phenylephrine-hydrochloride and Facial-Neoplasms

Craniofacial prostheses (or epitheses) are artificial substitutes for facial defects. Today, prostheses made of silicone are state-of-the-art. They may be fixed anatomically (to already existing structures), mechanically (to spectacle frames), chemically (using adhesives), or surgically (to osseointegrated titanium implants). With the existing extraoral implant systems, prostheses may be securely anchored to the bone regardless of size and location of the defect. The classic atraumatic surgical technique has remained an unchanged prerequisite for successful implantation by avoidance of any heat trauma to the bone. This review outlines the indications and contra-indications as well as advantages and disadvantages of craniofacial prostheses and their retention methods in various facial regions. It summarizes the basic principles of extraoral implantology in respect to implant positioning and the management of children and radiated patients.

Topics: Adolescent; Adult; Biocompatible Materials; Child; Ear, External; Esthetics; Eye, Artificial; Face; Facial Neoplasms; Humans; Nose; Orbit; Osseointegration; Prostheses and Implants; Prosthesis Design; Prosthesis Fitting; Prosthesis Implantation; Silicones; Skull; Suture Anchors; Tissue Adhesives; Titanium

The bilobed transposition flap has earned its reputation as a reliable and predictable flap, offering aesthetically appealing reconstructive results on difficult nasal defects. Several modifications to the bilobed technique have been made in recent years and there is a tendency towards bigger flaps executed at non-nasal locations. This review describes the development since Esser's original design, and summarizes present knowledge on bilobed flap repair. Furthermore, insight is offered into the latest indications for non-nasal reconstructions.

Topics: Carcinoma; Carcinoma, Basal Cell; Face; Facial Neoplasms; Forearm; History, 20th Century; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Soft Tissue Neoplasms; Surgery, Plastic; Surgical Flaps

A case of Malignant Syringoma (syn. = Microcystic Adnexal Carcinoma, Sclerosing Swat Duct Carcinoma) of the nose in a 44 year old female patient is reported. The tumor had been misdiagnosed as a Rhinophyma some 20 years before and had thus been treated under cosmetic aspects. Besides the appearance, the patient did not suffer any complaints and was referred to the ENT-department of the Klinikum Hannover for cosmetic reasons. Histopathological examination after removal revealed a malignant syringoma, which, due to its extensive size and subepithelial growth pattern, made a complete ablation of the entire nose and the adjacent soft tissue of the face necessary. Pathohistologically cellular atypia, invasive growth pattern, perineural and perivascular infiltration was characteristic. Quantitative DNA anaylsis revealed a tumor with a diploid stem line and only few aneuploid cells. Malignant syringoma is a rare differential diagnosis of face skin tumors. The present case is discussed based on a review of the literature.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Skin Appendage; Diagnosis, Differential; Eyelid Neoplasms; Facial Neoplasms; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Rhinophyma; Sweat Gland Neoplasms; Syringoma; Time Factors

The purpose of this study was to evaluate retrospectively the use of ITI dental implants used for anchoring facial prostheses in the restorative treatment of midface defects. The authors analyzed the clinical data of 26 patients with orbital defects (n = 11), orbitonasal defects (n = 4), orbitonasomaxillary defects (n = 3), and nasal defects (n = 8). Data included age, sex, primary disease, implant position, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. Follow-up was at 1, 3, 6, and 12 months and then on a yearly basis. The authors noted the status of healing and complications, if any. In total, 62 implants were placed as follows: 27 (43.5 percent) for orbital prostheses, 12 (19.4 percent) for orbitonasal prostheses, 14 (22.6 percent) for orbitonasomaxillary prostheses, and nine (14.5 percent) for nasal prostheses. Thirty-eight implants (61.3 percent) were placed in previously irradiated areas in 18 patients (69.2 percent). Mild skin reactions together with mild accumulation of sebaceous crusting around implants were recorded in 14.2 percent of the skin observations. No patient experienced severe inflammation requiring administration of systemic antibiotics or surgical revision. Implant success was 100 percent in both irradiated and nonirradiated patients. In conclusion, ITI dental implants result in a high rate of success in retaining midface prostheses and offer good stability and aesthetic satisfaction.

Topics: Adult; Aged; Aged, 80 and over; Dental Implants; Equipment Design; Eye Neoplasms; Face; Facial Neoplasms; Female; Follow-Up Studies; Foreign-Body Reaction; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Nose; Orbital Implants; Osseointegration; Plastic Surgery Procedures; Postoperative Complications; Prostheses and Implants; Radiation Injuries; Radiotherapy; Retrospective Studies; Titanium; Treatment Outcome

Facial defects created by removal of various types of skin cancer are usually closed primarily. There are some areas of the face where primary closure produces less than optimal results. We have utilized a non-reactive collagen sponge (Collagen Matrix) to enhance closure by secondary intention following removal of skin cancers. This presentation describes the properties of Collagen Matrix as well as the technique we utilized for closure of facial defects following tumor removal.

Topics: Aged; Carcinoma, Basal Cell; Collagen; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nose

The cosmetic appearance of a facial scar is a concern for patients undergoing Mohs micrographic surgery (MMS). Although suturing technique may influence scar cosmesis, few studies have been published comparing suturing methods for MMS repair.. To compare the cosmetic appearance of facial MMS scars sutured with either continuous or interrupted percutaneous nylon sutures.. Patients with facial MMS defects were randomized to have half their scar sutured with interrupted 5-0 nylon stitches, whereas the other half of the scar was closed with running 5-0 nylon stitches. The appearance of each half of the scar was assessed at 1 week, 8 weeks, and 6 months by the principal investigator. Blinded photographic evaluation at 1 week and 6 months was completed by a plastic surgeon and general dermatologist.. A total of 105 patients were entered into the trial, and 101 completed all time point assessments. There was no statistically significant difference in scar outcome using each of the 3 scar assessment scales, at any time point, for any assessor (blinded and nonblinded).. Interrupted and continuous 5-0 nylon sutures result in an equivalent final cosmetic appearance of facial MMS scars. Given its advantages, running sutures may be the preferred closure technique for facial repair.

Topics: Adult; Aged; Aged, 80 and over; Cheek; Cicatrix; Facial Neoplasms; Female; Forehead; Humans; Lip; Male; Middle Aged; Mohs Surgery; Nose; Photography; Prospective Studies; Single-Blind Method; Suture Techniques

Although patient satisfaction with reconstructive outcomes after facial skin cancer resection is an important consideration in Mohs surgery, there is limited information evaluating this concern using validated patient-reported outcome tools.. To characterize predictors that may be associated with increased postoperative patient satisfaction with facial appearance after Mohs surgery using the FACE-Q/Skin Cancer survey, a patient-reported outcome tool that has been validated in various studies.. A total of 202 patients who underwent Mohs surgery for facial skin cancer at the Brigham and Women's Faulkner Hospital between April 2017 and November 2021 were included after completing the postoperative Satisfaction with Facial Appearance scale (FACE-Q scale).. Male patients were significantly more likely to have higher satisfaction scores compared with female patients (aOR 2.4, 95% CI 1.1-5.1). Increased preoperative facial satisfaction scores was directly correlated with increased postoperative facial satisfaction scores ( p < .01). Patients with tumors on the lower face/neck (aOR 3.88; 95% CI 1.4-10.7) had significantly greater satisfaction scores compared with those with tumors on their nose/nasolabial folds.. Potential interventions and counseling methods can be tailored toward specific patient populations with lower satisfaction scores to increase their overall satisfaction with reconstructive outcomes.

