External auditory meatus and/or conchal bowl reconstruction with postauricular island flap in patients with Basal Cell Carcinoma or Squamous Cell Carcinoma

AIMS

Presenting our clinical experience with the postauricular island flap (pif) and estimation of the results following partial external auditory canal (eac) and/or auricular conchal bowl reconstructions with the pif in patients after carcinoma resections.

METHODS

We have analyzed postoperative results of 19 patients after auricular conchal bowl (11), or auricular conchal bowl and eac (8) reconstructions with pif, following malignant tumor resections, between 2000-2015. The patients were followed-up and evaluated in respect of early and long-term results after surgical treatment considering plastic surgeon's and patient's opinion.

RESULTS

The cancers were completely excised in all patients, and there were no recurrences within at least 2 years of follow-up. The observed complications after reconstructions comprised venous congestion in five cases (26.3 %), pinning of the operated ear in four patients (21 %), prominent earlobe in three (15.8 %), and eac constriction in three cases (15.8 %). Postoperative result was very good in all cases (both in the opinion of plastic surgeon and patients), except patients with pinning of the operated ear, prominent earlobe (moderately satisfied). Conclusions 1. Combined operations involving postauricular island flap reconstructions after partial (external auditory meatus and/or auricular conchal bowl) resections allowed for complete removal of malignant tumors with no evidence of recurrence, and also preservation of proper conchal shape in the reconstructed ear. 2. Retroauricular approach in cases with cancer involvement of the external auditory meatus allowed for proper visualization and estimation of lesions extent, as well as adequate surgical access.

Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae

BACKGROUND

Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem.

OBJECTIVES

The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD.

METHODS

Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation.

RESULTS

Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences.

CONCLUSION

In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.

Comparison of objective and subjective evaluation of breast symmetrization results in patients with Poland syndrome

Introduction: There are many methods of analyzing the appearance of the breasts, but most of them are based on the patient’s subjective assessment or on the opinion of a specialist panel. Anthropometric measurements enable objective breast evaluation. The aim of the study was to compare the objective and subjective evaluation of aesthetic results of breast symmetrization in patients with Poland syndrome. Material and methods: The analysis of the results of the treatment was performed in 7 patients treated surgically due to unilateral breast underdevelopment in Poland syndrome. In the postoperative assessment, the following features were considered: 1 - breast volume, symmetry of: 2 – nipple areola-complexes (NAC), 3 - inframammary folds (IMF), 4 – upper poles (UP). The subjective assessment performed by the patient included each of the listed features and the overall satisfaction with the results of symmetrization on the 10-point Likert scale. Then, objective metric breast analysis was performed. Results: Overall assessment of postoperative breast asymmetry (mean 8.1) indicates a high level of patients’ satisfaction with breasts symmetrization. An objective analysis showed that the average breasts’ difference in volume was about 36 cc and the difference in NAC location was about 1.2 cm. Conclusion: 3D imaging is helpful in planning breast symmetrization procedures, especially in breast prostheses’ selection. Combination of this method with clinical experience results in good postoperative effects.

Do body build and composition influence striae distensae occurrence and visibility in women?

BACKGROUND

Striae have been reported to be one of the most common skin changes and a commonly encountered esthetic problem.

OBJECTIVES

To analyze risk factors of striae not associated with pregnancy and verify if body build and composition influence striae distensae (SD) occurrence and visibility.

METHODS

Eighty female students (40 with striae (the mean age 23.9 years, SD 2.05 years) and 40 without these lesions (24.7 years, SD 6.2 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors of SD. Body build and composition were examined using Tanita SC-331S Body Composition Analyzer.

RESULTS

Women without striae more often reported a history of intended weight loss (P < .0001), less frequently had a history of contraceptives intake (P < .001) and more often their family history of striae was negative or unknown (P = .01). Multivariate analysis including body build and composition parameters indicated BMI as risk factor of SD (P = .021; OR =1.155, 95% CI 1.006; 1.325).

CONCLUSIONS

History of contraceptives intake and a family history of striae are risk factors of SD occurrence, while weight loss can reduce the risk of these lesions. BMI appeared to be the risk factor of striae visibility, especially in abdomen, but not on the buttocks. Further clinical researches are needed to examine the pathophysiology of this condition and to inform patients about the possibility to reduce the risk of striae occurrence.

Are animal-related injuries in rural areas a social problem? A survey from Poland

OBJECTIVE

The aim of this study was to analyze the mechanisms of animal-related injuries in Polish rural areas, and to evaluate the effects of such injuries on subjects' health and social life.

MATERIAL AND METHODS

Data concerning animal-related injuries were collected from 102 patients (45 females and 57 males, mean age 45.01±11.4 years) on the basis of a questionnaire. The study was conducted in the rural area of central Poland. Moreover, to assess the severity of injuries to the head and neck region, the Facial Injury Severity Scale (FISS) was applied.

RESULTS

The most commonly affected body areas are the upper and lower limbs, which explains the fact that most subjects do not recognize the injury-related deformity as an aesthetic defect.Statistical correlations were observed in several aspects, amongst others: - women were significantly more likely than men to consider undergoing surgical procedures to eliminate/reduce post-traumatic deformities and scars (p<0.05); - injury-related deterioration in appearance resulted in limitations of patients' social life (p<0.0001).

Digit ratio (2D:4D) and postoperative pain perception

BACKGROUNDS

It has not been established whether sex differences in pain perception are influenced by prenatal sex hormones. Digit ratio as an indicator of prenatal hormone exposure can be used as a simple measure of the influence of prenatal hormones on pain sensitivity or perception in adulthood.

OBJECTIVE

The aim of this study was to determine a correlation between the 2D:4D ratio and pain perception in the postoperative period after rhinoplasty.

METHOD

A prospective cohort study of 100 patients (50 women of the mean age of 30.74±8.09years and 50 men of the mean age of 30.98±10.86years) who underwent posttraumatic rhinoplasty due to the nose trauma in Plastic, Reconstructive and Aesthetic Surgery Clinic. The following measurements were taken the day before a surgery: body height, waist and hip circumference, II and IV digits' lengths and body weight. All subjects filled in a questionnaire including 0-10-point VAS scales to assess postoperative pain 1h after an operation (AO), 6h AO, 12h AO, 24h AO and 48h AO.

RESULTS

Women with low 2D:4D reported significantly more pain 1h after an operation than women with high 2D:4D. Similar correlation was observed for low 2D:4D in women 48h AO. In men, low 2D:4D was associated with lower postoperative pain 12h AO (p=0.029).

