Abstract
Craniofacial surgery has revolutionized the surgical treatment of congenital anomalies affecting the facial and cranial skeleton. Similar techniques have since been used in the reconstruction of patients with extensive craniofacial injuries and following craniofacial resection of tumors involving the midface. The application of microsurgical free flaps to some of these craniofacial problems is another significant advance.
Microsurgical transfer of deepithelialized skin flaps or omentum will allow the augmentation of soft tissue contour defects of the face in patients with hemifacial microsomia and Romberg's progressive facial hemiatrophy. Following craniofacial resection of extensive tumors of the midface, microsurgical free flaps and vascularized bone grafts will provide soft tissue coverage and, occasionally, both bone and soft tissue composite reconstruction of the resultant defect. Finally, intracranial infection, following Craniofacial Surgery and neurosurgical excision of tumors involving the skull base, may be effectively prevented by separation of the dura from the nasopharynx by microsurgical transfer of free muscle flaps and omentum.
Résumé
La chirurgie craniofaciale a révolutionné le traitement des malformations congénitales du squelette facial et crânien. Des techniques semblables ont été utilisées pour la reconstruction après traumatismes étendus craniofaciaux et après résection de tumeurs craniofaciales de l'étage moyen. Les techniques microchirurgicales constituent également un important progrès.
Les techniques de la microchirurgie permettent de transférer des lambeaux cutanés désépithélialisés ou des lambeaux d'épiploon pour combler des défauts de parties molles chez les patients qui présentent une microsomie de l'hémiface et un syndrome de Romberg. Après résection étendue des tumeurs de l'étage moyen de la face, les lambeaux libres composites ostéocutanés et les lambeaux osseux vascularisés permettent le recouvrement cutané, et éventuellement la reconstruction simultanée du défect osseux et cutané. Enfin, l'infection intracrânienne après chirurgie crâniofaciale et exérèse neurochirurgicale des tumeurs de la base du crâne peut Être prévenue en séparant la dure-mère de l'oropharynx grâce au transfert microchirurgical de lambeaux libres musculaires et d'épiploon.
Resumen
La cirugía craneofacial ha revolucionado el tratamiento quirÚrgico de las anomalías congénitas que afectan al esqueleto facial y craneano. Técnicas quirÚrgicas similares han sido utilizadas para la reconstrucción en pacientes con lesiones craneofaciales extensas y en aquellos con defectos consecutivos a la resección de tumores de la parte media de la cara. La aplicación de colgajos libres obtenidos por microcirugía a la solución de este tipo de problemas es otro avance significativo
La transferencia microquirÚrgica de colgajos desepiteliolizados de piel o de epiplón permite corregir defectos de contorno de los tejidos blandos de la cara en pacientes con microsomia hemifacial y con hemiatrofia facial progresiva de Romberg. Después de extensas resecciones craneofaciales de tumores de la parte media de la cara, los colgajos libres microquirÚrgicos y los injertos óseos vascularizados proveen cubrimiento de tejidos blandos y, ocasionalmente, permiten la reconstrucción compuesta, ósea y de tejidos blandos, del defecto resultante. Por Último, la infección intracraneana que ocurre como consecuencia de cirugía craneofacial y de la resección neuroquirürgica de tumores de la base del cráneo, puede ser prevenida en forma efectiva mediante la separación de la dura de la nasofaringe con la transferencia microquirÚrgica de colgajos libres de mÚsculo y de epiplón.
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Jones, N.F. The contribution of microsurgical reconstruction to craniofacial surgery. World J. Surg. 13, 454–464 (1989). https://doi.org/10.1007/BF01660757
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DOI: https://doi.org/10.1007/BF01660757