is difficult to fit an ocular prosthesis and correct periorbital depression deformity in a patient who has undergone radiotherapy after enucleation of the eye for retinoblastoma during infancy. Simultaneously, developmental disturbances of the eyelids and severe periorbital depression deformities develop. However, due to recent advances in microvascular surgery, free flap transplantation is increasingly used for eye socket reconstruction because of its good circulatory effects with enough volume to augment large periorbital tissue defects. In the present study, we report on our success in using a free groin flap, scapular flaps and parascapular flaps simultaneously for reconstruction of eye sockets and correction of depressed deformities.

Chest wall deformities.

Chest wall deformities are principally depression deformities, the most common being pectus excavatum (funnel chest). The most common protrusion deformity is pectus carinatum (pigeon breast). Pectus carinatum is a cosmetic problem, but its presence can be psychologically devastating to the patient. Pectus excavatum is definitely a physiologic problem, the effects of which may be reversible by surgical correction. Surgery is safe, complications are minimal, and results are usually satisfactory.

Chest Wall Deformities

Chest wall deformities are principally depression deformities, the most common being pectus excavatum (funnel chest). The most common protrusion deformity is pectus carinatum (pigeon breast). Pectus carinatum is a cosmetic problem, but its presence can be psychologically devastating to the patient. Pectus excavatum is definitely a physiologic problem, the effects of which may be reversible by surgical correction. Surgery is safe, complications are minimal, and results are usually satisfactory.

Correction of orbital hypertelorism in Asian patients.

In this article, correction of orbital hypertelorism in Oriental patients is summarized. An orbital osteotomy is currently used to correct an abnormally wide interorbital distance. At present, associated deformities such as a short nose and a depression deformity in the temporal region following orbital osteotomy can be partially corrected. In Oriental patients, the Mongolian fold can be enhanced after correction of orbital hypertelorism. This fold can be easily corrected by epicantoplasty.

Clinical aspects and problems in chest wall protrusion and depression deformities: W.Ch. Hecker, M. Happ, C. Soder, et al. Z Kinderchir 43:15–22, (February), 1988

Clinical aspects and problems in chest wall protrusion and depression deformities: W.Ch. Hecker, M. Happ, C. Soder, et al. Z Kinderchir 43:15–22, (February), 1988

Clinical aspects and problems of pigeon breast and funnel chest

Chest wall protrusion and depression deformities, also known as funnel chest and pigeon chest, are nosologically a uniform entity. Our own histopathological studies revealed secondary changes, found likewise in arthroses, scolioses, aseptic osteonecroses and inflammatory processes, as well as changes found in so-called primary collagenous diseases of unknown aetiology. Investigation of the collagen metabolism did not disclose differences from the normal II-type collagen either qualitatively or quantitatively. The aetiology of funnel chest and pigeon chest can be defined as follows: A hereditary disturbance of metabolism results in weakening of the wall of the parasternal cartilage, effecting a deformation secondary to mechanical strain by respiration and growth. Psychocosmetic reasons are recognised as indication for operation. In our opinion, the optimal age for operation is the second to the sixth year of life. During 20 years, 765 patients were operated on at our hospital without lethality. Postoperative complications were pneumothorax (4%), pneumonia (2%), after bleeding (2%) and disturbed wound healing (7%). Late results 5 years following surgery were excellent in 57%, good in 27%, satisfactory in 10% and unsatisfactory in 6% of the cases, thus adding up to 84% good results.

Rhinoplasty for saddle nose

Homograft cartilage preserved in absolute alcohol looses immunogenicity. It is found to be more suitable in rhinoplasty for depression deformities, than iliac crest bone. No transplantation reaction, or, resorption, or, calcification occurred in 14 months of surveillance.

The rib hump in idiopathic scoliosis. Measurement, analysis and response to treatment.

This paper describes a simple method for the recording of rib deformity in idiopathic scoliosis. The relationships have been recorded between the measured rib hump and rib depression deformities and 1) the rotation of the vertebral bodies (as measured by the method of Nash and Moe on the standing radiograph); 2) the degree of lateral curvature (as measured by the method of Cobb on the standing radiograph); and 3) the rib-vertebra angles and their differences (as described by Mehta). No clear linear relationships were found. Many examples of irregular relationship were recorded, for example, marked spinal rotation with minimal rib hump. The response of the rib deformities to treatment by Milwaukee brace in fifty-two patients is described; the hump is little changed but the depression on the opposite side may be considerably reduced. Harrington instrumentation may have a similar effect.

Removal of a large frontoethmoid osteoma.

The large frontoethmoid osteoma has been an enigma to many surgeons. For while this tumor is benign, its removal has often led to ocular and intracranial complications, to say nothing of the unsightly depression deformities of the brow and forehead. A large osteoma of the right orbit was successfully removed from our patient via a dacryocystorhinostomy approach utilizing a mastoid drill and perforating bur as opposed to the more popular hammer-and-chisel technique. The surgery was uncomplicated, the frontal margin of the orbit was maintained, and the patient is now seven years postoperative with normal ocular function and good cosmetic result.

Pulmonary insufficiency in pectus excavatum associated with left pulmonary agenesis, congenital clubbed feet and ectromelia. Improvement following operation.

An 11-year-old girl with severe funnel chest and agenesis of the left lung associated with ectromelia of the left hand and bilateral club feet had developed severe exertional dyspnea. Respiratory function tests demonstrated both obstructive and restrictive defects with associated ventilation-perfusion imbalance. Correction of the depression deformity of the sternum resulted in a significant change in her appearance and posture, disappearance of the exertional dyspnea, and documented improvement in respiratory function.

Bone chip plastic repair of congenital chest deformities

In the year 1594, Bauhinus described in the early medical literature a seven-year-old boy with a marked depression of the sternum and ensiform cartilage. 1 This was the first clinical treatise on the congenital and developmental deformities of the anterior chest wall which have since been generally classified into two categories: the depression deformity (pectus excavatum) and the protrusion deformity (pectus carinatum). Not until 1911 was surgical repair of this malformation attempted, 2 and only in recent years have adequate surgical corrective techniques been developed. This paper presents bone chip plastic reconstruction as a simplified operative procedure for an anatomical, physiological, and functional correction of these congenital chest deformities. Classification and Etiology Pectus excavatum is a funnel-shaped depression of the anterior chest wall whose deep apex is the xiphoid and whose walls are the posteriorly displaced sternum and attached costal cartilages. Its pattern can be symmetrical or asymmetrical in which

Bone chip plastic repair of congenital chest deformities.

In the year 1594, Bauhinus described in the early medical literature a seven-year-old boy with a marked depression of the sternum and ensiform cartilage. 1 This was the first clinical treatise on the congenital and developmental deformities of the anterior chest wall which have since been generally classified into two categories: the depression deformity (pectus excavatum) and the protrusion deformity (pectus carinatum). Not until 1911 was surgical repair of this malformation attempted, 2 and only in recent years have adequate surgical corrective techniques been developed. This paper presents bone chip plastic reconstruction as a simplified operative procedure for an anatomical, physiological, and functional correction of these congenital chest deformities. Classification and Etiology Pectus excavatum is a funnel-shaped depression of the anterior chest wall whose deep apex is the xiphoid and whose walls are the posteriorly displaced sternum and attached costal cartilages. Its pattern can be symmetrical or asymmetrical in which