CONCLUSION

In conclusion, we showed that low 2D:4D in women was associated with high postoperative pain, and low right 2D:4D in men was associated with low postoperative pain. This may suggest that intrauterine estrogen exposure makes women more resistant to pain.

Results of Auricular Conchal Bowl Reconstructions Following Cancer Resections with Postauricular Island Flap

The aim of the study was to present our experience with the postauricular island flap (pif) and clinical evaluation of the results following auricular conchal bowl reconstructions with the pif in patients after carcinoma resections.

MATERIAL AND METHODS

We analyzed results in 13 patients who underwent auricular conchal bowl reconstructions with pif following malignant tumor resection between 2000-2013. The patients were followed-up. We estimated early and long-term results after surgery including plastic surgeon's and patient's opinion.

RESULTS

The malignancies were completely excised in all patients, and there were no recurrences within 2 years of follow-up. Observed complications of conchal bowl reconstructions were venous congestion in two cases (15.3 %), and pinning of the operated ear in two patients (15.3%). Postoperative result was very good in 11 cases (both in the opinion of plastic surgeon and patients), whereas in two patients with pinning of the operated ear was satisfied.

CONCLUSIONS

1. Postauricular island flap reconstructions after auricular conchal bowl resections allowed for complete removal of malignant tumors with no evidence of recurrence, and also preserved proper conchal shape in the reconstructed ear. 2. Reconstructions of auricular conchal bowl with the postauricular island flap resulted in very good postoperative results, which confirms the efficiency of the applied technique. 3. Reconstructive surgery with postauricular island flap of individuals with partial auricular conchal bowl defects contributed to postoperative satisfaction in both patients and doctors' estimations.

Evaluation of the complex treatment for congenital blepharoptosis

OBJECTIVE

To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders.

METHODS

Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed.

RESULTS

Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients.

CONCLUSIONS

Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.

Nose underdevelopment - etiology, diagnosis and treatment

INTRODUCTION

Clinical picture of nose underdevelopment is very polymorphic. It can exist from partial disturbances of nose development, through unilateral hypoplasia of the nose to congenital absence of the nose (arhinia).

AIM

The aim of this study is to present own experience of treatment of patients with different types of nose underdevelopment.

MATERIAL AND METHOD

Plastic Surgery Out-patient Clinic has under care 13 patients with isolated nose underdevelopment. In this group there were 5 men and 8 women. The patients' age, at the time of first consultation, was from 6 months to 19 years.

RESULTS

The most frequent type of defect in analyzed group was congenital saddle nose (6 persons). Three patients were diagnosed with absence of the quadrilateral cartilage of the nasal septum, two with isolated underdevelopment of the alar cartilage and one with bilateral underdevelopment of the nasal bones. The most advanced disturbance was observed in 6 months old girl, who had unilateral hypoplasia of the nose. Nine patients were surgically treated.

CONCLUSIONS

Nose underdevelopment is rare congenital anomaly and is characterized by variable clinical picture. Medical history and precise physical examination are fundamental in proper diagnosis. Disturbances in nose development can lead to serious functional consequences and require individual plan of treatment.

Penetrating trauma of the face and facial skeleton - a case series of six patients

Penetrating traumas of the facial skeleton are relatively rare; however, they can be dangerous and even life-threatening. The epidemiology of facial skeleton trauma is diverse and depends on the affected region, age, and the kind of foreign body that caused the injury. In Poland, the most common cause of penetrating traumas are accidents and assaults, and only rarely accidents are related to improper use of firecrackers or fireworks. The aim of this study is to present a literature review and our own experience with penetrating traumas of the face and the facial part of the cranium. Six cases with severe wounds and fractures of the facial skeleton were treated between the years 2000 and 2012 in our department. The applied treatment methods depended mainly on the general condition of the patients. In all cases, we achieved acceptable functional and aesthetic outcomes.

Long-Term Results of Partial Nasal Reconstructions with Indian Flap

The aim of the study was clinical evaluation of the results following reconstruction with the Indian flap in patients with partial nasal defects, and estimation of their postoperative life quality in functional and aesthetic aspects.

MATERIAL AND METHODS

We analyzed results in 38 patients who underwent reconstructions with the Indian flap in the Department of Plastic, Reconstructive and Aesthetic Surgery between years 2000‑2013. The patients were followed-up for at least 2 years. We estimated their life quality in aesthetic and functional aspects after surgery.

RESULTS

Observed complications of nasal reconstruction were alar asymmetry in 6 patients (15.8%), nasal obstruction in 6 persons (15.8%), wide postoperative scar in 4 (10.5%), and non-aesthetic appearance of the donor site in two cases (5.3%). Estimation of life quality post surgery in the examined group of patients revealed significant postoperative improvement in both functional and aesthetic aspects.

CONCLUSIONS

1. Reconstructions of nasal defects with the Indian flap resulted in satisfactory longterm postoperative results, which confirms the efficiency of the applied technique. 2. Reconstructive surgery with Indian flap of individuals with partial nasal defects contributed to significant postoperative improvement in both functional and aesthetic aspects and their life quality.

Satisfaction with Life and Social Factors in Decision-Making Proces on Breast Reconstruction in Women after Mastectomy

The aim of the study was to analyse the correlation between satisfaction with life in women after mastectomy and motivation to undergo breast reconstruction, compared to women who after breast amputation did not decide to undergo reconstructive treatment.

MATERIAL AND METHODS

Comparative analysis comprised patients after mastectomy, who decided on breast reconstruction (40) and those who did not undergo reconstructive surgery (40). The study was conducted in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz and Department of Oncological surgery and Breast Diseases ICZMP, Łódź, between 2013-2015. In the study the question whether higher satisfaction with life prompts decision on breast reconstruction was investigated. The Satisfaction with Life Scale (SWLS) was used, as well as an original questionnaire. The correlations between statistical parameters were evaluated using the chi-square test.

RESULTS

We have demonstrated differences between the level of satisfaction with life in patients who decided to undergo breast reconstruction and those who did not choose reconstructive surgery. The discrepancies may reflect differences in the system of values and level of satisfaction with life before reconstructive treatment and also point to potential effect of these factors on the decision to undergo surgery.

CONCLUSIONS

1. Differences in cognitive structures between 'Amazons' determine the decision on reconstructive treatment. 2. Transfer of information between the therapeutic team and women after mastectomy is not satisfactory. 3. Higher level of satisfaction with life has a positive effect on the decision of breast reconstruction.

Personality Traits and Decision on Breast Reconstruction in Women after Mastectomy

The aim of the study was evaluation of the correlation between selected personality traits in women after mastectomy and their decision on breast reconstruction.

