Secondary orbital implant insertion in an anophthalmic patient after orbital reconstruction.

The authors report the case of a 20-year-old man who underwent enucleation of his right eye with teratoma when he was an infant, without volume replacement by an implant. As a result, an underdeveloped shallow bony orbit finally occurred. Also, a contracted socket was present with shallow lower fornix, making ophthalmic prosthesis fitting almost impossible. The patient underwent surgical reconstruction of the orbit with expansion of the orbit vertically and horizontally. A secondary implant with an adequate volume was inserted to correct the orbital volume deficit. The previous expansion of the orbit allowed the insertion of an 18 mm-diameter hydroxyapatite implant wrapped in fascia lata. The lower fornix was expanded with a mucosal graft in order to overcome the socket contraction and the conjunctival shortage. The authors conclude that the final result of this approach is satisfactory. Almost 20 years after enucleation of an eye with teratoma, an attempt was made to correct most of the difficult problems dealing with a malformed shallow orbit and a contracted socket. The young patient is now able to wear a fine ophthalmic prosthesis and his appearance is greatly improved.

Treatment of plagiocephaly in infancy.

Plagiocephaly is commonly attributed to the synostosis of a single coronal suture. Esthetic deformities associated with plagiocephaly range from mild to severe. Because the deformities are progressive, and more difficult to correct in older children and adults, early diagnosis and correction are important. Linear craniectomies, previously widely practiced, have not yielded good results. Current craniofacial techniques allow extensive orbitocranial reconstruction, which can be done safely in infants and in older children as well. These techniques have produced excellent cosmetic results and are routinely used in craniofacial centers.

Sphincter pharyngoplasty for correction of velopharyngeal incompetence.

Sphincter pharyngoplasty is our procedure of choice for cases of velopharyngeal incompetence with good mobility of the lateral pharyngeal walls. The technique and results in 16 patients are discussed.

Nonsurgical control of massive acute gastric mucosal hemorrhage with antacid neutralization of gastric content.

A simple and safe method of medical treatment for control of massive acute gastric mucosal hemorrhage is described. The procedure was developed from the observation that gastric HCl played a central role in peretuating the syndrome. The treatment consists in neutralization of the gastric acid with antacid to pH of 7.0. In preliminary observations of consecutive admissions, 19 of 20 (95 per cent) patients treated with this techinique stopped bleeding. The one remaining patient required surgery. There were no deaths. In contrast, 10 of 15 (66 per cent) patients stopped bleeding with conventional medical therapy. Four of the remaining patients required surgery to control the bleeding. One patient did not stop on medical management. All five (33 per cent) patients died.