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Lashin R, Elshahat A. Modified Technique for Auricular Helical Rim Reconstruction in Adult Patients with Subtotal Helical Rim Defects. J Craniofac Surg 2024:00001665-990000000-01310. [PMID: 38299845 DOI: 10.1097/scs.0000000000009983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND In adults, the volume of costal cartilage is enough for reconstruction, but floating cartilage is hard, brittle, and easily broken due to calcification, in addition to being short, making it unsuitable for helical rim reconstruction in such age groups. AIM OF STUDY This study describes a novel technique in which adult patients underwent 2-stage helical rim reconstruction using the syncytium of sixth and seventh costal cartilage. MATERIAL AND METHODS A single-arm clinical trial involves 35 adults with total and subtotal helical rim defects, either congenital, post-traumatic, postburn, or postvascular malformation excision. Twenty-nine unilateral and 6 bilateral cases. The age of patients ranged between 19 and 40 years. In the period between April 2021 and April 2023. Follow-up was 6 months. RESULTS There were no technique-related complications, such as broken helix. In most cases, scars were invisible, with the normal contour of helical rim. Among the 35 patients, 19 were graded as excellent, 13 as good, and 3 as fair. In objective photographic evaluation, all patients were evaluated with high (3 or 4) ratings; the score was 3 in 19 patients and 4 in 16 patients. All patients were satisfied with the size, contour, position and details of the new helix. CONCLUSION Using the syncytium of the sixth and seventh costal cartilage to fabricate the helical rim in adult patients gives a suitable volume of cartilage graft as regards the length and width, which suits the reconstruction of the helical rim, and shows a good configuration with satisfactory surgical results.
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Affiliation(s)
- Riham Lashin
- Department of Plastic, Burn, and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Auricular Reconstruction in Adult Patients With Unprepared Congenital Microtia: A Single Institution's Experience. Ann Plast Surg 2022; 89:395-399. [PMID: 36149980 DOI: 10.1097/sap.0000000000003294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
METHODS From January 2015 to January 2021, auricular reconstruction was performed in 38 adult patients (39 ears) of congenital microtia based on autologous costal cartilage. The whole procedure was divided into 2 stages: stage I, the individualized framework carved with autologous costal cartilage was inserted into subcutaneous pocket in the mastoid region; then, the earlobe was transposed backward; and stage II, ear elevation, harvesting the retroauricular fascial flap to cover the support scaffold and closing the defect with free skin graft, was performed. RESULTS All patients successfully underwent ear reconstruction. The follow-up time ranged from 3 months to 3 years. Infection occurred in 1 patient. The ear frameworks were partially broken at the helix in 4 cases. Retroauricular graft skin survival was poor in 1 patient. Retroauricular hypertrophic scars occurred in 2 cases. Bad projection of the reconstructed ear occurred in 1 case. Totally 38 patients were satisfied with the results. CONCLUSIONS According to the physiological characteristics of the costal cartilage and skin soft tissues of adult patients, improvements are made to details based on the Nagata's method, so that the adult patients with microtia can obtain satisfactory surgical results.
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Jablonski RY, Veale BJ, Coward TJ, Keeling AJ, Bojke C, Pavitt SH, Nattress BR. Outcome measures in facial prosthesis research: A systematic review. J Prosthet Dent 2021; 126:805-815. [PMID: 33581868 PMCID: PMC8664412 DOI: 10.1016/j.prosdent.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. PURPOSE The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. MATERIAL AND METHODS Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. RESULTS Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. CONCLUSIONS Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics.
