Cirugía Oral y Maxilofacial - Técnica Asensio
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Cirugía Oral y Maxilofacial - Técnica Asensio
- 2. NASAL CONSIDERATIONS IN THE UNILATERAL CLEFT LIP USING THE ASENSIO TECHNIQUE
- 20. MODIFIED ASENSIO POSTOPERATIVELY NOSTRIL CONFORMATION BY MEANS OF A STENT Benarroch, 1998
- 25. EARLY POST-OP WITHOUT NASAL PROCEDURES ORIGINAL ASENSIO
- 26. EARLY POST-OP WITH NASAL PROCEDURES MODIFIED ASENSIO BENARROCH, 1.998
Notas del editor
- The incidence of cleft lip and or palate in venezuela is similar than the reported worldwide, 1 in 800 live births. In year 2.000 we are going to have 23.247 patients with the deformity, becoming a public health problem.
- Initially the Asensio technique, like others concentrated its attention on lip repair only. Recently, cleft nasal repair has been emphasized given equal attention directed to reconstruction of the lip and nose. The lip will not be reviewed in this presentation, a complete description of dr. Asensio Technique was oresent early this afternoon.
- The nasal deformity in unilateral clefts is an integral part of the complex cleft syndrome that includes the lip, alveolus, palate, maxilla and nose. Unilateral clefting results in a nasal deformity that may be caused by three major factos: imbalance of the facial musculature, hy poplasia of the skeletal base and asymetry of the skeletal base
- When analyzing the nasal deformity, it must be realized that correction of one of the factors rarely suffices to alleviate the existing nasal deformity. It should be understood that these factors produced changes in the lower lateral cartilage, nostril, columella. Septum, alar base and nasal tip.
- The following is a list of characteristics of a typical unilateral nasal deformity; however, they are not necessarily listed in order of frequency or importance. All of them may be present prior to lip repair and subsequent to the primary operation.
- With this reubication, we gain a precious amount of excess mucosa, in order to avoid narrowing inside the nose. Mucosa that we can use and play with.
- This prolongation around the alar base and posterior dissection of the soft tissues, allows to oriented and positioned without tension the alar base complex.
- Gaining access through the same alar base incision, the ala lateral crura of the lower cartilage is separated from the skin and from the the underlying nasal mucosa .
- When straightening the septum, two points have to be considered: 1.-The curved frontal part must be released from the bone and 2.- The mucosa must be detached from the catilage in this area. After dissecting the mucosa on both sides of the curved septum and disconnecting it from the bone the septum and all other structures can be shifted to the midline. In addition, excessive mucosa is gained on the cleft side.
- In this part of the operation we place the dropped ala in a symmetric position relative to the normal side and lift the nasal tip on the cleft side. This mobilization is accomplished trough extensive undermining of the nasal skin and separation of the cartilages from each other within the columella and the dome.
- With this maneuver and only excising little portions of skin we obtain equally wide nostrils and must be no narrowing inside the nose
- After closure, we used the nostril splint to contour and reshape the lower lateral cartilage, homeostasis and space maintainer for 15 days.
- Summarizing our experience, two questions must be addressed
- The advantages of this approach have led to good results, especially when compared to patients who were operated on, before application of this concept. Correction of the nasal deformity, resulted in adequate and symmetric nose, good projection of the nasal tip and shape of the nostril, and finally curved shape of the alar rim . In conclusion our results do not differ with other publications worldwide that included nasal procedures to the original lip closures techniques .
- Many studies have been publish related to this controversial subject . No growth impairment was mentioned in any of this publications, justifying further application of this procedures .
- In a great number of patients, lip repair alone leads to the typical nasal deformity with functional and aesthetic disorders, that causes discontent in patients, parents and the surgeon.
- Sum nasal procedures to the original Asensio Technique achieving: Symmetry of the nasal floor,ala,and dome on both sides. Symmetric nasal tip projection Reshaping of the lower lateral cartilage Repositioning of the lower lateral cartilage and alar base Reshaping of the nasal ala