Background:The retroauricular tissues have been used for a long time for ear reconstruction, but the anatomical bases of flaps of this region are not completely clear. The aim of this study was to estimate blood supply area and location of this on the skin and fascia retroauricular dependent of posterior auricular artery (PAA) to establish safe margins to design flaps for auricular reconstruction.Methods:Dissection under magnification (×3.5) of the PAA through a cervical approach; injection of methylmethacrylate in the PAA as a staining technique; retroauricular approach to identify the territory of irrigation of PAA in the retroauricular skin and fascia; measuring and location of the stained area; and report of 2 cases of ear reconstruction with fasciocutaneous and fascia flaps based on PAA, designed according to the anatomical study.Results:In a sample of 10 cadaveric specimens, the PAA irrigated an area of the retroauricular skin and fascia of 10.7 cm length × 7.07 cm wide equivalent to 60.44 cm2 (95% CI, 37.07–83.81), with a distribution posterior to external auditory canal of 7.15 cm (95% CI, 5.53–8.77) and posterior to the helix insertion of 6.12 cm (95% CI, 4.89–7.35). In the 2 patients treated with fascia and fasciocutaneous flaps based on the PAA, these were good options for ear reconstruction.Conclusion:A fascia or fasciocutaneous flap from the retroauricular region based on PAA within the dimensions and location found in this study will be a safe option for reconstruction of the ear.
Pediatric facial fractures are uncommon, especially orbital fractures, which can be unnoticed in 30% of the cases. Any delay regarding either diagnosis or treatment implies the risk of long-term sequels. Limited data exists concerning craniofacial fractures in children, especially the ones compromising the orbital substructures. Distribution varies upon several series; however, there is inexistence of literature regarding specific and isolated fractures of the lacrimal skeletal system. Injuries to the medial orbital wall canthal tendon can lead to disinsertion/ruptures of the medial canthal tendon. A canthopexy is the most indicated treatment to restore the original canthal position and the re-establishment of palpebral normal function. This paper's purpose is to present an isolated posterior lacrimal crest fracture/avulsion case secondary to a high-energy trauma involving a 6-year-old girl and present an exhaust literature revision.
We describe a case of left homolateral complete cleft lip/palate associated with a congenital left maxillary teratoma and left orbital teratoma. The patient required step-by-step reconstruction that first included resection of the 2 teratomas in consideration of cleft lip repair, cleft palate repair, and correction of the left periorbital anomalies, which were performed later. After performing all the necessary procedures, complete resection of the tumors and correction of the anomalies associated with the lip, palate, and left orbit were achieved. The rare occurrence of this type of association and its devastating effect on a patient's growth, aesthetics, and function of craniofacial elements require careful surgical planning to enable restoration of the anatomy and proper functional development. At follow-up, the patient showed significant improvement in the functional and aesthetic aspects.
This article describes 2 patients with complex facial asymmetry characterized by hemiarhinia, microorbitism, palpebral fissure shortening, ipsilateral canthal dystopia, maxillomandibular hypoplasia, and occlusal plane inclination. These unusual phenotypes are part of the oculoauriculo-vertebral spectrum. Their devastating functional, esthetic, and psychologic effects demand the use of different craniofacial surgery techniques, in order to alleviate the profound impact of these pathologies. Initial skeletal balance through bimaxillary distraction osteogenesis and orbital expansion sets the basis for further reconstruction of the nose and periorbital area with local tissue.
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