The Journal of craniofacial surgery
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The aim of this review was to familiarize the reader with critical facial nerve anatomy relating to facial rejuvenation surgeries. The temporal branch to the upper orbicularis oculi muscle (OOM): The temporal branch was under the temporoparietal fascia above the zygomatic arch and divided into 2 to 4 branches. The highest level of the twigs that entered the OOM on the x axis and the y axis with the origin of the lateral canthus is +2.51 ± 0.23 cm and +2.70 ± 0.35 cm; and the lowest, 0 cm and +2.68 ± 0.32 cm, respectively. ⋯ Most ramifying points (14/17, 82%) were located within a circle with a 5-mm radius, and the center was 12 mm lateral and 26 mm superior to the mouth corner. The mandibular branch according to the neck position: At the one-fourth point, the border-nerve distance decreased (4.32 ± 2.60 mm) with the neck in ipsilateral rotation and the border-nerve distance increased (5.97 ± 2.62 mm) with the neck in contralateral rotation. We hope that this knowledge will aid surgeons in achieving successful outcomes.
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Skull base reconstruction presents a challenging therapeutic problem requiring a multispecialty surgical approach and close cooperation between the neurosurgeon, head and neck surgeon, as well as plastic and reconstructive surgeon during all stages of treatment. The principal goal of skull base reconstruction is to separate the intracranial space from the nasopharyngeal and oropharyngeal cavities, creating support for the brain and providing a water-tight barrier against cerebrospinal fluid leakage and ascending infection. We present a case involving a 58-year-old man with anterior skull base defects (2.5 cm × 3 cm) secondary to the removal of olfactory neuroblastoma. ⋯ During 28 months of follow-up after coverage of the anterior skull base defect, the dual flap survived completely, as confirmed through follow-up magnetic resonance imaging. The patient was free of cerebrospinal fluid leakage, meningitis, and abscess, and there was minimal donor-site morbidity of the radial forearm free flap. Reconstruction of anterior skull base defects using the dual flap technique is safe, reliable, and associated with low morbidity, and it is ideal for irradiated wounds and low-volume defects.
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Parapharyngeal space tumors are very rarely seen, and surgical approach to these tumors has not been well established. Most of these tumors are benign and originated from salivary glands and neurogenic in nature. In this case, we report a patient who has a trigeminal schwannoma extending into the deep parapharyngeal space and explain our surgical approach.
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Comparative Study
Secondary skull reconstruction with autogenous split calvarial bone grafts versus nonautogenous materials.
Skull reconstructions, which can be required for various reasons, including decompressive craniectomy, trauma, and tumors, are challenging issues in plastic surgery. Moreover, obtaining a low complication ratio in secondary skull reconstructions is more difficult than in primary skull reconstructions. Because standardized protocols have not been established, we here compare cranioplasty performance using fresh autogenous split calvarial bone grafts and allogenic or alloplastic materials in secondary revisional cases. ⋯ Secondary cranial defect reconstructions with autogenous calvarial bone grafts showed better functional and esthetic results than skull reconstructions with nonautogenous materials.
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Some anatomic patterns formed by the anterior border of the ascending ramus relative to the mandibular canal can cause nerve complications during surgery. We determined the frequency of obstructive anatomy in patients undergoing jaw surgery, and we described a perioperative method for a bilateral sagittal split osteotomy that ensured inferior alveolar nerve (IAN) protection. The anatomy of the anterior border of the ascending ramus of the mandible was examined on axial and cross-sectional cone beam computed tomographic images of 114 consecutive patients undergoing bilateral sagittal split osteotomies. ⋯ Pattern A was observed in 146 cases (64%); pattern B, in 82 (36%) cases. The use of the nerve hook resulted in no injuries to the IAN in all cases. The described procedure ensured direct visualization of the IAN, which prevented inadvertent damage to the IAN during instrumentation and surgical procedures at the mandibular foramen.