A NEW METHOD FOR TOTAL RECONSTRUCTION OF THE NOSE : THE EARS AS DONOR AREAS
|
|
- Coleen Alexander
- 5 years ago
- Views:
Transcription
1 A NEW METHOD FOR TOTAL RECONSTRUCTION OF THE NOSE : THE EARS AS DONOR AREAS By MIGUEL ORTICOCHEA, M.D. 1 Professor of Plastic Surgery, Medical School, Javeriana University, Bogotd, Colombia THE early history of plastic surgery is largely concerned with man's attempts to reconstruct a missing nose and the techniques in use today are but modifications of methods evolved many years ago. Pedicled cheek flaps were described by Sushruta around 6oo B.C. in India, the importation of tissue from a distance is exemplified by the Tagliacotian arm flap from sixteenth-century Italy and the popular forehead flap was first described from India in the Gentleman's Magazine of I794 (McDowell et al., I952). FIG. I The patient prior to reconstruction showing the extent of the nasal loss. No technique is ideal. Facial skin is of the proper texture and colour but its use leaves considerable secondary scarring of the donor area (Apolo et al., r952 ). Pedicles from trunk or arm rarely have the appearance of facin skin and multiple uncomfortable stages are required for their transportation (Moiler, I956). None of the donor sites at present in use provide either a cartilaginous framework or a built-in lining. There is in fact only one area other than the nose which consists of a thin layer of cartilage sandwiched between two layers of skin and that is the ear. An entirely new method of nasal reconstruction has now been evolved making use of the whole concha with the cartilage for support and the pre- and post-anricular skin supplying the lining and skin cover respectively. The remainder of the ear is untouched, the auricular pavilions are reconstituted and little visible.scarring on the donor area results. Reversal of Flow in the Superficial Temporal Vessels after Arteriovenous Transplantation.--The technique depends on the transfer of each concha by a p edicle flap with its base on the temple and including the superficial temporal vessels. To make this feasible the natural flow of blood in these vessels must be reversed. This is accomplished by dividing the vessels in front of the ear and transplanting them into the substance of the flap behind the ear. The retrograde blood supply comes from the anastomoses with 1 Former student, Pasteur Hospital, Montevideo, Uruguay. Head, Plastic Surgery Division at the National Cancer Institute, Bogoui. 3A z25
2 226 BRITISH ]'OURNAL OF PLASTIC SURGERY the branches of the ophthalmic vessels (supra-orbital, supra-trochlear and lacrimal). This principle of reversal of blood flow is applicable to many flaps in facial reconstruction and makes Fossible new designs of flaps. Teehniques.MThe nasal reconstruction requires three stages: firstly the flaps are prepared and delayed on each side, secondly the auricular portion is sutured to its new site in the nasal region (Figs. 9 and IO) and thirdly the pedicles are returned to their donor sites and any revisions of the new nose carried out. A B FIG. 2 Diagram showing the flap outlined. It is 4 cm. broad and overlies the superficial temporal vessels. The pre-anricular incision at " A " allows exposure of the vessels before ligation and transplantation. The arrow indicates the natural direction of arterial flow. The posterior branches of the vessels are ligated as shown. FIG. 3 A, The post-auricular portion of the flap is marked. The posterior line of incision follows the hair line as far as the mastoid process ; the anterior runs parallel to and I cm. away from the rim of the ear as far as the lobule. B, The frontal and post~auricular incisions have been made and also the incision to expose the superficial temporal vessels. Stage /.--Under general anaesthesia, the patient is placed in the Trendelenburg position to engorge the superficial temporal vessels, and the flaps, which overlie these vessels, are marked with brilliant green. Each flap measures 4 by 12 cm. (Fig. 2). The patient is returned to the Fowler position before the flaps are incised. The frontal portion of the flap is dissected free through the layer of loose areolar tissue between the galea and the pericranium. The posterior branch of the superficial temporal vessels and other collaterals are sectioned and tied. The auricular portion is a prolongation of the frontal portion and includes the full thickness of the concha. The pre-auricular skin and the cartilage are sectioned along the anterior, superior and posterior borders of the concha leaving intact a small inferior pedicle 2 cm. wide to ensure a blood supply to the thin pre-auricular skin. On the posterior aspect of the ear the lower incision continues parallel to the helix and about
3 NEW METHOD FOR TOTAL RECONSTRUCTION OF THE NOSE 227 I cm. from the rim of the ear as far as the retro-auricular groove. The upper incision is carried along the hair line to the lower margin of the mastoid process. A 4 cm. wide pedicle over the mastoid is retained to ensure the blood supply of the posterior auricular skin ; at this stage this still comes from below and not from above. It will be noted that the flap includes all the skin covering the posterior aspect of the concha plus all the hair-free skin over the temporal bone and the mastoid process. When separating this skin from the underlying structures, the posterior auricular vessels are divided. FIG. 4 Diagram of the incision on the anterior surface of the ear. The pre-auricular skin and the cartilage are divided as shown. Three vascular bridges are xetained ; the skin covering the concha is supplied through that marked "3 ", while the remainder of the ear is nourished by the pedicle at the crus of the helix and the lobule. Fro. 5 A, Lateral view of the fronto-conchal flap. At this stage it is nourished through three pedicles, at the temple (I), the mastoid (2) and the inferior end of the concha (3)- The superficial temporal vessels have been tied and divided. B, Separation with scissors of the frontal portion of the flap from the underlying bone and muscle. C, The skin covering each side of the concha is sutured along its external border. This ensures the blood supply of the anterior skin when its pedicle (3) is divided at the next stage. Clamps have been placed on the ends of the superficial temporal vessels. At this stage, a strip of cortex from the temporal bone and the mastoid may be included in the flap if required for support of the nasal skeleton. Transplanting the Superficial Temporal Vessels.--The thin skin at the upper end of the post-auricular sulcus which connects the auricular portion of the flap with the scalp pedicle has few blood vessels and constitutes a vascular barrier. The transplantation of the superficial temporal vessels is essential during the second stage to overcome this barrier and ensure adequate blood supply to the auricular end of the flap. Through a vertical prc-auricular incision 1.5 cm. in front of the ear (Figs. 2 and 6), the vessels are dissected free but the fatty areolar tissue surrounding them is retained.
