The use of nail enfolded flaps for reconstruction of full-thickness ala nasi defects: an early report of experience.

The most common etiology of nasal defects that require reconstruction is basal cell carcinoma, as well as squamous cell carcinoma and melanoma. In reconstructing full-thickness ala nasi defects following excision of basal cell carcinomas, we present our technique of the nail enfolded local flaps which involves the harvesting of the nail plate and placing it to serve as a supporting component. In four patients, the nail plate grafts are inserted into various local flaps, and used for reconstruction of full-thickness ala nasi defects. Lining deficiencies of the alar lobule were resurfaced with skin grafts. None of the cases experienced skin graft loss or nail plate exposure. The nail graft prevented alar collapse by supporting the nasal airway. This technique discards the need for a second operation.

A primitive neuroectodermal tumor on the face: case report.

In 1918, Stout defined the lesion in which small round cells originating from the ulnar nerve formed a rosette as neuroepithelioma. It was claimed that this tumor originated from neuroectodermis and was different from the classical neuroblastoma. The term primitive neuroectodermal tumor (PNET) involves a group of tumors of the soft tissue originating from neural crest and resulting from the brain, spinal cord and branches of the sympathetic nervous system. Extracranial primitive neuroectodermal tumors originate from neural crest cells outside the sympathetic and central nervous system. PNET also has some distinctive histological, immunohistochemical and ultrastructural features. It is usually encountered in children and young adults; most frequently located in thoracopulmonary region (Askin's tumor). The second most commonly involved body part is the extremities. It is very rarely located on the face. PNET is an aggressive tumor. In fact, the disease has a rapid progression, causes local or distant metastases and 50% of the patients die within two years of the presentation. It is treated with aggressive surgery as well as chemotherapy and radiotherapy. In this report, we presented a case of PNET located on the right cheek with multiple distant metastases. Clinicians should be on alert when treating facial tumors, not to skip PNET, which is a very aggressive one.

Silastic sheet integrated polymethylmetacrylate splint in addition to surgery for commissure contractures complicated with hypertrophic scar.

Numerous appliances or methods have been used to manage perioral deep burns and resultant contractures, however, until now, no particular technique is considered to be the "ideal technique". In this article, a new modified design of an extraoral appliance, composed of polymethylmetacrylate and silicon sheet is introduced. Two female and one male patient of a mean age of 33 were included in the study. They had a common history of facial thermal injury and hypertrophic scar formation. All three had a history of failed preceding operations to release commissure contractures. The appliance was placed within 14 days following the operation and stretched continuously for 6 months. During 14 months of follow-up period, no recurrence was encountered and a relatively symmetrical and satisfactory mouth opening was obtained. Owing to the effect of the silicon sheet, a more smooth, flattened scar surface and pliable commissure was achieved. No ulcerations, or tissue breakdown was observed. Extraoral appliances composed of polymethylmetacrylate silicon sheet were considered to be practical, convenient and efficient for the postsurgical treatment of the oral commissure contractures complicated with hypertrophic scar formation.

Multiple atrophies following tooth extraction.

Following a molar tooth extraction, the patient developed a depression and atrophy of the right ear, the right half of the mentum, and the tongue. These atrophy deformities were successfully corrected with dermografts.

Use of beta blockers for increasing survival of free fat grafts.

Fat tissue is abundant in the body and preferred in soft tissue augmentation. Since resorption is its greatest disadvantage, many agents have been tried in an attempt to increase fat graft survival in various studies. Yet selective beta1 blocker had not been used before. The effect of selective beta1 blockers on resorption following auto-transplantation of free fat graft was examined in rats. The effect of selective beta1 blockers was compared with those of insulin and saline solution as a control. For this comparison, the weight of fat grafts was measured both during and nine months after operation using the "liquid overflow method" in which obtained material was put into 5 cc syringe filled with saline solution and the increase in liquid level was recorded as graft volume. Histological examination of grafts and statistical analyses of the results were also made. Our in vivo study demonstrated that selective beta1 blocker significantly increased free fat graft survival. It is our conclusion that selective beta1 blocker is a promising agent for decreasing fat graft resorption.

Modified mandibulotomy approach to tumors of the oropharynx.