MATERIAL AND METHODS

The study was conducted between 2013‑2015, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, and Department of Oncological and Breast Surgery, CZMP. Comparative analysis comprised 40 patients, in whom mastectomy and breast reconstruction was done, and 40 women after breast amputation, who did not undergo reconstructive surgery. Basing on self-constructed questionnaire, five features of personality were evaluated in these women: pursue of success in life, ability to motivate others, openness to other people, impact of belonging to a social group on sense of security and the importance of opinion of others about the respondent. Apart from the questionnaire, in both groups of women a psychologic tool was used (SUPIN S30 and C30 tests) to determine the intensity of positive and negative emotions.

RESULTS

Women who did not choose the reconstructive option were statistically significantly older at mastectomy than women who underwent breast reconstruction. There were statistically significant differences between both groups in response to question on being open to other people and value of other people's opinion. The differences in responses to question on the impact of belonging to a social group on personal sense of safety were hardly statistically significant. In psychometric studies there were significant differences in responses to SUPIN C30 test for negative emotions and S-30 for positive emotions. The level of negative emotions - feature of group A was in 47.5% in the range of high scores and in 47.5% within low and low-average scores. Among women from group B 57.5% had high scores, while 37.5% low and average scores. There were significant differences in the results of positive emotions evaluation in S-30. Women who did not undergo breast reconstruction usually had high scores, while those who decided on reconstructive surgery usually had low scores and low-high scores.

CONCLUSIONS

1. The decision on breast reconstruction after mastectomy is connected with personality features of patients. Introvert women, who base their self-opinion on opinion of others and their sense of security on belonging to a social group, rarely choose to undergo breast reconstruction. 2. Younger patients after mastectomy more frequently choose the breast reconstructive option. 3. A special algorithm of medical and psychological care in patients after mastectomy should be created to improve their further quality of life.

Evaluation of the complex treatment for congenital blepharoptosis

Objective

To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders.

Methods

Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed.

Results

Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients

Conclusions

Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.

Classification of congenital nasal deformities: a proposal to amend the existing classification

Congenital nasal anomalies are rare malformations with a broad spectrum of defects. The only existing classification strictly relating to nasal anomalies was presented by Losee et al. (Plast Reconstr Surg 113(2):676-689, 2004). The aim of this paper is to propose some suggestions, based on our current knowledge and experience gained by treating our patients in the clinic, in creating a specification of patients with congenital nasal anomalies. All patients with congenital nose defects treated in our health center were selected for this study. The research was retrospective and included years from 1995 to 2015. Nasal anomaly associated with cleft lip and palate was excluded. Patients were classified into four categories of congenital nasal anomalies, according to Losee et al.

CLASSIFICATION

In the period of 20 years, 191 patients with congenital nasal anomalies were treated in our health center. Type 1 defects were found in 124 patients, type 2 in 15, type 3 in 32 and type 4 in 20 patients. The nasal defect accompanying craniofacial syndrome is the most common type of nose malformation. The nose cleft is not always a part of craniofacial clefts; isolated forms of such malformations can occur. Vascular anomalies, due to different etiology, categorization and treatment, should not be recognized as nasal malformation.

Evaluation of the Surgical Treatment for Congenital Blepharoptosis Using Mustarde's Modified Method

The aim of the study was evaluation of the results of surgical treatment of congenital blepharoptosis (CBP) using Mustarde's modified method.

MATERIAL AND METHODS

Between 2005-2014 forty eight children with CBP underwent surgical correction of CBP by Mustarde's modified method. Basing on the results of ophthalmic and orthoptic examination, and standard measurements, we estimated postoperative difference in the position and symmetry of the upper eyelids, and postoperative complications in our patients.

RESULTS

Very good results were obtained in all cases with mild, in 89.5% with moderate, and in 85.7% with severe unilateral CBP after correction by Mustarde's modified method. Lagophthalmos was seen in 6.25%, and undercorrection in 12.5% of cases.

CONCLUSIONS

1. Mustarde's modified method allows for obtaining very good functional and aesthetic results in CBP patients. 2. Mustarde's modified method is a valuable supplemental surgical technique in CBP, and contributes to a low rate and small range of lagophthalmos.

Long-Term Results of Incisional Hernia Repair with Concomitant Abdominoplasty in Postbariatric Patients

The aim of the study was evaluation of long-term results after simultaneous incisional hernia repair and abdominoplasty in patients following RYGB (Roux-en-Y Gastric By-pass) and estimation of quality of life before and after this complex operation.

MATERIAL AND METHODS

We analyzed long-term results in 18 patients who underwent complex anterior abdominal wall surgery after massive weight loss, following previous RYGB. The patients were followed-up for at least 8 years. We compared the quality of life before and after hernia repair combined with abdominoplasty.

RESULTS

Observed wide postoperative scar in 4 persons, permanent dysesthesia in one, and flaccidity of the anterior abdominal wall in three cases. Estimation of the quality of life revealed significant improvement in functional, aesthetic and psychological aspects after complex surgery.

CONCLUSIONS

1. Simultaneous incisional hernia repair and abdominoplasty resulted in satisfactory long-term postoperative results, which confirms the efficiency of complex anterior abdominal wall surgery in patients following RYGB after massive weight loss. 2. Surgery in patients afflicted with disfigurements of the anterior abdominal wall contributed to significant improvement in their life quality in functional, aesthetic and psychological aspects, as compared with preoperative estimations. 3. All persons confirmed positive influence of abdominal wall surgery on their possibility to take challenges in life, and fulfill plans. 4. Surgery of the anterior abdominal wall deformities, if needed after massive weight loss, should become an integral part of complex multidisciplinary treatment in postbariatric individuals.

Photographic Documentation in Plastic Surgeon's Practice

The aim of the study was to analyze practices of clinical photographic documentation management among plastic surgeons in Poland as well as to gain their opinion about the characteristics of "ideal" software for images archiving.

MATERIAL AND METHODS

The on-line survey link was send (via e-mail) to all members of Polish Society of Plastic, Reconstructive and Aesthetic Surgery. From 187 members, 86 subjects (47.5%, 54 men and 32 women, of the mean age 40.8 years ± 10.6 years) filled in the on-line questionnaire, which constitutes a representative sample of plastic surgeons practicing in Poland.

RESULTS

The study showed that only 7% of plastic surgeons use IT applications dedicated to archiving photographs. Instead, more than half of them store photos in ordered folders on computers. The majority of respondents (89.3%) are interested in using a dedicated computer application to archive photographic documentation. The most important features, which an application of this type should have are (265 answers): quick search (26%), easy to use (24%), quick data entry (22%), data security (15%), an ability to print selected data (7%), availability only to authorized employees of the unit (5%).