4 228 BRITISH JOURNAL OF PLASTIC SURGERY FIG. 6 Prior to division~ the superficial temporal vessels are dissected free with a surrounding layer of fibro-fatty tissue. FIG. 7 A and B~ The superficial temporal vessels divided. C, A tunnel is dissected through the substance of the flap between the skin and the epicranial aponeurosis with fine pointed haemostats. D, The vascular pedicle is passed through the tunnel and sutured to the posterior border of the flap at the upper level of the auricular portion. FIG. 8 Healed result after completion of the first stage. The flap remains behind the rest of the ear. It is the anastomoses formed between the small vessels in this and the vessels in the flap which L*lc::ease the blood supply to the concha. The superficial temporal vessels are ligated at the level of the lower border of the tragus (Fig. 7). A tunnel is then made
5 / B FIG. 9 Stage II has been completed by dividing the auricular pedicles and returning the remaining portion of the ear to its normal position. Note the abmadance of non-hairy skin in the flaps. The arrows indicate the reversal of blood flow in the superficial temporal vessels. A--artery. V--vein. FIG. IO A, Reconstruction begins by suturing the pre-auricular skin covering the concave side of the concha to the nasal lining. B and C, Lateral skin sutures completed and flaps joined together in the midline. Note the abundance of tissue in the nasal region and the normai shape and good aesthetic appearance of the ears from which the tissue has come.
6 230 BRITISH JOURNAL OF PLASTIC SURGERY with scissors through the substance of the flap at the upper end of the concha, the divided vessels are passed through and sutured to the posterior border of the flap. The raw undersurface of the flap is covered with a split skin graft. Finally, the donor area is resurfaced with a similar graft after undermining and approximating the edges as far as possible (Fig. 7, D). This graft covers in turn the pericranium of the frontal bone, the temporal fascia, the musculo-skeletal surface of the temporal bone FIG. I I Final result. The patient has a nose of nearly normal shape, size, colour and appearance and his breathing is normal. Both ears are of normal size, shape and position and there are no visible scars at the donor sites. and mastoid process, and the site where the concha was in contact with the bone. The fronto-conchal flap now remains behind the remainder of the ear. The same procedure is carried out on each side (Fig. 8 and Fig. 13, A). Stage//.--The auricular end of each pedicle is detached by dividing the two skin bridges and the inferior attachment of the concha. They are then sutured in place to the lateral borders of the nasal defect and to each other in the midline. A two-layer closure of both lining and skin is made in each case but the cartilage is not sutured. Finally, the remaining portion of the ear is returned to its normal position and sutured to the neighbouring tissues (Fig. IO and Fig. 13, B).
7 NEW METHOD FOR TOTAL RECONSTRUCTION OF THE NOSE 23I FIG. 12 FIG. 13 Fig. I2. Partial loss of left side of the nose. Fig. I3. A, A bipedicled fronto-conchal flap has been delayed. B, The conchal portion of the flap is rotated to the nasal region. FIG. 14 Final result.
8 232 BRITISH JOURNAL OF PLASTIC SURGERY Stage III.mThe pedicle of the flap is divided at the desired level in the nasal region. When this is done and the lower ends of the superficial temporal vessels are divided, an abundant blood flow from the artery is seen, of the same strength and speed as normal, thus demonstrating the reversal of flow which has been achieved. The pedicles are returned to their donor site and the necessary trimming of the nasal flaps is carried out (Fig. I I). The technique is of course equally suitable for unilateral defects (Figs ). Complieations.--Four possible complications have been observed : I. If the flap is very short with the frontal origin too low, there may be difficulty in bringing the concha sufficiently far to reconstruct the alae, nostrils and columella. 2. Vascular impairment of the upper pole of the remaining portion of the ear may occur if the crus of the helix pedicle is too narrow. The skin of the crus of the helix must be wide and k is important to include with k all the skin adjacent to the triangular fossa to ensure adequate blood supply. 3. Post-operative oedema of the reconstructed nose may persist for some months but disappears later. 4- Tissue contracture occurs post-operatively at all stages. For this reason all of the post-auricular skin is included in the flap ; although at the first stage, the tissue available may seem excessive, too much is better than too little. At the same time, hair-bearing skin is not included as this would mean further surgery to remove it later. CONCLUSIONS AND SUMMARY In the author's experience the concha of the ear is the best donor site for total nasal reconstruction no matter what the cause of the loss of the nose. In summary, the advantages of the technique are : I. The skin is of the same colour, texture and thickness as that of a normal nose. 2. The osteo-cartilaginous framework is automatically provided by the conchal cartilage and a bony strut when required. 3. The lining is also an integral part of the flaps and does not require to be provided from other sources. 4- The nostrils are of good size and the patient breathes normally. 5. The ears from which the concha has been removed keep their normal shape, size and appearance and are only slightly fatter than normal ears. Replacement of the concha by a skin graft does not change ks cosmetic appearance. REFERENCES APOLO, E., PIETROPINTO, J. and GONZALEZ METHOL, J. (I952). Ventaias del Colgajo Frontal Mediano. Second Uruguayan Congress of Surgery. Talleres Graficos de A. Monteverde y Cia Montevideo, Uruguay. McDOWELL, F., VALONE, J. A. and BROWN, J. B. (I952). Bibliography and historical note on plastic surgery of the nose. Plastic and Reconstructive Surgery, IO, MOLLER, G. (I965). Rinofima : tratarniento quirurgico. Revista de Cirugia Plastica de Uruguay, 6, 5-8.
