Riccardo F. Mazzola

Vocal fold augmentation by autologous fat injection with lipostructure procedure

BACKGROUND: Fat is theoretically the ideal implant for vocal fold augmentation because it is soft, easily available and biocompatible. However, reabsorption is a frequent cause of long-term failure. OBJECTIVE: We prospectively tested Colemans “li-postructure” technique used for facial recontouring in the treatment of glottic incompetence. STUDY DESIGN AND SETTING: Fourteen patients (aged 18–74 years, mean 48) with breathy dysphonia secondary to laryngeal hemiplegia (7) or anatomical defects (7) underwent vocal fold lipoinjection. Fat harvested by liposuction was centrifuged, and the fat cell layer injected into the vocalis muscle. The patients underwent pre- and postoperative videolaryngostroboscopy, maximum phonation time (MPT) measurements, GRBAS perceptual evaluations, and Voice Handicap Index (VHI) self-assessments. RESULTS: Voice quality improved soon after surgery and remained stable over 3–26 months (mean 10.6), being confirmed by the GRBAS, MPT and VHI evaluations (P < 0.005). The results were best in the seven patients with paralytic dysphonia. CONCLUSION: Lipostructure is a valuable technique for voice rehabilitation in glottic incompetence.

Treatment of haemangiomas in children by intralesional injections of steroids - A long term follow-up

SummaryThe author reports his experience with the treatment of rapidly enlarging mixed strawberry and cavernous haemangiomas in the head and neck area by the use of steroids. The drug, Methylprednisolone Acetate, is locally injected within the lesion at the dosage of 2 mg/kg bodyweight weekly for four weeks. Normally after one course of treatment a dramatic reduction of the lesion is evident. In case of failure or “rebound effect”, a second course may be prescribed. Some sites respond particularly well to this therapy, while others less so or not at all. Among the 11 cases presented in this report, 7 obtained an immediate benefit after 1, maximum 2 courses. One, with a massive haemangioma of the parotid and labial region, obtained a dramatic reduction of the parotid lesion, but no response of the labial, thus requiring a surgical excision. The other three, after one unsuccessful course, underwent surgical excision. The parotid region seems to respond particularly well to this therapy.

Treatment of Velopharyngeal Insufficiency by Pharyngeal and Velar Fat Injections

The aim of this prospective study was to evaluate the effectiveness of fat injections in the treatment of velopharyngeal insufficiency (VPI). The study involved 10 patients (6 adults aged 19-48 years and 4 children aged 5-13 years) with mild/moderate VPI who were injected with 3.5 to 8 mL of fat in the posterior, lateral pharyngeal walls and soft palate under general anaesthesia. A second fat-grafting procedure was performed in 2 patients to achieve further improvement. Nasoendoscopy revealed a reduction in the closure gap in all patients, and the perceptual evaluation demonstrated improved speech intelligibility and resonance and reduced nasal air leakage in all cases (P < .005). The aerodynamic assessment showed a significant reduction in nasal airflow during phonation (P < .05). Follow-up was 6 to 23 months. In conclusion, fat injections improved voice resonance and reduced nasal air escape in all treated cases and can be a promising alternative to major procedures, such as velopharyngoplasties, for the treatment of mild/moderate VPI.

History of fat grafting: from ram fat to stem cells.

Fat injection empirically started 100 years ago to correct contour deformities mainly on the face and breast. The German surgeon Eugene Hollaender (1867-1932) proposed a cocktail of human and ram fat, to avoid reabsorption. Nowadays, fat injection has evolved, and it ranks among the most popular procedures, for it provides the physician with a range of aesthetic and reconstructive clinical applications with regenerative effects on the surrounding tissues. New research from all over the world has demonstrated the role of adipose-derived stem cells, present in the adipose tissue, in the repair of damaged or missing tissues.

A contribution to the treatment of permanent facial paralysis by free muscle grafting based on 21 cases

SummaryTwenty-one patients with unilateral permanent facial palsy were treated by free muscle grafting following Thompsons technique.Cases were divided into three groups according to the surgical procedure used and to the muscles transplanted.The muscle used was the extensor digitorum brevis of the foot for the 10 cases of group 1; the palmaris longus of the forearm for the 10 cases of group 2; the extensor digitorum brevis and the palmaris longus of the forearm for the case of group 3.In the patients of group 2 and 3 face-lifting was added to the standard Thompson procedure, in order to correct the relaxation of the soft tissue of the face on the paralysed side.In the subject of group 3, moreover, an upper based pedicle flap from the masseter muscle was rotated and fixed to the orbicularis oris muscle on the paralysed side, to improve smiling movements.Follow-up ranged from 6 months to 2 years. EMG activity of the grafts was recorded at 4, 6 and 12 months postoperatively.In 5 cases biopsy of the muscle grafts was taken 8 to 24 months after the transplants and histological as well as histochemical studies were carried out.Overall analysis of results leads the authors to point out that even though the muscle transplants survive, their function is mainly limited to the restoration of the sphincteric mechanisms of the eyelids and lips.On the other hand, the static as well as cosmetic appearance of the face is generally improved, especially when a face-lifting is added.Best results in the correction of unilateral permanent facial palsy may at present be achieved by combining face-lifting and rotation of a masseter muscle pedicle flap to the Thompson procedure.

