Rolf-Dieter Bader

Scalp defect repair: a comparative analysis of different surgical techniques.

AbstractScalp defects often arise in multimorbid patients. This study aimed at establishing an algorithm of defect repair with particular focus on new regenerative options.All patients, who consulted to the Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Jena between April 2005 and March 2010 were reviewed. Different reconstructive options were compared with regard to duration of hospital stay as well as rate of reoperations needed to achieve full closure.Sixty-eight patients were identified. Local flaps were more effective than skin grafts (P = 0.038) and microvascular free flaps (P = 0.037) in case of skin-galea-periosteal-defects. However, no differences were found between skin grafting in combination with wound bed preconditioning using a dermal regeneration template and microvascular free flap transfer.Scalp defects should be repaired based on careful evaluation of defect anatomy as well as patient’s general health. Application of dermal regeneration templates allows for an increase of the indication spectrum of free skin grafts.

The zygomaticomaxillary complex fracture – An anthropometric appraisal of surgical outcomes

Before undergoing repair of zygomaticomaxillary complex fractures, most patients are worried about their postoperative appearance. Furthermore, there is an ongoing discussion about the selection of the surgical approach to the inferior orbita and resulting eyelid deformities. We present a photo-assisted postoperative evaluation of zygomaticomaxillary complex fracture repair based on reference anthropometric data. Two hundred and twenty-one patients underwent zygomaticomaxillary complex fracture repair. An analysis of standardized postoperative photographs included measurements of eye fissure width and height, lid sulcus height, upper lid height, upper and lower coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, and whether a transconjunctival or a subciliary approach was performed. Surgery per se significantly influenced eyelid deformities as measured by its impact on eye fissure index, lower iris coverage and rate of scleral show and ectropion. The surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating distortion of the lower eyelid. Investigations regarding orbital fractures should clearly differentiate the type of fracture. The subciliary approach included the highest risk of postoperative lower eyelid deformity in zygomaticomaxillary complex fracture repair. The standardized measurements described here are accurate and objective to evaluate postoperative results.

Perioral aging – An anthropometric appraisal

To adequately perform perioral rejuvenation procedures, it is necessary to understand the morphologic changes caused by facial aging. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate such changes. Photographs of 346 male individuals were evaluated using 12 anthropometric indices. Data from two groups of health subjects, the first exhibiting a mean age of nearly 20 and the second of nearly 60 years, were compared. To evaluate the influence of combined nicotine and alcohol abuse, the data of the second group were compared to a third group exhibiting a similar mean age who were known alcohol and nicotine abusers. Comparison of the first to the second group showed significant decrease of the vertical height of upper and lower vermilion and relative enlargement of the cutaneous part of upper and lower lips. This effect was stronger in the upper vermilion and medial upper lips. The sagging of the upper lips led to the appearance of an increased mouth width. In the third group the effect of sagging of the upper lips, and especially its medial portion was significantly higher compared to the second group. The photo-assisted anthropometric measurements investigated gave reproducible results related to perioral aging.

Outcomes analysis of eyelid deformities using photograph-assisted standardized anthropometry in 311 patients after orbital fracture treatment.

BACKGROUND Before undergoing repair of orbital fractures, most patients are worried about their postoperative appearance. Furthermore, there is an ongoing discussion in the literature about the influence of trauma and surgical approach to the inferior orbita on eyelid deformities. METHODS In this retrospective comparative study, we present an evaluation of a series of 311 postoperative results of orbital fractures on standardized photographs based on reference anthropometric data. Analysis included eye fissure width and height, lid sulcus height, upper lid height, upper and lower iris coverage, position of cornea to inferior palpebra, canthal tilt, scleral show, ectropion, and entropion. It was clearly differentiated between operated and contralateral eyelid type of fracture of the midface and whether a transconjunctival or a subciliary approach was used. RESULTS Surgery and the chosen approach presented significant effects on eye fissure index, lower iris coverage, scleral show, and ectropion. Different types of fractures affecting the orbita showed no influence on the investigated values. CONCLUSION Not surprisingly, an association between surgery and lower lid retraction was found. The underlying osseous trauma did not show a significant influence on the presented measurements. Subciliary approaches increased the risk of lower lid retraction. The standard measurements described here are accurate and objective to evaluate postoperative results. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.

Microvascular free flaps for mandibular reconstruction in Goldenhar syndrome.

Although Goldenhar syndrome is a relatively common craniofacial malformation, there is some debate regarding the ideal treatment of severe mandibular hypoplasia. Traditionally, patients with severe mandibular deficits have been treated with iliac or costochondral bone grafts followed by distraction osteogenesis, with mixed results. The authors present their experience with the use of the osteocutaneous fibula and scapula free flap for mandibular reconstruction in patients with severe mandibular hypoplasia. The cases of 4 patients who underwent free-flap reconstruction of a severely hypoplastic mandible due to Goldenhar syndrome are presented. Microvascular reconstruction of the severely hypoplastic mandible is possible with the osteocutaneous scapula and the fibula flap. Minimal donor-site morbidity is elicited. Furthermore, the vertical relationship can be restored adequately, and breathing is facilitated. The microvascular fibula and scapula flap are a viable option for reconstruction of the severely hypoplastic mandible in patients with Goldenhar syndrome.

