Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 21 cases published to date. Orbital roof fractures are generally encountered in males between 20 and 40 years of age following automobile collision. We report a case of an orbital roof fracture with traumatic encephalocele into the left orbit. Early diagnosis and treatment are very important because the raised intraorbital pressure may irreversibly damage the optic nerve. Computed tomography with 3-D reconstruction, the imaging modality of choice, showed the displaced fracture fragment deep into the orbit. Reconstruction of the orbital roof should be performed in every case. We used an extracranial approach to elevate the fracture with titanium mesh to stabilize the fragment. The cosmetic results were excellent but delay in treatment was responsible for delayed recovery of vision. The case report is followed by a brief overview of orbital roof fractures including pertinent review of literature.

Aims:Cranial vault reconstruction can be performed with a variety of autologous or alloplastic materials. We describe our experience using high-density porous polyethylene (HDPE) cranial hemisphere for cosmetic and functional restoration of skull defects. The porous nature of the implant allows soft tissue ingrowth, which decreases the incidence of infection. Hence, it can be used in proximity to paranasal sinuses and where previous alloplastic cranioplasties have failed due to implant infection.Materials and Methods:We used the HDPE implant in seven patients over a three-year period for reconstruction of moderate to large cranial defects. Two patients had composite defects, which required additional soft tissue in the form of free flap and tissue expansion.Results:In our series, decompressive craniectomy following trauma was the commonest aetiology and all defects were located in the fronto-parieto-temporal region. The defect size was 10 cm on average in the largest diameter. All patients had good post-operative cranial contour and we encountered no infections, implant exposure or implant migration.Conclusions:Our results indicate that the biocompatibility and flexibility of the HDPE cranial hemisphere implant make it an excellent alternative to existing methods of calvarial reconstruction.

Objective:This report details our experience with the use of the temporoparietal fascia flap in different scenarios of reconstruction and to discuss our technique of harvest, clinical applications, and review of literature of this versatile flap.Materials and Methods:A retrospective study of 82 cases of temporoparietal fascia flap in 71 patients, operated over a period of 10 years was conducted. Patients were grouped based on various clinical indications. The follow up period ranged from a minimum of 1 to a maximum of 10 years (Mean-four and a half years). All patients were analyzed for functional and aesthetic outcome using preoperative and postoperative photographs.Results:No significant complications were seen in our series. Only 2 out of 82 flaps had partial necrosis of flap (2.44%). Two patients who were operated for release of submucous fibrosis developed recurrence due to continued use of tobacco. The final outcome in one patient of ear reconstruction was unsatisfactory due to flap failure. The remaining patients had satisfactory functional and aesthetic outcomes (95.77%). None had other complications like temporal branch of facial nerve injury or alopecia along the scar line.Conclusion:The TPFF is one of the most reliable and versatile flap in the head and neck region. It can also be reliably used as free fascial flap. When its advantages are combined with the surgeon's resourcefulness, various defects can be successfully reconstructed using the temporoparietal facia flap with satisfactory aesthetic and functional outcome.

Despite advances in the acute management of craniofacial fractures, some patients will present with secondary deformities. In an attempt to formulate treatment guidelines, we present a review of 152 cases of post-traumatic craniofacial deformities treated by us using different surgical techniques. Analysis of the underlying bony and soft tissue deficits was followed by stepwise reassembly of the skeletal fragments and re-establishment of facial contour and symmetry. The postoperative outcomes were evaluated in terms of aesthetic and functional parameters. Though all patients had considerable improvement after secondary correction of these deformities, soft tissue deficits and time elapsed till secondary reconstruction remain the major factors in achieving an ideal aesthetic outcome.

Context:The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle.Aims:We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity.Settings and Design:This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty.Subjects and Methods:The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a score from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the total score was rated as 31–40 = excellent, 21–30 = good, 11–20 = fair and 0–10 = Poor. The patients' overall satisfaction was assessed at 6 months postoperatively to record their impression of the aesthetic improvement after our procedure.Results:The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative complications. The authors' assessment judged 15 (71.4%) patients as having an excellent outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective satisfaction with the post-operative appearance of their upper lip and rated their results as improved and overall satisfaction scoring was high.Conclusions:This technique is a new addition to the repertoire of procedures which already exist for the correction of bilateral cleft lip nose deformity. It is safe, reliable and has a good aesthetic outcome with no significant morbidity.