cirugía oral y maxilofacial - técnica asensio

www.clinicabenarroch.com

ORALORAL & MAXILLOFACIAL & MAXILLOFACIAL DEPARTAMENT DEPARTAMENT

SAMUEL BENARROCH MD, DDS SAMUEL BENARROCH MD, DDS RODOLFO RODOLFO ASENSIO MDASENSIO MD


NASAL CONSIDERATIONS NASAL CONSIDERATIONS IN THEIN THE

UNILATERAL CLEFT LIP UNILATERAL CLEFT LIP USING THE USING THE

ASENSIO TECHNIQUEASENSIO TECHNIQUE


CLEFT LIP- NOSE AND PALATECLEFT LIP- NOSE AND PALATE DEFORMITYDEFORMITY

SECOND CONGENITAL : 1:750 a 1: 1000 BIRTHSSECOND CONGENITAL : 1:750 a 1: 1000 BIRTHSVENEZUELA:VENEZUELA: 2 C. L.P. 24 HOURS 2 C. L.P. 24 HOURS 1 C. P. / 24 HOURS 1 C. P. / 24 HOURS 517 NEW CASES / YEAR 517 NEW CASES / YEAR YEAR 2. 000: 23.247 PATIENTS YEAR 2. 000: 23.247 PATIENTS USA BUREAU OF CENSUS, INTERNACIONAL DATA BASE, 1997USA BUREAU OF CENSUS, INTERNACIONAL DATA BASE, 1997


ROTATION AND ADVANCEMENT ROTATION AND ADVANCEMENT FLAPSFLAPSRESTABLISH LIP ANATOMYRESTABLISH LIP ANATOMY

DO NOT CONSIDER ISOLATED DO NOT CONSIDER ISOLATED NASAL PROCEDURES NASAL PROCEDURES

Asensio, Oscar. Asensio, Oscar. Labio Leporino Unilateral; Técnica Labio Leporino Unilateral; Técnica

quirurgica para su correccionquirurgica para su correccion. Revista . Revista Guatemalteca de Estomatologia, Vol. 2, Num.. 2, Guatemalteca de Estomatologia, Vol. 2, Num.. 2, 1.972. 1.972. Millard, RalphMillard, Ralph. Cleft . Cleft Craft: The evolution of its Surgery - The Craft: The evolution of its Surgery - The Unilateral Deformity,Unilateral Deformity,The Asensio Technique for The Asensio Technique for Unilateral Cleft lipUnilateral Cleft lip. Vol.. 1, p408-412, 1.976. Vol.. 1, p408-412, 1.976

ASENSIO TECHNIQUEASENSIO TECHNIQUE


MORPHOLOGIC FACTORSMORPHOLOGIC FACTORS

IMBALANCE OF THE IMBALANCE OF THE FACIAL FACIAL MUSCULATURE.MUSCULATURE.

HIPOPLASIA OF THE HIPOPLASIA OF THE SKELETAL BASESKELETAL BASE

ASIMMETRY OF THE ASIMMETRY OF THE SKELETAL BASESKELETAL BASE


ANALISIS OF NASAL DEFORMITYANALISIS OF NASAL DEFORMITY

HUFFMAN- LIERLE, 1.949 HUFFMAN- LIERLE, 1.949 HURWITZ,1.976 HURWITZ,1.976 ANDERL, 1.985 ANDERL, 1.985

McCOMB, 1.986McCOMB, 1.986 BARDACH, 1.987BARDACH, 1.987 SALYER, 1.987SALYER, 1.987


DESCRIPTION OF THE NASAL DESCRIPTION OF THE NASAL DEFORMITYDEFORMITY

The columella is shorter on the cleft side.The columella is shorter on the cleft side.

The columella has an oblique position with its base desviated to The columella has an oblique position with its base desviated to the noncleft side.the noncleft side.

The lateral crus of the lower lateral cartilage and the adherent The lateral crus of the lower lateral cartilage and the adherent skin are drawn into an S- shaped fold.skin are drawn into an S- shaped fold.

The lateral crus of the lower lateral cartilage is longer on the cleft The lateral crus of the lower lateral cartilage is longer on the cleft side.side.



The lower lateral cartilage is displaced in the frontal and horizontal The lower lateral cartilage is displaced in the frontal and horizontal (backward and downward) planes(backward and downward) planes

The nasal tip is displaced in the frontal and horizontal planes The nasal tip is displaced in the frontal and horizontal planes following displacement of the lower lateral cartilage.following displacement of the lower lateral cartilage.

The nasal tip is asymmetric.The nasal tip is asymmetric.

The vestibular dome is excessively obtuseThe vestibular dome is excessively obtuse..



The ala is flattened, resulting in a horizontal orientation of the nostril.The ala is flattened, resulting in a horizontal orientation of the nostril.

The nostril is smaller or larger than that of the opposite sideThe nostril is smaller or larger than that of the opposite side

The nasal tip is displaced in the frontal and horizontal planes The nasal tip is displaced in the frontal and horizontal planes following displacement of the lower lateral cartilage.following displacement of the lower lateral cartilage.

The nasal tip is asymmetric.The nasal tip is asymmetric.



The vestibular dome is excessively obtuse.The vestibular dome is excessively obtuse.

The ala is flattened, resulting in a horizontal orientation of the The ala is flattened, resulting in a horizontal orientation of the

nostril.nostril.

The nostril is smaller or larger than that of the opposite sideThe nostril is smaller or larger than that of the opposite side

The base of The ala is displaced laterally and/or posteriorly, and The base of The ala is displaced laterally and/or posteriorly, and or inferiorlyor inferiorly..



The nasal floor is absent and is lower on the cleft side.The nasal floor is absent and is lower on the cleft side.