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Affiliation(s)
- Rachael Y Jablonski
- Specialty Registrar in Restorative Dentistry and NIHR Doctoral Fellow, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
| | - Benjamin J Veale
- Medical Student, Hull York Medical School, University of York, York, UK
| | - Trevor J Coward
- Reader and Honorary Consultant in Maxillofacial and Craniofacial Rehabilitation, Academic Centre of Reconstructive Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Andrew J Keeling
- Clinical Associate Professor, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - Chris Bojke
- Professor of Health Economics, Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- Professor of Translational and Applied Health Research, Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Brian R Nattress
- Clinical Professor and Honorary Consultant, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
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Implant prognosis in irradiated versus non-irradiated nasal, orbital and auricular sites. Int J Oral Maxillofac Surg 2019; 49:636-648. [PMID: 31668784 DOI: 10.1016/j.ijom.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/06/2019] [Accepted: 09/12/2019] [Indexed: 01/08/2023]
Abstract
The purpose of this systematic review was to evaluate implant survival in irradiated nasal, auricular, orbital sites and to compare them with non-irradiated respective sites. Four electronic databases and seven related journals were searched until December and March 2018, respectively. A total of 7892 articles were identified, 18 of which were included in this review; one non-randomized clinical trial, two prospective cohort, eight retrospective cohort and seven cross-sectional studies. Using the ROBIN-I Cochrane tool for risk assessment, 13 studies were judged at serious, one at moderate and four at critical risk of bias. Thirteen were included in 18 meta-analyses, the results of which showed a significant difference between irradiated and non-irradiated sites, favouring non-irradiated with risk ratio (RR) = 0.93, 95% confidence interval (CI) 0.89-0.97, P=0.001. Comparisons among nasal, auricular and orbital sites revealed no significant differences, whether in irradiated or non-irradiated patients at P<0.05. Hence, it was concluded that, within the limitations of this review, survival of craniofacial implants is negatively affected by radiotherapy, especially in orbital sites. Level of evidence is moderate. Therefore, further prospective cohort studies with calculated sample sizes, restricted or properly managed confounders and no deviations from intended interventions might produce different results.
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Guo P, Jiang H. [Surgical treatment progress of acquired auricular defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1218-1222. [PMID: 30129340 PMCID: PMC8413983 DOI: 10.7507/1002-1892.201712126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 07/29/2018] [Indexed: 11/03/2022]
Abstract
Objective To review the surgical treatment progress in repair and reconstruction of acquired auricle defects. Methods The related literature concerning the surgical methods and techniques for acquired auricle defects was reviewed and summarized. Results In order to attain an aesthetic ear with a clear structure, the location, size, and condition of surrounding skin must be taken into account when planning excision and repair. The application of tissue engineering and digital technology for acquired auricle defects can achieve a satisfactory effectiveness. Conclusion The surgical programs for acquired auricular defects have been constantly improved in recent years, and the emerging medical technologies also play a promoting role in the process, which providing a great deal of reference for obtaining structurally clear and stereoscopic auricle.
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Affiliation(s)
- Peipei Guo
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144,
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Chen J, Li W. [Research progress of pedicled flaps for defect repair and reconstruction after head and neck tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:369-376. [PMID: 29806291 PMCID: PMC8414284 DOI: 10.7507/1002-1892.201710098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/22/2018] [Indexed: 11/03/2022]
Abstract
Objective To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Methods Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. Results The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. Conclusion The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.
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Affiliation(s)
- Jian Chen
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Wuhan Hubei, 430079, P.R.China
| | - Wei Li
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Wuhan Hubei, 430079,
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Reich W, Exner A, Winter E, Al-Nawas B, Eckert AW. Complex functional and epithetic rehabilitation after ablation of recurrent retroauricular basal cell carcinoma - a case study. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2018; 6:Doc18. [PMID: 29423354 PMCID: PMC5803444 DOI: 10.3205/iprs000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The reconstruction of extended defects of the concha poses a complex challenge for plastic surgeons. In cases of subtotal ablation, an alternative method designed especially for elderly oncological patients consists of epithetic rehabilitation. However, inserting an implant-retained concha epithesis proves challenging in patients with antecedents of deep resections involving the mastoid process. In the present case study, we report on the long-term treatment course (2009-2017) of a 79-year-old male patient suffering from a recurrent basal cell carcinoma of the retroauricular region. Following tumor resection, along with lateral mastoidectomy, reconstruction, and adjuvant radiotherapy, functional and esthetic deficits primarily due to peripheral facial nerve palsy were successfully managed using a multistep procedure. The procedure was completed by inserting an implant-retained concha epithesis, resulting in improved quality of life. Due to prior lateral mastoidectomy, ultra-short implants (4 mm) were inserted, partially at atypical positions. For maintaining healthy periimplant soft tissue, aftercare comprised cold plasma treatment. This oncologic case demonstrates the therapeutic necessity of using a broad spectrum of reconstructive procedures, along with their limitations, in a critical anatomic region. Specific features include the presentation of a workflow using ultra-short implants in a compromised mastoid region. Surgeons should consider alternative implant positions in the event of any compromised mastoid process. A particular emphasis has been put on meticulous aftercare to preserve healthy periimplant soft tissues.
