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Soedjana H, Hasibuan LY, Prasetyo AT, Suryadinata KL. Surgical reconstruction of the external nose: Alar rotational and hinged flap techniques for facial cleft Tessier 0-1 with lipoma on dorsal nasal region - A case report. Int J Surg Case Rep 2024; 119:109708. [PMID: 38677253 PMCID: PMC11059510 DOI: 10.1016/j.ijscr.2024.109708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Tessier Craniofacial Clefts Numbers 0 and 1 represent unique facial deformities, with Number 0 involving midline structure hypoplasia and Number 1 exhibiting features like a notched soft triangle and affected alar dome. These anomalies can extend near the midline, leading to complications like telecanthus, necessitating innovative surgical strategies for reconstruction. CASE PRESENTATION A five-month-old girl presented with Tessier 0 and 1 clefts and a dorsal nasal lipoma, challenging traditional repair methods due to structural limitations. This case required a comprehensive approach, including aesthetic excision of the lipoma and reconstruction of both the internal and external aspects of the nose. CLINICAL DISCUSSION The patient underwent successful nasal reconstruction using a transpositional alar flap with a pedicle from the angular artery and a hinge flap for the inner lining. The procedure involved cranial dissection through the flap incision for lipoma excision. This case highlights the complexity of nasal reconstruction in the presence of facial clefts and demonstrates the effectiveness of the alar transpositional flap as a viable technique for achieving aesthetically pleasing outcomes. CONCLUSION The case underscores the necessity for precise surgical planning and execution to address both cosmetic and functional aspects of nasal defects in facial cleft patients.
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Affiliation(s)
- Hardisiswo Soedjana
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Lisa Y Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kevin Leonard Suryadinata
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Datusanantyo RA, Anggrahini SM, Prasetyo AT. Stunted girl: A heartbreaking case report of underdiagnosed and untreated posterior ankyloglossia. Int J Surg Case Rep 2024; 118:109648. [PMID: 38653172 PMCID: PMC11053302 DOI: 10.1016/j.ijscr.2024.109648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Plastic surgeons can help to eliminate stunting by surgically treating children born with congenital craniofacial anomalies such as tongue-tie, or ankyloglossia. Releasing ankyloglossia can help to support breastfeeding and the later development of orofacial anatomy and physiology. Failure to do so can lead to growth and development difficulties in children. We report a heartbreaking case of a stunted 8 year-old female with underdiagnosed and untreated ankyloglossia. PRESENTATION OF CASE The patient was consulted with a short stature, speech disorder, and swallowing disorder. History taking and physical examination led to a diagnosis of type 4 (posterior) ankyloglossia. The Hazelbaker Assessment Tool for Lingual Frenulum Function mandated a frenotomy. Under general anesthesia, frenotomy was performed surgically, and significant tongue mobility was gained. DISCUSSION This case alerted both surgeon and pediatrician that collaboration is a must to intervene in such a specific congenital anomalies. Posterior (type 4) ankyloglossia may cause difficulties in tongue mobility which can lead to difficulties in breastfeeding and swallowing, speech disorders, and malocclusion. Posterior ankyloglossia is not only the most severe form of ankyloglossia, but also the most difficult to diagnose. CONCLUSION In the absence of social and environmental factors, posterior (type 4) ankyloglossia was the single most responsible factor in this growth and development delay in the girl. Timely diagnosis and treatment could have prevented such a stunted condition.
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Affiliation(s)
- Robertus Arian Datusanantyo
- Department of Surgery, Prof. Dr. W. Z. Johannes General Hospital/Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Simplicia Maria Anggrahini
- Department of Pediatrics, Prof. Dr. W. Z. Johannes General Hospital/Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
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Hasibuan LY, Prasetyo AT, Pramono GNTW. Enhancing Aesthetic Harmony: Comprehensive Anthropometric Lip Measurements in Youthful and Attractive Indonesian Adults for Precision Cosmetic Procedures. JPRAS Open 2024; 39:198-206. [PMID: 38293286 PMCID: PMC10825920 DOI: 10.1016/j.jpra.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/16/2023] [Indexed: 02/01/2024] Open
Abstract
Lips are an important part of our perception of beauty, youthfulness and attractiveness. Aesthetic lips, as with the rest of the face, differs according to age, ethnicity and sex. The aim of this study was to evaluate the anthropometric measurements of the lips of young and attractive Indonesian adults. Photographs of faces were taken at an anterior neutral position for 100 participants; 47 men and 53 women volunteered to participate in this study. Seven landmarks were used in this study: stomion (st), sublabiale (sl), subnasale (sn), labiale superius (ls), labiale inferius (li), crista philtre (cp) and chelion (ch). Using these landmarks, lower lip height, upper lip height, philtrum length, upper vermillion height, lower vermillion height, cutaneous lower lip height, philtrum width and mouth width were measured. The results were analysed using independent t-test and Mann-Whitney test. Significant differences in lip size were observed between men and women in all the measurements st-sl (lower lip height), sn-st (upper lip height), sn-ls (philtrum length), li-sl (cutaneous lower lip height), sn-ls/ls-st (philtrum length and upper vermillion height) and ls-li/ch-ch (cutaneous lower lip height and mouth width) with a significance of p=0.003, p=0.007, p<0.001, p=0.05, p=0.005 and p=0.021, respectively. Male lip measurements of ch-ch (overall lip width) and ls-st/li-st (overall lower lip height) were significantly smaller than those of female lips. The lip ratios calculated in this study were congruent with aesthetic parameters reported in other populations. This study suggests that the same measurement standards cannot be used on different populations, but these ratios may offer a better framework for precision cosmetic procedures. We believe that the results obtained in this study on lip anthropometry will help in optimising the standard values that can be used for the Indonesian population aged 20 to 35 years.
