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Chaisrisawadisuk S, Chaisrisawadisuk S. Structural Rhinoplasty as an Effective Surgical Approach for Frontonasal Dysplasia. J Craniofac Surg 2024:00001665-990000000-01492. [PMID: 38709047 DOI: 10.1097/scs.0000000000010206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 05/07/2024] Open
Abstract
Frontonasal dysplasia (FND), a rare congenital craniofacial disorder, primarily influences the development of midline craniofacial structures. A notable manifestation of this condition is nasal hypoplasia. This report details the treatment of a 19-year-old male patient diagnosed with FND accompanied by a severe case of nasal hypoplasia. The authors used structural rhinoplasty to achieve total nasal reconstruction. Albeit with some minor sequelae, the outcome of this surgery was markedly positive, enhancing both the cosmetic appearance and functional capacity of the nose. This case underscores the effectiveness of structural rhinoplasty as a feasible therapeutic approach for individuals suffering from FND and its associated nasal hypoplasia.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Department of Surgery, Division of Plastic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
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Heshemipour Y, Rehman U, Adebayo O, Sarwar MS, Neves S, Kamel Y, Brennan PA. Use of human acellular dermal matrix in rhinoplasty: a systematic review of the literature and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:105-112. [PMID: 38199888 DOI: 10.1016/j.bjoms.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
Alloplastic implants such as acellular dermal matrix (ADM) have been used for various aesthetic and reconstructive purposes since the 1990s. Rhinoplasty addresses both aesthetic and functional nasal impairments, often involving the adoption of grafting materials. Currently, autologous grafts, such as those using septal cartilage, are the gold standard. However, they pose the risk of donor site morbidity, technical challenges, and additional operative time. We review total complications, resorption/re-operation and success rates associated with the use of ADM in rhinoplasty. A literature search was conducted on PubMed, Prospero, DynaMed, DARE, EMBASE and COCHRANE databases. (Registry: CRD42023428019). A total of 462 patients from 15 studies were included, the mean (range) age was 30 (12-65) years, with a female-to-male ratio of 2:1. The most common indications for ADM were for cosmetic (35%, n = 163) and functional rhinoplasty (5%, n = 24). The most common type of ADM used was Alloderm (46%, n = 211). The most common indication for ADM was dorsal nasal augmentation (68%, n = 314). Eleven patients (2%) required revision surgery. The pooled success of ADM in rhinoplasty was 96% (95% CI 94 to 99, p = 0.93; I2 = 0%). 2% of patients developed postoperative complications and no statistically significant difference was seen in complications or success rates when comparing the different types of ADM. ADM in rhinoplasty was associated with fewer complications and re-operation rates, and similar if not less resorption compared to traditional autografts. Therefore, it can be a viable alternative to current autologous grafts in rhinoplasty surgery.
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Affiliation(s)
- Yaldasadat Heshemipour
- Department of Plastic Surgery, Swansea Bay University Hospital, Swansea, United Kingdom.
| | - Umar Rehman
- Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Oluwasemilore Adebayo
- Department of Surgery, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK.
| | - Mohammad S Sarwar
- Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Salma Neves
- Imperial College London, London, United Kingdom
| | - Yasmin Kamel
- University of Buckingham, Buckinghamshire, United Kingdom
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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Santos M, Cunha B, Abreu V, Ferraciolli S, Godoy L, Murakoshi R, Amaral LLF, Conceição C. Imaging of pediatric skull lytic lesions: A review. J Neuroimaging 2024; 34:26-43. [PMID: 37933199 DOI: 10.1111/jon.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions can be misinterpreted for their aggressiveness, as with larger lesions eroding cortical bone, containing soft tissue components, leading to excessive and, in some cases, invasive inappropriate etiological investigation. In this review, we present multiple several conditions that may present as skull lesions or pseudolesions, organized by groups (anatomic variants, congenital and development disorders, traumatic injuries, vascular issues, infectious conditions, and tumoral processes). Anatomic variants are common imaging findings that must be recognized by the neuroradiologist. Congenital malformations are rare conditions, such as aplasia cutis congenita and sinus pericranii, usually seen at earlier ages, the majority of which are benign findings. In case of trauma, cephalohematoma, growing skull fractures, and posttraumatic lytic lesions should be considered. Osteomyelitis tends to be locally aggressive and may mimic malignancy, in which cases, the clinical history can be the key to diagnosis. Vascular (sickle cell disease) and tumoral (aneurismal bone cyst, eosinophilic granuloma, metastases) lesions are relatively rare lesions but should be considered in the differential diagnosis, in the presence of certain imaging findings. The main difficulty is the differentiation between the benign and malignant nature; therefore, the main objective of this pictorial essay is to review the main skull lytic lesions found in pediatric age, describing the main findings in different imaging modalities (CT and MRI), allowing the neuroradiologist greater confidence in establishing the differential diagnosis, through a systematic and simple characterization of the lesions.
