Chapter 8:
Soft Tissue Deformities


Craniomaxillofacial Trauma

Zygomatic Fractures

Maxillary Fractures

Nasoethmoid Orbital Fractures

Internal Orbital Fractures

Mandibular Fractures

Post-Traumatic Facial Deformities

Soft Tissue Deformities

Facial Bone Contouring

 

CHAPTERS 

Introduction

Clefts of the Lip and Palate

Ear Reconstruction

Craniosynostosis

Orbital Reconstruction

Treacher Collins Syndrome

Nasal Reconstruction

Orthognathic Surgery

Trauma Reconstruction

Hemifacial Microsomia

Summary

 

Soft tissue deformities may involve the skin, subcutaneous tissue, underlying muscle or a combination of any of these elements. There are a number of syndromes such as hemifacial microsomia in which asymmetry of the soft tissue may be a component. However, the number one cause of facial soft tissue deformities is trauma. Traumatic facial injuries may be blunt, penetrating and/or avulsive in nature. An avulsion or loss of soft tissue may create a significant deformity which requires reconstruction. Generally the facial skeletal deformities are reconstructed first followed by correction of soft tissue problems.

One example of a severely deforming and psychologically crippling injury is the scalp avulsion. This presents a very challenging problem particularly if the avulsed portion is very large and cannot be replanted by microvascular technique. A new and innovative approach to this type of problem has been the use of the tissue expander. These expanders are much like deflated balloons placed beneath adjacent normal tissue. Over a period of weeks these expanders are gradually inflated, stretching the normal skin for use in reconstruction. An example of this technique is shown for reconstruction of the scalp.

Soft tissue tumors are another cause of facial deformities. Resection of either benign or malignant facial tumors can result in a significant cosmetic deformity. Craniofacial techniques can be used to help reconstruct these defects and restore facial appearance.

Soft Tissue Deformities

Thirty-five year old male with soft tissue injuries and complex facial fractures. Postoperative result after one-stage reconstruction of soft tissue and bone.

Five year old boy was attacked by a pit bulldog and lost almost all his scalp and forehead.

This injury was initially repaired with skin grafts.

Using tissue expanders his entire hair-bearing scalp has been restored.
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The Tennessee Craniofacial Center, part of the Erlanger Health System, is located in Chattanooga, Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the evaluation and treatment of patients of all ages with craniofacial deformities. Location: 975 East Third Street. Chattanooga, Tennessee 37403
Phone: 423-778-9192 or 800-418-3223 Fax: 423-778-8172
Internet: www.craniofacialcenter.com Copyright ©1997, 2000, Erlanger Health Systems