Rare craniofacial anomaly: Tessier no. 2 cleft.

Four cases of facial cleft that fit the anatomic description of the rare Tessier no. 2 cleft, with two patients having the no. 12 cleft extending to the cranium as no. 2 clefts, are presented. In all patients, clinical expressions of the anomaly were different. Thus, diverse surgical procedures were used in all cases. These cases and review of the literature help to define the soft-tissue and bony course of these clefts, and also emphasize the role of three-dimensional computed tomography scan imaging to show the bony cleft route. The diagnosis and treatment plan of the no. 2 cleft as well as its cranial counterpart are discussed in this report.

Marjolin's ulcers arising in burn scars.

Epidermoid carcinoma in nonhealing scar tissue, known as Marjolin's ulcer, is not uncommon and is thought to behave in a more aggressive fashion than those from other causes. Between 1982 and 1997, 56 patients with Marjolin's ulcer were treated at our center, Ege University Medical School, Izmir, Turkey. All lesions were secondary to various kinds of burns. Forty of these patients could be followed up 5 years or more. These 40 patients' medical records were reviewed retrospectively.

Gunshot wounds of the face in attempted suicide patients.

PURPOSE: The purpose of this retrospective study was to evaluate the functional and cosmetic results of the treatment of gunshot wounds associated with attempted suicide that resulted in facial injury. PATIENTS AND METHODS: The records of 12 patients with facial injury resulting from gunshot wounds with a suicidal origin, who were hospitalized and treated at Ege University Hospital, Department of Plastic and Reconstructive Surgery, were reviewed. RESULTS: All injuries were limited to the head and neck region; in only one patient did intracranial penetration occur. Mandibular fractures were detected in all cases. Fractures of the maxilla were present in 11 patients. Eight patients suffered from zygomatic fractures. Perforating ocular trauma was present in two cases. Soft tissue repair was performed by primary closure, local flaps, or skin grafts, and rigid fixation was used for fractures. Procedures such as distant flaps or bone grafting were left for delayed reconstruction. CONCLUSION: Only 3 of 12 patients returned for follow-up and reconstruction. It was therefore concluded that relatives of these patients believe that the repair of such deformities, even if it is a functional deformity, is not necessary. Thus, in such cases, one should do as much reconstruction as possible at the primary surgical intervention.

The effects of fronto-parieto-squamosal suture fusion on cranial growth: an experimental study.

Craniosynostoses have been known for at least 20 centuries, but their etiopathogeneses are still unclear. There are three main theories to explain the etiology of craniosynostosis, Moss's theory being the most popular. According to Moss, the development of the neurocranial form is viewed as an integration of the growth of the skull base, the calvarial bones, the meninges, and the enclosed brain. Experimental studies, however, are generally focused on cranial vault suture synostosis. This study aims to demonstrate the effects of cranial base synostosis by performing fronto-parieto-squamosal suture fusion. This fusion affected the whole cranial configuration. These effects were more prominent closer to the cranial vault, increasing at the anterior facial height and the lower facial length, reflected by ventral dislocation of the total face, and increasing of the kyphosis at the cranial base. It has also been demonstrated that synostosis of a junction point near the cranial base affects the vault and the base simultaneously. Any approach that tries to treat the cause, and not the symptom, of synostosis must, then, be based on an understanding of how cranial growth occurs and of how sutural growth processes are related to the totality of cranial growth.