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Affiliation(s)
- Mariana Santos
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Bruno Cunha
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Vasco Abreu
- Neuroradiology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Suely Ferraciolli
- Neuroradiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luís Godoy
- Neuroradiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Neuroradiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Murakoshi
- Neuroradiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Neuroradiology and Head & Neck Department, Hospital Rede D'Or, São Paulo, Brazil
| | | | - Carla Conceição
- Neuroradiology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Fujisawa K, Watanabe S, Kato M, Utsunomiya H, Watanabe A. Costochondral Grafting for Nasal Airway Reconstruction in an Infant With Frontonasal Dysplasia. J Craniofac Surg 2019; 30:200-201. [PMID: 30475292 DOI: 10.1097/scs.0000000000004914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Frontonasal dysplasia (FND) is a congenital malformation of the central portion of the face, including the eyes, nose, and forehead. Owing to its rarity and wide spectrum of phenotypes, the optimal timing and technique of surgery remain controversial. Here, we report a case of a patient with FND, who presented with respiratory distress. The deformed nostrils were so small that the patient could not normally breathe through the nose immediately after birth. Rhinoplasty using a costochondral graft was performed at 16 months of age. After surgery, the nostrils enlarged and the appearance of the nose improved. Although congenital nasal deformity is frequently corrected during adolescence, surgery at an early stage can be considered when important issues are noted, such as inability to breathe through the nose.
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Affiliation(s)
- Kou Fujisawa
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
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A systematic approach in the diagnosis of paediatric skull lesions: what radiologists need to know. Pol J Radiol 2019; 84:e92-e111. [PMID: 31019602 PMCID: PMC6479152 DOI: 10.5114/pjr.2019.83101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
Paediatric skull lesions are commonly identified on imaging. They can be challenging to image, given their location and size, and often require several imaging modalities to narrow down the differential diagnosis. Accurate diagnosis of these lesions is paramount because the clinical therapy can vary tremendously. In this review, we provide a simple and systematic approach to clinical-radiological features of primary skull lesions. We highlight the imaging characteristics and differentiate pathologies based on imaging appearances. We also accentuate the role of cross-sectional imaging in lesion identification and management implications.
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Kanazawa S, Kiya K, Kubo T, Hosokawa K. Hydroxyapatite implantation for the repair of a congenital nasal anomaly: 10 years follow-up. J Surg Case Rep 2018; 2018:rjy146. [PMID: 29992000 PMCID: PMC6019076 DOI: 10.1093/jscr/rjy146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/08/2018] [Indexed: 11/14/2022] Open
Abstract
Frontonasal dysplasia is a rare congenital anomaly characterized by ocular hypertelorism, a broad nasal root, and vertical median cleft of the nose and/or upper lip and palate. We report a case of frontonasal dysplasia in which hydroxyapatite was used to treat a nasal deformity in early childhood. In the 10 years of follow-up of our case, there were no complications such as infection, malpositioning, or exposure, and computed tomography revealed no resorption or malpositioning of the implant. Hydroxyapatite implants may be a viable alternative to autologous bone/cartilage grafts for the repair of congenital nasal anomalies until nasal development is completed.
