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Approximately one quarter of polytrauma patients has facial injuries, which usually lead to loss of form and function. Several specialties are involved in the acute and reconstructive phases of facial injuries, such as oral and maxillofacial surgery, otorhinolaryngology, plastic surgery, ophthalmology and dentistry.A 25-year-old man with severe facial injuries was brought to the shock room after sustaining high-energy trauma. He had a panfacial fracture that required reconstruction. This was done with two surgeries, with an interval of 4 days. The patient recovered successfully after this.Because of the complexity of facial trauma, many factors are involved in acute care and treatment. It is therefore important to designate one coordinating specialty to guide this process. The oral and maxillofacial surgeon plays a vital role in this.

Achtergrond: Ongeveer een kwart van de multitraumapatiënten heeft aangezichtsletsel, wat meestal leidt tot verlies van vorm en functie. In de acute en reconstructieve fase van aangezichtsletsel zijn verschillende specialismen betrokken, zoals mondziekten-, kaak- en aangezichtschirurgie, kno-heelkunde, plastische chirurgie, oogheelkunde en tandheelkunde.Casus: Een 25-jarige man werd met ernstig aangezichtsletsel naar de shockroom gebracht na een hoogenergetisch trauma. Hij had een panfaciale fractuur waarvoor reconstructie nodig was. Deze vond plaats tijdens twee operaties, met een tussenpoos van 4 dagen. Hierna herstelde patiënt voorspoedig.Conclusie: Door de complexiteit van aangezichtstrauma spelen veel factoren een rol bij de opvang en behandeling. Het is daarom belangrijk één coördinerend specialisme aan te wijzen dat dit proces in goede banen leidt. De MKA-chirurg speelt hierin een belangrijke rol.

Item does not contain fulltext BACKGROUND: Approximately one quarter of polytrauma patients has facial injuries, which usually lead to loss of form and function. Several specialties are involved in the acute and reconstructive phases of facial injuries, such as oral and maxillofacial surgery, otorhinolaryngology, plastic surgery, ophthalmology and dentistry. CASE DESCRIPTION: A 25-year-old man with severe facial injuries was brought to the shock room after sustaining high-energy trauma. He had a panfacial fracture that required reconstruction. This was done with two surgeries, with an interval of 4 days. The patient recovered successfully after this. CONCLUSION: Because of the complexity of facial trauma, many factors are involved in acute care and treatment. It is therefore important to designate one coordinating specialty to guide this process. The oral and maxillofacial surgeon plays a vital role in this.

Hoofd-halskankerpatiënten kunnen functionele slik- en/of stemproblemen ontwikkelen als gevolg van volumeverlies of atrofie van de tongbasis of farynxachterwand na behandeling met chirurgie, radiotherapie en/of chemoradiatie. Indien reguliere (logopedische) therapie geen uitkomst biedt en de problemen lang aanhouden, kan behandeling door middel van transplantatie van autoloog vetweefsel (lipofilling) mogelijk de functionele problemen verhelpen door bestaande weefseldefecten en weefselverlies op te vullen. In deze studie beschrijven wij de toepassing vanlipofilling bij negen hoofd-halskankerpatiënten met chronische dysfagie en/of dysfonie. Op basis van de resultaten tot nu toe lijkt lipofilling een veilige en vaak ook effectieve methode om de slik- en stemfunctie te verbeteren.

We present a child with neurofibromatosis type I (NF-I) who underwent excision of a large upper lid neurofibroma using a CO2-laser. Plexiform neurofibromas are notorious for their bleeding tendency and the inability to achieve complete surgical excision. The CO2-laser is an adjunct to achieving better hemostasis and delineation of the tissue in the absence of natural tissue planes caused by the tumor's diffuse mode of growth. Using the CO2-laser achieves better cosmesis, while reducing operation time and limiting complications.

A varying period of training followed by examinations is the usual way to become a specialist in one of the many fields of Medicine. Plastic Surgery is one of the surgical fields that require good technical and cognitive skills. The best way to train and evaluate a candidate is hard to judge. The model of training and board examination varies, every country having its own method. This is a descriptive report presenting the ways of training residents in Plastic Surgery and then examining them in Romania, Israel, U.S.A., Germany and the Netherlands. Specific points regarding the structure and the format are addressed for all models and also for factors that might influence the objectivity of the examination. The authors bring their thoughts on these issues

Congenital Melanocytic Naevi (CMN) are birthmarks that can cover large areas of the body. They affect 1:100 new-borns, and large (>20 cm in adulthood) and giant CMN (>40 cm in adulthood) affect 1:20.000 and 1:500.000 new-borns, respectively. The clinical threat of CMN is the risk of developing malignant melanomas or neurocutaneous complications. In addition to these complications, the occurrence of CMN can lead to psychosocial problems due to their remarkable appearance or the extra care they may require.Adequate information and management for patients and their parents is crucial. Although different management strategies have been described, the quality of evidence is generally low which makes it difficult to set up best practice for CMN and to advise patients and their parents. One of the reasons for the low quality of the studies may be the limited patient numbers in studies owing to the rarity of the disease. Moreover, there is a lack of uniformity regarding the outcomes and measurement instruments used for CMN care and research. Heterogeneity impedes the comparison and pooling of outcomes of the small CMN studies. The aim of this thesis was to evaluate clinical considerations regarding CMN management and to achieve harmonization in the outcomes used in CMN care and research by developing a core outcome set. A core outcome set is a consensus-based (i.e. developed by patients and professionals) agreed minimum set of outcomes that are recommended to be measured in all care and research of a certain condition.

Hidradenitis suppurativa is a life impairing skin disease. The treatment of hidradenitis suppurativa has been extensively discussed in the literature and remains extremely challenging. For severe cases of hidradenitis suppurativa, a multi-disciplinary approach is usually necessary, combining medical agents and surgical interventions. The surgical management varies greatly between countries, hospitals and physicians and there are very few guidelines available to guide clinical practice. This, in combination with the severity of the disease burden and considerable amount of health-care costs, makes it is a challenge to perform a surgical intervention with a low risk of recurrence and complications, as well as providing an optimal functional and aesthetic outcome. The main aim of this thesis was to evaluate outcomes regarding recurrence, classification, complications, functional and esthetic outcomes, and patient satisfaction after surgical treatment of patients with hidradenitis suppurativa.

Lipofilling is a new treatment option for head- and neck cancer patients who suffer from chronic and severe (chemo-) radiation or surgery-related swallowing problems. Lipofilling is a technique of autologous grafting in which living fat cells are transplanted from one location to another in the same patient. In the case of head and neck cancer patients, volume loss or muscle atrophy of the tongue or pharyngeal musculature caused by the treatment may result in oropharyngeal dysfunction. Firstly, intensive swallowing therapy will be given, but if that offers no further improvement and the functional problems persist, lipofilling can be considered. By transplantation of autologous adipose tissue, the functional outcomes might improve by compensating the existing tissue defects or tissue loss. Only a few studies have been published which evaluated the effectiveness of this new treatment option. The results of those studies show that the lipofilling technique seems safe and of potential value for improving swallowing function in some of the included patients with chronic and severe dysphagia after surgery and/or (chemo-) radiation therapy for head and neck cancer. The lipofilling procedure will be described in detail as well as the clinical implications.