Acquired nasopharyngeal stenosis in a patient with sarcoidosis.

INTRODUCTION: Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. CASE REPORT: A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. CONCLUSION: This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.

Scalp aplasia cutis congenita presenting with sagittal sinus hemorrhage.

We describe an infant with aplasia cutis congenita of the scalp complicated by sagittal sinus hemorrhage. The defect was successfully managed by primary closure with scalp flaps. The literature on aplasia cutis congenita is reviewed, including etiology, genetic transmission, associated anomalies, and options for management. The potentially fatal outcome highlights the importance of early surgical coverage of the exposed superior sagittal sinus to avoid life-threatening hemorrhage and other complications.

Velopharyngeal insufficiency and articulation impairment in velo-cardio-facial syndrome: the influence of adenoids on phonemic development.

Velo-cardio-facial syndrome is the most common contiguous gene disorder in humans and constitutes 8% of patients with clefts of the secondary palate. Speech disorders, including severe hypernasality and articulation impairment have been documented as among the most common clinical manifestations of the disorder. A series of 36 consecutive patients with VCFS ranging in age from 3 to 14 years, all confirmed to have a 22q11.2 deletion, were studied to determine specific risk factors associated with VPI and articulation impairment. Factors studied included palatal clefting, hypotonia, platybasia, and adenoid size. The factor that correlated most strongly with speech disorders was adenoid hypoplasia or absence, a common manifestation in the syndrome. It is hypothesized that early identification of the absence or hypoplasia of the adenoids can result in the implementation of appropriate therapy plans to avoid severe disorders of speech intelligibility.

Secondary craniofacial surgery for trauma.

Injuries to the face may leave long-term defects with both aesthetic and functional consequences. This holds true especially when treatment is delayed, inadequate, or absent altogether. The wide spectrum of posttraumatic deformities leaves the surgeon with a formidable challenge of reestablishing harmonious facial contour and proper function of each craniofacial unit. Camouflage techniques may be used to correct minor deformities whereas osteotomies and repositioning of segments are needed for more complex problems. Bone replacement is often required as part of the treatment. Although autograft bone is the gold standard, bone substitutes can provide acceptable results. This article focuses on posttraumatic defects of the fronto-orbital region as well as those involving occlusion. Basic principles applying to facial harmony, bone healing and grafting, dental occlusion, and surgical correction specific to each region are discussed.

Advances in congenital craniofacial surgery.

Surgery for the correction of craniofacial anomalies has come a long way since its beginnings more than three decades ago. Throughout this period numerous developments have occurred in diagnosis and management, as well as a better understanding of the etiology of craniofacial anomalies. Significant technological advancements in imaging have allowed for more precise diagnosis and surgical planning. Quantitative analysis techniques have been developed allowing for more precise results analysis. Nonsurgical management techniques have improved, as has the understanding of the proper utilization of nonsurgical treatment. Most nonsynostotic cases of head shape abnormality can be successfully managed nonsurgically. Improvements in surgical management include ways of diminishing the need for transfusions. Operative technical refinements also allow for improved results. The discovery of intracranial migration of rigid fixation hardware has led to decreased utilization of the metallic implants. Bone cements and absorbable plating systems promise further enhancements. Distraction osseogenesis allows skeletal changes to be made gradually reducing risks. Finally, the etiologies of craniosynostosis are being elucidated and promise to lead to more elegant management, reducing or alleviating the need for surgery. Genetic manipulation may eliminate many of these problems.

Internal fixation of maxillofacial fractures: indications and current implant technologies and materials.

Rigid fixation techniques are frequently utilized for the repair of maxillofacial skeletal injuries. This paper reviews the commonly available implants and materials along with their typical indications. The focus is primarily on the most recent trends and developments. Latticework plates and meshes provide greater fixation strength with smaller amounts of metal; modern reconstruction plates allow for fixation of the screws directly to the plates; self-drilling screws make application faster and easier. Resorbable implants made of various polyester polymers are now available, though their indications remain limited thus far. Future developments are discussed as well, including the advent of endoscopic plate placement and image-guided skeletal repositioning.