NEW THREE-FLAP SCALP RECONSTRUCTION TECHNIQUE
NEW THREE-FLAP SCALP RECONSTRUCTION TECHNIQUE By MIGUEL ORTICOCHEA, M.D. Professor of Plastic Surgery, Medical School, Javeriana University, Bogotd, Colombia Former Student, Pasteur Hospital, Montevideo,
More informationRECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland
RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP By MICHAL KRAUSS Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION of the nose is one of the composite procedures in
More informationOF CONCHA-HELIX DEFECTS. BY JAMES K. MASSON, M.D. Mayo Clinic and Mayo Foundation, Rochester, Minnesota
British Journal qf Plastic Surgery (x97z), 7,5, 399-403 A SIMPLE ISLAND FLAP FOR RECONSTRUCTION OF CONCHA-HELIX DEFECTS BY JAMES K. MASSON, M.D. Mayo Clinic and Mayo Foundation, Rochester, Minnesota AFTER
More informationTHIEME. Scalp and Superficial Temporal Region
CHAPTER 2 Scalp and Superficial Temporal Region Scalp Learning Objectives At the end of the dissection of the scalp, you should be able to identify, understand and correlate the clinical aspects: Layers
More informationTikrit University College of Dentistry Dr.Ban I.S. head & neck anatomy 2 nd y.
Lec [3]/The scalp The scalp extends from the supraorbital margins anteriorly to the nuchal lines at the back of the skull and down to the temporal lines at the sides. The forehead, from eyebrows to hairline,
More informationThe bi-pedicle post-auricular tube flap for reconstruction of partial ear defects
The British Association of Plastic Surgeons (2003) 56, 593 598 The bi-pedicle post-auricular tube flap for reconstruction of partial ear defects Mohammed G. Ellabban*, Maamoun I. Maamoun, Moustafa Elsharkawi
More informationbe very thin and variable. Facial nerve branches that exit the parotid gland are deep to the SMAS.
The Superficial musculoaponeurotic system (SMAS) fascia is a fanlike fascia that envelops the face and provides a suspensory sheet which distributes forces of facial expression.. The SMAS is continuous
More informationOPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY PARAMEDIAN FOREHEAD FLAP NASAL RECONSTRUCTION SURGICAL TECHNIQUE Brian Cervenka, Travis Tollefson, Patrik Pipkorn The paramedian forehead
More informationcally, a distinct superior crease of the forehead marks this spot. The hairline and
4 Forehead The anatomical boundaries of the forehead unit are the natural hairline (in patients without alopecia), the zygomatic arch, the lower border of the eyebrows, and the nasal root (Fig. 4.1). The
More informationKevin T. Kavanagh, MD
Kevin T. Kavanagh, MD Axial Based upon a named artery. Survival length depends upon the artery not the width of the flap. Random Has random unnamed vessels supplying it. Survival length is directly proportional
More informationPrinciples of Facial Reconstruction After Mohs Surgery
Objectives Principles of Facial Reconstruction After Mohs Surgery Identify important functional anatomy and aesthetic units of the face. Describe techniques used in facial reconstruction. Discuss postoperative
More informationThe SCALP. Prof. Dr. Muhammad Imran Qureshi
The SCALP By Prof. Dr. Muhammad Imran Qureshi The SCALP includes FIVE layers external to the Calvaria. These are: S: Skin & Superficial Fascia C: Connective Tissue A: Aponeurosis (Epicranial) L: Loose
More informationAesthetic reconstruction of the nasal tip using a folded composite graft from the ear
The British Association of Plastic Surgeons (2004) 57, 238 244 Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear Yong Oock Kim*, Beyoung Yun Park, Won Jae Lee Institute
More informationHead and Face Anatomy
Head and Face Anatomy Epicranial region The Scalp The soft tissue that covers the vault of skull. Extends from supraorbital margin to superior nuchal line. Layers of the scalp S C A L P = skin = connective
More informationAssociate Professor of Plastic Surgery, Karol. Institute; Plastic Department, Serafimerlasarettet, Stockholm, Sweden
A NEW METHOD OF SHAPING DEFORMED EARS By A. RAGNELL, M.D. Associate Professor of Plastic Surgery, Karol. Institute; Plastic Department, Serafimerlasarettet, Stockholm, Sweden NUMEROUS methods of shaping
More informationSTEP 1 INCISION AND ELEVATION OF SKIN FLAP STEP 3 SEPARATE PAROTID GLAND FROM SCM STEP 2 IDENTIFICATON OF GREAT AURICULAR NERVE
STEP 1 INCISION AND ELEVATION OF SKIN FLAP Create a modified Blair Figure 1 or facelift incision. Figure 2 Raise a superficial cervico-fascial flap between the Superficial Musculo Aponeurotic System (SMAS)