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Affiliation(s)
- Shigeyuki Kanazawa
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, 2-2-C11 Yamadaoka, Suita-shi, Osaka, Japan
| | - Koichiro Kiya
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, 2-2-C11 Yamadaoka, Suita-shi, Osaka, Japan
| | - Tateki Kubo
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, 2-2-C11 Yamadaoka, Suita-shi, Osaka, Japan
| | - Ko Hosokawa
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, 2-2-C11 Yamadaoka, Suita-shi, Osaka, Japan
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Abstract
In craniofacial surgery, a wide spectrum of pathological conditions are usually treated. The aetiology of these could be congenital, traumatic, infective, post-tumor resection, postradiation, autoimmune, iatrogenic, or other miscellaneous conditions. The surgical approach for the procedures is usually via a coronal incision. In a large proportion of the patients, the frontal bone is removed to obtain intracranial access. The frontal bone is then replaced either in its original form or in a remodeled state. In congenital conditions the supraorbital bar and frontal bone is often also removed, remodeled, and replaced. One of the common late sequelae following craniofacial surgery is contour irregularities of the frontal region. These irregularities can vary in their extent. They are invariably palpable and often visible. Surgeons have attempted various methods to improve the contour irregularities. Despite these measures contour irregularities can still ensue. In the authors' unit, the authors have been using acellular dermal matrix in an attempt to diminish the contour irregularities in the frontal region following craniofacial reconstruction for craniosynostosis. This has been used in 35 patients undergoing craniosynostosis correction. Of the 35 patients, 12 were for plagiocephaly, 7 for brachycephaly, 10 for scaphocephaly, 4 for trigonocephaly, and 2 for combined coronal and metopic synostosis. The age of the patients ranged from 5 months to 12 years (mean 20.5 months). There were 21 males and 14 females. The follow-up ranged from 10 to 48 months (mean 23 months).
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Affiliation(s)
- Anil Madaree
- Department of Plastic and Reconstructive Surgery, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa
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Tawfik A, El-Sisi HE, Abd El-Fattah AM. Surgical correction of bifid nose. Int J Pediatr Otorhinolaryngol 2016; 86:72-6. [PMID: 27260584 DOI: 10.1016/j.ijporl.2016.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Evaluation of the aesthetic outcome and functional aspect after surgical correction of bifid nose by combined Millard forked flap with external rhinoplasty BACKGROUND Bifid nose is a rare congenital anomaly that results during facial development but the explicit mechanism is not clearly understood. Clinical findings are quite variable with a wide range of severity. Surgical correction still represents great challenge to facial plastic surgeons; extensive deformities in many cases, rarity of condition and paucity of publications are contributing factors. METHODS Surgical correction of six patients with bifid nose by a combined Millard forked flap with external rhinoplasty RESULTS The aesthetic and functional outcomes were acceptable for all patients and parents. There were no considerable postoperative complications. CONCLUSIONS This approach is highly effective for various grades of bifid nose. Early management is preferable to avoid psychological morbidity. Secondary rhinoplasty is usually needed for cosmetic refinement.
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Affiliation(s)
- Ali Tawfik
- Otolaryngology Department, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Hossam Elsayed El-Sisi
- Otolaryngology Department, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt.
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Damsgaard TE, Hammer-Hansen N, Eschen GT, Kiil BJ, von Oettingen G. Porcine acellular dermal matrix for reconstruction of the dura in recurrent malignant schwannoma of the scalp. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-015-1128-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Núñez-Villaveirán T, Frohner BB, Urcelay PR, Sánchez RL, Molina CM, Palacios EDT. Bifid nose - a mild degree of frontonasal dysplasia. A case report. Int J Pediatr Otorhinolaryngol 2013; 77:1374-7. [PMID: 23810549 DOI: 10.1016/j.ijporl.2013.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/30/2013] [Accepted: 06/02/2013] [Indexed: 10/26/2022]
Abstract
Frontonasal dysplasia is an unusual congenital condition with a wide phenotypic range. Because of this, only a small number of cases and their management have been reported in the literature. The ideal surgical procedures to correct mild cases of frontonasal dysplasia, and the time to perform them, are still controversial. The case of a 9-month-old girl with a mild form of this condition (a congenital bifid nose and a duplicated frenulum), and its surgical management, is presented. The surgery achieved an early improvement of the patient's appearance and she had no complications. In the future, it is probable that she will need secondary rhinoplasty to aid in the projection of the tip and refine the shape of the nose.
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