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Lessons learned in facial and craniofacial plastic surgery on behalf of long-term follow-up in children and young adults

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Defense Thèse de privat-docent : Univ. Genève, 2020
Abstract The history of facial plastic surgery begins more than 1400 before Christ in India with the complex subject of nasal reconstruction. In Europe, nasal reconstruction was first reported only more than 1500 after Christ by the famous Italian surgeon Gaspare Tagliacozzi. The evolution of plastic surgery from the first flaps and skin grafts leads to more sophisticated and invasive facial surgery, in parallel with the progresses of anaesthesiology. In the middle of the 19th century, cranio-facial surgery began a new chapter by including the transcranial approach to facial surgery. These corrections of the bony facial base improved the surgical results of congenital craniofacial malformations radically. In Geneva, the Division of Plastic, Reconstructive and Aesthetic Surgery of the University Hospitals was created in 1984. They offered from the beginning modern facial and craniofacial surgery, including microsurgery after the early 1990s. Collaborations with different humanitarian organisations allowed to take in charge rare craniofacial disorders and to treat complex facial destructions from an unknown disease named noma. The latter is a severe facial gangrene that affects children between age 2-7 years suffering from malnutrition and immunodepressed state due to concomitant diseases like malaria. Actually, noma patients live in poor and remote areas without access to medical care. If they survive the disease, noma provokes large perioral defects, which heal spontaneously. The scarring process leads to extra-articular ankylosis in a great part of the patients. Beyond the altered appearance and social problems due to tissue destruction, they suffer from difficulties in oral feeding and communication. The Geneva Division developed different original surgical techniques and strategies in the field of facial and craniofacial plastic surgery. This thesis and my particular interest are focused on the long-term results of the genuine techniques, in order to evaluate their advantages and weaknesses and improve them. The lessons learned on behalf of long-term results are the following: Regarding facial reconstruction of noma sequelae: - Plan the size of a flap adequately, keeping in mind the important scar contraction, that may persist for years and do not undersize your flap. - Do not operate on extra-articular ankylosis patients if you cannot provide a follow-up and physiotherapy to assure mouth opening exercises. - Plan staged reconstruction, beginning with the bony base, if necessary and large soft tissue reconstruction, perform reconstruction of typical features like lips, noses eyelid position in the end and using remnants if possible. - When operating on young children, keep in mind the high probability of further surgeries after entering adulthood and plan surgical procedures accordingly. Regarding rare congenital craniofacial cleft surgery: - The good timing of surgery in children according to growth is crucial. - Keep in mind that a great part of these patients will need more than one surgery. - Do not underestimate the importance of good results of nasal reconstructions and positioning of the eyelids and canthus as the overall result depends mostly on these two.
Keywords Facial plastic surgeryCraniofacial surgeryNomaReconstruction
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RUEGG, Eva. Lessons learned in facial and craniofacial plastic surgery on behalf of long-term follow-up in children and young adults. Université de Genève. Thèse de privat-docent, 2020. doi: 10.13097/archive-ouverte/unige:141998 https://archive-ouverte.unige.ch/unige:141998

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Deposited on : 2020-09-24

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