Cranial bone grafting in maxillofacial trauma and reconstruction.

Although manipulation of cranial bone has a long history, the use of cranial bone for reconstruction of craniomaxillofacial defects has only become popular in the last 15 years. Many refinements in harvesting and placement techniques have occurred over that time period. Cranial bone is valued for craniofacial skeletal reconstruction because of the proximity of the donor site to the recipient site, reasonable resistance to resorbtion, suitable geometry, and ability to be rigidly fixated. Although intracranial injury is a possibility, careful harvesting techniques minimize donor site morbidity. A detailed knowledge of the anatomy of the tissues around the skull is critical to safe harvesting of cranial bone grafts. Selection of appropriate graft types, proper handling techniques, and use of rigid fixation when indicated result in reliable reconstruction and augmentation of the craniofacial skeleton.

Concepts in midface reconstruction.

The midface is a complex area. It is highly visible, and it participates in multiple critical functions of the head and neck. There is a large spectrum of reconstructive options that provide acceptable functional and aesthetic results. An understanding of the complex anatomy and physiology of the area coupled with adherence to basic reconstructive principles will provide consistent positive outcomes.

Maxillofacial fixation with absorbable miniplates: computed tomographic follow-up.

Rigid internal fixation has become a mainstay of treatment for maxillofacial trauma. Refinement in materials and manufacturing have led to unobtrusive titanium miniplates and microplates. However, concerns remain regarding the presence of plates and screws after fracture healing has occurred. Absorbable rigid fixation systems ideally would provide sufficient strength and fixation to allow osseous healing and then be absorbed without sequelae. Plates and screws made from polylactic acid-polyglycolic acid copolymer approach this ideal. Four maxillofacial trauma patients underwent open reduction and internal fixation using absorbable plates and screws. Direct coronal computed tomographic (CT) scans were obtained before and after repair of the fractures. CT scan 6 months after repair shows adequate reduction of fractures and osseous healing. Clinical follow-up shows no significant sequelae.

Chondrocyte volume fraction distribution in porcine septal cartilage: an initial stereoscopic evaluation.

This study uses stereology to determine the volume fraction distribution of chondrocytes throughout septal cartilage. En bloc submucous resection of septal cartilage from four different age groups was performed. Each age group contained three pigs. The weight, volume, and dimensions of the septi were determined. The septi were fixed, embedded in plastic, sectioned vertically at regular intervals along their anterior-posterior axis, and stained with toluidine blue. Each section was further stratified horizontally to allow chondrocyte volume fraction changes to be observed as a function of the two-dimensional location within the septum. The volume fraction of the chondrocytes within the septal cartilage was obtained through light microscopy and stereologic technique. Nested analysis of variance for age groups, individuals within age groups, and locations on the septum was performed. Additionally, unequal number-comparison tests for age groups were calculated. Gross septal parameter changes regarding weight, volume, and length all increased with advancing age. Overall, chondrocyte volume fraction decreased with advancing age. Chondrocyte volume fraction was not found to vary along the anterior-posterior axis or along the vertical axis. Stereologic methodology is an unbiased, simple, and efficient technique to understand the distribution of cells within a tissue.

Metastasizing pleomorphic adenoma of the nasal septum.

Pleomorphic adenoma is the most common benign tumor of glandular tissue occurring in the head and neck region. There have been several reports of metastasis of this benign-appearing tumor from the salivary glands to distant sites, suggesting hematogenous spread and implantation. Although occurrence of pleomorphic adenoma on the nasal septum has been described, to our knowledge this is the first reported case of recurrent septal pleomorphic adenoma with histologically benign tissue in an enlarged metastatic ipsilateral submandibular lymph node, suggesting lymphatic spread. The literature concerning the subject is reviewed. Wide septal excision and modified neck dissection is the recommended treatment.