"Dimple"-matically correct - Revisiting the technique for the creation of a chin dimple.

The boom in cosmetic surgery has ushered in the age of the "designer dimple." In the current scenario where an increasing number of Indians are seeking cosmetic surgery, we present our technique for creation of chin dimples. We used this simple and straightforward technique in one patient. The principal steps of the technique include thinning the skin flap, creating a concave indentation in the mandibular symphysis, and obtaining an adhesion between the thinned skin flap and the indented bone. An aesthetically pleasing chin dimple was achieved. We propose that the bony contouring improves the chances of creating a permanent chin cleft or dimple. Our technique for creation of chin dimples aims to give an aesthetic and permanent result by altering the underlying contour of mandibular symphysis and achieving accurate skin coaptation with non-absorbable sutures.

Median cleft lip: A new method of surgical repair.

The aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with midline cleft lip were repaired with our technique of muscle repair and the results evaluated. Our new method of muscle repair in the form of 'Z' helps in forming the philtral dimple.

Release of oral submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft--a new technique.

Long standing oral submucous fibrosis is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. This article introduces a new technique of release of submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft. The surgical technique involves a pre-auricular incision extending into the temporal region with dissection carried out in the sub follicular plane to develop the superficial temporal fascia flap to its maximum extent. The masseter muscle origin is released from the zygomatic arch and the temporalis muscle insertion is released from the coronoid process through an external approach. The entire fibrosed mucosa is released intraorally to create a mucomuscular defect thus achieving full mouth opening. The superficial temporal fascia flap is then brought in and sutured to the intraoral defect, which is then covered with a split thickness skin graft. This procedure is performed bilaterally. A total of five patients were treated with this new technique and all of them showed good mouth opening in long term follow up. There was no donor site morbidity. The incision line is well hidden in the hair bearing area. A well vascularised superficial temporal fascia flap brings in good blood supply to the area of affected muscle and mucosa to improve its function.

Management of concomitant maxillofacial, cervical spine and laryngeal trauma--case reports.

Three cases are presented to stress important points in the diagnosis and management of concomitant maxillofacial, cervical spine and laryngeal trauma. Emergency tracheostomy to control airway, immediate rigid fixation of maxillofacial fractures, early computed tomographic (CT) scans to evaluate the extent of laryngeal and cervical spine injury and the early repair of laryngeal injury will provide better aesthetic and functional results.

Extramammary Paget's disease: a report of three cases and review of the literature.

Extramammary Paget's disease (FMPD) is a rare skin disease with a tendency to recur even in the face of adequate excision. It was first suggested by Weiner in 1937 to be a carcinoma of the apocrine sweat gland with intraepithelial excision. Thus, most cases of EMPD occur in the perianal, perigenital and axilla regions where sweat glands abound, with scrotal EMPD being the commonest. EMPD can occur in both benign or malignant form and is often confused with chronic dermatitis. Diagnosis can only be confirmed by an excision biopsy. The long-term survival in patients without an underlying carcinoma is good. However, EMPD associated with an underlying adnexal carcinoma tends to be more aggressive and the prognosis is poor in such cases. EMPD is also associated with other malignancies such as prostatic, rectal, cervical, breast, bladder and skin carcinomas. Incidences of up to 40% have been reported. Thus, patients with EMPD should be thoroughly screened for associated primary growths. The treatment of EMPD is essentially by surgical excision with clear margins. The options available for a clear margin include intraoperative frozen section,Moh's surgery and paraffin section with delayed re-excision. In this report, we present three cases of EMPD with markedly different outcomes and a review of the literature.

Two flag flaps based on the supratrochlear vessels for nasal reconstruction.

A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reconstruction of defects of the lower nose when both lining and cover are needed. Two flag flaps based on the supratrochlear vessels were used in a patient with a full-thickness alar defect and a narrow, short forehead.

V-Y advancement flap out of an existing flap.

A case is reported in which a large V-Y flap was fashioned out of a flap already present over the dorsum of the hand, to cover a defect created adjacent to it. The V-Y advancement appeared more effective to fill the defect than the traditional method of mobilisation of a part of the flap achieved by dissecting it from its base.

Corrosive acid strictures of the stomach (a case report).

Two patients presented with history of suicidal acid ingestion. Both the patients developed strictures exclusively in the stomach without involvement of the oesophagus, after a period of 12 weeks. The mechanism of this involvement is presented. The literature on this subject is briefly reviewed.