Topics: Facial Neoplasms; Female; Humans; Male; Mohs Surgery; Nasolabial Fold; Nose; Patient Satisfaction; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Face; Facial Neoplasms; Humans; Lip; Male; Mohs Surgery; Nose; Plastic Surgery Procedures; Postoperative Complications; Surgical Flaps

Topics: Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Surgical Flaps; Treatment Outcome; Wound Closure Techniques

Topics: Aged; Carcinoma, Basal Cell; Facial Neoplasms; Humans; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Surgical Flaps; Treatment Outcome; Wound Closure Techniques

Topics: Cheek; Facial Neoplasms; Humans; Lip; Male; Nose; Plastic Surgery Procedures; Surgical Flaps

Vismodegib is an oral inhibitor of the Hedgehog signaling pathway and has been used to treat basal cell carcinoma (BCC) in adults. This article reports clearance of a nodular BCC of the nasal tip in an 8-year-old boy with xeroderma pigmentosum (XP). BCC can pose therapeutic challenges when located in areas that are not amenable to traditional therapies such as Mohs micrographic surgery or topical agents. Vismodegib was used at a dose of 150 mg/day to treat the boy's BCC. After 4 months of therapy, we achieved complete clinical clearance. During 21 months of follow-up, the patient's nose remained clinically clear of tumor. Vismodegib was successfully used to treat a child with XP and nodular BCC. Our goal in using vismodegib was tumor regression while avoiding cosmetic and functional disfigurement. Vismodegib was effective in clinically clearing the tumor, and the patient has shown no signs of recurrence. Further studies are warranted.

Topics: Anilides; Carcinoma, Basal Cell; Child; Facial Neoplasms; Humans; Male; Nose; Pyridines; Skin Neoplasms; Xeroderma Pigmentosum

Topics: Facial Neoplasms; Female; Humans; Lip; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Facial Neoplasms; Female; Humans; Lip; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center.. A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05.. A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates.. Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.

Topics: Age Factors; Aged; Aged, 80 and over; Anesthesia; Carcinoma, Basal Cell; Facial Neoplasms; Female; Forehead; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Nose; Retrospective Studies; Risk Factors; Skin Neoplasms; Surgical Flaps; Time Factors; Tumor Burden

The glabella is an aesthetic subunit placed on the forehead between the eyebrows. The reconstruction of this area can be challenging for cosmetic outcomes. In our experience, moderate glabellar defects reconstruction should introduce extra skin to preserve the interciliary space.. Under local anesthesia, tumoral excision with safety margins on the glabellar area was performed in 5 patients. The oncologic resection resulted in moderate sized glabellar defects. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site.. Five nasal root island flaps were successfully performed for glabellar defects reconstruction after tumoral excisions. The aesthetic results were satisfactory with respect to color and texture match and scars qualities. The eyebrow junction was successfully avoided.. We present an alternative method for the reconstruction of central and moderate sized glabellar defects. The nasal root island flap is a reliable and easy to perform 1-stage technique with satisfactory aesthetic outcomes.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Head and Neck Neoplasms; Humans; Hutchinson's Melanotic Freckle; Male; Middle Aged; Myocutaneous Flap; Nose; Plastic Surgery Procedures; Pseudolymphoma; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome

Angular artery, lateral nasal artery, and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects. An alternative pedicle to raise a flap in the nasolabial area is the superior labial artery. Superior labial artery is a constant branch of the facial artery, arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip. This makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flap.. Reverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients. Eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose. Auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patients.. All flaps survived completely. Temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days. All patients healed without any postoperative complications and the final results were considered satisfactory.. Reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery-based nasolabial flaps where these arteries could also be used as pedicle.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Ear Cartilage; Facial Neoplasms; Female; Humans; Lip; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Facial cutaneous oncological pathology often involves more than one esthetic unit due to their close boundaries. The reconstruction of both the nasolabial and perinasal regions may be especially complex and challenging for the surgeon. Traditionally, these defects have been reconstructed with local random flaps based on the vascularization provided by the superficial musculoaponeurotic system. In this article, we present our experience in the reconstruction of the aforementioned defects using the propeller facial artery perforator (FAP) flap.. A propeller FAP flap was performed for reconstruction in 12 patients with nasolabial or perinasal complex defects after tumoral resection between the years 2011 and 2013. The flap was designed parallel to the nasolabial fold in all cases for achieving direct closure and an aesthetically pleasing outcome. In one of the cases, a paramedian forehead flap was performed simultaneously.. Nine patients healed uneventfully, with good functional and esthetic outcomes. One of the flaps developed partial necrosis of the distal end, and another developed temporary postoperative venous congestion, lymphedema, and, finally, trapdoor deformity. The latter complication also occurred in one more flap.. The propeller FAP flap is reliable and versatile, with few complications, and it is especially useful when reconstructing complex defects that involve the nasolabial and perinasal regions; therefore, it should be considered as one of the first reconstructive options for the described defects.

Topics: Aged; Aged, 80 and over; Arteries; Face; Facial Neoplasms; Female; Free Tissue Flaps; Humans; Lip; Male; Middle Aged; Nose; Plastic Surgery Procedures; Postoperative Complications

We have used the retroangular flap for the reconstruction of facial defects after excision of tumours. Important variables such as vascular mapping, type of anaesthesia, duration of stay in hospital, and the diagnosis and treatment of complications were taken into account in assessing its effectiveness. We studied 187 patients, 103 men and 84 women, who were treated with the retroangular flap, and the morphological and cosmetic results analysed. There are many vascular variations of the flap The patients were followed up for a median of 12 (range 12-125) years and their reconstructions were successful. The technique can be considered as one of first methods of choice for the reconstruction of cutaneous defects of the middle third of the face.

Topics: Anesthesia, Local; Angiography; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Microsurgery; Necrosis; Nose; Perforator Flap; Plastic Surgery Procedures; Postoperative Complications; Skin; Skin Transplantation; Surgical Flaps

This case series explores the use of vismodegib to treat locally advanced basal cell carcinoma (laBCC), with a focus on tolerability, efficacy, and outcomes after treatment cessation.. Data from patients who underwent vismodegib treatment for laBCC at a single institution from 3/6/2012 through 3/15/2015 was utilized in this study. For all included cases, treatment responses as recorded at the first follow-up after treatment cessation were assessed and are reported as complete clinical response (CCR), partial clinical response (PCR), stable disease, or progressive disease. In cases of CCR, clinical disease free survival (DFS) was calculated as the time from cessation of vismodegib until last available follow-up, death, or recurrence. Data pertaining to side effects and adverse events was also recorded, and results are presented using descriptive statistics.. A total of 24 patients and 31 tumors met inclusion criteria. CCR was observed in 17 of 31 tumors (55%), and 13 of 31 tumors (42%) demonstrated PCR. Stable disease was seen in one patient (one tumor) (3%). No cases demonstrated clinical tumor progression during treatment. The mean clinical DFS at time of data cut off for all cases of CCR was 9.3 months (range 2-21 months). In cases of PCR, the mean reduction in tumor size was 52% (range, 11%-80%). Only two patients (8%) discontinued treatment secondary to side effects.. Each patient and each tumor responds uniquely to vismodegib treatment, including variable tumor responses and a wide range of side effects and tolerability. This study highlights important unique observations, and our data as a whole adds to previously published studies, leading to thought provoking questions. Overall, the FDA approval of vismodegib for advanced basal cell carcinoma has markedly improved the prognosis and care of affected patients.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cheek; Disease Progression; Disease-Free Survival; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Nose; Pyridines; Scalp; Skin Neoplasms; Thorax; Treatment Outcome; Tumor Burden

To explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.. (1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.. The facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.. The flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Topics: Anastomosis, Surgical; Arteries; Cadaver; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Facial Neoplasms; Humans; Nevus; Nose; Perforator Flap; Skin Neoplasms; Skin Transplantation; Software; Tomography, Spiral Computed

Conidiobolomycoses (Conidiobolus coronatus fungal infections) are rare and potentially severe infections prevalent in the tropics. The disease starts in the facial sinus and evolves as a subcutaneous tumor on the mid face. A 19-year-old female patient from Burkina Faso presented with an acquired nasal deformation having evolved for a few months, associated to bilateral nasal obstruction. The patient had no medical or surgical history. The pathological analysis of the surgical exeresis allowed diagnosing a C. coronatus infection.. The C. coronatus lives in decaying vegetation in hot and humid climates. It is a potential human pathogen that infects immunocompetent patients presenting with micro-wounds of the sinus and nasal mucosa. Hundred cases have been reported. The management is specific. The diagnosis should be discussed in case of distorting tumors of the midface.