More informationTHE pedicled flap, commonly used by the plastic surgeon in the reconstruction
THE PEDICLE!) SKIN FLAP ROBIN ANDERSON, M.D. Department of Plastic Surgery THE pedicled flap, commonly used by the plastic surgeon in the reconstruction of skin and soft tissue defects, differs from the
More informationPrinciples of flap reconstruction in ORL-HN defects. O.M. Oluwatosin Department of Surgery
Principles of flap reconstruction in ORL-HN defects O.M. Oluwatosin Department of Surgery Nasal defects and deformities Cleft palate and Velopharyngeal incompetence Pharyngeal and oesophageal defects Pinnal
More informationRECONSTRUCTION OF MICROtia
ORIGINAL ARTICLE A 2-Stage Ear Reconstruction for Microtia Haiyue Jiang, MD; Bo Pan, MD; Yanyong Zhao, MD; Lin Lin, MD; Lei Liu, MD; Hongxing Zhuang, MD Objective: To introduce our 2-stage reconstruction
More informationSuperior View of the Skull (Norma Verticalis) Anteriorly the frontal bone articulates with the two parietal bones AT THE CORONAL SUTURE
Superior View of the Skull (Norma Verticalis) Anteriorly the frontal bone articulates with the two parietal bones AT THE CORONAL SUTURE 1 The two parietal bones articulate in the midline AT THE SAGITTAL
More informationThis article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and
This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution
More informationPARTIAL RECONSTRUCTION OF THE AURICLE
Hirosaki Med.J. 66:99 104,2016 REVIEW PARTIAL RECONSTRUCTION OF THE AURICLE Satoshi Urushidate,Katsunori Yokoi,Yosuke Watanabe, Makoto Mikami and Yuko Higuma Abstract Auricular reconstruction is often
More informationNose Reshaping (Rhinoplasty)
Nose Reshaping (Rhinoplasty) Are you interested in improving the appearance of your nose? If so, you re not alone. Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed
More informationHospital das Clinicas, Brazil
THE IMPORTANCE OF THE CARTILAGINOUS FRAMEWORK IN PLASTIC SURGERY OF THE NOSE By ROBERTO FARINA, M.D., OSVALDO DE CASTRO, and RICARDO BAROUDI, M.D. Hospital das Clinicas, Brazil As far as plastic surgery
More informationORIGINAL ARTICLE. Reconstruction of the Nasal Columella. David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A.
ORIGINAL ARTICLE Reconstruction of the Nasal Columella David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A. Hilger, MD Objective: To report techniques successful for nasal columella
More informationRECONSTRUCTION OF SCALP DEFECTS: AN INSTITUTIONAL EXPERIENCE Sathyanarayana B. C 1, Somashekar Srinivas 2
RECONSTRUCTION OF SCALP DEFECTS: AN INSTITUTIONAL EXPERIENCE Sathyanarayana B. C 1, Somashekar Srinivas 2 HOW TO CITE THIS ARTICLE: Sathyanarayana B. C, Somashekar Srinivas. Reconstruction of Scalp Defects:
More informationReconstruction of Scalp Defects: An Algorithmic Approach Author: DR.M.Sundararaj, M.ch, Corresponding Author: DR.A.KavithaPriya, M.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 8 Ver. IX (Aug. 2017), PP 40-44 www.iosrjournals.org Reconstruction of Scalp Defects: An Algorithmic
More informationFOLLOWING INTRODUCTION OF
ORIGINAL ARTICLE Alternative 1-Step Nasal Reconstruction Technique Kazuo Kishi, MD, PhD; Nobuaki Imanishi, MD, PhD; Yusuke Shimizu, MD; Ruka Shimizu, MD, PhD; Keisuke Okabe, MD; Hideo Nakajima, MD, PhD
More informationStracture The scalp consists of five layers,the 1st three of which are intimately bound together and move as a unit.to assist one in memorizing the
Anatomy of Scalp Stracture The scalp consists of five layers,the 1st three of which are intimately bound together and move as a unit.to assist one in memorizing the names of the five layers of the scalp,use
More informationExtended Bilaminar Forehead Flap With Cantilevered Bone Grafts for Reconstruction of Full-Thickness Nasal Defects
J Oral Maxillofac Surg 63:566 570, 2005 Extended Bilaminar Forehead Flap With Cantilevered Bone Grafts for Reconstruction of Full-Thickness Nasal Defects Jason K. Potter, DDS, MD,* Yadranko Ducic, MD,
More informationNeurosurgical Techniques
Neurosurgical Techniques EBEN ALEXANDER, JR., M.D., EDITOR Supratentorial Skull Flaps GuY L. ODOM, M.D., AND BARNES WOODHALL,!V[.D. Department of Surgery, Division of Neurosurgery, Duke University Medical
More informationSurgical treatment of non-melanoma skin cancer of the head and neck: expanding reconstructive options van der Eerden, P.A.
