phenylephrine-hydrochloride and Contracture

To review the recent literature in regards to complications after reconstruction of Mohs defects, outline common pitfalls and to discuss the literature on avoiding complications as outlined per aesthetic subunit.. Complications in facial Mohs reconstruction commonly consist of infection, wound necrosis and dehiscence, hematoma and suboptimal scarring. However, site-specific complications such as hairline or eyebrow distortion, eyelid retraction or ectropion, nasal contour abnormality, alar retraction, nasal valve compromise, significant facial asymmetry or even oral incompetence must also be considered.. A successful reconstruction mimics the premorbid state and maintains function. The use of perioperative antibiotics, sterile technique, meticulous hemostasis, subcutaneous dissection and deep sutures to minimize wound tension should be considered for all Mohs reconstructions. Cartilage grafting can minimize nasal deformity and obstruction. Reconstruction near the lower eyelid should employ periosteal suspension sutures to minimize downward tension and lid retraction. Perioral complications, such as microstomia and oral incompetence, typically improve with time and therapy. Always consider secondary procedures such as dermabrasion, steroid injection, scar revision and laser resurfacing to help optimize aesthetic outcome.

Topics: Cartilage; Contracture; Humans; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Postoperative Complications; Surgical Flaps; Surgical Wound Dehiscence; Surgical Wound Infection; Suture Techniques

Nasal vestibular stenosis is caused by a disruption of the nasal vestibular lining with secondary proliferation of granulation and fibrous tissue. It is most commonly the result of significant nasal trauma of foreign body reaction. In the pediatric population, it is exceedingly rare, with only a few cases reported in the literature. We report the first case, to our knowledge, of complete stenosis caused by traumatic vaginal delivery. This case demonstrates the profound effect nasal vestibular stenosis can have on the developing nose. Correction can be difficult because of the tendency of wound contracture and recurrence. A new approach is presented, using a hard palate mucosal graft. This graft is tough, resilient, and easily harvested. Its ability to resist contracture obviates the need for postoperative stenting, which is especially useful in the pediatric population.

Topics: Birth Injuries; Constriction, Pathologic; Contracture; Fibrosis; Granulation Tissue; Humans; Infant; Male; Mouth Mucosa; Nasal Mucosa; Nasal Obstruction; Nose; Nose Diseases; Obstetrical Forceps; Palate; Recurrence; Wound Healing

The nasal contracture after rhinoplasty is one of the most severe complications in East Asian patients. The classification and treatment algorithm of nasal contracture have not yet been established. This study aimed to develop a new classification system and treatment algorithm of contracted noses in East Asian patients to improve treatment outcomes.. A retrospective study was conducted with 62 patients with nasal contracture who underwent a revision rhinoplasty between March 2017 and March 2021. The authors classified the 62 patients into 3 groups based on the classification system. All patients underwent rhinoplasty designed according to the corresponding classification. The patients were followed up after surgery, and the rhinoplasty outcomes evaluation (ROE) was used to evaluate their satisfaction rate.. A total of 59 female patients and 3 male patients (mean age, 29.45 ± 7.73 years) were included in this study. Forty-five cases presented mild nasal contracture (72.58%), 11 presented moderate nasal contracture (17.74%), and 6 presented severe nasal contracture (9.68%). There were statistically significant differences in the number of prior rhinoplasty procedures, infection history, and preoperative ROE scores among the three groups, with no differences in sex ratio, age, kinds of initial implant materials, and postoperative ROE scores. Almost all patients achieved satisfactory outcomes after the revision surgery designed by different classifications.. The authors have established a new classification system and treatment algorithm for contracted noses based on the change in pathological anatomy of nose, which is effective for guiding the treatment of contracted noses with good results.

Topics: Adult; Algorithms; Contracture; Female; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Retrospective Studies; Rhinoplasty; Treatment Outcome; Young Adult

Acid burn injuries in the midfacial region cause contracture of the skin and nasal aperture, which can lead to nasal airway obstruction. Management of such complicated situations requires a multidisciplinary approach, including prosthetic intervention. This article describes a clinical treatment for fabricating a custom nasal conformer for a 28-year-old man who presented with a history of an acid burn injury leading to obstructed external nares and fusion of the tip and columella of the nose with the philtrum of the upper lip. The prosthesis served the dual function of maintaining the nasal airway passage and preventing the contracture of the graft placed over the upper lip during reconstructive surgery.