Topics: Burkina Faso; Conidiobolus; Diagnosis, Differential; Face; Facial Asymmetry; Facial Neoplasms; Female; Humans; Nasal Obstruction; Nose; Young Adult; Zygomycosis

The importance of the paranasal and periorbital regions on the aesthetics of the face presents a variety of reconstructive challenges for surgical and traumatic defects of those regions. We used the cranially based nasolabial flap in patients with full-thickness soft-tissue defects of the paranasal and periorbital regions harvested from the contralateral side of the present defect. We present our experience in 25 patients of geriatric population (13 females and 12 males with a mean age of 76) with complex soft-tissue defects in the paranasal and periorbital regions whose defects were reconstructed with contralateral nasolabial skin flaps. Sizes of the defects changed between 2 × 3 cm and 6 × 7 cm. The flap sizes varied from a width of 2 to 5 cm (average 3 cm) and a length of 7 to 11 cm (average 8 cm). Primary closure of the donor sites of the flaps was possible in 24 of the patients in this series. Twenty-one flaps of this series (84%) healed without any necrosis and completely survived. The contralateral nasolabial flap is a very convenient, safe and reliable flap that can be used in medium to large paranasal and periorbital defects. Optimal aesthetic results for a variety of central facial defects could be obtained with this flap, especially when the ipsilateral nasolabial flap cannot be used due to various reasons.

Topics: Aged; Aged, 80 and over; Eye; Face; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Relatively deep and complex surgical defects, particularly when adjacent to or involving free margins, present significant reconstructive challenges. When the use of local flaps is precluded by native anatomic restrictions, interpolation flaps may be modified to address these difficult wounds in a single operative session.. To provide a framework to approach difficult soft tissue defects arising near or involving free margins and to demonstrate appropriate design and execution of single-stage interpolation flaps for reconstruction of these wounds.. Examination of our utilization of these flaps based on an anatomic region and surgical approach.. A region-based demonstration of flap conceptualization, design, and execution is provided.. Tunneled, transposed, and deepithelialized variations of single-stage interpolation flaps provide versatile options for reconstruction of a variety of defects encroaching on or involving free margins. The inherently robust vascularity of these flaps supports importation of necessary tissue bulk while allowing aggressive contouring to restore an intricate native topography. Critical flap design allows access to distant tissue reservoirs and placement of favorable incision lines while preserving the inherent advantages of a single operative procedure.

Topics: Cartilage; Ear, External; Face; Facial Neoplasms; Humans; Lip; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps

Topics: Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Middle Aged; Mohs Surgery; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Different prosthetic treatment plans for three patients with variable degrees of acquired maxillofacial defects were reported and analyzed. Combined extraoral-intraoral prostheses were selected to restore the three cases. Two patients were rehabilitated using two separated prostheses, while the third one was restored with a coupled two-unit prosthesis. The design of extraoral-intraoral prosthesis either separated or connected, is influenced by the condition and nature of the residual tissues, defect configuration, patient needs, degree of tissue damage and the anticipated success rate or complications with the treatment. It was observed that separating the intraoral part from that of the extraoral resulted in better retention, stability, and more comfort to the patient with combined defects. Furthermore, fabrication and repair of each part is technically easier as perceived it can be carried out independently and the patient can continue to use one-part and send the other for repair. Another advantage is the reduction of size and weight of the prosthesis.

Topics: Adult; Aged; Dental Implants; Dentofacial Deformities; Denture Design; Denture Retention; Facial Neoplasms; Humans; Magnets; Male; Maxillofacial Prosthesis; Microstomia; Nose; Orbital Implants; Palatal Obturators; Prostheses and Implants; Prosthesis Design; Prosthesis Retention

Topics: Carcinoma, Basal Cell; Facial Neoplasms; Female; Health Knowledge, Attitudes, Practice; Health Status; Humans; Mohs Surgery; Nose; Skin Neoplasms

To investigate and compare the effectiveness of perichondrial cutaneous graft (PCCG) of dorsal auricle for repairing defect after excision of melanocytic nevus in different parts of the face.. Between February 2008 and October 2012, 29 cases of facial melanocytic nevus were admitted. There were 11 males and 18 females, aged 3-25 years (median, 11 years). The locations were the upper eyelid in 5 cases, the nose in 15 cases, and the buccal region in 9 cases. The size of the nevi ranged from 1.2 cm x 1.0 cm to 4.0 cm x 2.2 cm. Defects after excision of nevi were repaired by PCCG of the dorsal auricle, which size ranged from 1.5 cm x 1.5 cm to 4.2 cm x 2.5 cm. The postoperative effectiveness was scored by patients according to color match, scar formation, and flatness of the reception site. The satisfaction evaluations were compared by the score among different parts.. All the PCCG survived. All the patients were followed up 7-15 months (mean, 10 months). All the reception site had good color match and acceptable scar formation. The nasal part had good flatness, and the upper eyelid had poor flatness. Score comparison showed no significant difference in color match between 3 parts (P > 0.05). Nasal part had significantly less scar formation than buccal region and upper eyelid (P < 0.05), but no significant difference between buccal region and upper eyelid (P > 0.05). Nasal part and buccal region both had significantly better flatness than upper eyelid (P < 0.05), but no significant difference between nasal part and buccal region (P > 0.05). The overall evaluation score of nasal part and buccal region was significantly higher than that of the upper eyelid group (P < 0.05), and the score of the nasal part was significantly higher than that of the buccal region (P < 0.05).. PCCG of dorsal auricle has a good color match in repair of facial defect, especially in repair of nasal defect with good flatness and no obvious scar formation.

Topics: Adolescent; Adult; Child; Child, Preschool; Ear, External; Face; Facial Neoplasms; Female; Humans; Male; Nevus, Pigmented; Nose; Plastic Surgery Procedures; Skin; Skin Neoplasms; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps; Treatment Outcome; Wound Healing; Young Adult

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Lip; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Adult; Biopsy; Diagnosis, Differential; Facial Dermatoses; Facial Neoplasms; Female; Folliculitis; Humans; Nose; Pseudolymphoma

Various treatment options are available for basal cell carcinoma (BCC). We report a case of a patient with a nodular BCC on the nose who was treated with combination therapy consisting of cryotherapy with liquid nitrogen followed by imiquimod cream 5% 5 times weekly for 6 weeks. Clearance of the lesion was histologically confirmed.

Topics: Aged, 80 and over; Aminoquinolines; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Cryotherapy; Facial Neoplasms; Humans; Imiquimod; Male; Nose; Skin Neoplasms

To reconstruct the cheek, surgeons will need a variety of techniques including local flaps, pedicled flaps, as well as split- or full-thickness skin grafts. Depending on the size and the location of the defect as well as possible impeding conditions (revision, previous irradiation) or extended surgery (parotid gland, cervical lymph nodes), the extent of surgery needs to be adapted. The aesthetic units in the face, the relaxed skin tension lines and the free margins of the lower eyelid, and the nasal ala and the lip need to be respected. Considering these conditions, various approaches in cheek reconstruction are discussed in this article.