UvA-DARE (Digital Academic Repository) Surgical treatment of non-melanoma skin cancer of the head and neck: expanding reconstructive options van der Eerden, P.A. Link to publication Citation for published
More informationSurgical Treatment of Short Nose
Surgical Treatment of Short Nose Dr. Otto YT Au MD (JEFFERSON, USA) 1957, MCPS (MANITOBA) 1963, FHKAM (SURGERY) 1995 Diplomate American Board Plastic Surgery Plastic Surgery Specialist Dr.OttoYTAu A nice
More informationChapter(2):the lid page (1) THE LID
Chapter(2):the lid page (1) THE LID Anatomy of the lid: * Check movie anatomy of the lid model The eyelids are two movable muco-cutaneous folds which protect the eye on closure. The are joined temporary
More informationInteresting Case Series. Scalp Reconstruction With Free Latissimus Dorsi Muscle
Interesting Case Series Scalp Reconstruction With Free Latissimus Dorsi Muscle Danielle H. Rochlin, BA, Justin M. Broyles, MD, and Justin M. Sacks, MD Department of Plastic and Reconstructive Surgery,
More informationAN EXPERIMENTAL TUBE PEDICLE LINED WITH SMALL BOWEL. By J. H. GOLDIN, F.R.C.S.(Edin.) Plastic Surgery Unit, St Thomas' Hospital, London
British Journal of Plastic Surgery (I972), 25, 388-39z AN EXPERIMENTAL TUBE PEDICLE LINED WITH SMALL BOWEL By J. H. GOLDIN, F.R.C.S.(Edin.) Plastic Surgery Unit, St Thomas' Hospital, London ONE of the
More informationAlexander C Vlantis. Selective Neck Dissection 33
05 Modified Radical Neck Dissection Type II Alexander C Vlantis Selective Neck Dissection 33 Modified Radical Neck Dissection Type II INCISION Various incisions can be used for a neck dissection. The incision
More informationCHAPTER 17 FACIAL AESTHETIC SURGERY. Christopher C. Surek, DO and Mohammed S. Alghoul, MD. I. BROW LIFT (Figures 1 and 2)
CHAPTER 17 FACIAL AESTHETIC SURGERY Christopher C. Surek, DO and Mohammed S. Alghoul, MD I. BROW LIFT (Figures 1 and 2) A. Open Coronal Brow Lift Technique 1. Coronal incision is made in the hair-bearing
More informationUniversity Journal of Surgery and Surgical Specialties
University Journal of Surgery and Surgical Specialties ISSN 2455-2860 Volume 2 Issue 1 2016 Ear lobe reconstruction Techniques revisited ANANTHARAJAN NATARAJAN Department of Plastic Reconstructive Surgery,
More informationOPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY BUCCINATOR MYOMUCOSAL FLAP The Buccinator Myomucosal Flap is an axial flap, based on the facial and/or buccal arteries. It is a flexible
More informationFace. Definition: The area between the two ears and from the chin to the eye brows. The muscles of the face
Face Definition: The area between the two ears and from the chin to the eye brows. The muscles of the face The muscle of facial expression (include the muscle of the face and the scalp). All are derived
More informationVancouver, B.C., Canada
THE "ALAR SHIFT" REVISITED By THEODORE F. WILKIE, B.A., M.D., F.R.C.S.(C), F.A.C.S. Vancouver, B.C., Canada IN the hands of many plastic surgeons certain procedures have an evanescent history. Usually
More informationDISSECTING A PIG S HEART
DISSECTING A PIG S HEART LAB 59 OBSERVATION STUDENT BOOK Chapter 6, page 185 Goal Locate and observe structures of a mammal s heart. Observation criteria Identify the structures of the heart indicated
More informationDr.Ban I.S. head & neck anatomy 2 nd y. جامعة تكريت كلية طب االسنان مادة التشريح املرحلة الثانية أ.م.د. بان امساعيل صديق 6102/6102
جامعة تكريت كلية طب االسنان مادة التشريح املرحلة الثانية أ.م.د. بان امساعيل صديق 6102/6102 The scalp The scalp extends from the supraorbital margins anteriorly to the nuchal lines at the back of the skull
More informationT HERE is an unusual and interesting variety of craniosynostosis in
SURGICAL TREATMENT OF CONGENITAL ANOMALIES OF THE CORONAL AND METOPIC SUTURES TECHNICAL NOTE DONALD D. MATSON, M.D. Neurosurgical Service, The Children's Medical Center, and Deparlment of Surgery, Itarvard
More informationISPUB.COM. Cutting Burr Otoplasty. D Wynne, N Balaji INTRODUCTION ANATOMY CUTTING BURR TECHNIQUE
ISPUB.COM The Internet Journal of Otorhinolaryngology Volume 7 Number 1 D Wynne, N Balaji Citation D Wynne, N Balaji.. The Internet Journal of Otorhinolaryngology. 2006 Volume 7 Number 1. Abstract Prominent
More informationSequellae of Chemical Burn.. Scar management in burn patient
Sequellae of Chemical Burn.. Scar management in burn patient ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก กก ก ก ก ก ก (hypertrophic scar) ก ก ก ก ก ก ก ก ก immature 12 18 ก ก กก ก ก ก ก ก ก ก ก ก ก ก immature (2-9 )
