Massive Intradural Dermoid Cyst Without Sinus Tract.

Dermoid cysts can present as a rare, benign, congenital intracranial tumor of neuroectoderm origin trapped during embryogenesis. Past clinical reports have reported lesions in the posterior fossa, at the midline, and in the intradural region all in conjunction with a superficial sinus tract. The authors present a unique patient of a completely intracranial, intradural, dermoid tumor of the midline cerebellum devoid of any evidence of sinus tract. The histological characteristics, radiological features, and management of this unusual patient are described.

New sterilization technology and the effects on bone pencil.

BACKGROUND: The changing technology today with sterilizing surgical tools has called into question the ability to adequately sterilize the bone pencil. Concern has arisen as to the sterilization of bone pencil and whether the new technology used in sterilizing the operating equipment meets the standards set by the Centers for Disease Control and Prevention. This study was performed to compare the older gas sterilizing technology (ETO) with the newer hydrogen peroxide-based Sterrad sterilizer. METHODS: An equal number of standard number 2 pencils were used for both methods of sterilization. Three separate batches were used for a total of 13 pencils in each group. All pencils were cultured at 24 and 48 hours after sterilization. RESULTS: All culture plates showed no growth during the incubation process. CONCLUSIONS: Bone pencil can be sterilized using the new gas sterilization equipment as well as the older equipment.

Disorders of the female breast in the pediatric age group.

SUMMARY: Disorders of the female breast in the pediatric age group are a relatively common finding; however, there is limited information in the current literature. The plastic surgeon treating these patients is faced with a wide range of reconstructive problems. By understanding the various breast disorders, the plastic surgeon can better diagnose and treat this patient population appropriately.

Secondary alveolar bone grafting: An outcome analysis.

OBJECTIVE: To review the outcome of secondary alveolar bone grafting in unilateral and bilateral cleft lip and palate. DESIGN: A surgeon's experience, by retrospective chart review, of 70 consecutive patients at a tertiary care centre. OUTCOME MEASURE: Periapical radiographs were taken at least six months after secondary alveolar bone grafting. The Enemark grading system was used to stratify graft-take. RESULTS: In unilateral clefts, 33% were level 1, 36% were level 2, 20% were level 3 and 11% were level 4. In bilateral clefts, 29% were level 1, 50% were level 2, 14% were level 3 and 7% were level 4. There was no statistically significant difference between the level of take and the type of cleft. Complications encountered were infection (n=3), fistula (n=3), pain (n=4) and bone graft exposure that led to failure (n=2). Two patients required reoperation for bone grafting. CONCLUSIONS: The iliac crest is a good donor site with excellent results and minimal morbidity.

Symptomatic plate removal in maxillofacial trauma: a review of 76 cases.

This study reviewed the fate of titanium plates used to correct maxillofacial trauma in 76 patients to define risk factors for plate removal. Medical records of 76 consecutive patients at a single institution, over a 10-year period, were retrospectively reviewed. Variables included age, sex, trauma type, diagnosis, fracture type, fracture diagnosis, plate location, surgical approach, and reasons for plate removal. Fracture diagnosis was described as panfacial (42%), blowout (3%), midface (28%), zygoma (26%), mandible angle (6%), ramus (7%), and symphysis (9%). All plate removals according to fracture diagnosis were in the mandible angle (30%) and symphysis (20%). When plate location was reviewed, 68% of the plates were placed in the upper and midface and 32% were placed in the mandible. Specifically, plates were placed in the frontozygomatic suture (18%), zygomaticomaxillary suture (19%), infraorbital rim (14%) and mandible symphysis (15%), mandible angle (9%), piriform (6%), nasal (5%), mandible ramus (4%) and body (4%), zygoma (2%), and frontal (2%). Of 163 plates that were placed, 6 plates (3.7%) were removed. Three (12%) of the symphysis plates and 3 (20%) of the angle plates were removed. Among all variables, only fracture diagnosis (P = 0.01) and plate location (P = 0.01) were statistically significant in plate removal. Five plates were removed for abscess/infection; 1 plate was removed for osteomyelitis. Further review revealed that 4 out of 6 plates removed involved synchronous mandible fractures. Most infections after maxillofacial trauma occur in the mandible, and often these infections are the main reason for plate removal. More vigilance is needed in the treatment of mandible angle and symphyseal fractures, especially if there are synchronous fractures, to prevent infection, plate removal and subsequent malunion.