CONCLUSIONS

Cooperation of health care providers with informatics may lead to the conceptualization of a program fulfilling the requirements of specific medical groups. On the basis of the questionnaire study we have collected the data necessary to create the concept of the unique software that would be useful for clinical practice of plastic surgeons as well for other specialists dealing with photographic documentation.

Prevalence of cleft lip and/or palate in children from Lodz between years 1981-2010

Congenital malformations constitute a serious problem of both medical and social nature. Cleft lip and/or palate represent the most common congenital anomaly of the face that is why it is essential to know the real frequency of the described phenomenon. The aim of this paper is to determine the frequency of cleft lip and/or palate and the types of malformations that occurred in Lodz city between the years 1981-2010. Our clinic has been carrying on the studies concerning the incidence of cleft lip and/or palate since 1981. The Polish Registry of Congenital Malformations has been operating in Poland since 1 April 1997. The team has managed to obtain data, from the Registry, concerning the total number of all live born infants and the number of children with cleft lip and/or palate, who were born in Lodz, between 1998 and 2010. In years 1981-2010, 319 children, in 210 952 live born infants, were born with cleft lip and/or palate in Lodz. The isolated cleft palate was observed more frequently in girls and the unilateral cleft of lip and palate in boys. In all three decades palate clefts are more common whereas bilateral lip, alveolus and palate clefts are more infrequent. A small tendency to decrease in actual cleft lip and/or palate frequency among children, in the period of 30 years, is observed in Lodz. Over the years it has still been observed that the isolated cleft palate is the most common type of defect.

Skin color parameters and Fitzpatrick phototypes in estimating the risk of skin cancer: A case-control study in the Polish population

BACKGROUND

Light skin pigmentation is a known risk factor for skin cancer.

OBJECTIVE

Skin color parameters and Fitzpatrick phototypes were evaluated in terms of their usefulness in predicting the risk of skin cancer.

METHODS

A case-control study involved 133 individuals with skin cancer (100 with basal cell carcinoma, 21 with squamous cell carcinoma, 12 with melanoma) and 156 healthy individuals. All of them had skin phototype determined and spectrophotometric skin color measurements were done on the inner surfaces of their arms and on the buttock. Using those data, prediction models were built and subjected to 17-fold stratified cross-validation.

RESULTS

A model, based on skin phototypes, was characterized by area under the receiver operating characteristic curve = 0.576 and exhibited a lower predictive power than the models, which were mostly based on spectrophotometric variables describing pigmentation levels. The best predictors of skin cancer were R coordinate of RGB color space (area under the receiver operating characteristic curve 0.687) and melanin index (area under the receiver operating characteristic curve 0.683) for skin on the buttock.

LIMITATIONS

A small number of patients were studied. Models were not externally validated.

CONCLUSIONS

Skin color parameters are more accurate predictors of skin cancer occurrence than skin phototypes. Spectrophotometry is a quick, easy, and affordable method offering relatively good predictive power.

Results of auricular helical rim reconstruction with post-auricular tube flap

The aim of the study was to present our experience with post-auricular tube flap (ptf) and clinical evaluation of the results following auricular helical rim reconstruction with this technique in patients after trauma.

MATERIAL AND METHODS

We analyzed the results in 12 patients who underwent three-staged auricular helical rim reconstruction with ptf following trauma in the Department of Plastic, Reconstructive and Aesthetic Surgery between 2005-2014. The patients were followed-up for at least 1 year. We evaluated early and long-term results after surgery including plastic surgeon's and patient's opinion.

RESULTS

Postoperative results were satisfactory (very good) in 10 cases, both in the opinion of the plastic surgeon and patients. Transient venous congestion of the helix occurred in two cases (16.6%). This complication did not have any influence on estimation of the results after surgery. Delayed wound healing in the poles of the reconstructed helical edge, as well as non-aesthetic helical scars with imperfections of helical rim, were seen in another two patients (16.6%).

CONCLUSIONS

1. Post-auricular tube flap reconstructions after helical rim trauma allowed for complete restoration of contour, size and orientation of the helix and the whole operated ear, which confirms the efficiency of the applied technique. 2. Reconstructive surgery with post-auricular tube flap in patients with auricular helical rim defects contributed to postoperative satisfaction in both patients and doctors' estimations.

Rare Facial Clefts

In 1976 Dr. Paul Tessier described numeric classification for rare craniofacial clefts. He first emphasized that a fissure of the soft tissue corresponds, as a general rule, to a cleft of the bony structure. The classification, easy to understand, became widely accepted because the recording of the malformations was simple and facilitated communication between observers. The aim of this study was to present our own experience with treatment of patients with rare facial clefts.

MATERIAL AND METHODS

Our Department has 11 patients with rare craniofacial clefts under its care. This group includes 8 boys and 3 girls. The patients aged from 2 months to 18 years at the time of the first consultation.

RESULTS

In two patients the cleft was median, in seven patients it was one-sided and in two--bilateral. The most common type of cleft was number 6, and the rarest were 2, 3, and 7. All patients underwent surgical treatment.

CONCLUSIONS

Atypical facial clefts are rare congenital anomalies, however because of functional and aesthetic disturbances they constitute a serious medical and therapeutic problem. Facial clefts are characterized by variable clinical presentation and require individualized treatment plan.

How Do Patients Assess Outcomes Of Treatment Of Prognathism?

The aim of the study was to analyze the results of patients' subjective self-assessment of surgical treatment of prognathism.

MATERIALS AND METHODS

The study included 35 patients who underwent extraoral vertical ramus osteotomy. Each patient responded to 12 questions contained in the questionnaire created by the authors.

RESULTS

All respondents positively assessed their appearance after surgery. In most cases they pointed out the positive impact of treatment on their self-confidence (82.9% of responses). The vast majority of respondents felt improvement in biting off food (91.4%).

CONCLUSIONS

Patients positively evaluate the outcome of surgical treatment with extraoral vertical ramus osteotomy. The subjective improvement of the facial appearance, as well as chewing and articulation functions took place after the treatment.