Topics: Adult; Burns; Cleft Lip; Contracture; Dental Implants; Humans; Male; Nose; Plastic Surgery Procedures; Stents

Many Asian patients desire a narrower nasal base with less flaring of the alar lobules. However, patients who underwent multiple rhinoplasty surgeries with nostril contracture or an overreduction of the alar base may experience nostril contracture and deformity, which may lead to further airway obstruction. We present a technique that combines paranasal augmentation with composite chondrocutaneous graft transfer to overcome this problem.. Nine patients underwent composite chondrocutaneous graft transfer to the soft triangle or alar base combined with paranasal augmentation using preshaped porous polyethylene implants to correct nostril contracture and airway obstruction between September of 2014 and May of 2018. Preoperative and postoperative alar base distances and cross-sectional areas of the nostrils were measured and compared.. The average thickness of paranasal augmentation was 5.5 mm (range, 4.0-7.0 mm). Eighteen composite grafts were located over the soft triangle (n = 3) and the alar base (n = 15). The average number of composite grafts for each person was 2 (range, 1-4). All composite grafts survived totally or partially, and no graft failed. The average follow-up was 10.9 months (range, 3-28 months). The alar base increased 13.9% (range, 2.2%-23.9%), and the nostril area increased an average of 78.1% (range, 4.5%-316.8%) postoperatively. Patients had satisfactory aesthetic and functional outcomes.. Combining paranasal augmentation and composite graft transfer increased the cross-sectional area of the external valve and improved nostril contracture and airway obstruction after the overresection of the alar base or nose contracture after multiple rhinoplasty surgeries.

Topics: Contracture; Esthetics; Humans; Nasal Cavity; Nose; Rhinoplasty

Silicone implant-based augmentation rhinoplasty or mammoplasty induces capsular contracture, which has been acknowledged as a process that develops an abnormal fibrotic capsule associated with the immune response to allogeneic materials. However, the signaling pathways leading to the nasal fibrosis remain poorly investigated. We aimed to explore the molecular mechanism underlying the pathogenesis of nasal capsular contracture, with a specific research interest in the signaling pathways involved in fibrotic development at the advanced stage of contracture. By examining our recently obtained RNA sequencing data and global gene expression profiling between grade II and grade IV nasal capsular tissues, we found that both the RAP1 and JAK/STAT signaling pathways were hyperactive in the contracted capsules. This was verified on quantitative real-time PCR which demonstrated upregulation of most of the representative component signatures in these pathways. Loss-of-function assays through siRNA-mediated Rap1 silencing and/or small molecule-directed inhibition of JAK/STAT pathway in ex vivo primary nasal fibroblasts caused a series of dramatic behavioral and functional changes, including decreased cell viability, increased apoptosis, reduced secretion of proinflammatory cytokines, and synthesis of type I collagen, compared to control cells, and indicating the essential role of the RAP1 and JAK/STAT signaling pathways in nasal capsular fibrosis. Our results sheds light on targeting downstream signaling pathways for the prevention and therapy of silicone implant-induced nasal capsular contracture.

Topics: Cells, Cultured; Contracture; Fibroblasts; Fibrosis; Humans; Janus Kinases; Nose; Prostheses and Implants; rap1 GTP-Binding Proteins; Signal Transduction; Silicones; STAT Transcription Factors

Controlling the nasal tip in terms of definition, projection, and rotation requires a firm platform for subsequent scar contracture, healing, and skin thinning. Complications from tip surgery are diverse and range from symmetry, unnatural appearance, graft problems (migration, infection, extrusion), and issues with function. Implants are a large part of untoward results at the tip, and this article will focus on common complications that arise. In general, substantial projection should be pursued with a caudal extension graft rather than simple columellar strut. Compressive forces at the tip are formidable and the caudal septum, or simpler suture techniques, will often not hold up. Cap grafts and tip grafts that are used for projection or definition must be carefully camouflaged, irrespective of the thickness of the overlying skin. Even ethnic patients with thick skin will often reveal the edges of their grafts after several years. Alloplastic implants can be used but only after careful deliberation of risks and alternatives.

