Gottfried Lemperle

Background: Early diagnosis of giant tumors of the oral cavity allows appropriate removal, reconstructive surgery, and orthodontics to avoid future suffocation. This work elucidates the sociodemographic and clinical determinants of emergency surgery for giant benign oral tumors in resource-limited settings.Methods: This is an ambispective, descriptive study involving patients with giant benign tumors of the oral cavity that were operated on by INTERPLAST-Germany teams during their six visits to Goma from 2015 to 2019 and in 2022. JASP 0.95.4.0 software was used for the analyses.A Kaplan-Meier curve was used to assess the risk of recurrence, and the significance threshold was p=0.05.Results: 16 patients were collected and operated on for giant tumors of the oral cavity. The mean age was 33.7±8,8years, with a male predominance (13 cases). Every patient had jaw abnormalities, and 6.3% of patients experienced suffocation due to the tumor, but all had trouble chewing. Primary treatment involved complete tumor excision with magnifying loupes, ensuring healthy margins and reconstructive procedures. There was a correlation between the risk of postoperative recurrence of the giant suffocating tumor (p = 0.032 and Pearson's r = 0.537). The Kaplan-Meier curve indicates that the risk of oral giant tumor recurrence in patients with suffocation remains high from the median 34th month onwards (p = 0.002)Conclusion: Early diagnosis of an oral cavity tumor before it grows extensively can prevent future suffocation. Several alarming clinical and paraclinical situations can influence an urgent surgical decision, but multidisciplinarity remains a significant factor. Despite the urgency in the field of oncology, complete tumor removal and reconstructive surgery remain common practices, even when resources are limited. Therefore, developing a treatment protocol would be an asset in making urgent surgical decisions.

Background Common otoplasties through incisions behind the ear with blind scoring or scratching the anterior perichondrium often leave an irregular surface of the antihelix. Method To avoid these tiny side effects, a skin incision along the ventral antihelical fold (scapha) is used to thin and fold the flat antihelix under vision. After local anesthesia of the ventral ear skin, an incision along the scapha allows its blunt lifting toward the concha and to expose the cartilaginous antihelix. Its future shape is marked and the thickness of the cartilage is thinned with a dermabrader by approximately half or until one sees the gray of the inner cartilage. The now missing perichondrium causes the antihelix to fold by itself with an absolute smooth surface and is fixed with three absorbable mattress sutures. Results The technique has been developed in 1985 in Frankfurt and has since been performed on over 1000 patients with optimal results and a low complication rate. The skin flap is so well perfused that no skin necrosis and only 5.7% wound healing problems were experienced. Conclusion This approach from ventral is safe, timesaving, and avoids contour irregularities of the antihelix often seen after traditional techniques. It can be left to beginners in plastic surgery without hesitation. The fear of hypertrophic scars or even keloids can be dispelled with the fact that ear keloids only occur after wound infection. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Background: As people age, the intraorbital fat may diminish and palpebral fissures may narrow, causing the eyes to increasingly tear outside in cold weather. As the bulbus recedes from the conjunctiva, a “wind trap” is formed in the lateral corner of the eye. This wind trap appears to irritate the adjacent lacrimal gland. In this article, an 84-year-old patient experienced annoying outdoor tearing despite having undergone three tarsal strip canthopexies during the past 20 years. Methods: Retrobulbar injections of 3.5-mL high-viscous dermal fillers (Bellafill or Radiesse) pushed the eyeballs forward, aligned the bulbus with the conjunctiva, and closed the wind trap behind the lateral canthus. Magnetic resonance imaging confirmed the filler material in the posterior lateral corner of the orbit. Results: The effect was immediate: the patient’s constant outdoor tearing had resolved after the first treatment of his senile enophthalmos. In addition, the narrow palpebral fissure had widened by 2 mm and rejuvenated his aging eyes. Conclusions: An eyeball that has receded with age can be pushed forward with a retrobulbar injection of a long lasting dermal filler to reattach to the eyelids.

(1) Background: Protruding ears are the most common auricular malformation affecting approximately 5% of the population. One common factor leading to auricular protrusion is a deficiency or total absence of the antihelix. A technique first described by Gottfried Lemperle in 2003 attempts cartilage thinning, folding, and fixation by non-absorbable mattress sutures after ventral skin incision along the ventral helical rim. (2) Methods: Retrospective analysis of patient records was performed for otoplasties according to this technique, performed between 1985 and 2014 at Agaplesion Markus Hospital in Frankfurt, Germany. All recorded complications were examined. (3) Results: A total of 912 single otoplasties were performed according to this technique from 1985 to 2014. Overall complications included 26% minor complications not requiring further surgery and 11% major complications leading to revision surgery. Within those requiring revision surgery, the most common reason was recurrence of auricular protrusion (5%), followed by suture granulomas (5%) and hematomas (2%). (4) Conclusions: Lemperle’s otoplasty technique addresses the open thinning and shaping of the antihelix through a ventral incision along the helix to prevent irregularities and possible ridges. Results show a low complication rate comparable to data found in published studies. This technique is easy to perform, safe, and avoids often seen contour irregularities of the antihelix compared to techniques with a posterior approach.

An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lackexperimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months.Host defense mechanisms react differently to the various filler materials, but all substances— resorbable or nonresorbable—appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances.

Background: A surgical team from Interplast-Germany removed 387 keloids in 302 patients during 4 visits to Goma, Democratic Republic of the Congo, from 2015-2018. Preoperative and postoperative photographs and a thorough anamnesis of keloids were done for all patients. In addition, 18 selected biopsies from 4 types of keloids were histologically examined in Germany. Methods: Treatment options were tested and keloid recurrence rates were compared with data from questionnaires, photographs, and histology. Results: Keloids were classified accordingly as follows: (1) fresh nodular (continuously growing) keloids had a 30% recurrence rate after surgery: no common adjuvant therapy but triamcinolone acetonide (TAC) injections on onset, only; (a) earlobe keloids had the lowest recurrence rate after complete excision with negative resection margins; (2) superficial spreading (or butterfly) keloids were treated with TAC injections only; (3) mature (nongrowing or burned-out) keloids had also a low recurrence rate of 4.5%, which were then treated with TAC on onset, only; and (4) multiple keloids comprise various types in different stages. Conclusions: According to this classification, about 50% of keloids may be removed surgically without risk of recurrence in the examined patient population in Africa, where only TAC injections, but no radiation, are available. Adjuvant TAC or radiation should be started at the onset of recurrence and not generally.