Surgical Correction of a Webbed-Neck Deformity in Turner'S Syndrome

Turner's syndrome occurs in approximately 1 out of every 2,000 to 2,500 live-born girls. This genetically determined pathology is characterised by multiple congenital anomalies. A typical form of this syndrome is associated with a lack of one of the sex chromosomes (karyotype 45, X). From the point of view of plastic surgery, one of the most important elements of the therapy is correction of the webbed neck deformity. The aim of the study was to present the possibilities of surgical treatment of a webbed neck of patients with Turner's syndrome and the evaluation of treatment results. In the years 2000-2012, six children with Turner's syndrome were treated because of the webbed neck deformity. The age of patients ranged from 9 to 17 years. In the case of all patients, the aim was to distribute the neck skin folds by using Z-plasty in conjunction with a shift to the back of glabrous skin flaps mobilised from the anterolateral surface of the neck. In the case of four operated patients, the folds were completely removed and a correct symmetrical outline of the neck was obtained. One patient was found to have unilateral moderate webbed neck recurrence after about 2 years of treatment. In one case, the correction was insufficient. The performed surgical procedures enabled correction of low hairline only in the lateral parts of the neck. The lower line of the scalp in the central part of the neck has remained unchanged. The lateral approach with a shift of glabrous skin flap to the back, which we performed, allows for effective reduction of the webbed neck, excision of bands of the connective tissue and correction of the low hairline on the side of the neck. Z-plasty enables an adequate extension of scars and improves the contour of the neck.

Can digit ratio (2D:4D) studies be helpful in explaining the aetiology of idiopathic gynecomastia?

BACKGROUND

Aetiology of idiopathic form of gynecomastia is unknown and it has not been established if it is related to factors present at the prenatal period or if it is caused by yet unidentified environmental conditions.

OBJECTIVE

The aim of this study is to compare digit ratio (2D:4D) in men with idiopathic gynecomastia and unaffected male and female controls from the general population.

METHODS

The study involved 250 subjects (50 men with idiopathic gynecomastia, 100 control men and 100 control women). Eight measurements were taken: body height, waist and hip circumferences, II and IV digits' lengths (right and left), and body weight, and 4 indices were calculated: BMI, WHR, and 2D:4D for the right and left hand.

RESULTS

2D:4D in men with gynecomastia ([median (I-III quartiles)]: 1.03 (1.01-1.04) for right hand and 1.03 (1.01-1.03) for left hand) was significantly different than the ratio in control men [0.97 (0.95-0.99)] for right and left hand) (p<0.0001) and similar to the ratio found in control women [1.02 (1-1.03)] for right and left hand) (p=1). Men with gynecomastia were characterized with higher values of the following variables: weight, waist and hip circumferences, BMI and WHR. Their body height was significantly greater than in women (p<0.0001) but similar to the values observed in control men (p=0.2687).

CONCLUSION

The findings presented in this study may influence the aetiology-related classification of gynecomastia and justify introducing the new group: "gynecomastia related to the prenatal sex hormones disturbances".

[Total upper and lower eyelid reconstruction using an expanded forehead flap supplied by the frontal branch of superficial temporal artery]

Eyelids form the protective eye apparatus. Loss of upper or lower eyelid can lead to infection, vision impairment or even blindness. Although there are many techniques for upper or lower eyelid reconstruction, there are only few articles to report simultaneous reconstruction of both eyelids. The aim of this study is to present a two-stage eyelid reconstruction method using the forehead flap. A 60-year-old woman was admitted to our Department with animal bite wounds in the left periorbital area. During the first operation, the eyelid defect was covered with forehead flap and in the second stage, horizontal incision was created in the flap above the eyeball to form a palpebral fissure. During this two-step surgical treatment, both eyelids of the left eye were reconstructed. The length and width of palpebral fissure were 30 mm and 14 mm, respectively. The patient was satisfied with the surgery outcomes. Reconstruction of both eyelids with forehead flap supplied by the frontal branch of the superficial temporal artery provides the elementary protection to the eyeball, enables vision preservation and offers good aesthetic result.

Dermatoscopy as a Helpful Tool in Plastic Surgeon’s Practice – A Preliminary Study

The aim of the study was to examine the utility of dermatoscopy in plastic surgeons’ practice in pigmented and non-pigmented skin lesions management.

Material and methods. The examined group consisted of 68 patients with 132 lesions (50 women and 18 men) aged from 12 to 75 years (the mean: 47.2 years ± 16.9 years), who underwent dermatoscopy. Dermatoscopic photographs were analysed according to the ABCD and 7-point scales and then, a further treatment (surgical excision, electro resection or regular follow-up and observations) was planned.

Results. The mean score of all lesions according to ABCD scale was 2.34 while in 7-point scale it was 0.62. In male and female groups the number of lesions and their ABCD and 7-point scale scores were similar (p>0.05). Histopathological examination revealed that all excised lesions were benign (compound melanocytic nevi) which corresponded with dermatoscopic evaluation.

Conclusions. Dermatoscopy seems to be helpful in surgeons’ dealing with skin lesions practise and in many cases it enables to choose less invasive technique of lesions’ removal (electro resection), which gives better aesthetic results.

[Sebaceous carcinoma of the eyelid--two case reports]

Sebaceous carcinoma of the eyelid is a very rare, slow growing, malignant tumor. Most ocular sebaceous carcinomas originate in the tarsal meibomian glands. It commonly occurs in the sixth to eighth decade of life, with preponderance for women and Asians. The upper eyelid is affected more frequently. The disease can spread directly by orbital invasion, lymphatic spread to regional lymph nodes and hematogenous spread to distant organs. Correct diagnosis of sebaceous carcinoma is often delayed due to its resemblance to a variety of benign conditions of the eyelids such as chalasion or chronic blepharoconjunctivitis. This paper presents cases illustrating two clinical forms of sebaceous carcinoma (spreading and nodular), discusses clinical manifestation, differential diagnostic difficulties and therapy.

Variety of complications after auricle piercing

BACKGROUND

Body piercing is a known and popular method of body ornamentation. Modern body piercing includes wearing jewelry in such body areas as the helix (ear), eyebrows, nose, lips, tongue, chin, nipples, navel, and genitals. The current piercing definition does not comprise piercing of the earlobe; however, this body area is still the most common on which jewelry is worn. The aim of this research is to present a spectrum of complications after auricle piercing and to consider including earlobe piercing in the modern definition of body piercing.

METHODS

Studied group consisted of 75 patients treated in the Department of Plastic, Reconstructive, and Aesthetic Surgery (Medical University of Lodz, Lodz, Poland) for complications after auricle piercing. Age of participants ranged from 7 to 62 years (mean age 23.7 years).

RESULTS

The most common complications in the examined group were post-traumatic tearing of the earlobe and keloid formation. Of all the patients with complications after auricle piercing, most had lesions located in earlobes; it seems that complications in earlobes are significantly more common than in the helix (P < 0.001).

CONCLUSIONS

The fashion of body piercing is not safe. Complications after earlobe piercing are similar to those occurring in other sites of the auricle after piercing. Moreover, due to its prevalence, complications after earlobe piercing are statistically more common, which is why it is worth considering including earlobe piercing in the modern definition of body piercing.