Topics: Asian People; Contracture; Facial Asymmetry; Humans; Nasal Cartilages; Nasal Septum; Nose; Postoperative Complications; Prostheses and Implants; Rhinoplasty; Surgical Wound Infection

Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new disease entity characterized by limited mouth opening due to contracture of the masticatory muscles, resulting from hyperplasia of tendons and aponeuroses. In this case series, we report what methods of airway establishment were conclusively chosen after rapid induction of anesthesia. We had 24 consecutive patients with MMTAH who underwent surgical release of its contracture under general anesthesia. Rapid induction of anesthesia with propofol and rocuronium was chosen for all the cases. In 7 cases, intubation using the Macintosh laryngoscopy was attempted; however, 2 of those cases failed to be intubated on the first attempt. Finally, intubation using the McCoy laryngoscopy or fiber-optic intubation was alternatively used in these 2 cases. In 7 cases, the Trachlight was used. In the remaining 10 cases, fiber-optic intubation was used. Limited mouth opening in patients with MMTAH did not improve with muscular relaxation. "Square mandible" has been reported to be one of the clinical features in this disease; however, half of these 24 patients lacked this characteristic, which might affect a definitive diagnosis of this disease for anesthesiologists. An airway problem in patients with MMTAH should not be underestimated, which means that other intubation methods rather than direct laryngoscopy had better be considered.

Topics: Androstanols; Anesthesia, Dental; Anesthesia, General; Anesthetics, Intravenous; Connective Tissue; Contracture; Fiber Optic Technology; Humans; Hyperplasia; Intubation, Intratracheal; Laryngoscopy; Mandible; Masseter Muscle; Neuromuscular Nondepolarizing Agents; Nose; Oral Surgical Procedures; Propofol; Rocuronium; Tendons

Topics: Contracture; Equipment Design; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Postoperative Complications

The surgical correction of nostril stenosis and external nasal valve collapse typically involves the addition of tissue to widen and strengthen these areas. However, over the ensuing months, postoperative scar contracture may act to reverse the surgical modifications. This study aimed to determine the safety and efficacy of the use of nasal stents fashioned from a nasopharyngeal airway tube to prevent postoperative contracture at these sites.. Retrospective review of six patients who underwent functional rhinoplasty with alar batten graft placement for nasal valve collapse and one patient who underwent composite graft repair of unilateral nostril stenosis.. Patients completed a survey inquiring about the ease of use, discomfort, presence of infection, and ability to breathe with these nasal stents. Patients also completed the NOSE (nasal obstruction symptom evaluation) instrument to compare their overall level of preoperative and postoperative nasal breathing. The functional rhinoplasty patients were examined for degree of dynamic airway nasal wall collapse and position of the lateral nasal wall on intranasal examination.. Six of seven patients overall reported no to minimal discomfort, easy application, and no to minimal obstruction of nasal breathing with the use of the stents. One patient reported difficulty with application. Preoperative NOSE scores averaged 67.1 (SD 10.4), 18.6 (SD 14.6) at the time of splint removal, and 21.4 (SD 15.2) at 3 months after stent removal. Paired t test analysis showed significant differences between the NOSE scores preoperatively as compared with the time of splint removal (P = .0002) or 3 months after splint removal (P = .0003). All patients demonstrated a significant reduction of lateral nasal wall collapse with inspiration on physical examination.. The use of nasal stents made from nasopharyngeal airway tubes is a safe, convenient, and economic treatment for the prevention of contracture after surgical correction of nostril stenosis or nasal valve insufficiency.