Evaluation of alveolar bone grafting: a survey of ACPA teams.

OBJECTIVE: To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. DESIGN: An anonymous survey was mailed to 240 American Cleft Palate- Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. RESULTS: Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. CONCLUSION: There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.

Gynecomastia: an outcome analysis.

BACKGROUND: Gynecomastia refers to the presence of femalelike mammary glands in a male. This disorder can lead to significant psychologic stress and self-consciousness. This study consists of a chart review of 174 patients treated surgically between July 1, 1976, and February 27, 2001. RESULTS: Operative procedures were excision, excision with suction-assisted lipectomy (SAL), SAL, skin excision (skin) and skin excision with SAL. Overall complication rate was 20%. No significant difference in complication rates was found between grades or procedures. Revision rates between grades were I = 10.3%, II = 14.5% and III = 34.8% (P < 0.001). In grade III, gynecomastia revision rates for excision +/- SAL was 29% and skin +/- SAL was 38.1% (P = 0.644). Of the 8 revisions in the skin-sparing procedures, 6 were revised with a scar-forming procedure. Therefore, 77% of patients with grade III gynecomastia were adequately treated with a skin-sparing procedure. CONCLUSION: Skin-sparing operations should be the initial procedure chosen for most grade III gynecomastia patients.

Bilateral reduction mammoplasty in an adolescent population: adolescent bilateral reduction mammoplasty.

Bilateral reduction mammoplasty in adolescent patients can be a controversial procedure because of the significance of possible long-term complications and the permanence of the results. There are no current criteria specifically for adolescent candidates for reduction surgery, although many of these young women may have severe physical symptoms. Therefore, the demographics and outcomes of these patients are of particular interest in determining the risks and benefits particular to this surgery for younger patients. Seventy-three patients who had undergone bilateral reduction mammoplasty between 1981 and 2000 were identified in the hospital and office records of four midwestern plastic surgeons. Patient ages ranged between 12.5 and 18.9 years, with a mean age of 16.1 years. A two-pronged investigation involved examination of demographics of the adolescent population and short- and long-term outcomes and satisfaction. Demographic survey included age, weight, height, BMI, breast size, and amount of tissue removed. Indications for surgery and postoperative complications were surveyed in office records and via questionnaire. Seventeen patients (23%) were successfully contacted and returned a detailed questionnaire evaluating indications for surgery, preoperative and postoperative complications, and overall satisfaction. Eighty-two percent of patients reported resolution of their physical symptoms, including back, shoulder, and neck pain. Self-esteem, however, was cited most commonly as a reason to recommend this procedure to other adolescent women. Nearly 65% of respondents would repeat their adolescent surgical experience, and 82.4% would recommend this procedure to a teenaged friend in a similar situation. The authors' data suggest that adolescent patients benefit significantly from reduction mammoplasty and that long-term satisfaction remains high, despite the age of the patients at surgery.

A local perspective on the initial management of children with cleft lip and palate by primary care physicians.

OBJECTIVE: To evaluate the frequency and referral patterns, need for continuing education, and information given to parents of children with cleft lip and palate by local primary care physicians. STUDY DESIGN: A survey was sent to primary care physicians from the pediatrics, family practice, and internal medicine/pediatrics specialties in six surrounding counties of a regional craniofacial center located within northeastern Ohio with a population base of 1.5 million people. Particular aspects of care evaluated included protocols of care, information for parents, referral patterns, conferences attended, and literature read. RESULTS: Nearly 30% of physicians had standard protocols when children are born with clefts. Eighty-seven percent of physicians referred children within 2 weeks of diagnosis, yet only 48% gave referrals to a multidisciplinary team. Physicians providing team referrals were nearly three times as likely to attend related conferences and approximately four times as likely to have a set plan at the time of diagnosis of the cleft. Forty-nine percent of physicians gave oral information, 35% gave oral and written information, and 10% did not give parents information. Ninety-four percent of physicians gave parents the option to call with concerns. Pediatricians were approximately four times as likely to attend cleft conferences and desire continuing education updates. However, family practitioners were over three times as likely to give proper referrals, compared with pediatricians. CONCLUSION: There is a necessity to educate local primary care physicians who manage children with cleft lip and palate regarding cleft information for parents, referral guidelines, the cleft team concept, and the role of primary physicians.