More information1 The nasal bones are deeper and are therefore MATERIAL AND METHODS. At the Department of Plastic and Reconstructive
Technical Experiences Reconstruction of the Nasal Tip Valerio Cervelli, MD, DJ Bottini, PhD, Pietro Gentile, MD Rome, Italy Defects of the nasal tip present complex problems in terms of reconstruction,
More informationScientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim
Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the lar Rim Richard Ellenbogen, MD; and Greg azell, MD ackground: lthough the alar rim has frequently been neglected in correction
More informationSkeletal system. Prof. Abdulameer Al-Nuaimi. E. mail:
Skeletal system Prof. Abdulameer Al-Nuaimi E-mail: a.al-nuaimi@sheffield.ac.uk E. mail: abdulameerh@yahoo.com Functions of Bone and The Skeletal System Support: The skeleton serves as the structural framework
More informationAn island flap based on the anterior branch of the superficial temporal artery for perioral defects
Free full text on www.ijps.org Original Article An island flap based on the anterior branch of the superficial temporal artery for perioral defects V. Bhattacharya, Ganji Raveendra Reddy, Sheikh Adil Bashir,
More informationTikrit University collage of dentistry Dr.Ban I.S. head & neck anatomy 2 nd y. Lec [5] / Temporal fossa :
Lec [5] / Temporal fossa : Borders of the Temporal Fossa: Superior: Superior temporal line. Inferior: gap between zygomatic arch and infratemporal crest of sphenoid bone. Anterior: Frontal process of the
More informationThomas T. Jeneby, M.D Wurzbach Suite 801 San Antonio, TX /
Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed today. Often, the structure or size of the nose is not proportionate with the other features on the face.
More informationRepair of scalp defect using a superficial temporal fascia pedicle VY advancement scalp flap *
British Journal of Plastic Surgery (2005) 58, 676 680 Repair of scalp defect using a superficial temporal fascia pedicle VY advancement scalp flap * Kiyoshi Onishi a, *, Yu Maruyama b, Akiteru Hayashi
More informationChapter 7. Skeletal System
Chapter 7 Skeletal System 1 Skull A. The skull is made up of 22 bones: 8 cranial bones, 13 facial bones, and the mandible. B. The Cranium encloses and protects the brain, provides attachments for muscles,
More informationOPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY THE NASAL SEPTUM IN RHINOPLASTY: BASIC SEPTOPLASTY TECHNIQUES FWA Otten Introduction Septal corrections form an important step in rhinoplastic
More information3. The Jaw and Related Structures
Overview and objectives of this dissection 3. The Jaw and Related Structures The goal of this dissection is to observe the muscles of jaw raising. You will also have the opportunity to observe several
More informationFour Limb Shaped Auricular Chondrocutaneous Composite Graft for the Alar and the Columellar Defects
ORIGINAL ARTICLE https://doi.org/10.14730/aaps.2017.23.3.149 Arch Aesthetic Plast Surg 2017;23(3):149-154 pissn: 2234-0831 eissn: 2288-9337 aaps Aesthetic Plastic Surgery Four Limb Shaped Auricular Chondrocutaneous
More informationPearls for Keeping it Simple in Cutaneous Reconstruction
Pearls for Keeping it Simple in Cutaneous Reconstruction Jerry D. Brewer, MD, MS, FAAD brewer.jerry@mayo.edu Professor of Dermatology Division of Dermatologic Surgery Department of Dermatology Mayo Clinic
More informationTympanoplasty conchal cavum approach
Man and Nunez Journal of Otolaryngology - Head and Neck Surgery (2016) 45:1 DOI 10.1186/s40463-015-0113-3 HOW I DO IT ARTICLE Open Access Tympanoplasty conchal cavum approach S. Christopher Man 1* and
More informationBony orbit Roof The orbital plate of the frontal bone Lateral wall: the zygomatic bone and the greater wing of the sphenoid
Bony orbit Roof: Formed by: The orbital plate of the frontal bone, which separates the orbital cavity from the anterior cranial fossa and the frontal lobe of the cerebral hemisphere Lateral wall: Formed
More information3-Deep fascia: is absent (except over the parotid gland & buccopharngeal fascia covering the buccinator muscle)
The Face 1-Skin of the Face The skin of the face is: Elastic Vascular (bleed profusely however heal rapidly) Rich in sweat and sebaceous glands (can cause acne in adults) It is connected to the underlying
More informationProboscis lateralis: report of two cases
