In the OR, the superior labial artery and a small outflow vein, which was likely part of the superior labial venous plexus, were identified and isolated from the lateral portion of the lip. However, the nasal segment contained no identifiable viable artery or vein. Therefore, the nasal and eyebrow portions were replanted similarly to full thickness skin grafts and the upper lip was replanted using microvascular techniques. The segments of each vessel were flushed with heparinized saline. Then, the superior labial artery was anastomosed using 9-0 nylon interrupted sutures, followed by anastomosis of the vein using 9-0 nylon. After three hours and 19 minutes of operating time, arterial blood flow was immediately apparent, but venous flow was not definitive. The wounds of the upper eyelid and right cheek were debrided and then closed.
Upper Lip Reconstruction Pdf Download
Later that day, the patient reported upper extremity numbness. After a non-contrast CT showed no intracranial abnormality, he received 8.34 mg bolus of tPA followed by 75.1 mg of IV tPA over the course of an hour for possible ischemic stroke. Subsequent MRI showed a small acute left frontal cortical infarction. The next morning the patient reported chest discomfort and an EKG showed ST-segment elevation of inferior leads with elevated troponin peak of 132.2 due to myocardial infarction. The patient then underwent left heart catheterization that showed adequate flow and no need for further intervention. After these events, he received 30 mg of enoxaparin twice a day per protocol.
One complication of replantation specific to our patient is the anatomy of the upper lip in relation to bite injuries. Establishing venous anastomosis with an adequate flow in the upper lip is technically challenging because the superior labial vein is frequently a venous plexus [6-7]. Additionally, the crush and shear forces associated with a bite can result in extensive damage to the venous intima further complicating the establishment of good venous drainage [7-9]. Furthermore, maintaining outflow of venous drainage can also be difficult. To solve this problem, leeches have been employed to prevent venous congestion and anticoagulants have been implemented to prevent thrombus formation [8]. Unfortunately, we are unable to determine if thrombosis developed in our patient because immediate revision and exploration were subsequently cancelled due to the post-operative stroke and STEMI. Nonetheless, awareness of the challenge of achieving patent venous drainage is essential in management of microsurgical lip replants.
Stevens Johnson syndrome (SJS) is a rare and often fatal hypersensitivity reaction commonly triggered by drugs which results in the uncontrolled destruction of keratinocytes with both cutaneous and mucosal involvement. Fusion of the oral commissures, although reported in burn victims, is a very uncommon complication of SJS. The successful reconstruction of oral commissures fusion using a modified commissuroplasty technique in a 19-year-old Hispanic female with severe microstomia secondary to SJS is presented here. Re-establishment of normal speech, oral intake, as well as aesthetic appearance were achieved.
Flores S, Maglic D, Moores N, Hosein R, Siddiqi F, Gociman B. Successful reconstruction of bilateral oral commissure fusion secondary to Stevens Johnson syndrome. Plast Aesthet Res 2018;5:24. -9264.2018.31
Flores S, Maglic D, Moores N, Hosein R, Siddiqi F, Gociman B. Successful reconstruction of bilateral oral commissure fusion secondary to Stevens Johnson syndrome.Plastic and Aesthetic Research. 2018; 5:24. -9264.2018.31
Flores, Shadai, Dino Maglic, Neal Moores, Rayaad Hosein, Faizi Siddiqi, Barbu Gociman. 2018. "Successful reconstruction of bilateral oral commissure fusion secondary to Stevens Johnson syndrome"Plastic and Aesthetic Research.5: 24. -9264.2018.31
Flores, S.; Maglic D.; Moores N.; Hosein R.; Siddiqi F.; Gociman B. Successful reconstruction of bilateral oral commissure fusion secondary to Stevens Johnson syndrome.Plast. Aesthet. Res.2018, 5, 24. -9264.2018.31
Cleft lip and cleft palate are among the most common birth anomalies affecting children in North America and worldwide. The incomplete formation of the upper lip (cleft lip) or roof of the mouth (cleft palate) can occur individually, or both defects may occur together. The conditions can vary in severity and may involve one or both sides of the mouth. Surgery is required to repair cleft lip and/or cleft palate.
A cleft, or separation of the upper lip and/or the roof of the mouth, occurs very early in the development of your unborn child. During fetal development, certain components of the upper lip and roof of the mouth fail to grow together normally. In some cases, a syndrome may be responsible for the occurrence of the cleft. For most affected children, however, the cause will no be known. In these cases, the cleft is thought to result from a complex interaction of genetic and environmental factors.
Surgery to repair a cleft of the lip or palate is highly individualized. Surgery is intended to close the cleft defect, but also to help your child ability to function and grow normally. Cleft lip repair, also called cheiloplasty, includes reconstruction of the lip to create a more normal appearance, namely:
Cleft lip: Congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. It is thought to be caused by faulty migration of the mesoderm in the head region.
A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.
Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech. 2ff7e9595c
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