Extirpation of tumors of the maxilla is usually followed by radiation therapy. The resultant defects are difficult to repair. In addition to the cosmetic consequences, the patient will frequently have functional problems, with a large oronasal fistula and loss of teeth that impair feeding and speech. Traditional reconstruction with split-thickness skin grafts and dental obturative prosthesis is not ideal, and other surgical approaches are limited by the amount of local tissue available. The authors, Rudy J. Triana, Jr, MD, et al from the United States and Vedran Uglesic, MD, et al from Croatia Article , review 58 patients who underwent free flap reconstruction of the maxilla. The results in this large series were excellent, with only one flap failure. All palatal defects were sealed, and all patients were able to converse on the telephone without difficulty. Eight patients had an implant-borne prosthesis, and 30 patients had a conventional partial prosthetic. The excellent functional and cosmetic results in these difficult cases reaffirm the utility of osteocutaneous free flaps for midface reconstruction.
The treatment of vascular birthmarks in children is variable. Edwin F. Williams III, MD, and colleagues Article review the diagnosis and treatment of 208 new patients who presented to their vascular malformation clinic over a 26-month period. Conclusions reached from their evaluation and review of the literature are presented as a clinical algorithm to recommend intervention, including systemic steroids, laser therapy, or surgical debulking in patients with proliferating hemangiomas or involuting but disfiguring hemangiomas. Accurate diagnosis and treatment are important in these young patients. The authors' experience adds to the literature on this somewhat confusing subject. Long-term follow-up is most important, and recommendations may change with new laser technology and longer-term evaluation.
Facial measurements are used by both reconstructive and cosmetic surgeons to evaluate and treat their patients. The majority of these measurements were determined by studying normal populations of white patients. Other ethnic groups have been studied but to a much lesser extent. Roland Song Teck Sim, MBBS(Singapore), FRCS(Glasg), FAMS, et al Article evaluated 100 southern Chinese women from photographs with some widely used photometric proportions, angles, and measurements. Major differences included a wider nasal base, variations in the profile measurements of the lower face, and differences in the eyelids. These data are useful for surgeons treating patients in this ethnic group and add to an expanding international database of facial proportions. Although studies in countries around the world use the averages of normal subjects to establish ideal measurements, faces that are judged to be beautiful in these countries often differ in consistent ways from these averages.
Repair of craniofacial defects remains a significant clinical challenge. Autologous grafts have donor site limits and associated morbidity and may sustain loss of volume over time. Alloplastic implants resolve these problems and decrease operative time. Craig D. Friedman, MD, et al Article evaluated their experience with 40 patients who underwent reconstruction with a new calcium phosphate cement formulation, hydroxyapatite cement (HAC), which forms hydroxyapatite under physiologic conditions via a setting reaction that should enhance implant integration. The authors compare their experience in reconstructing anterior craniofacial defects with HAC vs historical controls with methylmethacrylate. The overall success rate, defined as maintaining implant volume at 24 months, was 82%. The success rate and complication rate compared favorably with other techniques. This study provides good clinical validation for the use of HAC to reconstruct selected anterior skull defects.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2000;2(2):90. doi: