Subject(s)
Diptera , Myiasis/diagnosis , Screw Worm Infection/diagnosis , Travel , Adult , Animals , Belize , Child, Preschool , Female , Humans , Insect Bites and Stings/parasitology , Male , Middle Aged , Myiasis/etiology , Myiasis/surgery , Scalp/parasitology , Scalp/surgery , Screw Worm Infection/etiology , Screw Worm Infection/surgerySubject(s)
Adult , 21003 , Case Reports , Child, Preschool , Female , Humans , Male , Middle Aged , Diptera , Myiasis/diagnosis , Travel , Screw Worm Infection/diagnosis , Belize , Insect Bites and Stings/parasitology , Myiasis/etiology , Myiasis/surgery , Scalp/parasitology , Scalp/surgery , Screw Worm Infection/etiology , Screw Worm Infection/surgeryABSTRACT
Six patients with parotid pseudocysts following face lifts are reported. Insertion of a suction drain in three patients provided earlier resolution than repeated aspiration in the other three.
Subject(s)
Cysts/surgery , Parotid Diseases/surgery , Rhytidoplasty/adverse effects , Aged , Cysts/etiology , Female , Humans , Parotid Diseases/etiology , SuctionABSTRACT
Tumors of neurogenic (ectodermal) origin are well-described causes of nasal deformity. We present a patient with a benign mesodermal tumor (unclassified spindle cell) producing nasal deformity. A retrospective review of the two senior authors' records provided an additional three patients with nonvascular benign mesodermal nasal masses (fibroma and leiomyoma). Benign mesodermal masses can occur in the midline of the nose and need to be differentiated from dermoids and gliomas. Misdiagnosis is the rule. Excisional biopsy is required for definitive diagnosis. In addition, excisional biopsy is curative and can help to minimize the subsequent nasal deformity if performed early in the disease process. Immunohistochemical and electron microscopy may be required for comprehensive diagnosis and treatment.
Subject(s)
Leiomyoma/complications , Nose Deformities, Acquired/etiology , Nose Neoplasms/complications , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Leiomyoma/diagnosis , Leiomyoma/surgery , Male , Middle Aged , Nose Neoplasms/diagnosis , Nose Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
In the absence of clinically positive regional nodes, any value of prophylactic dissection in malignant melanomas depends on accurate preoperative determination of the pathway of lymphatic drainage. We report on the use of noninvasive radionuclide lymphoscintigraphy in the determination of regional patterns of lymph node drainage in patients with melanomas. Ten patients were studied; treatment was altered by test results in 2. Eleven node groups were excised in 7 patients. There have been no metastatic melanomas found in any nodal basins not detected by lymphoscintigraphy 23 to 42 months after operation.
Subject(s)
Melanoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Technetium Compounds , Adult , Antimony , Female , Humans , Lymph Node Excision , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Melanoma/pathology , Melanoma/surgery , Middle Aged , Neoplasm Staging , Radionuclide Imaging , Skin Neoplasms/pathology , Skin Neoplasms/surgery , TechnetiumABSTRACT
For the past 25 years at Children's Memorial Hospital in Chicago a protocol has been followed for complete clefts that involves placement of an infant maxillary orthopedic appliance prior to lip closure, surgical closure of the lip, autogenous split-rib grafts to the alveolus to stabilize maxillary segments, and palatal closure, generally within the first year of life. The oldest 36 patients whose skeletal growth was for all practical purposes finished have been followed to determine the need for and type of orthognathic surgery. Of the total sample, 8 patients (22.2 percent) required some type of sagittal orthognathic surgery (1 patient in this group also required vertical maxillary alignment) and 2 patients required maxillary augmentation only in the form of an onlay graft. This report may serve as a baseline for others who wish to report on the incidence and type of orthognathic surgery in their cleft palate centers.
Subject(s)
Bone Transplantation , Cleft Lip/surgery , Cleft Palate/surgery , Surgery, Plastic/methods , Adolescent , Adult , Cephalometry , Child , Female , Humans , Male , Maxilla/surgery , Time FactorsABSTRACT
In 1982, the first long-term study of our early bone-grafting and infant maxillary orthopedic approach to newborn complete clefts of the lip, alveolus, and palate was published. The protocol and sequence of procedures were shown on the first 16 consecutively treated orthodontic patients, with a mean age of 14 years. Cephalometric analysis evaluated anteroposterior and vertical facial growth. This report follows the next 37 consecutively treated individuals in a similar manner and includes not only 20 complete unilateral clefts, but also 17 complete bilateral clefts. Results, when evaluated alone and in comparison with the original series, show once again that there are no adverse growth restraints and that early primary bone grafting in our protocol leads to teeth in better overall occlusion than if it had not been undertaken.