[Comparison of the prevalence of cleft lip and/or palate in children in Lodz province in the period of 1996-2010 in 5-years intervals]

Clefts of lip and/or palate are the most common facial malformations. Taking into consideration complexity of this defect and necessity of multidisciplinary treatment the knowledge of actual scale of this phenomenon seems to be relevant. The aim of this paper it to describe and to compare the prevalence of cleft lip and/or palate in Lodz province in the period of 1996-2010 in 5 years intervals. MATERIAL AND METHODS; From Polish Register of Congenital Malformations we managed to obtain the data of the number of live born infants and birth of children with clefts in Lodz province in 2001-2010. On the basis of previously performed studies Department of Plastic, Reconstructive and Esthetic Surgery has the data of clefts' prevalence in Lodz province from year 1996 to 2000.

RESULTS

The mean frequency of clefts was 1,67/1000 live born infants in 1996-2000, during years 2001-2005 - 1,47/1000, and 1,13/1000 in 2006-2010.

CONCLUSIONS

Significant decrease of the prevalence of cleft lip and/or palate is observed in Lodz province in the period of 1996-2010. In boys the most frequent defect is cleft lip and palate, while in girls--isolated cleft palate.

Biometric characteristics of the pelvis in female-to-male transsexuals

The objective of the study was to evaluate the metric features of pelvises of 24 female-to-male (FtM) transsexuals as compared to control groups of 24 healthy males and 24 healthy females. The participants had their pelvises X-rayed with the same X-ray apparatus and in the same position. Seventeen measurements were taken on the basis of X-ray pictures of FtM transsexuals' pelvises and both comparison groups. Additionally, their body height was compared. The results showed that FtM transsexuals having female body height represent an intermediate size of three pelvic features and male values of five variables. In order to develop a model based on metric variables of the pelvis that would best discriminate the FtM transsexuals, the control females, and the control males, a discriminant analysis was applied. The model included four variables out of 17 metric features: the height of the pubic symphysis, the greatest pelvic breadth, the interischial distance, and the acetabular diameter. The model was found to be the best in discriminating males from females and FtM transsexuals, but considerably less effective in discriminating transsexuals from the two control groups. The results demonstrate that a number of FtM transsexuals' pelvic measurements reveal "masculinization," which confirms current results demonstrating a shift in the somatometric traits of transsexual females towards male traits. A discriminant analysis based only on pelvic metric features shows some differences between the size of the pelvis and chromosomal sex in FtM transsexuals, which might indicate a biological basis for gender identity disorder.

[Image of female-to-male transsexuals in Polish society]

AIM

The aim of the study was to determine the image of female-to-male transsexuals (FtM) in the opinion of women and men. Methods. The questionnaire studies were carried out in a group of 300 students. Respondents answered questions concerning their age, sex, birthplace and the questions related to different aspects of female-to-male transsexuals' life (their childhood, occupational preferences, social and sexual relationships).

RESULTS

The results showed that the image of FtM transsexuals created in the male and female group varies because of the lack of opinion expressed more frequently by male students.

CONCLUSIONS

(1) Students' opinion on psychical, social and sexual life of transsexuals indicates a lack of understanding of their problems. (2) Men do not report much opinion about FtM transsexuals' different aspects of lives which may result from their insufficient knowledge and little interest in the topic of transsexualism.

[Evaluation of the results of surgical treatment for protruding ears]

INTRODUCTION

Protruding ears are the most common congenital deformity of external ear. Defect usually occurs bilaterally and it may be asymmetric. Popular term for prominent ears concur to psychological problems, especially for children. The optimal time for prominent ears correction fells between 10-14-years-old. There is a lot of techniques for surgical treatment of patients with prominent ears.

AIM

Clinical evaluation of postoperative results in patients afflicted with prominent ears.

MATERIAL AND METHODS

A retrospective review of 61 females and 15 males aged from 11 to 39, who underwent surgical corrections of protruding ears by Mustarde method. At the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, between 2005-2010 was conducted. We estimated early and distant postoperative results in studied group.

RESULTS

Aesthetic results of surgery were good and very good in patients (97.4%). Postoperatively wound bleeding was observed in 2 cases (2.6%) and in 1 case (1.3%) wound infection occurred. Long-lasting complications like keloids occurred in 2 patients (2.6%).

CONCLUSIONS

1. Surgical correction of protruding ears does not burden with any significant complications. 2. Surgery treatment by Mustarde method gives satisfactory aesthetic results. 3. We confirmed favourable influence of corrected ears on patent's mental status. 4. Severity of protruding ears, coexisting anomaly of external ears together with age of the patient determine individual surgical treatment.

[Long-term aesthetic results of rhinoplasty in congenital nose deformities--comparison of surgeon's and patient's evaluation]

INTRODUCTION

Nose as the most projected face structure focuses the biggest people's attention. Nasal localization causes that even its small deformities are visible and subjected to different opinions. Rhinoplasty is one of the most common procedures in plastic surgery and at the same time one of the most difficult operation in facial surgery. The aim of this research is to analyze the long-term aesthetic results of rhinoplasty in congenital nose deformities in evaluation performed by surgeon and patient.

MATERIAL AND METHOD

The study was carried out in the group of 50 patients operated on in the Department of Plastic, Reconstructive and Aesthetic Surgery due to congenital nose deformity. The group consisted of 38 women and 12 men, aged from 27 to 56 years. Long-term aesthetic results' evaluation was performed on the basis of clinical examination done by doctor and questionnaire filled in by patients and surgeon.

RESULTS

Evaluation of long-term results after aesthetic rhinoplasty in patients' opinion qualified the effects as very good in 70%. In surgeon's opinion such a result was obtained in 62% of patients. Satisfactory result of performed operation was marked by 92% of patients while surgeon qualified results as a satisfactory in the group of 88%. Reoperation was considered by 12% of patients and doctor such a necessity reflected in 10%.

CONCLUSIONS

Satisfactory results of rhinoplasty in congenital nose deformities are possible to obtain while taking the degree and type of deformity into consideration and choosing proper surgical method. Surgical procedures in congenital nose deformities give good aesthetic results in patients' and as well as surgeon's opinions. Doctor evaluates surgical results in more critical way.

Tattooing and body piercing--what motivates you to do it?

BACKGROUND

Body ornamentation is becoming more and more popular, especially among young people.

AIMS

To establish the sociodemographic characteristics of people with tattoos or body piercing and to analyze the motivations for body ornamentation.

METHODS

The questionnaire studies were undertaken in Lodz--one of the largest cities in Poland. The data was collected from a group of 968 people, 476 of whom had a piercing and 492 a permanent tattoo.

