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1/179. Nasal reconstruction in children: a review of 29 patients.

    Acquired large nasal defects are much more common in adulthood than in childhood because of the frequency of skin tumors after a certain age. However, from their experience in treating a number of children with sequelae of noma and burns, the authors have collected a series of 17 total and 12 partial nasal reconstructions in children aged 1 to 15 years. After reviewing the various methods used for recreating the lining, the support, and the skin cover in the whole series, three cases are reported in detail. A 1-year-old patient received a tempororetroauricular flap after total amputation of the nose and was observed for 17 years. Another patient, who was burned as a baby, underwent reconstruction at age 10 with a deltopectoral flap and was observed for 7 years. The third patient underwent total nose reconstruction at age 12 with an Indian forehead flap. From their experience, the authors conclude that, for psychosocial reasons, nasal reconstruction should be started early, despite possible reoperation at a later age. The best results are certainly obtained at the end of growth or at least after the age of 12. Adjacent bone or soft tissue defects further enhance the difficult challenge of restoring a satisfactory aesthetic appearance in these children. ( info)

2/179. Reduction of nasal orbital fractures and simultaneous dacryocystorhinostomy.

    A technique for restoration of structure and function in naso-orbital fractures has been described. Three case reports demonstrate a few of the final results. The case reports also indicate that many of these fractures require late definitive surgery in spite of optimal surgical treatment immediately subsequent to injury. ( info)

3/179. Stenosis of the nasal vestibule and its treatment.

    From our own experience and a review of the literature, we present a few techniques which, in our eyes, give the surgeon the possibility to treat most encountered cases of stenosis of the nasal vestibule. During 1991 to 1998 the author in Stuttgart (W.G.) performed simple z-plasty combined with local flaps in 6 patients and composite grafts only in 12 cases, to correct nasal vestibule stenosis. The author in Lausanne (R.M.), who first described the paranasal myocutaneous flap to correct not only nasal vestibule stenosis but also alar base malposition has treated over 50 patients with this technique and with composite grafts during the last 20 years. ( info)

4/179. Polyvinylsiloxane dental bite registration material used to splint a composite graft of the nasal rim.

    We describe the construction of a nostril splint made from heavy body silicone-based dental impression material. This bio-compatible material supported a large chondrocutaneous auricular graft during early healing. The splint immobilized and maintained the shape of the alar rim and was further used nightly during the expected period of wound contraction. ( info)

5/179. An unusual complication of augmentation rhinoplasty: late displacement of dorsal nasal splint.

    Silastic (Dow-Corning) implants are used for augmentation rhinoplasty. Complications following their use usually occur within the first 24 months. We report a case in which the dorsal splint became displaced spontaneously five years after surgery. ( info)

6/179. Necrotizing infection of the face secondary to intranasal impaction of "crack" cocaine.

    "Crack" is a crystalline form of cocaine that is readily available and sold in the form of small granules. The authors report a unique case of forced intranasal impaction of crack cocaine with subsequent extensive necrosis of the nose and upper lip accompanied by a necrotizing infection of the subcutaneous soft tissue of the cheeks, forehead, and temporal regions. The treatment of extensive facial necrosis resulting from infection and ischemia centers around the early diagnosis of the infectious process, prompt and aggressive surgical debridement, and the administration of broad-spectrum antibiotics. ( info)

7/179. A case of reconstruction of saddle nose deformity in leprosy.

    A case of reconstructive surgery for saddle nose deformity is presented in this paper. A 22 year-old Bengali female who had completed WHO/MB regimen for 27 months underwent reconstructive surgery for saddle nose deformity. Since a saddle nose is one of the symbols of leprosy, it often causes serious psychological and social troubles to patients. This happens more often when the patient is a young unmarried woman. In this case the saddle nose seemed to be very serious. After being discharged from hospital she got married and had a baby. This operation gave the patient great relief to live in the community, because she no longer had serious visible evidence of leprosy on the body. Though the correction of the deformity without any dysfunction does not always have priority over other surgeries at a busy leprosy control project in bangladesh, it has merit both in patients themselves and in the society around them because it leads to the elimination of the stigma of leprosy. ( info)

8/179. Nasal abnormalities in facial clefts.

    After a short review of their development rare clefts of the nose occurring together with facial clefts are described in a number of clinical cases. These may be divided into 6 groups: 1. clefts of the nose; 2. oblique facial clefts; 3. nasal abnormalities in cleft lip and palate cases; 4. nasal abnormalities in median cleft palate cases; 5. aplasia of the premaxilla; 6. syndromes associated with nasal abnormalities and facial clefts. The discussion deals with the literature, aetiology, prognosis and therapeutic aspects. The publication of individual rare cases is suggested. ( info)

9/179. Bilateral congenital choanal atresia and absence of respiratory distress.

    Bilateral congenital choanal atresia is considered a lethal congenital malformation in an obligatory nasal breathing neonate. Described herein are two cases of bilateral choanal atresia associated with craniofacial anomalies who did not present respiratory distress in the neonatal period. Our first patient had a complete unilateral cleft lip which facilitated oropharyngeal respiration. The second patient presented wory distress in the neonatal period by providing an oropharyngeal airway. ( info)

10/179. Bilateral aplasia of the nose: a case report.

    After presenting a case of bilateral agenesis of the nose, and description of normal morphogenesis of the face, an explanation for the malformation is sought. The comparison of non-existent, rudimentarily preformed and existing elements with normal facial morphogenesis leads to the assumption of an incomplete formation of the frontal process, which has led to a hypoplasia of the secondary processes (nasal processes). The reason is advanced for abandoning the construction of a functioning nose and the reconstruction of the external nose is described. ( info)
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