Topics: Cheek; Ear, External; Esthetics; Eyelids; Facial Neoplasms; Fascia; Humans; Lip; Mandible; Muscle, Skeletal; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Physiological Phenomena; Skin Transplantation; Surgical Flaps

Surgical site infections (SSIs) after dermatologic surgery cause pain, prolong healing, result in unaesthetic complications, and lead to excessive use of antibiotics. The pathogenesis of wound infections is complex and is dependent on bacterial load and diversity, among several factors.. To investigate bacterial dynamics at dermatosurgical sites at different time intervals and assess the correlation with postoperative outcomes and to examine different endo- and exogenous factors that may contribute to SSIs.. Eighteen patients undergoing skin grafting of the face were studied. The following SSI-related factors were registered: age and sex of the patient, ulceration of the lesion, diabetes, immunosuppressive therapy, smoking, anticoagulative therapy, and use of antibiotic prophylaxis. Wounds from each patient were swabbed preoperatively, intraoperatively, and postoperatively. The bacterial composition of the swabs was then analyzed quantitatively and qualitatively.. Sixteen of 18 surgical sites contained varying quantities of surface-associated bacteria. Coagulase-negative staphylococci and Propionibacterium acnes were the predominant bacteria isolated at all times. Intraoperative analysis was not predictive of SSIs. Use of antibiotic prophylaxis was the only registered SSI-related factor that showed significant variation in bacterial load between pre- and postoperative samples. Postoperative bacterial load was found to be lower than preoperative load in patients who received antibiotics. This was in contrast to patients who did not receive antibiotics, who had significantly higher postoperative levels (p=.02). The presence of high postoperative bacterial loads, regardless of the bacterial species isolated, showed a statistically significant positive correlation with a complicated postoperative outcome (p≤.001).. This study provides novel insights into the bacterial dynamics of dermatologic surgery-induced wounds and the variation of this over time. The results highlight the potential relevance of quantifying bacterial loads, as well as determining specific types of bacteria, in dermatologic surgery.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Bacterial Load; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Facial Neoplasms; Female; Floxacillin; Forehead; Humans; Keratosis, Actinic; Male; Middle Aged; Nose; Perioperative Period; Propionibacterium acnes; Skin Neoplasms; Skin Transplantation; Skin Ulcer; Staphylococcus; Surgical Wound Infection; Treatment Outcome

Nevoid basal cell carcinoma syndrome is a genetic abnormality that often manifests with skin abnormalities and odontogenic pathology at a relatively young age. Whenever basal cell carcinoma is discovered, a more detailed history must be taken that goes back to the patient's youth. A suspicious history should lead to further follow-up. The diagnosis of NBCCS should not deter the clinician from treating the underlying skin carcinoma; rather, it should educate both the patient and the clinician that a more complex pathology exists that requires more aggressive and frequent oversight by a dermatologist.

Topics: Adult; Basal Cell Nevus Syndrome; Facial Neoplasms; Humans; Male; Military Personnel; Neoplasm Recurrence, Local; Nose; Odontogenic Cysts; Skin Neoplasms

Topics: Adult; Facial Neoplasms; Female; Forehead; Humans; Lip; Male; Mohs Surgery; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Facial Neoplasms; Humans; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

We developed the orbicularis oris myomucosal island flap (OOMMIF) to reconstruct the nasal lining in one stage. The OOMMIF blood supply derives from the intramuscular vascular network which communicates with the submucosal vascular plexus via the vascular network formed by the deep ascending branches of the superior labial artery. An oral mucosal flap of approximately 2 x 3cm can be harvested from the upper lip pedicled solely on the orbicularis oris muscle. We transferred this flap to a nasal lining defect located in the ala in four patients, the nasal floor in two patients, and the columella in two patients. The flap donor site was closed primarily. All flaps took completely with satisfactory results. Minor complications included slight asymmetry of the vermilion height due to donor site contracture in one patient and flap drooping in two patients corrected by secondary debulking. Upper lip functional loss was not observed, although upper lip hypoaesthesia occurred in one patient, which disappeared within 6 months. An OOMMIF can be easily elevated with minimal donor site morbidity. Thus, the OOMMIF is a good candidate for one-stage reconstruction of small nasal lining defects.

Topics: Aged; Facial Injuries; Facial Neoplasms; Humans; Male; Middle Aged; Mouth Mucosa; Muscle, Skeletal; Nose; Nose Deformities, Acquired; Surgical Flaps

In considering periorbital reconstructive options, the goals of reconstruction are to obtain functional and esthetic results. At the medial canthus, reconstruction should maintain the normal concavity of the canthus without distortion of the surrounding tissues and should maintain normal eyebrow contour and symmetry. The authors represent their flap in flap technique that provides normal concavity of the canthus and does not cause any complex and undesirable scars.. A new modification of conventional glabellar flap which was named "flap in flap technique" was raised to cover medial canthal defect. We designed an inverted V-shaped advancement flap (123Delta-A flap) that contains both B (145Delta flap) and C (2345) flaps. The B flap is designed in the glabellar region, which is at medial side of the defect and is transposed to defect, and the C flap is planned in V-Y fashion to release tension over the B flap.. To date, we have used this technique successfully in 5 patients (4 women and 1 man), requiring a glabellar flap to reconstruct the medial canthus and proximal nasal dorsum. All defects were secondary to excision of basal cell carcinoma. All were satisfied with the cosmetic and functional results.. Our glabellar flap in flap technique for the reconstruction of medial canthal defects has several advantages such as maintaining concavity of the canthus without distortion of the surrounding tissues and providing normal eyebrow contour and symmetry.

Topics: Adult; Carcinoma, Basal Cell; Esthetics; Eyelid Neoplasms; Eyelids; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Eyelid Neoplasms; Eyelids; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Skin Neoplasms; Skin Pigmentation; Skin Transplantation; Subcutaneous Tissue; Surgical Flaps; Tissue and Organ Harvesting; Wound Healing

Epitheses, also known as craniofacial prostheses, are artificial substitutes for facial defects. The breakthrough for rehabilitation of facial defects with implant retained epitheses came with the development of the modern silicones and bone anchorage. After the discovery of the osseointegration of titanium in the 1960s, dental implants have been made of titanium. In 1977, the first extraoral titanium implant was inserted in a patient. Later, various solitary extraoral implant systems have been developed. Besides, grouped implant systems have been developed, which may be placed more reliably in areas with low bone offering, as in the nasal and orbital region, or the ideally pneumatised mastoid process. Today, even large facial epitheses may be securely retained. The classical atraumatic surgical technique has remained an unchanged prerequisite for successful implantation of any system. This review outlines the basic principles of osseointegration as well as the main features of extraoral implantology.

Topics: Biocompatible Materials; Bone Plates; Bone Screws; Craniofacial Abnormalities; Ear, External; Esthetics; Eye, Artificial; Face; Facial Neoplasms; Humans; Nose; Orbit; Osseointegration; Prosthesis Design; Prosthesis Implantation; Radiation Injuries; Suture Anchors; Titanium

Basal cell carcinoma (BCC) grows by direct extension replacing local anatomical structure; it rarely metastasizes, however may cause severe injure expanding to contiguous tissues with a biological invasive behaviour. BCC of the nose is often a highly aggressive neoplasia with infiltrative growth pattern. Fast cancer extension to the adjacent facial structures requires wide resection for oncological management. In our study we present a 69-year-old male affected by BCC of the nose back and treated by surgical radical excision with free margin disease at histological examination. Patient, subsequently, developed a local relapse. Therefore, he underwent surgical excision of the recurrence and the histological evaluation pointed out a metatypical and infiltrative BCC pattern without margins involvement. Afterwards, the patient developed another local recurrence involving the left alar nose and the omolateral cheek. Histological examination still demonstrated a metatypical and infiltrative pattern, with disease free margins, but nasal vestibule involvement. Successively the patient had another local wide resection from the nasal wing to the maxillary bone without reconstructive procedure. Three years after, the patient developed another local relapse and underwent another surgical procedure, consisting in a very wide resection with concomitant selective left laterocervical node dissection. Histological evaluation demonstrated a metatypical solid infiltrative BCC pattern with disease free margins and lymph nodes. One year after, forehead flap was made to reconstruct the nose and left cheek deficit. At 16 months follow-up the patient remains disease free.

