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Figure three Postoperative results after second osteofasciocutaneous fibula flap. (A) Microstomia and restricted selection of movement. (B) Lack of lower lip projection. (C) Skin paddle from cost-free fibula flap replaces decrease lip and chin. (Pictures are courtesy of Colonel this site Robert ... Patient 2 Patient 2 can be a 37-year-old male soldier injured in Iraq by an explosive gadget. His injuries incorporated perforating wounds on the encounter leading to a Le Fort II fracture, comminuted bilateral mandibular condyle, ramus and physique fractures, too as soft tissue avulsion of 40% from the proper upper lip and 80% in the reduced lip, which include the ideal commissure. First stabilization in theater included tracheotomy and maxillomandibular fixation (MMF; Fig. 4). Figure 4 (A) Avulsion of two-thirds of the perioral structures soon after explosive damage.

(B) Le Fort II fracture and comminuted mandibular body and rami from perforating shrapnel. (Photos are courtesy of Colonel Robert Hale.) Patient two arrived at BAMC 1week after injury in steady ailment. He was taken on the operating area for examination below anesthesia and debridement of his wounds. The Le Fort II fracture was anatomically decreased and fixated with miniplates. Postoperatively, computed tomography (CT) scans have been performed to fabricate a mandibular stereolithography resin model. Based upon the resin designs, reconstruction plates had been bent preoperatively. Patient 2 returned on the working area 2.5 weeks postinjury for open reduction internal fixation of your mandibular fractures by means of a neck incision. The comminuted correct ramus and condyle fractures were deemed nonrepairable.

Right after debridement with the comminuted fractures, the ideal ramus and condyle region was reconstructed with an immediate costochondral graft along with a two.4-mm reconstruction plate. The comminuted Entinostat left condyle and physique fractures were repaired with 2.0-mm reconstruction plates (Fig. five). A correct cheek wound was closed in layers right after debridement and placement of the drain. Figure 5 (A and B) Key fracture reconstruction; comminuted right condyle debridement and reconstructed with immediate costochondral graft. (Images are courtesy of Colonel Robert Hale.) Four weeks soon after bone reconstruction (Fig. 6A), the ear, nose, and throat support carried out soft tissue reconstruction in the lip defects with lateral sliding cheek and rhomboid flaps.

The postoperative program was challenging by dehiscence of the flap and contracture of the right commissure with failure to achieve lip competence. A revision process was carried out six weeks later which has a buccal advancement flap. Figure 6 (A) Perioral deformity right after skeletal fix. (B) Resultant deformity after bilateral cheek advancement flaps and reconstructive advancement of reduce lip along with a buccal mucosa advancement flap to reconstruct maxillary lip.