RESULTS

Statistical analysis revealed that in the group of people with a tattoo, 36.8% were female and 63.2% were male. Contrary proportions were noted among people with a piercing: 78.8% female and 21.2% male.

CONCLUSIONS

Body piercing is significantly more popular among women while tattooing is more popular in men. Among adolescents, body piercing is performed considerably earlier than tattooing. The main reasons for body ornamenting in the Polish population are the desire to enhance one's individuality and the need to increase sexual attractiveness.

[Female-to-male transsexual's stereotype among university men and women on the basis of semantic differential]

AIM

The aim of this study is to determine female-to-male transsexual's (FtM) stereotypes created in female and male university students and comparing them in the analysed groups.

METHOD

300 university students (from the Technical University of Łódź, University of Łódź, Medical University of Łódź) received a questionnaire with 10 pairs of the opposite meaning adjectives (good-bad, weak-strong, fast-slow, ugly-pretty, fat-thin, suppressed-loud, clever-stupid, light-heavy, active-passive, kind-cruel) related to a notion 'female -to-male transsexual' and placed on the extremes of the 7-point scales. The respondents also described each adjective as positive, negative or neutral.

RESULTS

For most of the adjectives' pairs (fast-slow, ugly-pretty, fat-thin, suppressed-loud, clever-stupid, light-heavy and, in men's answers also good-bad and kind-cruel) the students placed FtM transsexual in the middle of the scales (the median was 4). Women significantly more often than men placed FtM transsexual closer to the adjectives "good", "pretty" and "kind", also they assessed the FtM transsexual more often as being "clever".

CONCLUSIONS

1. The Female-to-male transsexual is not perceived stereotypically among university students. 2. Men created more negative female-to-male transsexuals' image than women.

Are we aware of all complications following body piercing procedures?

BACKGROUND

The popularity of body piercing procedures is increasing around the world. Body piercing, depending on the age and social group, is believed to involve up to 51% of the general population. Complications following piercing procedures are variable.

OBJECTIVE

To present an unusual complication after lower lip piercing - embedding of a stud into the lip - and to determine why it occurred from the side of the mucous membrane and not from the side of the skin.

METHODS

A 21-year-old man presented to the plastic surgery outpatient clinic with embedding of piercing into the lower lip. Results In lateral X-ray film, a metallic shadow was observed in the area of the oral soft tissues. The length of the stick was only 8 mm. In this patient, a stick that was too short in relation to the thickness of the lip was used. In this situation, the ends of the stud pressed too strongly on the surrounding tissues. Consequently, this may have caused necrosis of the mucous membrane and embedding of the stud into the lip.

CONCLUSION

The observations described confirm a higher susceptibility to mechanical pressure of the mucous membrane than of the skin. An increasing rate of complications after body piercing reflects a lack of medical knowledge in individuals performing such procedures.

The metric features of teeth in female-to-male transsexuals

The aim of the study was to evaluate the odontometric characteristics of female-to-male transsexuals (FtM) in comparison to control groups of males and females. A total of 48 FtM, aged 20-28 years, were studied. For each tooth, two standard measurements were taken: the mesiodistal (MD) and the buccolingual (BL) diameter of the crown. Significant differences between males and females were found in BL measures of all maxillary teeth as well as mandibular lateral incisor and canine. Within the MD measures, the most distinguishing were maxillary and mandibular canines and the first molars. For seven teeth, there were a total of 14 comparisons of MD (half for the maxilla and half for the mandible) between the control men and women. Of these, the men had larger diameters for 12, of which four were statistically significant. There were also a total of 14 comparisons of BL diameter; of these, the men had larger diameters for 13, of which nine were statistically significant. For seven teeth, there were a total of 14 comparisons of MD between the control men and the FtM. Of these, the men had larger diameters for 12, of which seven were statistically significant. There were also 14 comparisons of BL; of these, the men had larger diameters for 10, of which six were statistically significant. For seven teeth, there were a total of 14 comparisons of MD between the control women and the FtM. Of these, the women had larger diameters for nine, of which three were statistically significant. There were also a total of 14 comparisons of BL; of these, the FtM had larger diameters for 13, of which five were statistically significant. Our study revealed that the shift of values of metric features in teeth of FtM towards males was more frequent in the more sexually dimorphic BL diameters characterized by significantly greater width of the crown of five teeth: maxillary canine, first and second molars, as well as mandibular incisors. The results showed intermediate status of female-to-male transsexuals' teeth between the males and females, which may suggest a genetic basis of transsexualism.

[Acceptance of transsexualism among university students from Lódź]

Transsexualism is one of the gender identity disorders where psychological sex is opposed to anatomical sex. This disorder leads to a discrepancy between the preferred social gender and the biological sex.

AIM

The aim of this research is to compare knowledge and attitude toward transsexualism in student's opinion, coming from three universities in Lódź.

METHOD

The questionnaire study was performed in the group of 300 students from three universities in Lódź: Technical University of Lódź, University of Lódź, Medical University of Lódź. The questionnaire contained 30 questions related to respondent's sex, birthplace, knowledge about definition and aetiology of transsexualism and also rights which students would grant to transsexuals.

RESULTS

The right definition of transsexualism was pointed by 64% of students from Medical University, 57% from Technical University and 40% from University of Lódź. The right to surgical sex change for transsexuals would be granted by 87% of students from the Medical University, 69% from the University of Lódź and 40% from the Technical University. Majority of medical students (90%) and respectively 78% and 57% from the University of Lódź and Technical University would accept a transsexual as his/her co-worker.

CONCLUSIONS

Student's knowledge about transsexualism is similar and does not differ from a foreign student's knowledge. Students from natural science studies (medicine and biology) are the most tolerant towards transsexuals.

Secular changes in the physical development of students of the Medical University of Łódź

This study analyses, using selected somatometric features, secular trend changes which have occurred over a quarter of a century in female and male students of the Medical University of Łódź. The study is based on the results of an anthropometric survey carried out among first-year students who commenced their studies in the academic years 1978/79 (240 females and 193 males), 1982/83 (347 females and 188 males), 1988/89 (178 females and 165 males) and 2003/04 (188 females and 77 males). The following features were examined in all participants in the survey: body height (B-v), the height of the lower body segment measured from a floor base to the crista iliaca at the point on the mid-axillary line (B-ic), shoulder width (a-a), intertrochanteric distance (tro-tro) and resting chest circumference. To compare average values Student's t-test was used with assumptions of equal and unequal variances. To gauge the magnitude of changes in specific features in the course of a quarter of a century a percentage difference in results was calculated for the years 2003/2004 and 1978/1979. The basis for the calculations was the initial value of a feature at the beginning of the period analysed. It was determined that in the 25-year period analysed (1978-2003) the young people commencing studies at the Medical University of Łódź exhibited an acceleration in the height of the lower body segment (B-ic) and of the intertrochanteric distance (tro-tro) and a deceleration in resting chest circumference. Additionally, an increase in shoulder width has been noted in female students; no significant intergenerational changes were noted in body height, although the last 15 years display certain symptoms of deceleration; there is an emerging tendency towards a blurring of the differences in body proportions between the sexes in the environment of the young people studying at the Medical University of Łódź.

