The surgical correction of the bony ankylosis of the temporomandibular joint.

Bony ankylosis of the temporomandibular joint (TMJ) is an uncommon problem. Since 1997 only seven patients have been treated by the Department of Surgery, three with unilateral involvement and four with bilateral involvement. The associated deformity of the mandible is dependent on the age at the onset of disease or injury. Surgical correction is the only way of treatment, with the main objective being to resume joint movement and jaw function as well as to prevent relapse and, hopefully, restore appearance and occlusion. Surgical procedure included condylectomy with or without coronoidectomy, degloving of the masticator muscles, temporalis muscle flap interposition, costochondral grafting and granioplasty. Postoperative wound infection was found in three patients, one died of gentamicin-induced renal failure six weeks postoperatively. In the long-term follow-up, one patient developed recurrence that was successfully treated repeated surgery.

The superior medial pedicle breast reduction in gigantomastia: A report of 2 cases.

Gigantomastia is an uncommon condition that may occur in puberty or during pregnancy. The etiology remains unknown. Since 1989, we had treated only 2 cases with massive breast hypertrophy that was unrelated to pregnancy. To alleviate the discomfort of the patients, the superior medical pedicle breast reduction was performed. The entire breast parenchyma and skin in the lower quadrant and some breast tissue in the upper outer quadrant of the breast was removed. The viability of the nipple-areola complex depended on the perforating branches of the internal mammary artery. The operations were uneventful and there has been no recurrence of the gigantomaatia during the follow-up period to the present.

Reduction mammoplasty by the inferior dermoglandular pedicle technique.

Since 1989, at our department, the inferior dermoglandular pedicle breast reduction had been performed in 22 patients. Twenty patients had macromastia and ptosis, one required this operation for opposite breast reduction during immediate breast reconstruction for cancer, one had asymmetrical breasts. The patient ages ranged from 18 to 61 years with a median of 28 year. Half of the patient were in the age between 18-23 years, all had virginal macromastia. This technique reserved the inferior dermoglandular portion of breast with nipple - areola complex from the inframammary crease to 1-2 cm. above the nipple - areola. The rest of breast parenchyma was removed in a monobloc fashion. The resected breast tissues ranged from 250 gm. To 850 gm. On each side. There was no postoperative nipple necrosis or impairment of nipple sensation and projection. One had partial dermal necrosis on both ends of the inverted T scar which required debridement and secondary suture. Two developed hypertrophic scar that needed revision after one year follow-up. The advantages of the inferior pedicle technique is that 1) there is a good blood supply to the nipple - areola, 2) the nerve supply is preserved and the duct integrity is retained.