ABSTRACT
OBJECTIVE: This paper describes the fabrication and use of a three-dimensional appliance, known as the microtia surgical positioner, to more accurately position and better sculpt the autogenous rib cartilage graft during microtia reconstruction. STUDY DESIGN: The authors introduce a new device design and surgical application. METHODS: An impression and plaster cast were made from the patient's auricular defect. On this cast, the artist then created a wax baseplate and an esthetically pleasing wax sculpture of an ideal ear similar to the patient's normal contralateral ear. The surface contour of the patient's auricular defect locked the wax baseplate into a stable position, the ear sculpture was then properly positioned on the baseplate, and the two pieces were joined. The artist made a silicone mold of the wax prototype and casted the clear acrylic resin surgical positioner using that mold. Finally, an opening along the helical portion was drilled in the positioner. Intraoperatively, the positioner locked into the surface contour of the patient's auricular defect, thus assuring accurate positioning of the cartilage graft. The surgeon marked the correct helix position with the device's helix and helical port and used the positioner as a model to guide the carving and assembly of the cartilage framework. RESULTS: Our group successfully created and used a microtia surgical positioner. The positioner guided accurate superior-inferior, anterior-posterior, and rotational placement of the helical portion of the cartilage graft. The surgical positioner also significantly contributed to detailed sculpting of the graft. CONCLUSIONS: : Medical artists and surgeons may cooperate to fabricate and use a surgical positioner to guide accurate placement of the cartilage framework and assist with sculpting of the graft for total auricular reconstruction.
Subject(s)
Cartilage/transplantation , Ear Cartilage/abnormalities , Ear Deformities, Acquired/surgery , Otologic Surgical Procedures/instrumentation , Adult , Ear Cartilage/surgery , Equipment Design , Female , Follow-Up Studies , Humans , Prosthesis Implantation/instrumentation , Plastic Surgery Procedures , Ribs , Transplantation, AutologousSubject(s)
Fibroma, Ossifying/pathology , Fibroma, Ossifying/surgery , Maxillary Neoplasms/pathology , Maxillary Neoplasms/surgery , Biopsy, Needle , Edema/diagnosis , Edema/etiology , Eye Diseases/diagnosis , Eye Diseases/etiology , Fibroma, Ossifying/diagnosis , Follow-Up Studies , Humans , Immunohistochemistry , Male , Maxillary Neoplasms/diagnosis , Middle Aged , Neoplasm Staging , Risk Assessment , Treatment OutcomeABSTRACT
During an annual physical examination, a middle-aged adult female olive baboon (Papio anubis) in the time-mated breeding colony at the Biologic Resources Laboratory at the University of Illinois at Chicago was found to have a high serum calcium value (> 12 mg/dl). To determine the cause of the hypercalcemia, additional diagnostic tests, including thoracic and abdominal radiographs and a parathyroid panel (parathyroid hormone (PTH), ionized calcium, and parathyroid hormone-related protein (PTH-rp) assays), were performed. The radiographs did not reveal lesions suggestive of neoplasia. A parathyroid panel was obtained twice. Both times the PTH (23.4 and 46.4 pmol/L, normal = 2.91 to 4.57 pmol/L) and ionized calcium (1.68 and 2.10 mmol/L, normal = 1.31 to 1.37 mmol/L) were increased above values for adult females with normal calcium concentration. A tentative diagnosis of primary hyperparathyroidism was made. After a gamma-radiation scan and magnetic resonance imaging of the neck were done, exploratory surgery was performed to identify and remove the affected gland. After gland removal, the baboon's serum calcium, PTH (1.6 pmol/L), and ionized calcium (1.59 mmol/L) values decreased. Results of histologic examination confirmed the diagnosis of benign solitary parathyroid adenoma.