Topics: Aged; Carcinoma, Basal Cell; Cheek; Disease-Free Survival; Facial Neoplasms; Follow-Up Studies; Humans; Male; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps; Time Factors; Treatment Outcome

To examine the results of open lacrimal drainage surgery in patients with rare nasal diseases.. A retrospective review of a group of patients with rare nasal disease who underwent open lacrimal surgery over a 15-year period at Moorfields Eye Hospital. Three main groups of disease were identified: (I) patients with treated mid-face tumours; (II) patients with prior major midfacial injury or surgery; and (III) patients with congenital nasal anomalies, including nasal aplasia. The more common systemic conditions of Wegener's granulomatosis and sarcoidosis were specifically excluded.. Eighty-six patients (43 men; 50%) were identified with an age range between 1 and 82 years at the time of surgery. A total of 100 primary procedures were performed in 85 patients and symptomatic relief was achieved in 83/100 (83%) eyes, with 18/100 eyes (18%) requiring two or more lacrimal procedures. Lacrimal reconstructive surgery was considered impractical in two further patients. There were no intraoperative and few postoperative complications.. With adequate experience, open lacrimal surgery appears to be a safe and effective procedure in the majority of patients with rare nasal diseases or major nasofacial anomalies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Dacryocystorhinostomy; Facial Neoplasms; Female; Humans; Infant; Lacrimal Duct Obstruction; Male; Middle Aged; Nose; Nose Deformities, Acquired; Rare Diseases; Retrospective Studies; Treatment Outcome

A 61-year-old woman developed multiple and clustered eruptive epidermoid cysts at the site of treatment of a basal cell carcinoma located on her nose with imiquimod 5% cream (5 times/week for 6 weeks). Clearing was achieved after topical treatment with tretinoin 0.025% cream (1 application/day for 1 month).

Topics: Aminoquinolines; Antineoplastic Agents; Biopsy; Carcinoma, Basal Cell; Diagnosis, Differential; Epidermal Cyst; Facial Neoplasms; Female; Follow-Up Studies; Humans; Imiquimod; Middle Aged; Nose

The medial canthus is an aesthetically and functionally important area. Adequate consideration of the local anatomy is essential when reconstructing this area. We developed a combined flap technique with a simple combination of standard flaps for the treatment of extensive defects of the nose and upper and lower eyelids, including full-thickness medial canthus defect. In our technique, a median forehead island flap is used for the nasal region, the anterior surface of the eyelid is reconstructed along aesthetic unit, and the posterior surface is reconstructed with a palatal mucoperiosteal graft. A cheek flap is then used for the reconstruction of the lower eyelid. When reconstructing a small defect of the upper eyelid, the upper eyelid is advanced, while a V-Y advancement flap within the upper eyelid is used for a large defect. To reconstruct the acute angle of the medial canthus, a 0.3 mm titanium wire was passed through the tip of the tarsal plate of the upper and lower eyelids to be reconstructed and was fixed in the perforated nasal bone on the affected side. Using this technique, the acute angle of the medial canthus is well preserved after surgery, and is located symmetrically with its counterpart on the intact side. Our technique provides good reconstructive results and should serve as a valid alternative for the reconstruction of this area.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Eyelids; Facial Neoplasms; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome

This disease was first described by von Recklinghausen and Festscher and has been known as the von Recklinghausen's disease or neurofibromatosis (NF). Numerous articles have been published on this subject where majority of the authors have stressed their difficulty in achieving favourable surgical results. This disease is pathologically accepted to be of neuroectodermal origin with a positive family history in approximately 50% of the cases, autosomal dominant trait and is known to involve the periorbital regions, orbit (preoperative CT scan: upper left and right photographs), temporal region to a variable extent, mid-facial region to the mandibular region. The indicated treatment for this disease is surgery including cranio-maxillofacial surgery even though re-evaluation of the conventional methods of surgery should be considered. This particular case is an extremely difficult and challenging case for any reconstructive plastic surgeon and required extensive preoperative planning. The systematic multiple stage surgical approach for an extremely severe von Recklinghausen's disease, elephantiasis neurofibromatosa is presented and discussed in detail.

Topics: Anesthesia, General; Anesthesia, Local; Cheek; Eyebrows; Face; Facial Neoplasms; Female; Humans; Lip; Middle Aged; Neurofibroma, Plexiform; Neurofibromatosis 1; Nose; Orbit; Plastic Surgery Procedures; Preoperative Care; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adolescent; Endoscopy; Face; Facial Neoplasms; Female; Hemangioma, Cavernous; Humans; Nose

An alternative method for fixation of soft tissue in the face, such as the medial and lateral canthus and free flaps, and for reconstruction of the nasolabial fold is presented, using the micro Mitek Anchor. The insertion of a bone anchor requires only a limited dissection, and the point of insertion can be determined accurately. These advantages are obvious when performing a canthoplasty. Using the bone anchor to fixate a free flap to the facial skeleton is an effective way to prevent sagging of the flap as a result of gravitational forces. In contrast, the use of bone anchors in facial neurofibromatosis has not been as rewarding.

Topics: Eyelids; Face; Facial Neoplasms; Humans; Lip; Neurofibromatoses; Nose; Orthopedic Fixation Devices; Plastic Surgery Procedures; Surgical Flaps

This clinical study examined the quality of life of face-disabled patients who had received a facial prosthesis.. The examination of the 58 patients was performed using different questionnaires. For the evaluation of the subjective health-related quality of life an instrument constructed by the WHO was used (WHOQOQL-Bref). The Frankfurter Scales of Body Concepts (FKKS) was chosen to measure the self-assessment of the patient's own body perception. For the assessment of the present general quality of life a visual analogue scale was used (Anamnestic Comparative Self-Assessment, ACSA). Additionally an ad hoc questionnaire was used, which registers the post-therapeutic epithetic rehabilitation. The health-related quality of life of this sample was compared to a healthy one of the normal population.. The examinations showed that the quality of life of the patients is reduced in contrast to the healthy group when the acquired defects were located in the region of the eye and the nose. The evaluation of the scales of body concepts showed that the patient's own body image was significantly altered. Body contact with other persons and their own sexual attraction was perceived as remarkably diminished. The patients believed that they spread an unpleasant odor. It is surprising that the wearers of a facial prosthesis indicated that they did not notice a restriction in the acceptance of their body by others. The influence of the application of camouflage did not have an impact on the quality of life.. To improve the restricted quality of life, to the raise the reduced well-being and to strengthen the altered body experience, psychological care should be provided besides further optimization of the surgical-epithetic therapy and the camouflage technique.

Topics: Adaptation, Psychological; Adult; Aged; Body Image; Ear, External; Esthetics; Eye, Artificial; Facial Neoplasms; Female; Follow-Up Studies; Humans; Male; Maxillofacial Abnormalities; Middle Aged; Nose; Prosthesis Implantation; Quality of Life

Maxillofacial surgeons are more and more confronted with wide defects of the face, particularly after resection of facial cancer. Complex wounds of the face, whatever the etiology may be, poses the difficult problem of their rehabilitation. The surgical reconstruction offers usually the most interesting solutions on the conceptual and morphological stages. There remain some particular cases where the therapeutic choice tends towards the rehabilitation by epitheses. The improvement of texture and color of epitheses and the improvement of the possibilities of their osseous anchorage by implants (endo-osseous or juxta-osseous) permit to reconstruct that kind of complex facial wounds with restoration of oral function and with a good morphologic result.