Primary nasal tip surgery: A conservative approach

BackgroundRhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures.MethodsFor 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1xa0year.ResultsThe results at 1xa0year showed high rates of improvement in tip definition (mean, 7.9xa0±xa02.4) and nasal tip only evaluation (mean, 6.5xa0±xa03.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2xa0±xa03.2), nostril symmetry (mean, 4.5xa0±xa04.1), and tip projection (mean, 5.8xa0±xa02.9).ConclusionsThis simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.

Regenerative Approach to Velopharyngeal Incompetence with Fat Grafting

Surgical management of velopharyngeal incompetence (VPI) aims at improving voice resonance and correcting nasal air escape by restoring a competent velopharyngeal sphincter. Assessment of VPI requires the examination of multiple variables. The dynamic study of movements of the velopharyngeal port during speech and the quantification of the closure gap, using flexible videonasoendoscopy and/or videofluoroscopy, is essential. Autologous fat injection represents a minimally invasive alternative to major surgery in the management of mild to moderate VPI that minimizes the risk of complications and sequelae, and can be performed without modifying the anatomy of the velopharyngeal port.

EURAPS at 20 years. A brief history of European Plastic Surgery from the Société Européenne de Chirurgie Structive to the European Association of Plastic Surgeons (EURAPS).

By the end of WWI, plastic surgery had reached unexpected heights. The high quality of the work done for soldiers with facial injuries and burns, either as an emergency or as a delayed procedure, demonstrated that this new discipline was honourable, worthwhile and socially crucial, thus deserving official recognition and independence. The establishment of new plastic surgery centres, scientific societies and specialised journals were the key to success for the achievement of this goal. In 1936, the Belgian Maurice Coelst (1894-1963) founded the Société Européenne de Chirurgie Structive, the first supranational society, with the aim of gathering once a year all those interested in this new branch of surgery and favouring confrontation of ideas by showing innovative clinical procedures. The very successful first Congress with a large international participation was held in Brussels, with Coelst as the president, the second in London, in 1937, organised by Kilner and the third in Milano, in 1938, arranged by Sanvenero Rosselli. Even live surgery was performed during the meetings. The beginning of the WWII stopped the Societés activities, which were never resumed. In the late 1980s, when plastic surgery reached its zenith, the necessity was felt to create a new supranational society, different in its purpose from the existing European Section of IPRAS, later European Society of Plastic Reconstructive and Aesthetic Surgery (ESPRAS), an organisation where all the official European plastic surgery societies merged automatically. The aim was to promote the excellence of plastic surgery in Europe, to furnish an annual forum for the selection of the best scientific works presented at national societies and to stimulate research and education at a European level. Established in 1989, 53 years after the foundation of the Société Européenne de Chirurgie Structive, it was named the European Association of Plastic Surgeons (EURAPS). The first scientific meeting took place in Strasbourg, France, city of the Council of Europe, on 7-9 June 1990. Based on the high scientific level of the clinical and aesthetic presentations, EURAPS soon ranked among the leading associations in Europe for plastic surgery and this leadership is now recognised all over the world. The EURAPS successfully celebrated its 20th anniversary in 2009.

Treatment of Haemangioma by Oral Prednisone Therapy

Summary9 patients affected by rapidly enlarging haemangiomas have been treated by oral prednisone administration.Among these patients, 7 were females and 2 males. The age ranged from 45 days to 2 years. Haemangiomas were of the mixed “strawberry” and cavernous type (with the exception of 1 case which was of the deep cavernous type). The haemangiomas were localized in the face or in the parotid region in 7 cases, in the vulvar region in 1 case, and in the mammary region in 1 case (female).Patients received prednisone dosages of 1.5 mg/kg daily for 3 days, then 1.0 mg/kg daily for the duration of 4 weeks in 5 cases. In 2 cases the duration was 3 weeks, and in 2 cases was 2 weeks. In 3 cases a second therapeutic course of 3 weeks was prescribed, from 3 to 1 months after the withdrawal of the first cycle.In 4 cases significant reduction of the lesion was obtained within 2 weeks of treatment, and persisted after a follow-up period of 6 months (2 cases), 3 months (1 case) and 1 month (1 case). In 4 cases the lesions ceased to increase in size and remained static after follow-up periods of 3–4 months. In 1 case the lesion was still enlarging 1 month after the withdrawal of a 3 week therapeutic course.Better results were obtained in younger patients (under 6 months of age) and in haemangiomas localized in the face or parotid region. No rebound effect was observed.On the whole, these results can be considered as positive ones, and support the impression that, in particular cases of haemangioma, prednisone may be an effective means of therapy, allowing one to adopt a waiting attitude otherwise impossible in such cases.

Structural Fat Grafting to Improve Outcomes of Vocal Folds’ Fat Augmentation: Long-term Results

Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI (P ranging between .004 and <.001). The results achieved 1 year postoperatively remained stable at 3 and 10 years. Videolaryn-gostroboscopy showed improved glottic closure in all patients despite a limited amount of fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.