The British Association of Plastic Surgeons (2003) 56, 704 708 CASE REPORT Proboscis lateralis: report of two cases Lütfi Eroğlu a, *, Osman Ata Uysal b a Faculty of Medicine, Department of Plastic and
More informationAnatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC
Anatomy of External NOSE By Dr Farooq Aman Ullah Khan PMC 24 th Nov. 2017 The External Nose Descriptions of the nose always begin with that part of it which is covered by the skin, i.e., the EXPOSED PART
More informationCombined tongue flap and V Y advancement flap for lower lip defects
British Journal of Plastic Surgery (2005) 58, 258 262 CASE REPORTS Combined tongue flap and V Y advancement flap for lower lip defects Kenji Yano*, Ko Hosokawa, Tateki Kubo Department of Plastic and Reconstructive
More informationThe eyebrow is so aesthetically important that. Reconstructive
Original Article Reconstructive Extended Hair-bearing Lateral Orbital Flap for Simultaneous Reconstruction of Eyebrow and Eyelid Shinji Matsuo, MD Ichiro Hashimoto, MD Takuya Seike, MD Yoshiro Abe, MD
More informationClin Plastic Surg 31 (2004) Ear reconstruction. E. Fred Aguilar III, MD, FACS a,b,c, *
Clin Plastic Surg 31 (2004) 87 91 Ear reconstruction E. Fred Aguilar III, MD, FACS a,b,c, * a Division of Plastic and Reconstructive Surgery and the Department of Otolaryngology/Head and Neck Surgery,
More informationWhat is Hemifacial Microsomia? By Pravin K. Patel, MD and Bruce S. Bauer, MD Children s Memorial Hospital, Chicago, IL
What is Hemifacial Microsomia? By Pravin K. Patel, MD and Bruce S. Bauer, MD Children s Memorial Hospital, Chicago, IL 773-880-4094 Early in the child s embryonic development the structures destined to
More informationRECONSTRUCTION of large surgical
Triple-Flap Technique for Reconstruction of Large Nasal Defects Timothy W. Wild, MD, DDS; C. Patrick Hybarger, MD ORIGINAL ARTICLE Objective: To determine the usefulness of a triple-flap technique for
More informationFascial Turn-Down Flap Repair of Chronic Achilles Tendon Rupture
19 Fascial Turn-Down Flap Repair of Chronic Achilles Tendon Rupture S. Ghosh, P. Laing, and Nicola Maffulli Introduction Fascial turn-down flaps can be used for an anatomic repair of chronic Achilles tendon
More informationBones Ethmoid bone Inferior nasal concha Lacrimal bone Maxilla Nasal bone Palatine bone Vomer Zygomatic bone Mandible
splanchnocranium - Consists of part of skull that is derived from branchial arches - The facial bones are the bones of the anterior and lower human skull Bones Ethmoid bone Inferior nasal concha Lacrimal
More informationPrimary closure of the deltopectoral flap-donor site without skin grafting
Primary closure of the deltopectoral flap-donor site without skin grafting Received: 4/3/2013 Accepted: 14/5/2013 Introduction Reliable and simultaneous reconstruction of head-and-neck defects has been
More informationVersatility of Reverse Sural Artery Flap for Heel Reconstruction
ORIGINAL ARTICLE Introduction: The heel has two parts, weight bearing and non-weight bearing part. Soft tissue heel reconstruction has been a challenge due to its complex nature of anatomy, weight bearing
More informationPrinciples of plastic and reconstructive surgery
Plastic surgery - in general Principles of plastic and reconstructive surgery Dr. T. Németh, DVM, Ph.D, Diplomate ECVS Assoc. Professor and Head Definition: Surgical correction of morphological and/or
More informationINTRA-CORNEAL LAMELLAR KERATOPLASTY*
Brit. J. Ophthal. (1960) 44, 629. INTRA-CORNEAL LAMELLAR KERATOPLASTY* BY TADEUSZ KRWAWICZ Ophthalmological Clinic, Medical Academy, Lublin, Poland THE operative technique of lamellar keratoplasty is still
More informationDalinde Hospital, Mexico City
RESTORATION OF THE FACE COVERING BY MEANS OF SELECTED SKIN IN REGIONAL testhetic UNITS By M. GONZ~LEZ-ULLOA, M.D., F.A.C.S. Dalinde Hospital, Mexico City IT is the purpose of the present study to emphasise
More informationMc Gregor Flap for Lower Eyelid Defect
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 4 Ver. V (April. 2017), PP 69-74 www.iosrjournals.org Mc Gregor Flap for Lower Eyelid Defect
More informationCase Report Reconstruction of Total Lower Eyelid Defects with the Temporoparietal Fascial Flap
Volume 2012, Article ID 927260, 4 pages doi:10.1155/2012/927260 Case Report Reconstruction of Total Lower Eyelid Defects with the Temporoparietal Fascial Flap Simon R. Bababeygy, 1 Anne R. Kao, 1 Niels
More informationAnatomical study. Clinical study. R. Ogawa, H. Hyakusoku, M. Murakami, R. Aoki, K. Tanuma* and D. G. Pennington?