[Developmental disturbances of medial part of face of patients with bilateral cleft lip and palate with special consideration of a nose]

Cleft is a developmental malformation, which is defined as a partial or complete lack of anatomic tissues continuity in typical areas of disorders in embryological face development. The reasons for cleft formation are not completely recognised but many hypotheses indicate both environmental and genetic factors as possible sources. The list of the cleft types is the following: cleft lip, cleft lip and alveolus, isolated cleft palate, cleft lip, alveolus and palate, and combined clefts. The malformation may occur unilateral or bilateral. According to World Health Organization cleft lip and palate is classified in the first ten of the most common developmental disorders, however the bilateral form of pathology is the least popular one.

MATERIAL AND METHODS

The aim of the study is the anthropometric measurement of a nose of children and adolescents with bilateral cleft lip, alveolus and palate in comparison with data gathered as a result of healthy people measurements. The research was conducted on 26 patients with the malformation: 12 girls and 14 boys at the age range between 7 and 18. The measurements were taken with the use of small bow and slide compasses. For the purpose of the statistical analysis we used formula for standardisation. Both, the arithmetic average and the standard deviation were estimated on the basis of research done on 30 healthy people of same sex and at proper age. Intersexual comparison of these values with the use of t-Student test was done. In order to distinguish homologues features in respect to the comparative group, one-way ANOVA and test post hoc (Duncan) were used.

RESULTS

Malformation was mainly reflected in increased width the base of the nose (sbal-sbal), width of nose (al-al) and its small prominence (sn-prn). Increase in head height values together with underdevelopment in sagittal plane was also observable. The increase of upper face height (n-sto) was recognized as stronger in case of females than males with the same malformation. The middle part of face was characterized by increase of height measurements together with sagittal plane underdevelopment.

CONCLUSIONS

It was stated that the patients with bilateral cleft lip, alveolus and palate tended to have flat and wide nose.

[Binder's syndrome--symptoms and treatment]

INTRODUCTION

The flat dorsum and short septum of the nose, enlarged nasal angle, small naso-labial angle, maxillary micrognathism, and augmented upper lip, what makes the concave midface profile are the symptoms of Binder syndrome (maxillonasal displasia). The treatment consists of nasal and maxillary correction followed by orthodontic rehabilitation.

MATERIAL AND METHODS

Five cases affected with Binder syndrome (age: 5-20 years old) were observed. Two patients were surgically treated in age 14 and 20-year-old. Nose correction was performed--elongation of skin nasal septum and bone graft to dorsum. Three patients need the orthodontic treatment of occlusal class III. There was no indication to corrective osteotomy of maxilla.

RESULTS

Five year long-term result after surgical nose correction is excellent.

CONCLUSIONS

The treatment schedule in Binder syndrome depends on the progress of the symptoms in the face occlusion. Surgical treatment can be limited only to reconstruction of the nasal dorsum and apex or additionally maxillary advancement. Grafting to the osteo-chondral scafold of the nose can be carry out from 14-year-old, and osteotomy of the nose or maxilla should be planned after 18-year-old. Every patient affected with maxillonasal displasia requires consultation and orthodontic treatment.

[Analysis of nose growth]

INTRODUCTION

During the last few decades the meaning of anthropometric methods has increased. Many medical disciplines use measurements of human body in clinical diagnosis, treatment planning and determining the best time for operation. In Polish literature current norms for nose development do not exist, however nose is particulary often the subject of corective, reconstructive and even creative operations. The aim of this review is metric description of the characteristic features and proportions of the nose in both gender among persons, who were 4, 14, 18 and 25 years old. Also we wanted to describe how advanced was development of the nose in each age group and when it finished its evolution.

MATERIAL AND METHOD

We have invastigated 240 persons (60 persons in each age group - 4, 14, 18, 25 years old). To this review we have clasiffied children and adults without any malformations or post-traumatic disfigurments of the face, including nose. We have analysed 10 anthropometric features and than we have calculated 10 proportion indexes. We have taken those measurements according to Martin's technics.

RESULTS

We have confirmed that most of features (without width of the nose basis) indicate statistically characteristic growth between 4 and 14 years old in both gender. Until 18 years old length of the nose foramens and width of the nasal septum in girls and length of the nose foramens and nasal tip protrusion in boys are growing. After 18 years old we have not seen any others essential changes. Also we have noticed that growth potential of nose parts is inverse proportional to the degree of nose development in the beginning of ontogenesis.

CONCLUSIONS

We suggest that any cosmetic operations of nose should be done after 18 years old.

[Selection of patient age for evaluation of treatment results in cleft lip and palate]

The results of the complex treatment of 125 patients with unilateral and bilateral lip and palate cleft, aged 3-5, 10-12 and 14-18 years, were evaluated by analysis of medical documentation. The study showed that the results of lip, vestibule and palate reconstruction and speech can be evaluated already at 12 years of age. However, final esthetic and functional assessment of the nose and maxillo-occlusional conditions is indicated after 14 years of age, best between 18-20 years.

[Assessment of long-term results in cleft lip and palate]

The study concerned 230 patients (175 UCLP and 55 BCLP) aged 14-20, who had been treated in the years 1972-82 in accordance with the Centre for Congenital Defects programme, at the Department of Plastic Surgery, Medical University of Lódź. The follow-up comprised: aesthetic and functional assessment of the lip, upper vestibule and nose as well as evaluation of occlusion and speech abilities (intelligibility, articulation, nasality). The assessment of lip and vestibule gave good and acceptable results in 97% of UCLP patients and in 89% of BCLP. The external nose appeared aesthetically and functionally good in 67% of UCLP and in 94% of BCLP. The defects of occlusion, mainly various forms of cross-bite, were found in 48% of UCLP, who had undergone orthodontic treatment. The maxillo-occlusal defects with no prior orthodontics were found in 63% of UCLP. Alike the defects of occlusion in untreated BCLP were most frequent. The intelligibility and articulation of speech were significantly better in patients who had undertaken the postoperational speech therapy (95%:75%). The assessment in general presented better results in UCLP patients, who had been submitted not only to surgery but also took up orthodontic treatment and speech therapy.