Nasolabial fistula may be present.Nasolabial fistula may be present.

The caudal edge of the nasal septum and the anterior The caudal edge of the nasal septum and the anterior nasal spine are deflected into the non cleft vestibule.nasal spine are deflected into the non cleft vestibule.



The nasal septum is desviated, resulting in varying The nasal septum is desviated, resulting in varying degrees of nasal obstruction on the cleft side.degrees of nasal obstruction on the cleft side.

The lower turbinate on the cleft side is hypertrophic.The lower turbinate on the cleft side is hypertrophic.

The nasal pyramid is asymetricThe nasal pyramid is asymetric


MODIFIED ASENSIOMODIFIED ASENSIO

Reubication of point number 6.Reubication of point number 6. Lateral extention of the alar base incision, on the cleft side.Lateral extention of the alar base incision, on the cleft side. Undermining the lower lateral cartilage (lateral crura).Undermining the lower lateral cartilage (lateral crura). Correction of the dislocated septum.Correction of the dislocated septum. Forming the nasal tip (medial crura).Forming the nasal tip (medial crura). Lateral reposition of the alar base.Lateral reposition of the alar base. Postoperatively nostril conformation by means of a splint Postoperatively nostril conformation by means of a splint

BENARROCH,1.998BENARROCH,1.998



REUBICATION OFREUBICATION OF POINT NUMBER 6 POINT NUMBER 6

Benarroch,1998Benarroch,1998


MODIFIED ASENSIO MODIFIED ASENSIO

LATERALLATERAL EXTENTION OF EXTENTION OF THE ALAR BASE THE ALAR BASE INCISIONINCISION

Benarroch, 1998Benarroch, 1998



UNDERMINING THE UNDERMINING THE LOWER LATERAL LOWER LATERAL CARTILAGE CARTILAGE (LATERAL CRURA)(LATERAL CRURA)



MODIFIEDMODIFIED ASENSIOASENSIO

CORRECTION OF CORRECTION OF THE DISLOCATED THE DISLOCATED SEPTUMSEPTUM

Benarroch,1998Benarroch,1998



FORMING THE FORMING THE NASAL TIP NASAL TIP (MEDIAL CRURA)(MEDIAL CRURA)




LATERAL LATERAL REPOSITION OF REPOSITION OF THE ALAR BASE THE ALAR BASE




POSTOPERATIVELY NOSTRIL POSTOPERATIVELY NOSTRIL CONFORMATION BY MEANS CONFORMATION BY MEANS

OF A STENTOF A STENT



RESULTSRESULTS

1. What are the results and advantages that can be 1. What are the results and advantages that can be achieved with simultaneous lip and nose repair? achieved with simultaneous lip and nose repair?

2. Is there any sign of growth retardation2. Is there any sign of growth retardation or alteration of the nose in long term or alteration of the nose in long term follow-up? follow-up?


ADVANTAGESADVANTAGES (variables to consider) (variables to consider)

Comparisons of the right and left sides of the nose.Comparisons of the right and left sides of the nose.

Desviation of the nose and septum.Desviation of the nose and septum.

Symmetry of the tip of the nose or asymmetry on the Symmetry of the tip of the nose or asymmetry on the cleft side.cleft side.

Shape and position of the alar cartilagesShape and position of the alar cartilages


Any signs of hypoplasia of the nose.Any signs of hypoplasia of the nose.

Shape of the nostrils (especially on the cleft side).Shape of the nostrils (especially on the cleft side).

Position and length of the columella and the shape of Position and length of the columella and the shape of the alar base.the alar base.

Evidence of hypoplasia of the underlying boneEvidence of hypoplasia of the underlying bone


NO NASAL GROWTH NO NASAL GROWTH DISTURBANCESDISTURBANCES

ORTIZ- MONASTERIOS, F, OLMEDO, A.(1981). Corrective rhinoplasty ORTIZ- MONASTERIOS, F, OLMEDO, A.(1981). Corrective rhinoplasty before puberty: A long term follow up. Plastic Reconstructive Surgery 68:381.before puberty: A long term follow up. Plastic Reconstructive Surgery 68:381.

SAYLER, SAYLER, K (1986). Primary correction of the unilateral cleft lip nose: a K (1986). Primary correction of the unilateral cleft lip nose: a 15- year experience. Plastic Reconstructive Surgery 75:791.15- year experience. Plastic Reconstructive Surgery 75:791.

McCOMB, H. (1985). Primary correction of the unilateral cleft lip nasal McCOMB, H. (1985). Primary correction of the unilateral cleft lip nasal deformity: a ten year review. Plast Reconstr Surg 75:791.deformity: a ten year review. Plast Reconstr Surg 75:791.

ANDERL, H. (1985). Simultaneous repair of lip and nose in the unilateral cleft ANDERL, H. (1985). Simultaneous repair of lip and nose in the unilateral cleft (a long term report). Recent Advances in Plastic Surgery. Edinburgh: Churcill (a long term report). Recent Advances in Plastic Surgery. Edinburgh: Churcill LivingdtoneLivingdtone


EARLY POST-OP WITHOUT EARLY POST-OP WITHOUT NASAL PROCEDURESNASAL PROCEDURES

ORIGINALORIGINAL ASENSIOASENSIO


EARLY POST-OP WITH NASAL EARLY POST-OP WITH NASAL PROCEDURESPROCEDURES

MODIFIED ASENSIO MODIFIED ASENSIO

BENARROCH, 1.998BENARROCH, 1.998

cirugía oral y maxilofacial - técnica asensio

Health & Medicine

nasal septum

nasal floor

unilateral cleft lip

lateral crus

lateral extentionof

modified asensio correction

alar base benarroch

cleft craft