Topics: Adult; Aged; Dental Implants; Esthetics; Eye, Artificial; Face; Facial Bones; Facial Injuries; Facial Neoplasms; Female; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Nose; Orbital Implants; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Coloring; Prosthesis Design; Surface Properties

After studying this article, the participant should be able to: 1. Understand the epidemiology of skin cancer in a patient with preexisting skin cancer. 2. Understand the indications for the use of a nasolabial flap and nonanatomic alar strut graft. 3. Describe the blood supply to the nasolabial flap. The goals of reconstructing deformities of the face acquired secondary to skin tumors include optimizing donor-site aesthetics and reconstructing the area with similar types of tissue when possible. Multiple skin-cancer defects are often seen by the plastic surgeon and complicate the reconstruction, requiring more than one flap or skin graft. A case analysis of an innovative application of the nasolabial flap for reconstruction of a simultaneous medial cheek and alar-base nasal defect is presented. Concepts in nasal reconstruction are reviewed, and the authors' approach to alar reconstruction is presented.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

In recent years, access osteotomies have been suggested to reach areas of the craniofacial skeleton that hitherto would not have been easily resectable. Some techniques of disassembling of the facial skeleton have been described in the past. In some cases, however, when the bony fragments were not pedicled to the soft tissue, reabsorption was noted. For this reason, new dismantling techniques with adequate blood supply to the bony fragments have been developed. Apart from the maxillo cheek flap, other composite flaps have been described. These flaps may be combined if necessary in selected cases. An overview of the surgical anatomy and surgical strategies will be presented. These reported techniques may be considered a major step forward in the treatment of deeply localized tumors in the craniomaxillofacial area.

Topics: Cheek; Facial Bones; Facial Neoplasms; Humans; Maxilla; Mouth; Nose; Orbit; Osteotomy; Plastic Surgery Procedures; Skull Neoplasms; Sphenoid Bone; Surgical Flaps; Zygoma

Topics: Aged; Carcinoma, Basal Cell; Facial Neoplasms; Female; Humans; Lip Neoplasms; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps; Sweat Gland Neoplasms; Treatment Outcome

The respective indications for oral or extra-oral implants lead to no confusion: stabilization of dental prostheses for the first, stabilization of maxilo-facial epitheses for the others. We demonstrate that the complementarity of the two types of implants can prove to be very useful in maintaining the maxillary dental prosthesis and the epithesis in a case of severe loss of facial substance affecting particularly the pre-maxilla. This complementary characteristic made it possible to recover fairly rapidly phonation and deglutition, and to remedy somewhat the esthetic damage. In other words to create the essential conditions for a return to everyday life.

Topics: Aged; Carcinoma, Squamous Cell; Dental Implantation, Endosseous; Dental Prosthesis Design; Eye Enucleation; Facial Neoplasms; Humans; Lip; Male; Maxilla; Maxillofacial Prosthesis Implantation; Neoplasm Invasiveness; Nose; Orbit; Patient Care Planning; Prosthesis Design; Zygoma

Topics: Adult; Aged; Carcinoma, Basal Cell; Facial Neoplasms; Female; Hematoma; Humans; Male; Middle Aged; Mohs Surgery; Nail Diseases; Nose; Skin Diseases; Skin Transplantation

The plastic qualities and vascular reliability of the frontal flap have been widely used for reconstruction of facial tissue. We revised the files of 105 patients who had undergone surgical repair of facial tissue loss with frontal flaps. The epidemiology, etiology of the repaired tissue loss and indications for frontal flap as well as the various techniques were analyzed: 66.7% of the patients were over 60 years of age; 74% had ambulatory surgical repair; 54.4% of the repaired tissue losses were situated in the nasal region; 80% of the losses were due to tumoral formations. The median flap was the most widely used (23.2%).

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Carcinoma, Basal Cell; Child; Child, Preschool; Esthetics; Face; Facial Injuries; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Precancerous Conditions; Retrospective Studies; Sensation; Skin Neoplasms; Skin Transplantation; Surgical Flaps

A 9-year-old domestic shorthair cat was referred for removal of a rostrally located fibrosarcoma on the face, which had previously recurred twice following excision. A wide excision was performed, using a neodymium:yttrium-aluminumgarnet (Nd:YAG) laser, resulting in a facial defect that could not be closed by primary suture. An interpolation skin flap was elevated, using skin from the side of the cat's face, and sutured in place over the defect. Recurrence of the tumor at the medial canthus of the left eye, which was observed 4 months after surgery, was treated by laser excision and cryotherapy. Other recurrences of the fibrosarcoma were not noticed for 2.5 years after referral, at which time the cat was euthanatized for other reasons. Necropsy revealed that the fibrosarcoma had not recurred. In this cat, an interpolation skin flap was useful in repairing a large rostral facial defect. Care should be taken when elevating this flap to preserve the palpebral nerve.

Topics: Animals; Cat Diseases; Cats; Facial Neoplasms; Female; Fibrosarcoma; Laser Therapy; Neoplasm Recurrence, Local; Nose; Postoperative Complications; Surgical Flaps

Lethal midline granuloma (LMG) is characterized by progressive ulceration and destruction of the midfacial tissue. It occurs more frequently in Oriental than in Western populations. Because of the progress in clinical pathology and immunohistochemistry, most cases have been proven to be malignant lymphomas, especially of T-cell lineage. We describe 92 cases of lethal midline granuloma or centrofacial malignant lymphoma in the period 1959-1993. All received complete courses of radiotherapy. Twenty of them also received combination chemotherapy. Thirty-six cases had specimens available for immunohistochemical study; 25 (69%) of these had a T-cell phenotype, and 6 (17%) were of B-cell lineage. The dose to the nasal region was in the range of 3000-7500 cGy in 11-58 days, and to the neck 3000-6400 cGy in 11-48 days. The overall survival rate for the LMGs was 59.5% at 5 years and 56.2% at 10 years (Kaplan-Meier). Combined chemotherapy seemed not to improve the overall survival in this study (p = 0.63), but the patient number was too small to make a firm conclusion. Based on the results of this study, we recommend a dose of 4500-5000 cGy to the midfacial region, since a higher dosage did not improve the treatment results (p = 0.88). Irradiation has a definite role in good locoregional control of this disease. The recent clarification of the disease nature and the recognition of the background clinicopathological features should provide valuable information for future patient management and prospective studies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; B-Lymphocytes; Cell Lineage; Child; Combined Modality Therapy; Disease-Free Survival; Facial Neoplasms; Female; Follow-Up Studies; Granuloma, Lethal Midline; Humans; Immunohistochemistry; Immunophenotyping; Lymphoma, T-Cell; Male; Middle Aged; Neck; Nose; Radiotherapy Dosage; Radiotherapy, High-Energy; Retrospective Studies; Survival Rate; T-Lymphocytes; Treatment Outcome

Topics: Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Humans; Male; Middle Aged; Nose; Prognosis

Reconstructive surgery does not always provide for sufficient functional, cosmetic und esthetic results of bone defects, loss of soft tissues and sense organs. 57 patients were treated by the "Bochum study group for oro-facial rehabilitation" from 1990 to 1992 using implant-retained prostheses. The advantages of the "Snap-Button-System" used for retention are presented.

Topics: Ear, External; Eye, Artificial; Facial Injuries; Facial Neoplasms; Humans; Nose; Prostheses and Implants; Prosthesis Design

Anecdotal reports and clinical observations have suggested that the response of port-wine stains to treatment with the pulsed dye laser is variable and dependent on the anatomical location of the lesion. To investigate anatomical variation in response to treatment, a retrospective study of 259 adults and children with port-wine stains of the head and neck treated with the pulsed dye laser was undertaken. Evaluation was performed by comparing simultaneously projected pretreatment and completion-treatment photographs. Anatomical differences in response were evaluated in three ways: (1) by anatomical subdivision of the head and neck into regions, (2) by dermatomal distribution, and (3) by response for midline lesions. The head and neck was subdivided into eight anatomical regions, which were independently evaluated for response. In addition, response for individual dermatomes and for midline lesions was evaluated. Response in all cases was assessed by determining the percentage of lightening from 0% to 100% (where 100% represents complete response) at the completion of treatment. Response grades were also assigned, using grades poor (0% to 25% lightening), fair (26% to 50% lightening), good (51% to 75% lightening), or excellent (76% to 100% lightening).. One hundred thirty-seven adults and 122 children were included in the study. Evaluation by subdivision of the head and neck into regions revealed that in adults and children the centrofacial regions (medial aspect of the cheek, upper cutaneous lip, and nose) responded less favorably than the other grouped regions (periorbital, forehead/temple, lateral aspect of the cheek, neck, and chin); the centrofacial regions showed a good response (mean lightening, 70.7%) while the other grouped regions of the head and neck showed an excellent response (mean lightening, 82.3%). Evaluation by dermatomal distribution revealed that dermatome V2 showed a good response (mean lightening of 73.8%), while combined dermatomes V1, V3, and C2/C3 showed an excellent response (mean lightening of 82.4%). Evaluation of midline lesions revealed excellent responses in adults and children (mean lightening, 92.4%).. Port-wine stains of the head and neck in adults and children demonstrate differences in response to treatment with the pulsed dye laser according to their anatomical location. Centrofacial lesions and lesions involving dermatome V2 in adults and children respond less favorably than lesions located elsewhere on the head and neck. Midline lesions respond very favorably in adults and children.