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Affiliation(s)
- Waldemar Reich
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anika Exner
- University School of Dental Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eileen Winter
- University School of Dental Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bilal Al-Nawas
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Walter Eckert
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Osseointegrated Prosthetic Ear Reconstruction in Cases of Skin Malignancy: Technique, Outcomes, and Patient Satisfaction. Ann Plast Surg 2017; 80:32-39. [PMID: 28984657 DOI: 10.1097/sap.0000000000001223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ear reconstruction with osseointegrated prosthetic implants is a well-established method of reconstruction after resection of skin malignancies on the external ear. There is limited literature reporting technique, outcomes, and patient satisfaction. METHODS We evaluated our outcomes over a 5-year period looking at osseointegrated prosthetic reconstruction after auriculectomy for external ear skin malignancies. We report demographics, disease characteristics, technique, and complications. The patients were surveyed looking at 6 domains: satisfaction, stability, comfort, ease of use, level of self-consciousness, and preoperative education. RESULTS Of the 21 patients included in the study, 14 (67%) were treated for invasive melanoma (Breslow depth, >0.8mm), 4 (19%) for squamous cell carcinoma, 2 (10%) for basal cell carcinoma, and 1 (5%) for an atypical fibroxanthoma. Complications rates were low. There were no cases of infection, hematoma, or bleeding. In 2 patients (9.5%), 1 of the 3 implants failed to osseointegrate and was removed, but the prosthesis was able to be secured with the remaining 2 posts. There were 3 cases (14%) of delayed healing and 1 with excessive granulation tissue growth. Survey results showed high satisfaction in all measured domains. CONCLUSIONS In cases of skin malignancy requiring total or subtotal auriculectomy, prosthetic ear reconstruction with osseointegrated implants is a good alternative to reconstruction with autologous tissue. Our experience demonstrates good outcomes and with low complication rates and high patient satisfaction.
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Nyberg EL, Farris AL, Hung BP, Dias M, Garcia JR, Dorafshar AH, Grayson WL. 3D-Printing Technologies for Craniofacial Rehabilitation, Reconstruction, and Regeneration. Ann Biomed Eng 2017; 45:45-57. [PMID: 27295184 PMCID: PMC5154778 DOI: 10.1007/s10439-016-1668-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/31/2016] [Indexed: 12/21/2022]
Abstract
The treatment of craniofacial defects can present many challenges due to the variety of tissue-specific requirements and the complexity of anatomical structures in that region. 3D-printing technologies provide clinicians, engineers and scientists with the ability to create patient-specific solutions for craniofacial defects. Currently, there are three key strategies that utilize these technologies to restore both appearance and function to patients: rehabilitation, reconstruction and regeneration. In rehabilitation, 3D-printing can be used to create prostheses to replace or cover damaged tissues. Reconstruction, through plastic surgery, can also leverage 3D-printing technologies to create custom cutting guides, fixation devices, practice models and implanted medical devices to improve patient outcomes. Regeneration of tissue attempts to replace defects with biological materials. 3D-printing can be used to create either scaffolds or living, cellular constructs to signal tissue-forming cells to regenerate defect regions. By integrating these three approaches, 3D-printing technologies afford the opportunity to develop personalized treatment plans and design-driven manufacturing solutions to improve aesthetic and functional outcomes for patients with craniofacial defects.
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Affiliation(s)
- Ethan L Nyberg
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, 400 N. Broadway, Smith 5023, Baltimore, MD, 21231, USA
| | - Ashley L Farris
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, 400 N. Broadway, Smith 5023, Baltimore, MD, 21231, USA
| | - Ben P Hung
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, 400 N. Broadway, Smith 5023, Baltimore, MD, 21231, USA
| | - Miguel Dias
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, 400 N. Broadway, Smith 5023, Baltimore, MD, 21231, USA
| | - Juan R Garcia
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amir H Dorafshar
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Warren L Grayson
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, 400 N. Broadway, Smith 5023, Baltimore, MD, 21231, USA.
- Department of Material Sciences & Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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