Cheek rotation flap reconstruction—an anthropometric appraisal of surgical outcomes

ObjectivesCheek rotation flaps are an established surgical procedure for coverage of facial skin defects especially of the cheek and infraorbital region. A comparison of pre- and postoperative anthropometric measurements may help to objectify intraoperative estimations with regards to postoperative appearance.Materials and methodsWe present an evaluation of 31 patients undergoing periorbital reconstruction by a cheek rotation flap on standardized photographs based on reference anthropometric data. Analysis included intercanthal, binocular and eye fissure width, eye fissure, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, scleral show, ectropion, and canthal tilt. Furthermore, it was clearly differentiated whether the defect to cover included eyelid skin or not.ResultsEctropion showed a significant association to surgery (p = 0.03) and time (p = 0.03). If the defect to cover included lower eyelid skin, lower iris coverage values decreased significantly (p = 0.02), meanwhile the rate of scleral show increased significantly (p < 0.01), indicating pre- to postoperative lower eyelid retraction.ConclusionsIn all patients analyzed, indices were reproducible and reliable. An association between surgery and ectropion was detectable. Whenever lower eyelid skin is involved in the defect to be covered, the significantly decreased lower iris coverage and increased rate of scleral show indicate an increased risk of lower lid retraction.Clinical relevanceWhenever eyelid skin is involved in a defect to be covered by a cheek rotation flap, there is an increased risk of postoperative lower lid distortion. Special care has to be taken to perform techniques preventing lower lid retraction.

Standardized anthropometric evaluation of ectropion repair results.

Background Before undergoing ectropion repair, most patients are concerned not only about the functional result, but also about their postoperative aesthetic appearance. Furthermore, there is an ongoing discussion in the literature about the influence of various surgical techniques on eyelid function and morphology. We present a photograph-assisted evaluation for preoperative planning, intraoperative estimation, and postoperative evaluation of ectropion surgery based on anthropometric measurements and clinical data. Patients and Methods From January 2008 to December 2010, 36 ectropion patients underwent a lateral tarsorrhaphy or fascial sling repair. An analysis of standardized preoperative and postoperative photographs included measurements of intercanthal width, biocular width, eye fissure width, eye fissure height, lid sulcus height, upper lid height, upper iris coverage, lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, and ectropion. Results Eye fissure index (P < 0.01) and lower iris coverage (P < 0.01) were statistically significantly influenced by surgery and time. The rates of scleral show (P < 0.01) and ectropion (P < 0.01) were significantly influenced, too. The 2 applied surgical techniques, lateral tarsorrhaphy and fascial sling repair, presented no significantly different effect in the preoperative to postoperative measurements. Conclusions In all analyzed patients, the performed measurements were reproducible and reliable. The methods described may help to estimate the necessary extent of correction in ectropion repair surgery. Furthermore, intraoperatively performed measurements could be compared with the postoperative results.

Mund-, Kiefer- und Gesichtsverletzungen

ZusammenfassungDas Gesicht ist für die Identität wesentlich. Nach einer Verletzung ist eine sorgfältige Wiederherstellung der Ästhetik ebenso wichtig wie die funktionell anatomische Rehabilitation. Das Spektrum der Weichgewebeverletzungen reicht von einfachen Riss-/Quetschwunden bis zu komplexen Amputationsverletzungen. Durch Nahlappen sowie mikrovaskulären Gewebetransfer können auch in komplexen Situationen zufrieden stellende Ergebnisse erzielt werden. Im Rahmen der Therapie dentoalveolärer Verletzungen sind standardisierte Erstversorgungskonzepte etabliert, die auf einen langfristigen Erhalt der verletzten Zähne fokussieren. Frakturen des Mittelgesichts stellen für den Operateur oft eine besondere Herausforderung dar. Durch den Einsatz der Endoskopie und computergestützten Planung können die operationsbedingte Morbidität reduziert und das ästhetische Outcome optimiert werden. Eine funktionelle Nachbehandlung, die zu einer Distraktion im Gelenk sowie einer Steigerung der neuromuskulären Aktivität führt, gewährleistet eine adäquate Funktion nach Frakturen im Gelenk tragenden Bereich des Unterkiefers. Funktionskieferorthopädische Geräte sollten in der Frührehabilitation nach Kollumfraktur erwogen werden.AbstractThe face determines the identity of an individual. Following injury careful rehabilitation of function and aesthetics are of equal importance. The pattern of soft tissue lesions ranges from simple lacerations and contusions to complex amputations. Employing local as well as microvascular free-flap transfer satisfying results can be achieved even in complicated cases. Standardized treatment algorithms focusing on long-term preservation of the injured teeth are well established in the management of dentoalveolar trauma. The repair of midfacial factures is still a challenge for the surgeon. Recent developments, such as endoscopy and computer-guided surgery might reduce postoperative morbidity of patients and optimize the aesthetic outcome. Early postoperative functional treatment focusing on both joint distraction as well as enhancement of neuromuscular activity is of outstanding importance to ensure adequate function following mandibular column fractures. Orthodontic functional appliances fulfill those criteria and should be considered in early functional rehabilitation.