British Journal of Plastic Surgery (2002) 55, 396-40 I 9 2002 The British Association of Plastic Surgeons doi: 10.1054/bjps.2002.3877 PLASTIC SURGERY An anatomical and clinical study of the dorsal intercostal
More informationPerichondrial Cutaneous Grafts in Facial Reconstruction
IJHNS Jamie G Bizzell, Jennings R Boyette ORIGINAL ARTICLE 10.5005/jp-journals-10001-1285 1 Jamie G Bizzell, 2 Jennings R Boyette ABSTRACT Aim: The purpose of this study is to review the indications, techniques,
More informationAnatomy and Physiology. Bones, Sutures, Teeth, Processes and Foramina of the Human Skull
Anatomy and Physiology Chapter 6 DRO Bones, Sutures, Teeth, Processes and Foramina of the Human Skull Name: Period: Bones of the Human Skull Bones of the Cranium: Frontal bone: forms the forehead and the
More informationFOR THE CORRECTION OF
ORIGINAL ARTICLE Revision Otoplasty How to Manage the Disastrous Result Alexander Berghaus, MD; Thomas Braun, MD; John Martin Hempel, MD Objective: To describe how severe ear deformities after otoplasty
More informationChapter 49: Reconstructive Rhinoplasty. Fred J. Stucker, Gary Y. Shaw. Conchal Cartilage Grafting for Nasal Valve Collapse
Chapter 49: Reconstructive Rhinoplasty Fred J. Stucker, Gary Y. Shaw Nasal reconstruction differs significantly from cosmetic rhinoplasty. A cosmetic rhinoplasty attempts to create fairly subtle changes
More informationAn alternative approach for correction of constricted ears of moderate severity
British Journal of Plastic Surgery (2005) 58, 389 393 An alternative approach for correction of constricted ears of moderate severity M.M. Al-Qattan* Division of Plastic Surgery, King Saud University,
More informationAnatomic Relations Summary. Done by: Sohayyla Yasin Dababseh
Anatomic Relations Summary Done by: Sohayyla Yasin Dababseh Anatomic Relations Lecture 1 Part-1 - The medial wall of the nose is the septum. - The vestibule lies directly inside the nostrils (Nares). -
More informationThe overprojected ( Pinocchio ) tip and the ptotic
Featured Operative Technique Management of the Overprojected Nose and Ptotic Nasal Tip William E. Silver, MD, FCS; and Giancarlo F. Zuliani, MD The overprojected ( Pinocchio ) tip and the ptotic tip are
More informationAll surgery carries some uncertainty and risk
Dr Mi chel s on@mi chel s onmd. com All surgery carries some uncertainty and risk While scar revision is normally safe, there is always the possibility of complications. These may include infection, bleeding,
More informationAlexander C Vlantis. Total Laryngectomy 57
07 Total Laryngectomy Alexander C Vlantis Total Laryngectomy 57 Total Laryngectomy STEP 1 INCISION AND POSITION OF STOMA A superiorly based apron flap incision is marked with the horizontal limb placed
More informationVeins of the Face and the Neck
Veins of the Face and the Neck Facial Vein The facial vein is formed at the medial angle of the eye by the union of the supraorbital and supratrochlear veins. connected through the ophthalmic veins with
More informationNIDCD NATIONAL TEMPORAL BONE, HEARING AND BALANCE PATHOLOGY RESOURCE REGISTRY
NIDCD NATIONAL TEMPORAL BONE, HEARING AND BALANCE PATHOLOGY RESOURCE REGISTRY Guidelines for Removal of Temporal Bones for Pathological Study The temporal bones should be removed as soon as possible. If
More informationSince the first attempt at auricular reconstruction PEDIATRIC/CRANIOFACIAL. Single-Stage Autologous Ear Reconstruction for Microtia.
PEDIATRIC/CRANIOFACIAL Single-Stage Autologous Ear Reconstruction for Microtia Leila Kasrai, F.R.C.S.C., M.P.H. Alison K. Snyder-Warwick, M.D. David M. Fisher, F.R.C.S.C., F.A.C.S. Toronto, Ontario, Canada;
More informationCHAPTER 7, PART II (BONES)
Anatomy Name: CHAPTER 7, PART II (BONES) Entry #: INSTRUCTIONS: 1) READ Chapter 7, pg. 140-161. 2) Using the outline, make a note card for each underlined bone name or phrase. 3) On each note card, put
More informationLAB 12-1 HEART DISSECTION GROSS ANATOMY OF THE HEART
LAB 12-1 HEART DISSECTION GROSS ANATOMY OF THE HEART Because mammals are warm-blooded and generally very active animals, they require high metabolic rates. One major requirement of a high metabolism is
More informationBiology 218 Human Anatomy. Adapted from Martini Human Anatomy 7th ed. Chapter 6 The Skeletal System: Axial Division
Adapted from Martini Human Anatomy 7th ed. Chapter 6 The Skeletal System: Axial Division Introduction The axial skeleton: Composed of bones along the central axis of the body Divided into three regions:
More informationONE out of every eight hundred children in the United States is born with
REPAIR OF THE CLEFT LIP ROBIN ANDERSON, M.D. Department of Plastic Surgery ONE out of every eight hundred children in the United States is born with a cleft lip, a cleft palate, or both. Within this group
More informationScapular & Parascapular flap FLAP TERRITORY ANATOMY. is normally accompanied by two venae comitantes.
Scapular & Parascapular flap FLAP TERRITORY This is a composite flap that is situated over the scapula with various incisional arrangements. It can be harvested as a skin and subcutaneous tissue flap,
More informationORIGINAL ARTICLE Correlation between projection of the ear, the inferior crus, and the antihelical body: analysis based on computed tomography
ORIGINAL ARTICLE Correlation between projection of the ear, the inferior crus, and the antihelical body: analysis based on computed tomography (brief title): Ear projection and inferior crus HIROSHI SHINOHARA
More informationThe Neck the lower margin of the mandible above the suprasternal notch and the upper border of the clavicle
The Neck is the region of the body that lies between the lower margin of the mandible above and the suprasternal notch and the upper border of the clavicle below Nerves of the neck Cervical Plexus Is formed
More information