ELASTIC TRACTION OF THE MIDFACE IN CRANIOFACIAL DISJUNCTION
AUTOR
Vera Lucia Nocchl Cardim, MD, PhDt; Rodrigo de Faria Valle Dornelles, MD';
Rolf Lucas Salomons, MD'; Sergio Pablo Pimentel Vela
From 1981 to 2001.42 patients with craniofaciostenosis undenvent operation of the midface with dass 111 elastic
traction after craniofacial disjunction for frontomaxillaym onobloc advancement. Bone grafts were used only in
the lateral walls of the orbits with semi-rigid fixation, initiallyallowing retroposition of the maxilla. Aftera period of
latency of 7 days, elastic traction of the maxilla was started, gradually moving it to a more anteriorposition and
achieving class I1 occlusion in approximately 40 days. Then, elastic traction was reduced and maintained for 4 months. In all cases, perfect ossification of the pteygomaxillarye a was achieved. Results were defhtive in
adultpatients; in children, results lasted formore than 1.5 year (untiladulthoodin 52.6% of them). Elastic traction
only requiredthepiacement of Erich arch barsin the arches, simplifying theprocedures in comparison to the use
of distractors and leading to a similar osteogenic result.
KEY WORDS
Osteogenesis, distraction; maxilla, dental occlusion; surgery
TÍTULO
MANDIBULAR DISTRACTION:
COMPARISON BETWEEN INTRAORAL
AND EXTRAORAL DEVICES
AUTOR
Nivaldo Alonso, MD, PhD'; Renato da Silva Freitas, PhDZ
Distraction osteogenesis (DO) is a method forbone lengthening that was popularized by llizarovin 1989. Do has
been increasingly used in craniofacial surgery since McCarthy showed the clinical feasibility of lengthening
hypoplastic mandibles, in 1992. Although the technique for DO seems to be simple, its performance is not.
Nonetheless, few reports about the use of extraoral or intraoral devices and associated advantages,
disadvantages and complications have been developed so far. In the present study, we report our experience
with DO in 65 cases of craniofacial microsomia, three cases of Treacher-Collins, and three cases of
temporomandibular ankylosis. Fifty-four patients used extraoral devices, and 17 used intraoral devices. The
decision on which device to use was made according to the anatomical characteristics of eachpatient. Patients
who required only unidirectional lengthening and had adequate mandibular bone stock were ideal candidates
for intraoral distraction devices. Patients presenting with severe mandibular deficiencies who demanded
multldirectional distraction were considered to be more adequately treated with an extraoral device. In generd
the extraoral device is known to allow for a more efficient lengthening vector than the intraoral device;
in our study, such problem was not obsewed. We managedto adequatelyposition the distradois m&nxb
Guerrero's device.
KEY WORDS
Osteogenesis, distraction, mandible, surgery
TÍTULO
GALEAL FLAP IN CRANIOMAXILLOFACIAL RECONSTRUCTION
AUTOR
Marcus Vinicius Martins Collares, MD, PhD1; Rinaldo De Angeli Pinto, MD2;
Nelson Pires Ferreira, MD3; Marcelo Paglioll Ferreira, MD4
The correction of soft tissues in craniofacial deformities is currently being pehrmed with fat grafts, dennis fat
grafts, microsurgical flaps, and aponeurotic galeal flaps. The present study aimed at discussing the use of
galeal flaps and its clinical use and purpose, vascular pedicle and surgical approach, as well as possible host
sites. Complications were also analyzed. Data were collected from a retrospective review of clinical records of
patients operated from 1991 to 2001. A total of 346patients had383 galeal flaps raisedduring the studyperiod.
Galeal flaps were successfully used in reconstruction in a large number of pathologies. lhe most frequent
surgical approach was coronal incision. Galeal flaps were used in almost every craniofacial region based on
four different vascularpedicles. In terms ofpurpose, flaps were used to cover underlying tissues orbone graffs;
to isolate cavities; and to add volume. Complications occurred in 16 flaps (4.18%) and included infection,
necrosis, and hematoma. Concerning 171 flaps used for volume comection, resorption occurred in 7.6% of
cases, leading to insufficient results in 6.43%. Positive aspects of the use of galeal flaps are their versatiliv,
proximity to host site, rapidbone revascularization andsmall rate of complications. Associatednegative aspects
include volume limitation and difiicultyin pedoming dissection. Galealflaps revealed to be an impoflant therapeutic
option for reconstruction in craniomaxilofacial pathologies.
In this review, we describe the main complications associated with mandibular fractures andmidface traumas.
As for mandibular fractures, we discuss complications which arise immediately after trauma and during the
surgical treatment, in addition to those related to rigid fixation, condylar fractures, andlate complications. As for
midface traumas, we discuss complications which arise immediately after trauma, those related to soft tissue, as
well as skeletal complications
KEY WORDS
Mandibular fractures; surgery; review literature.
TÍTULO
CRANIOFACIAL ONCOLOGICAL SURGERY:AESTHETIC USE OF FLAPS AND GRAFTS
A signirkant number of reconstructive surgeries is performed for the treatment of skin and lip carcinomas. The
present study aims at analyzing epidemiological aspects and the surgical management involved in those cases.
The authors retrospectively review the medical records of patients presenting with tumors in the cranioffacid
area, admitted to the Sewice ofPlasb Surgeryat Hospital Emesto Domelles, Brazil, andsubmitted to reconstrucfiVe
surgeries with flaps andgrah from November 2000 to November 2002. Twelve cases were reviewed, among
which 10 (83.3%) were male. Age ranged from 56 to 94 years (mean of 76.5). Being aware of epidemiological
features inherent to skin and lip carcinomas is crucial for the understanding of their impact and of the way they
manifest themselves in our context.
KEY WORDS
Medical oncology; carcinoma, basal cell; carcinoma, squamous cell; surgery