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Affiliation(s)
- Lisa Y. Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Universitas Padjadjaran/ Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Universitas Padjadjaran/ Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Prasetyo AT, Hasibuan LY, Suryadinata KL. Anthropometric analysis of the external nose of the Indonesian females: A basic data to achieve good nasal reconstruction. J Plast Reconstr Aesthet Surg 2024; 88:67-70. [PMID: 37952440 DOI: 10.1016/j.bjps.2023.10.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
| | - Lisa Y Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
| | - Kevin Leonard Suryadinata
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
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Prasetyo AT, Hasibuan LY, Arsyad M. Pedicled abdominal skin flap technique for fingers salvaging and reconstruction in a complex palmar hand burn injury: A case report. Int J Surg Case Rep 2024; 114:109199. [PMID: 38151001 PMCID: PMC10800593 DOI: 10.1016/j.ijscr.2023.109199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The only treatment option for full-thickness burn injury is surgical management, either skin grafting or a skin flap. Treatment may be challenging due to the multiple procedures that need to be performed and multiple factors that can affect treatment outcomes especially to do fingers reconstruction. CASE PRESENTATION A 25-years-old man was admitted because of a burn injury on the palm of his left hand. There are waxy and leathery appearances of burn injuries on the palm and 2nd to 5th digits of the left hand and diagnosed with a full-thickness contact burn injury and compartment syndrome. The patient underwent a pedicled abdominal skin flap followed by necrotomy, flap thinning, and digit separation as a reconstruction management. CLINICAL DISCUSSION Pedicled abdominal skin flap is one of the best surgical techniques available for full thickness burn injury reconstruction because it is believed to regain the closest natural-looking appearance and extremity functions. Abdominal flap as random flap is safe to be divided into small part to cover the fingers. CONCLUSION Thorough examinations and appropriate management such as pedicled abdominal skin flaps are important to perform in patients with full-thickness burn injuries.
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Affiliation(s)
- Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Lisa Y Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Muhammad Arsyad
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Soedjana H, Prasetyo AT, Mayrissa TF, Andalu N. Neglected Case of Facial Cleft Associated with Adam Complex: Soft Tissue Reconstruction with Abbe Flap and Nasal Transposition-A Case Report. J Maxillofac Oral Surg 2023; 22:966-971. [PMID: 38105852 PMCID: PMC10719168 DOI: 10.1007/s12663-023-01903-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
Tessier facial cleft is among the rarest facial clefts detailed in literary works and there are numerous issues contending around its multidisciplinary repairing methods. The authors describe a case of a 14-year-old girl with a neglected facial cleft associated with ADAM complex syndrome. The patient underwent soft tissue reconstruction using a combination of the forehead flap, bilateral mustardee flap, and Abbe flap. The results concerning the functional improvement for the soft tissue reconstruction are categorized as good in our terms. Surgical outcome analysis through a long-term follow-up becomes important to achieve the best possible results and patient satisfaction.
