Neonatal Mandibular Distraction Osteogenesis with Multivector External Devices

Pierre Robin sequence (PRS) is a craniofacial malformation characterized by micrognathia and glossoptosis, with or without cleft palate. A subset of infants with PRS will suffer from airway obstruction severe enough to merit surgical intervention. Surgeries for PRS include tongue lip adhesion, tracheotomy, gastrostomy, and bilateral mandibular distraction osteogenesis. Distraction osteogenesis refers to a process in which a bone is lengthened after an initial osteotomy by means of separating the two resulting segments slowly over time. In the neonatal mandible, hardware used for distraction may be implanted beneath the skin or affixed externally. Each device has its advantages and disadvantages, however external devices are less expensive, do not typically require preoperative computed tomography scanning, may be adjusted easily throughout the distraction process, and are easily removed following consolidation, avoiding a second invasive procedure and lengthy anesthetic. This video presents the technique of neonatal mandibular distraction osteogenesis using multivector external distractors.

Grade 1 Microtia Repair Using Autologous Auricular Cartilage Transfer

The goal of auricular reconstruction is to achieve a natural appearance of the reconstructed side with a form that resembles the normal ear and endures over a lifetime. For severe deformities in which major cartilaginous elements are missing, established reconstructive techniques using alloplastic constructs wrapped in temporoparietal fascia or carved costal cartilage grafts may be employed. For cases of minor deformity in which all named cartilaginous components are present, albeit deficient compared to the normal side, transfer of autologous auricular skin and cartilage may be used to achieve symmetry between normal and abnormal ears. This video presents the surgical technique and results of a grade 1 microtia reconstruction using autologous auricular cartilage transfer. This two-stage method of reconstruction avoids the use of autologous rib or alloplastic materials and often avoids the use of skin grafting altogether.

Upper Eyelid Blepharoplasty

Introduction: Cosmetic Upper Blepharoplasty involves removing excess skin from the upper eyelid to enhance the appearance of the upper eyelids.

Methods: Markings were made for the inferior incision on the upper eyelid between 8-10 mm above the upper lash line.  Forceps are used to pinch the excess upper eyelid skin in the middle, nasal, and temporal, aspects of the upper eyelid.  Markings are then made superiorly at the middle, nasal, and temporal points and are connected. Toothed forceps are used to pinch the excess upper eyelid skin, using the markings as a guide.  Iris scissor is used to excise the pinched excess skin and the underlying orbicularis muscle. The skin between the two eyelids was closed.

Conclusions: In our experience, cosmetic upper blepharoplasty is an efficient way to enhance the appearance of the eyes.  

By: Peyton Yee, Addison Yee

Surgeon: Suzanne Yee, MD, FACS

Dr. Suzanne Yee Cosmetic and Laser Surgery Center, Little Rock, AR, USA

Recruited by: Gresham T Richter, MD

Retroseptal Transconjunctival Approach to Orbital Floor Blowout Fracture

The transconjunctival approach was first described by Bourquet in 1924 and then modified by Tessier in 1973 for exposure of the orbital floor and maxilla for the treatment of facial trauma.

This approach can be carried out either in a preseptal plane by separating the orbital septum from within the eyelid (preseptal approach) or posterior to the septum and eyelid (retroseptal approach) by making an incision through the bulbar conjunctiva directly above the orbital rim.

The main advantage of the retroseptal approach is that it does not involve dissection and disruption of the eyelid itself, therefore, reducing the incidence of post-operative lid laxity and position abnormalities.

This video will show a retroseptal approach to an orbital floor blowout fracture. A lateral inferior cantholysis is performed to facilitate eversion and retraction of the lower eyelid.

Pre-operative marking for the Fisher technique in unilateral cleft lip repair

This video outlines the steps taken for pre-operative markings that need to be made prior to performing unilateral cleft lip repair using the Fisher anatomic subunit approximation technique. The technique has been written about in detail by Dr. David Fisher in his article “Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique”. This video simply outlines the markings that are made prior to performing this technique, which are crucial for correctly carrying out the repair.

Closed Nasal Reduction

Closed nasal reductions are the standard of care for displaced nasal bone fractures.  Reduction should occur within 3 weeks of the initial injury, but after swelling has subsided. The success rate is 60-90% in uncomplicated cases, however 6-17% of patients will require a future septorhinoplasty.

This procedure was performed under general anesthesia.

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