The surgical approach to tumors in the deep oral cavity, oropharynx, and parapharyngeal space has always been a problem. Midline mandibulotomy for exposure and resection of tumors in these areas is usually essential. However, postoperatively accurate and stable reconstruction of the symphysis is difficult. The authors present a modified notch mandibulotomy in a trapezoidal shape to stabilize the symphysis with only a four-hole miniplate. This shape of the osteotomy reduces the time to return to an unrestricted diet and permits more accurate occlusion.

Cartilage shaping using the Er:YAG laser: preliminary report.

Cartilage grafts have been widely used for reconstruction of congenital or acquired deformities. Reshaping and preserving the new shape of the cartilage grafts have been a problem. In this in vitro experimental study the authors studied the effect of the Er:YAG laser on cartilage reshaping in comparison with scalpel stripping and suture holding. The study consisted four groups (n = 9): group I, untouched cartilage; group II, the short edges of the cartilage were sutured to each other; group III, cartilage was incised using a scalpel; and group IV, Er:YAG laser stripping was applied to the cartilage. Changes in the shape of cartilage were evaluated at 15 minutes, and days 1, 4, and 10. The majority of cartilage in the scalpel-stripped group returned to the initial shape by day 10, whereas the laser-stripped cartilage showed progressive warping day by day, and almost all cartilage formed a circle by day 10. The Er:YAG laser enhanced cartilage warping by a mechanical effect of stripping and a thermal effect of laser radiation resulting in ultrastructural changes.

Three-dimensional computed tomography in evaluation of ankylosis of the temporomandibular joint.

Ankylosis is an uncommon disease of the temporomandibular joint (TMJ), the effective treatment of which requires detailed preoperative evaluation of the type and extent of the deformity. As well as lateral radiographs and computed tomography (CT), three-dimensional CT has been introduced to improve the preoperative evaluation. We present six patients with ankylosis of the TMJ who were evaluated by three-dimensional CT before and after condylectomy. Preoperative findings were compared with operative findings. Three-dimensional CT provides a detailed three-dimensional image of the TMJ non-invasively and we suggest that it is a valuable tool for evaluation of ankylosis in the TMJ.

Nonsurgical delay of cutaneous flaps using the flashlamp pumped pulsed dye laser.

The surgical delay procedure is an effective method for improving skin flap survival. However, it has many disadvantages, such as bleeding, infection, and pain. It also requires an additional operation and a long time for wound management. Nonsurgical delay has a great importance, but pharmacological efforts for delay phenomena have never found clinical application. In this study, the authors attempted to reproduce the delay phenomena via the flashlamp pumped dye laser. Forty Sprague-Dawley rats were studied in four groups of 10 rats each. The experimental and control flaps were on the same rat. Flaps were planned on the ventral skin of the rats, and were symmetrical, three sided, based caudally, and were 2 cm in width, extended to the measured midpoint between the xiphoid and the sternal notch. The laser was applied to the different areas of the experimental flaps 15 days before flap elevation. A week later flap survival was determined by overlaying millimeter-grid acetate paper. Full-surface and perimeter "lased" experimental flaps showed a marked increase in surviving areas when compared with the control flaps. This kind of flap delay has a great potential in clinic application.

Comparison of alexandrite laser and electrolysis for hair removal.

BACKGROUND: Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced. OBJECTIVE: To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation. METHODS: Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4-8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared. RESULTS: The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment. CONCLUSION: Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.

New tumor formation on split-thickness skin grafted areas in xeroderma pigmentosum.

Xeroderma pigmentosum is a relatively rare systemic disease transmitted through an incomplete sex-linked recessive gene. It is characterized by malignant skin degeneration. One of the most effective treatment choices for the malignant changes is full-face resurfacing with skin grafts. Grafts harvested from areas that have some freckles may show malignant degeneration by ultraviolet exposure. The authors present a patient whose face was resurfaced with a split-thickness skin graft and was admitted due to new tumor formation on her resurfaced face.

Late and long-standing capsular hematoma after aesthetic breast augmentation with a saline-filled silicone prosthesis: A case report.

Late capsular hematoma is an extremely rare complication after the implantation of silicone breast prostheses for aesthetic or reconstructive objectives. We present a unique case of late capsular hematoma in an aesthetic breast augmentation with a saline-filled, textured silicone implant, which remained for a year after formation.