RESUMO
Las fisuras oblicuas faciales son anormalidades poco frecuentes, aunque la incidencia exacta es desconocida, se reporta una incidencia de 1.5 a 5 por 100,000 nacimientos. Tessier en 1976 propuso una clasificación de las fisuras faciales, craneofaciales y laterofaciales. Morian describió la fisura oral nasoorbitaria (fisura número 3), que representa una de las malformaciones más difíciles de corregir para el cirujano plástico y reconstructivo. Reportamos un caso de fisura craneofacial Tessier número 3 así como la técnica de corrección quirúrgica empleada. Los autores enfatizan en el análisis de la embriología facial.
The oblique facial clefts are extremely rare facial anomalies, although the exact incidence of these facial clefts is unknown, is reported an incidence de 1.5 to 5 per 100,000 births. Tessier in 1976 proposed an anatomic classification of the facial, craniofacial, and laterofacial clefts. Number 3 clefts o oral-nasal-ocular cleft was described by Morian and represents one of the most difficult malformations to correct for the reconstructive surgeon. We report a case of unilateral Tessier No 3 craniofacial cleft and our approach to surgical correction. The authors emphasize in the analysis of the facial embryology.
RESUMO
BACKGROUND: Vaginal agenesis is a rare congenital disorder. It requires surgical management and still it is not defined universally. The surgical resolution of the pure vaginal agenesis, through fasciocutaneous pudendal thigh flaps, has few complications and allows the copulative function in normal conditions. OBJECTIVE: To assess the results of the vaginal agenesis surgical management. PATIENTS AND METHODS: From January 1996 to January 2005 we identified 33 patients with Müllerian duct and urogenital sinus disorders; eight of them had vaginal agenesis diagnosis. All the patients were subject to: complete medical history, karyotype study, determination of a complete gynecological profile, pelvic ultrasound, excretory urography, and, in some acute cases of hematometra or hematosalpinx, to an intervention with two surgical equipments: one of them used for the hematic collection emptiness of the internal genitals and the other one to solve the mechanical obstruction of vaginal agenesis. In some cases the study was completed through diagnostic laparoscopy. RESULTS: In our series six patients had functional uterus. When we made the surgical intervention we tried to make the uterus tunelization in the neovagina through the use of a Foley catheter. Nevertheless, they continued with symptoms of cyclical pelvic pain and chronic hematometra. One of the patients was exposed to total abdominal hysterectomy without bilateral oophorectomy, and in two more we are planning to make the same procedure in a short term. CONCLUSIONS: Fasciocutaneous pudendal thigh flaps technique is easy, safety and reliable, and it allows the creation of a neovagina in only one surgical time.