Pediatric Maxillofacial Trauma by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030530921
Publisher: Springer International Publishing

Replacement tissue of similar features

Long-term tissue support

These steps in surgical management are demanding and require patient and caregiver commitment over a long period of time.

Total-thickness alar defects 1–1.5 cm can be reconstructed with free composite grafts (skin-cartilage) from the auricular helix (Fig. 5.14a–d). A healthy, well-vascularized recipient bed is required for “take” and the graft must be supported in place for 2–3 weeks with nostril bolsters. Long-term nasal stents (commercial or fabricated) are helpful in preserving anatomical aperture and preventing collapse and stenosis. This is easier for the older child and adolescent as cartilage is more firm (Fig. 5.15a–c), whereas young children with flimsy cartilages and a temperament not conducive to longer stent retention and hygiene may make this a difficult task [58].

Fig. 5.14(a) Post-bite avulsion of left nasal side wall and alar rim with attendant nasal stenosis. (b) Preparation of alar site for composite graft by excision of nasal vestibular and dermal scar. Measurement of the defect is then carried out for determining the composite graft dimensions. (c) Composite graft donor site with attendant measurement. Grafts less than 1 cm will not require v-excision or releasing incisions to obtain donor-site primary closure. (d) Composite graft in place with respective bolster dressings. (e) 1 month post-graft and 2 weeks after bolsters removed. Note restoration of alar width, alar contour, and relief of stenosis

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