RESUMEN
This article presents orthodontic-surgical treatment in an eight-year-old patient with bilateral cleft lip and palate where premaxilla was surgically repositioned in the mixed dentition stage. By cranial and dorsal insertion of the premaxilla were created satisfactory occlusal relationship for ongoing eruption of permanent teeth, together with functional lip closure, improved pronunciation and a positive change in appearance of the centrofacial area. Reposition of premaxilla was associated with bilateral alveolar bone grafting of the cleft defect with cancellous bone from the iliac crest. Based on the model surgery were prepared rigid orthodontic wires, which ensured postoperative fixation of the segments of the upper jaw. The patient was wearing band fixed appliance for another 6 months after surgery. Healing was uncomplicated, the new position of the premaxilla was stable and more physiological. This procedure was friendly for a child patient and did not require fixation of the jaw segments by Sauer splint.
Asunto(s)
Trasplante Óseo , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/cirugía , Niño , Fijadores Externos , Humanos , Periodo PosoperatorioRESUMEN
BACKGROUND: Facelift is currently one of the most requested procedures among consumers of aesthetic plastic surgery. Like any operation, it is accompanied by a variety of potential complications, with postoperative bleeding probably the most frequent. Hematomas can cause hyperpigmentation,contour changes due to subcutaneous scarring, prolongation of healing, and necrosis of the skin flap. The most common treatment is manual expression of the blood coagula. Needle aspiration sometimes cannot be used because of the viscosity of the coagula. METHODS: Seven patients underwent a new method of hematoma removal from wounds. One to two sutures were removed above the hairline under local anesthesia and a short liposuction cannula, 2.5 mm in diameter and 1015 cm in length with one or two openings, was used for coagulum suction. RESULTS: All treated patients had the hematoma suction procedure without complications and with satisfactory outcomes and no subsequent bleeding. CONCLUSION: Coagulum suction is a simple and fast method that can shorten the recovery following a facelift.This method cannot replace surgical revision in cases in which there is substantial and/or persistent bleeding.However, it can reduce hematomas that are large enough to delay healing and interfere with convalescence, yet too small to warrant surgical revision.
Asunto(s)
Hematoma/cirugía , Ritidoplastia/efectos adversos , Adulto , Femenino , Hematoma/etiología , Humanos , Persona de Mediana Edad , Succión , Resultado del TratamientoRESUMEN
The prospective study of dental implant application into the reconstructed maxilla alveolus of cleft patients was started in 2001. Its aims are to specify precisely the indications, conditions and techniques, as well as the factors justifying the assumption that the results will be successful. Indication was based on an examination by a multidisciplinary therapeutic team (plastic surgeon, dental surgeon, orthodontist, and prosthetist), with the proviso that the patient should have a positive approach. Successful orthodontic treatment of intergnathic relation and shape of the dental arches served as the basis. It was followed by a reconstruction of the defective alveolus using autologous cancellous bone grafts, harvested from an iliac crest. Dental implants were inserted 12-15 weeks after the transplantation and subsequently a prosthetic component was applied with a time delay of at least 2 months. After the orthodontic preparation, reconstruction of the alveolus has so far been performed in 38 patients. Their age was at least 14 years, i.e. the age when growth of the orofacial region was finalised or already complete. The crucial tasks at this stage are to form a stable, three-dimensional voluminous alveolar crest, and to cover the grafts with a sufficient amount of quality soft tissue. We needed an average amount of 3.7 ccm of cancellous bone graft for the reconstruction. This amount can be harvested only from an enchondral bone. For soft tissue shell the mucoperiosteal shift of flap from cleft segment was used. In more serious cases contralateral or even bilateral shift was performed. The relief of tissue tension was performed by double cut-back. Using the approach described we attained a 84.2% success rate. Our results and experience derived within this project show that the success rate of this procedure depends on the continuous flow of the alveolar arch with a good intergnathic relation, with a length of defect between crowns of border teeth of at least 8 mm. The original osseous walls of the defect must definitely be of suitable height. On-lay augmentation does not work in these cases. A subsequent pitfall lies in resorption of transplanted bone, which may be reduced due to an early load by a dental implant. During the three months after the reconstruction a spongy osseous graft matures enough to ensure the primary stability of a fixture. We emphasise the necessity of close co-operation of the therapeutic team in such cases.
Asunto(s)
Proceso Alveolar/cirugía , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Implantes Dentales , Maxilar/cirugía , Adolescente , Adulto , Femenino , Humanos , Ilion/trasplante , Masculino , Estudios ProspectivosRESUMEN
Suction lipectomy is a very effective and safe method, if performed by an experienced plastic surgeon. The authors demonstrate using a group of 284 patients operated on at the University Clinic of Plastic Surgery in Prague between 1994-1998, indications, the method and complications.