Topics: Adolescent; Adult; Aged; Cheek; Child; Child, Preschool; Face; Facial Neoplasms; Female; Hemangioma; Humans; Infant; Laser Coagulation; Lip; Male; Middle Aged; Nose; Orbit; Photography; Rhodamines; Skin Neoplasms; Skin Pigmentation; Treatment Outcome; Trigeminal Nerve

Microcystic adnexal carcinoma is an unusual, locally aggressive tumor that recently has been recognized as a distinct clinicopathologic entity. It typically occurs on the face of young or middle-aged women and often requires extensive surgical excision to gain local control. A case involving the upper lip and columella of a young woman is described and the available literature reviewed. The difficult reconstructive challenge this lesion usually presents is illustrated in this patient who required upper lip and complete columellar reconstruction.

Topics: Adult; Carcinoma; Facial Neoplasms; Female; Humans; Lip; Mohs Surgery; Nose; Skin Neoplasms; Surgical Flaps

Topics: Carcinoma, Basal Cell; Cryosurgery; Curettage; Ear, External; Evaluation Studies as Topic; Facial Neoplasms; Humans; Nose; Skin Neoplasms

A young pregnant woman had facial swelling in the upper nasal region. This was initially considered to be lymphedema in view of a history of past severe facial acne. A biopsy was done when the lesion progressed; the specimen showed adenocarcinoma. This responded well to radiotherapy, the favorable response being maintained for more than 24 months.

Topics: Adenocarcinoma; Adult; Dacryocystorhinostomy; Facial Neoplasms; Female; Humans; Nose; Pregnancy; Pregnancy Complications, Neoplastic; Tomography, X-Ray Computed; Visual Acuity

Surgery for maxillofacial cancer often creates a defect, which may affect speech, swallowing, mastication and facial appearance. The provision of a prosthesis is one method to help restore these physiologic and psychologic functions. Prosthodontic planning and rehabilitation should be an integral part of the team management to provide not just the preservation, but a quality of life for the patient. Various types of appliances are illustrated and the role of the dental surgeon is emphasised.

Topics: Aged; Facial Neoplasms; Humans; Male; Maxillary Neoplasms; Maxillofacial Prosthesis; Middle Aged; Nose; Prostheses and Implants

The "Kite" flap is a triangular protruding flap attached underneath the skin. The authors present the results of the utilisation of this type of flap in reconstruction after removal of baso-cellular cancer of the face. After a brief historical and technical recall, they contemplate a study of 45 patients operated on by this method. The preferential localisations of this type of flap are analyzed (sub-orbital region, naso-genien region, labiogenien region). Other techniques of repair are discussed region by region. However, the authors emphasize the facility of execution of the "Kite" flap and its excellent aesthetic results, its principal use being in the reconstruction of the sub-orbital region.

Topics: Adult; Aged; Carcinoma, Basal Cell; Facial Neoplasms; Female; Humans; Lip; Male; Methods; Middle Aged; Nose; Orbit; Surgical Flaps

In summary, the use of free tissue transfers for nasal reconstruction offers a wide variety of tissues that provide cutaneous coverage, underlying support, and nasal lining. Obtaining the final aesthetic result frequently requires defatting and other touch-up procedures, which usually can be done under local anesthesia on an outpatient basis.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Esthetics; Facial Neoplasms; Female; Follow-Up Studies; Humans; Lip Neoplasms; Male; Middle Aged; Nose; Nose Neoplasms; Surgical Flaps

Topics: Denture Design; Denture, Partial; Facial Neoplasms; Humans; Male; Maxillofacial Prosthesis; Nose; Palatal Obturators; Patient Care Planning; Prostheses and Implants; Prosthesis Design

Topics: Airway Obstruction; Eye, Artificial; Facial Neoplasms; Humans; Maxillofacial Prosthesis; Nose; Prosthesis Design

During a period of over 20 years, 896 patients were treated with radiation in Wadsworth Medical Center, Los Angeles, for carcinoma of the lip and selected sites of skin of the head and neck. Basal cell carcinoma (BCC) was found in 467 (52%) patients, squamous cell carcinoma (SCC) in 362 (40%), and the remaining 67 (8%) had tumors with mixed basal and squamous cell features. BCC was the most common tumor (72%) among the 646 skin cancer patients while SCC predominated (99%) among the 250 lip cancer patients. Tumor control correlated well with the size of the lesion, p less than 0.0001. Histology of the lesion also had a significant (p = 0.021) influence on the tumor control rate, which was the highest among the BCC patients when compared with SCC or mixed cell patients. This study has again demonstrated the effectiveness of radiotherapy in controlling small and intermediate size epithelial tumors of the skin and lip. Additionally, irradiation, if administered properly, results in excellent cosmesis and a low incidence of treatment complications. Severe complications of radiotherapy reported in the literature took place at the beginning of this century and are no longer pertinent in the practice of modern radiation oncology. Larger lesions remain a challenge to radiation or surgical dermato-oncologists. A lack of tumor control in such lesions frequently results in a death of patient.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Lip Neoplasms; Middle Aged; Nose; Radiotherapy; Skin Neoplasms

A definition and classification of midfacial defects has been presented with a systematic approach to the prosthetic restoration of these defects. Patient factors, prognostic and diagnostic considerations, clinical procedures, fabrication, materials, and retention have been discussed. Patients with complex orofacial defects can be provided with prosthodontic treatment that results in an acceptable appearance and function consistent with the deficits encountered (Figs. 14 and 15).

Topics: Denture Design; Esthetics; Face; Facial Neoplasms; Female; Humans; Lip; Male; Maxilla; Maxillofacial Prosthesis; Nasal Cavity; Nose; Prognosis; Prosthesis Design

The technique of facial reconstruction used by the plastic team at the Cancer Center of the University of Brussels are presented. Free grafts are seldom performed because they often lead to disfigurement. An appropriate evaluation of the margins of resection is obtained during the operation by multiple frozen sections, and reconstruction is achieved by local flaps when possible. It is considered that a normal appearance is of extreme importance for old patients suffering from facial cancer, and that the aim of surgery is not only complete eradication of the lesion but also careful reconstruction of the removed structures by simple and safe procedures. The selected techniques are presented for each region of the face.

Topics: Aged; Carcinoma; Cheek; Ear Neoplasms; Ear, External; Eyelids; Face; Facial Neoplasms; Forehead; Humans; Lip; Middle Aged; Neoplasm Recurrence, Local; Nose; Scalp; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

Topics: Carcinoma, Basal Cell; Cryosurgery; Facial Neoplasms; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose

Topics: Adult; Aged; Attitude; Consumer Behavior; Ear, External; Face; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nose; Orbit; Prostheses and Implants

Twenty-two patients with congenital and acquired defects, rehabilitated with silicone ectoprostheses, were followed up for 6 mo to 4 yr. The simplicity of the procedure, its good results and the early physical and social rehabilitation attained, favor its use when adequately indicated.

