In medicine, classifications are designed to describe accurately and reliably all anatomic and structural components, establish a prognosis, and guide a given treatment. Classifications should be useful in a universal way to facilitate communication between health professionals and to formulate management protocols. In many situations and particularly with craniofacial microsomia, there have been many different classifications that do not achieve this goal. In fact, when there are so many classifications, one can conclude that there is not a clear one that accomplishes all these ends and defines a treatment protocol. It is our intent to present a new classification based on the Pruzansky's classification, later modified by Kaban, to determine treatment protocols based on the degree of osseous deficiency present in the body, ramus, and temporomandibular joint. Different mandibular defects are presented in two patients with craniofacial microsomia type III and IV according to our classification with the corresponding management proposed for each type and adequate functional results.

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En la actualidad no se conoce la frecuencia de los trastornos de alimentación en pacientes de cirugía estética, pero se sospecha que sea mayor a la población general. Hay diferentes pruebas o cuestionarios para detectar aquellos en riesgo, siendo el examen mental el que comprueba presencia de psicopatología aplicando criterios DSM IV y CIE 10. La prevalencia de trastornos del comportamiento alimentario ha venido en aumento en la población adolescente y no está claro si es un hecho real o que se ha mejorado la capacidad para detectarlos. No se puede descartar que los estereotipos de belleza actuales hacia una figura corporal más delgada, estén jugando un papel clave en la epidemiología. El conocimiento de los factores de riesgo es de vital importancia para su detección temprana y la toma de medidas preventivas que aseguren mejores resultados terapéuticos. Así se podrían identificar los casos con problemas en el posoperatorio o que no son candidatos para procedimientos quirúrgicos. El tratamiento multidisciplinario es fundamental para corregir las alteraciones nutricionales y mentales en forma paralela.

In this rare case, the authors show the difficulties when treating this disease. The follow-up of the patient showed a successful reconstruction with good functional results.

Background: The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated. Methods: A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia’s contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes. Results: A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754–16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes. Conclusion: For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.