Facial plastic surgery : FPS
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In the long history of otoplasty, the basic techniques used to correct prominent ears with a missing antihelix are based on incisions, scoring, and suturing of the cartilaginous framework of the auricle. In this article, modifications (subperichondrial dissection and adjusting sutures) of the anterior scoring technique of Chongchet are described.
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Current interest in minimally invasive surgery has extended to the repair of craniomaxillofacial fractures, including subcondylar fractures of the mandible. Recent experience indicates that rigid fixation by the endoscopic approach is technically feasible, particularly for subcondylar fractures with lateral displacement of the proximal fragment. The technique is more difficult (although not impossible) for medially displaced fractures. ⋯ Because evidence suggests that the outcome of open reduction of subcondylar fractures may be better than the outcome when closed management is performed, techniques that minimize the morbidity of open reduction should allow better long-term results. It is hoped that the endoscopic approach for the repair of subcondylar fractures of the mandible will provide these benefits. The technique is summarized with step-by-step explanations.
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Revision rhinoplasty is a challenge in reconstruction to the rhinoplasty surgeon, both in the techniques of repair and the choice of implant material for augmentation grafting. Often, patients seeking revision or reconstructive rhinoplasty have previously undergone septoplasty with sacrifice of major amounts of septal cartilage. These situations confront the surgeon with the need for a decision about the material that will be used for structural grafting. ⋯ With this in mind, the subject of this article is the use of auricular cartilage in revision rhinoplasty. Careful strategic planning must be undertaken to get the maximal and ideal benefit from the auricular cartilage. The revision rhinoplasty surgeon must understand the anatomy of the external ear and must be able to manage the precious cartilage supply to get the maximum use of it in reconstructive rhinoplasty.
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Auricular reconstruction is a unique area of facial plastic surgery where a wide array of reconstructive options often must be considered. The external ear is unique in its aesthetic role where the normal auricle often goes unnoticed; yet even a small irregularity can stand out and become conspicuous. ⋯ Two forms of auricular reconstruction are discussed: (1) those for a congenitally abnormal shape but no acquired tissue deficiency, that is, otoplasty, and (2) repairs requiring a reconstruction of discrete loss of tissue. A general algorithm is presented that can assist with flap selection and covers the techniques for grafts, framework repair, local and pedicled flaps, temporoparietal facial flaps, and auricular prostheses.
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Fractures of the middle portion of the facial skeleton are commonly referred to as midface or LeFort fractures. While significant progress has been made in terms of evaluation and treatment of such fractures, they remain a challenge for the maxillofacial surgeon. In this section, we will review the principles of midface fracture evaluation and repair, emphasizing the importance of understanding biomechanics and controversies that exist in respect to repair sequencing.