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Affiliation(s)
- Hardisiswo Soedjana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Hasan Sadikin General Hospital / Universitas Padjajaran, Jl. Pasteur No.38, Pasteur, Sukajadi, Kota Bandung, West Java 40161 Indonesia
| | - Arif Tri Prasetyo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Hasan Sadikin General Hospital / Universitas Padjajaran, Jl. Pasteur No.38, Pasteur, Sukajadi, Kota Bandung, West Java 40161 Indonesia
| | - Tengku Fitri Mayrissa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Hasan Sadikin General Hospital / Universitas Padjajaran, Jl. Pasteur No.38, Pasteur, Sukajadi, Kota Bandung, West Java 40161 Indonesia
| | - Naufal Andalu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Hasan Sadikin General Hospital / Universitas Padjajaran, Jl. Pasteur No.38, Pasteur, Sukajadi, Kota Bandung, West Java 40161 Indonesia
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Prasetyo AT, Putri IL, Wardani AE. Hemifacial microsomia associated with vascular malformation of vertebral: A case report. Int J Surg Case Rep 2023; 112:108906. [PMID: 37837667 PMCID: PMC10667787 DOI: 10.1016/j.ijscr.2023.108906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hemifacial microsomia (HFM) is a complex congenital facial anomaly characterized by a wide spectrum of clinical features, which encompass the facial skeleton and other organ systems. Currently, there is no evidence to suggest an association between Hemifacial Microsomia and vascular malformations, whether of the vertebral or any other kind. CASE PRESENTATION Reporting a case of a 12-year-old male diagnosed with Hemifacial Microsomia (HFM) and left Microtia. The patient had previously undergone left auricle reconstruction; however, unfortunately, the flap resulted in necrosis. In our next step, we intend to proceed with further reconstruction. Before this, we plan to perform CT angiography to identify viable flap options for effectively closing the auricular defect. During this evaluation, we identified an anomaly structure in the vertebral vascularization. CLINICAL DISCUSSION During the CT angiography, we found a vascular malformation in the vertebral region. This anomaly manifested as tortuosity in the left vertebral vein, with the diameter on the left side being larger than that on the right. Additionally, the diameter of the left internal jugular artery was found to be smaller than its counterpart on the right. The maxillary artery of the left side was larger than the right. Notably, there was an absence of a submental artery on the left side, and a hypoplasia of the left angularis artery was observed. CONCLUSION Hemifacial microsomia could be associated with other malformations. Despite the fact that vertebral artery anomaly is not considered common anomaly in HFM, it is mandatory to perform CT angiography before reconstructive surgery, considering the possibility of massive bleeding during the operation.
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Affiliation(s)
- Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Indri Lakhsmi Putri
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Universitas Airlangga Hospital, Surabaya, Indonesia; Airlangga Health Science Institute, Indonesia.
| | - Anggun Esti Wardani
- Department of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Soedjana H, Prasetyo AT, Dewi C. Paranasal transposition flap in facial soft tissue reconstruction of facial cleft Tessier type 3 & ADAM complex: A case report. Int J Surg Case Rep 2021; 87:106432. [PMID: 34607266 PMCID: PMC8497849 DOI: 10.1016/j.ijscr.2021.106432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Craniofacial Tessier Cleft type 3 as a common craniofacial cleft with nasolabial region soft tissue defect, forced surgeons to find their ways of reconstructing using localregional flaps to provide defect closure. The cleft may occur in existence with other constriction band syndrome entity such as the ADAM complex. The effort to repair and give back the basic function for daily activity, put surgeons to find ways and one among them are soft tissue reconstruction using most reliable are forehead and melolabial flaps. However, many cases may limit their usages. Case presentation A four-month-old boy presented with ADAM complex syndrome with bilateral facial cleft Tessier 3 was done soft tissue reconstruction to repair the bilateral cleft lips using a combination of the paranasal flap. No early treatment approach such as molding was used. Although the cleft was wide enough, with limitation in flap modality, the wound healing was remarkable with no dehiscence. Clinical discussion This patient nasal/glabellar flap was not feasible due to glabellar region defect. Some functional and aesthetic limitations of those flaps highlight situations in which the inferior-based interpolated paranasal flap (IPNF) offers an advantageous alternative. Conclusion Thus, an alternative flap from inferiorly based paranasal flap proven to be good flap modalities for alar nasal area. This case report shows the good result of design, lacks, and benefit in using paranasal flap. Craniofacial clefts are rare and existence of Adam complex at 1 in 15.000 births, with various degree of severity. Paranasal flap as good viable alternate modality for defect closure, especially when nasal/glabellar area are off limit Multifactor consideration are needed for good result of paranasal flap
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Affiliation(s)
- Hardisiswo Soedjana
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, University of Padjajaran - Hasan Sadikin General Hospital Bandung, Bandung, Jawa Barat, Indonesia.
| | - Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, University of Padjajaran - Hasan Sadikin General Hospital Bandung, Bandung, Jawa Barat, Indonesia
| | - Caroline Dewi
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, University of Padjajaran - Hasan Sadikin General Hospital Bandung, Bandung, Jawa Barat, Indonesia
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