Reconstruction of traumatic nasal deformity in Orientals.

PURPOSE: The application of rhinoplasty in the treatment of traumatic nasal deformity remains one of the most challenging problems for surgeons. Not only is the skeletal structure severely deformed, but the soft tissue may also be disfigured by a previous injury. Although autogenous bone and cartilage have been the primary choice for nasal reconstruction, synthetic material is desirable for various reasons. This article presents our experiences in the reconstruction of traumatic nasal deformity by using porous polyethylene (Medpor) implant in Orientals. MATERIALS AND METHODS: From May 1998 to January 2005, 32 patients, including 15 males and 17 females, underwent augmentation rhinoplasty for the correction of traumatic nasal deformity. Of these, 30 patients had experienced associated midfacial bone fractures. The surgical procedures employed consisted of the open-tip approach that was followed by implant carving, placement and fixation. Twenty patients received lateral nasal osteotomies, and septoplasty procedures were performed in nine patients, simultaneously. External taping was done, and nostril tampons were placed postoperatively and left in situ for 3 days. The outcome was assessed by an independent investigator and the patients themselves. RESULTS: The patients were, on average, 22 years old at the time of reconstruction and were followed up for an average period of 25.4 months. The interval from injury to the rhinoplasty procedure was 304 days, on average. The average length of dorsal grafts was 44.9 mm. The overall aesthetic-improvement rate was 90.6%, and the patient-satisfaction rate was 84.4%. There were three complications, including an implant-tip exposure and two implant infections. CONCLUSION: A porous polyethylene (Medpor) implant is an effective alternative to autograft for correction of traumatic nasal deformity in Orientals to achieve a pleasing appearance of the nose without donor-site morbidity. A meticulous execution of concomitant procedures and impregnation of the implant by submerging it in an antibiotics solution prior to use were helpful in decreasing the complications.

Split second- and third-toe transplantation in mutilating-hand-injury reconstruction.

Although bilateral second-toe transplantation has offered a satisfactory solution for multiple toe transplantation when the neighboring amputation stumps present an intact web space, exceptions exist. To provide an alternative and adapt the experience from the established methods, we propose split second- and third-toe transplantation in a 1-stage hand-function reconstruction. Three male patients underwent 4 split second- and third-toe transplantations for fingers amputated distal to the preserved or recreated web space. The average age was 22 years old, and all patients were reconstructed secondarily. No failure of transplantation occurred. All patients achieved restored hand functions for daily and occupational activities. In situations in which multiple lesser toe transplantations are required and harvesting toes from the bilateral foot may be needed, a split second- and third-toe transplantation with a healthy contralateral foot for allowing another toe transfer proves to have a satisfactory functional result and affords an opportunity for simultaneous or staged great toe transplantation.

Management of velopharyngeal insufficiency in the presence of enlarged tonsils: comparing a one-stage versus two-stage treatment result.

Alterations in velopharyngeal function after removal of enlarged tonsils were noted. However, the changes varied from previous reports. The purposes of this study were to examine the effect of tonsillectomy on velopharyngeal function and to look for proper management of velopharyngeal insufficiency in the presence of enlarged tonsils. Thirty patients who received tonsillectomy at one craniofacial centre were reviewed. The influence of tonsillectomy on velopharyngeal function was examined and correlations to nasopharyngoscopic or videofluoroscopic findings were made. The outcomes between simultaneous and staged tonsillectomy and velopharyngeal surgery were compared. Tonsillectomy was found to either improve or impair velopharyngeal function in a small proportion of patients; however, it did not alter the surgical management of velopharyngeal insufficiency. Nasopharyngoscopic or videofluoroscopic findings did not predict the influence of tonsillectomy on velopharyngeal function. Finally, simultaneous tonsillectomy and velopharyngeal surgery had an efficacy and complication rate comparable to that of the staged approach.

Diffuse gastric polyposis: report of a case.

In diffuse gastric polyposis, all or a large part of the gastric mucosa is covered with polyps. Diffuse gastric polyposis was accidentally found in a 59-year-old female during study of her anemia. The diagnosis was confirmed by esophagogastroduodenoscopy, double-contrast barium upper gastrointestinal roentgenography, and colonoscopy. Treatment was total gastrectomy with Roux-en-Y esophagojejunostomy. Differential diagnosis of inherited gastrointestinal polyposis syndrome should be considered; malignant potential is the greatest concern.