Topics: Constriction, Pathologic; Contracture; Humans; Nasal Obstruction; Nose; Postoperative Complications; Retrospective Studies; Rhinoplasty; Stents; Surveys and Questionnaires

We report a cohort of 148 African children operated on between 1985 and 2000 for noma sequelae. A total of 440 operations were performed. Lesions included mouth constriction in 70 of 148 cases, and severe bone destruction in 69 of 148 cases. A large proportion of children was transferred to Switzerland for surgical treatment, whereas the others were operated on in local hospitals in Africa. Vascularized calvarium flap was mostly used for bone reconstruction (n = 36). Pedicled latissimus dorsi myocutaneous flap was the preferred strategy for cheek reconstruction (n = 40). Expanded frontal flap was used for nasal reconstruction (n = 18), and pedicled heterolabial flap for lip construction (n = 37). Given the elevated level of recurrence of mouth constriction (extraarticular ankylosis), a minimum of 2 years' follow-up after surgical treatment was considered mandatory. Follow-up was conducted by field nurses from the humanitarian organizations, and a third of the patients were seen directly by our surgical team during special missions to Africa.

Topics: Adolescent; Bone Diseases; Bone Transplantation; Cheek; Child; Child, Preschool; Cohort Studies; Contracture; Face; Facial Bones; Female; Follow-Up Studies; Humans; Infant; Lip; Male; Mouth Diseases; Muscle, Skeletal; Noma; Nose; Patient Selection; Plastic Surgery Procedures; Recurrence; Skin Transplantation; Skull; Surgical Flaps

This is the first description of long-term follow-up of a case of Freeman-Sheldon syndrome. Microstomia was treated with a mouth expander for 2 to 3 hours per day before active orthodontic treatment. Separate impressions were necessary in each quadrant of both upper and lower jaws because of limited mouth opening.. Orthodontic treatment improved the patient's Class II malocclusion, which was accompanied by crowding and a deep bite.

Topics: Adolescent; Child; Contracture; Exercise Therapy; Eyelids; Facial Muscles; Follow-Up Studies; Humans; Joint Diseases; Lip; Longitudinal Studies; Male; Malocclusion, Angle Class II; Microstomia; Nose; Orthodontics, Corrective; Syndrome

Reconstruction of the lower third of the nose can be challenging. Maintaining the nasal subunit symmetry and providing good tissue match with regard to color, sebaceous quality, and thickness is essential. For extensive defects in this area, paramedian forehead flaps are often considered.. Our purpose was to develop the technique of preparing and executing the cheek island pedicle flap, as well as to define the limitations and "pitfalls" of the flap.. The cheek island pedicle flap is described.. The cheek island pedicle flap can provide excellent cosmetic results in reconstructing defects of the lower third of the nose. The flap dynamics are predictable, and anticipated complications are described.. The cheek island pedicle flap provides an excellent alternative to the paramedian forehead flap for reconstruction of extensive defects of the lower third of the nose.

Topics: Aged; Carcinoma, Basal Cell; Cartilage; Cheek; Contracture; Esthetics; Female; Graft Survival; Humans; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps; Wound Healing

We report a method for increasing the distance between two points on the skin surface by using two triangular flaps and a square flap. The theoretical lengthening is excellent when one of the triangular flaps is right-angled. The method has been used successfully in 40 cases of scar contracture, various clefts and cryptotia.

Topics: Adolescent; Axilla; Child; Cicatrix; Contracture; Ear, External; Elbow; Female; Humans; Male; Methods; Nose; Surgical Flaps

Topics: Burns; Contracture; Ear; Extremities; Eyelids; Hand Injuries; Humans; Melanoma; Nose; Pressure Ulcer; Radiation Injuries; Surgery, Plastic; Wounds and Injuries

Topics: Child; Cicatrix; Contracture; Female; Humans; Infant; Male; Methods; Middle Aged; Nose; Surgery, Plastic; Syndactyly

Topics: Burns; Congenital Abnormalities; Contracture; Ear, External; Face; Humans; Lip; Male; Nose; Surgery, Plastic; Wounds and Injuries

Topics: Anesthesia; Anesthesia, Endotracheal; Ankylosis; Contracture; Humans; Intubation, Intratracheal; Laryngoscopy; Lymphatic Metastasis; Mandibular Neoplasms; Maxillary Neoplasms; Muscle Relaxants, Central; Nose; Osteotomy; Parotid Neoplasms; Preanesthetic Medication; Salivary Gland Neoplasms; Surgical Procedures, Operative; Tracheotomy