Topics: Adolescent; Adult; Aged; Child; Ear Deformities, Acquired; Ear, External; Eye, Artificial; Face; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Prostheses and Implants; Silicones

Topics: Adult; Diagnosis, Differential; Eye; Facial Neoplasms; Female; Humans; Male; Maxillofacial Prosthesis; Nose; Orbit; Palate; Prostheses and Implants

Topics: Adult; Carcinoma, Basal Cell; Facial Neoplasms; Female; Humans; Lip; Neoplasm Recurrence, Local; Nose; Prognosis; Surgical Flaps

A series of large, midfacial, squamous cell and basal cell carcinomas treated by the Departments of Otolaryngology and Dermatology (Cleveland Clinic Foundation) are reported. Most cases required total/partial resection of the external nose, upper lip, hard palate, nasal septum, and adjacent midfacial soft tissues. Emphasis is placed on the principles of preoperative and intraoperative management as it relates to intraoral prosthetic design and total margin control of the surgical specimen. The immediate and delayed reconstructive philosophy and techniques employed here are discussed in detail. Recurrence rates and free-to-disease survival times are also reviewed.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Lip; Maxillofacial Prosthesis; Nose; Surgical Flaps

Topics: Carcinoma; Chin; Facial Neoplasms; Humans; Nose; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

The nasolabial flap was used for reconstruction of the nose, lip, and cheek in 23 patients with satisfactory results. From the standpoint of color and texture match, this flap was of considerable value for skin repair of the nose. As for the donor site, the limitation of the nasolabial flap is considered to be about 3 x 10 cm. The nasolabial flap is also discussed from the point of view of recent considerations on its special characteristics and applications.

Topics: Adolescent; Adult; Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Lip; Lip Neoplasms; Male; Middle Aged; Nevus; Nose; Nose Neoplasms; Surgical Flaps

Topics: Adolescent; Adult; Carcinoma, Squamous Cell; Cheek; Child; Face; Facial Neoplasms; Female; Fibrosarcoma; Fistula; Humans; Male; Melanoma; Middle Aged; Mouth Neoplasms; Nose; Nose Deformities, Acquired; Surgical Flaps

In the repair of large defects of the lower lid near the medial canthus, reconstruction with flaps and grafts is met with the problem of aligning variable skin thicknesses. This method of repair provides an alternative technique in which replacement of both thick and thin skin deficienies are met.

Topics: Cheek; Eyelids; Facial Neoplasms; Humans; Male; Middle Aged; Nose; Skin Transplantation; Surgical Flaps; Transplantation, Autologous

The cheek for reconstructive purposes if divided into a medial or lateral region. Some cheek defects are presented and the methods of their closure explained. Bilobed, trilobed and cranial pedicled rotation flaps, used to close lateral defects, are also described.

Topics: Cheek; Eyelids; Facial Neoplasms; Female; Humans; Lip; Male; Nose; Surgery, Plastic; Surgical Flaps

A patient developed a cutaneous deposit of leukaemic cells within a squamous cell carcinoma as the first presentation of acute myeloblastic leukaemia.

Topics: Aged; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Leukemia, Myeloid, Acute; Male; Neoplasms, Multiple Primary; Nose; Skin; Skin Neoplasms

Topics: Ear; Face; Facial Neoplasms; Humans; Nose; Prostheses and Implants; Radiation Injuries; Skin Transplantation; Skin Ulcer; Surgery, Plastic; Transplantation, Autologous

Topics: Cheek; Ear, External; Facial Injuries; Facial Neoplasms; Female; Humans; Lip; Male; Nose; Orbit; Surgery, Plastic; Surgical Flaps

Topics: Child; Child, Preschool; Congenital Abnormalities; Dermoid Cyst; Disorders of Sex Development; Ear, External; Eyebrows; Facial Neoplasms; Female; Fistula; Hemangioma; Hemangioma, Cavernous; Humans; Infant; Male; Neck; Nevus, Pigmented; Nose; Nose Neoplasms; Penis; Skin Neoplasms

Topics: Aged; Biopsy; Diagnosis, Differential; Face; Facial Neoplasms; Female; Fluorescent Antibody Technique; Humans; Laryngoscopy; Larynx; Leprosy; Lip; Lupus Vulgaris; Mouth; Nose; Pharynx; Potassium Iodide; Radiography; Skin; Syphilis Serodiagnosis; Syphilis, Congenital; Voice

Topics: Adult; Autopsy; Brain; Diagnosis, Differential; Facial Neoplasms; Female; Granuloma, Lethal Midline; Granulomatosis with Polyangiitis; Humans; Kidney; Male; Nose; Staining and Labeling

Topics: Bites and Stings; Burns; Face; Facial Injuries; Facial Neoplasms; Humans; Methods; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Cell Transformation, Neoplastic; Eyelid Neoplasms; Facial Neoplasms; Female; Humans; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Middle Aged; Neoplasm Metastasis; Nose; Orbital Neoplasms; Parotid Neoplasms

Topics: Congenital Abnormalities; Eyelid Neoplasms; Facial Neoplasms; Female; Head and Neck Neoplasms; Hemangioma; Hong Kong; Humans; Infant, Newborn; Male; Nose; Pedigree; Racial Groups

Topics: Adult; Aged; Diagnosis, Differential; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Papilloma

Topics: Adolescent; Adult; Biopsy; Child; Child, Preschool; Face; Facial Neoplasms; Female; Follow-Up Studies; Foreign Bodies; Humans; Male; Methods; Nose; Plastics; Polyethylenes; Postoperative Complications; Prostheses and Implants; Surgery, Plastic

Topics: Color; Ear, External; Facial Injuries; Facial Neoplasms; Humans; Maxillofacial Prosthesis; Nose; Nose Neoplasms; Prostheses and Implants; Rubber; Silicones; Tattooing

Topics: Adult; Cortisone; Diagnosis, Differential; Face; Facial Neoplasms; Female; Granuloma, Lethal Midline; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Lymphoma, Non-Hodgkin; Male; Middle Aged; Nasal Mucosa; Nose; Nose Neoplasms

Topics: Carcinoma, Basal Cell; Eyelids; Facial Neoplasms; Female; Humans; Lip; Male; Maxillofacial Prosthesis; Nose; Scalp; Skin Neoplasms; Skin Transplantation; Surgery, Plastic

Topics: Adipose Tissue; Adult; Carcinoma, Basal Cell; Ear, External; Face; Facial Neoplasms; Female; Humans; Male; Methods; Nevus; Nose; Nose Neoplasms; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Eye, Artificial; Facial Neoplasms; Female; Humans; Male; Maxillofacial Prosthesis; Nose; Nose Neoplasms

Topics: Ear; Ear Deformities, Acquired; Eye Neoplasms; Eye, Artificial; Facial Injuries; Facial Neoplasms; Female; Humans; Male; Maxillofacial Prosthesis; Nose; Nose Neoplasms

Topics: Acne Vulgaris; Adult; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Female; Fibrosarcoma; Follow-Up Studies; Humans; Lymphoma; Neoplasm Recurrence, Local; Neoplasms, Radiation-Induced; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Facial Neoplasms; Glioma; Humans; Infant; Nose; Nose Neoplasms

Topics: Congenital Abnormalities; Ear Deformities, Acquired; Ear, External; Facial Injuries; Facial Neoplasms; Humans; Mandibular Injuries; Nose; Nose Deformities, Acquired; Plastics; Prostheses and Implants; Surgery, Plastic

Topics: Acrylic Resins; Artificial Organs; Ear, External; Eye, Artificial; Face; Facial Neoplasms; Humans; Nose; Polyvinyls; Prostheses and Implants; Prosthesis Implantation; Tissue Adhesives

Topics: Eyelids; Facial Neoplasms; Humans; Nose; Plastic Surgery Procedures; Skin Transplantation; Surgery, Plastic; Surgical Procedures, Operative; Transplantation, Autologous; Wound Healing

Topics: Child; Face; Facial Neoplasms; Humans; Infant; Neoplasms; Nose; Rhabdomyosarcoma