Subject(s)
Bone Transplantation/methods , Cleft Lip/surgery , Cleft Palate/surgery , Adolescent , Cephalometry , Child , Cleft Lip/pathology , Cleft Palate/pathology , Face/pathology , Humans , Infant , Mandible/pathology , Maxilla/pathology , Time FactorsABSTRACT
The exposed knee joint poses a challenge to the reconstructive surgeon. The currently popular approach to the repair of exposed knee joints is use of muscle flaps. However, this leaves the patient with a deficit. We have therefore begun using the fasciocutaneous flap as an initial approach to this problem. In seven patients, aged 28 to 74 years, fasciocutaneous flaps have been the reconstructive procedure of choice for repair of exposed knee joints. One patient with a very large open wound required a concomitant medial gastrocnemius muscle flap. One minor wound separation occurred in a paraplegic patient with severe spasm. No other complications occurred. Follow-up ranged from 3 to 12 months, with good success in wound closure. An approach to small and intermediate wounds is presented in which the V-Y technique is used to obviate the need for skin grafting of the donor site.
Subject(s)
Knee/surgery , Surgical Flaps/methods , Adult , Aged , Humans , Knee Injuries/surgery , Knee Prosthesis , Middle Aged , Postoperative Complications/surgery , Surgical Wound Dehiscence/surgery , Wound HealingABSTRACT
Twenty patients with neurofibromas of the head and neck have been observed for periods ranging from ten to 25 years. Seventeen patients had classical von Recklinghausen's disease. Of these, ten showed recurrence or appearance of new lesions after surgical resection, whether it was done during childhood or adulthood. While there is no known means of curing or even arresting neurofibromatosis, it is desirable to remove, as completely as possible, tumors which are deforming or symptomatic. Subsequent operations are often necessary to keep pace with the growth of the tumors. However, surgical resection, incomplete and imperfect as it may be, is extremely useful in improving the appearance, comfort and quality of life of these unfortunate patients.
Subject(s)
Head and Neck Neoplasms/surgery , Neurofibroma/surgery , Neurofibromatosis 1/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Head and Neck Neoplasms/physiopathology , Humans , Infant , Infant, Newborn , Male , Neurofibroma/physiopathology , Neurofibromatosis 1/physiopathology , Prognosis , ReoperationABSTRACT
A simple but effective means of guiding the cleft alveolar ridge into good contour of the upper dental arch is presented. When apposition of the alveolar ridge is achieved, the position is stabilized with a rib graft at from 4 to 9 months of age. The palate is not repaired until the bone graft is well fixed. The contour of the alveolar ridge in severe clefts is markedly improved over that previously achieved.
Subject(s)
Cleft Palate/surgery , Acrylates , Cleft Lip/surgery , Humans , Infant , Infant, Newborn , Palatal Obturators , Ribs/transplantationABSTRACT
To date there are conflicting reports in the literature as to the efficacy of early maxillary orthopedic procedures and primary osteoplasty in newborns with complete clefts of the lip, alveolus, and palate. Ross accounts for the disagreement by stating that the critical variable may be the surgical procedure utilized in closing the palate, not necessarily the placement of the graft. Friede has also postulated that perhaps it is principally a difference in the graft techniques. Cephalometric evaluation of our sample at 13 years 11 months of age compared with a like sample wherein the primary osteoplasty had not been done showed the two samples to be clinically the same. We feel that in utilizing our sequence of procedures and carefully monitoring facial growth of these children we do not adversely influence facial growth and, in fact, present a more favorable maxillary segment alignment and teeth in better overall occlusion than if we had not done these procedures. From our results, we conclude that there should be no condemnation of the principle of this treatment because of individual failings and failures. Although differences in techniques can and do influence results, the concept of maxillary orthopedics and primary osteoplasty need not be thrust aside even if some techniques are found wanting.
Subject(s)
Bone Transplantation , Cleft Lip/surgery , Cleft Palate/surgery , Age Factors , Cephalometry , Cleft Palate/diagnostic imaging , Female , Humans , Infant , Infant, Newborn , Longitudinal Studies , Male , Malocclusion/prevention & control , Maxilla/diagnostic imaging , Maxilla/surgery , Maxillofacial Development , Orthodontic Appliances , RadiographyABSTRACT
A rapid non-invasive test for the presence of B. melaninogenicus in the wounds of crepitant non-clostridial gangrene is described. The wounds are viewed under an ultraviolet light, and the presence of bright red fluorescene indicates the probable presence of B. melaninogenicus.
Subject(s)
Bacteroides Infections/diagnosis , Gangrene/diagnosis , Ultraviolet Rays , Fluorescence , Gangrene/etiology , Humans , Prevotella melaninogenicaABSTRACT
A fifteen year old female juvenile diabetic had severe ulceration of NLD lesions, which were treated by skin grafting. Twenty-four months postoperatively, she has an excellent cosmetic result.
Subject(s)
Diabetes Mellitus, Type 1/surgery , Necrobiosis Lipoidica/surgery , Adolescent , Diabetes Mellitus, Type 1/complications , Female , Humans , Necrobiosis Lipoidica/complications , Skin Transplantation , Transplantation, HomologousABSTRACT
Fifty-three patients with frontonasal tumors were seen in a 17 -year period. Of these patients, 33 were females (62 percent) and 50 were caucasians (94 percent). The correct diagnosis was made preoperatively in 87 percent of the cases. Eighty-five percent of the patients were children, and most of the lesions (83 percent) were developmental anomalies rather than true neoplasms. The most common lesions were dermoids (17), hemangiomas (16), and encephaloceles (9), but 13 different types of lesions were encountered. The treatment of all is surgical excision, and a cooperative effort by the neurosurgeon and the plastic surgeon is required in some cases.