Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis.

Ankylosis of the temporomandibular joint has been a daunting problem in oral and maxillofacial surgery. Condylectomy with gap arthroplasty is the basic technique for treatment of the fully grown patient. In the past, reconstruction has primarily been accomplished with alloplastic materials or with autogenous tissue harvested from the patient. Joints reconstructed with alloplastic materials have been subject to complications such as acute infection and chronic inflammatory problems as a result of foreign-body reaction with the immune system. Biologic reconstruction with autogenous materials does expose the patient to the risk of complications at the donor site. In the last 4 years, we have treated seven patients between the ages of 20 and 42 years who had complete temporomandibular joint ankylosis. In each patient, the affected joint was exposed through an extended preauricular incision. The ankylosed mandibular condyle with the surrounding abnormal bone, together with the coronoid process, was resected and removed. The ankylosed area was resected until an improvement of at least 15 mm in the interincisal opening distance was obtained. A solvent-preserved homologous cartilage graft was sculpted according to the size and shape of the gap and was then placed in it as interpositional material. Physical therapy, including active and passive mouth-opening exercises, began on the second postoperative day and continued for 6 months. Patients were observed for 6 months to 4 years. During this period, no major complications were noted, and satisfactory results were obtained. The initial mean interincisal opening distance was 15.2 mm after surgery, and the final mean interincisal opening distance was 32 mm after completion of physiotherapy. No recurrence was seen during the 4 years of follow-up. This technique seems to be an effective, time-saving, and simple alternative to other methods of joint reconstruction in adults who have fairly extensive ankylosis of the temporomandibular joint. In this article, a description of the surgical technique, a review of all cases, and recommendations for the use of this type of graft material are discussed. Our clinical experience over the past 4 years with the use of preserved homologous costal cartilage grafts as interpositional material has been encouraging.

Microvascular temporalis fascia transfer for penile girth enhancement.

The authors report a 44-year-old man with inadequate penile girth that caused psychological problems. Using microvascular temporalis fascia transfer, they achieved satisfactory penile girth enhancement based on reliable vascularity in a single stage.

Reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve.

Soft-tissue reconstruction of the hand needs to cover the vital structures with flaps. It is usually difficult to maintain function and form with minimal morbidity. Local tissue is preferable but it is also very valuable. Especially in the distal part of the upper extremity, flap coverage is a challenging problem because of limited reconstructive alternatives. On the dorsum of the hand, flaps can be designed based on the paraneural vascular network of the cutaneous sensory nerves. These paraneural vascular networks send branches to the surrounding tissues. The branches to the skin are known as neurocutaneous perforators. The authors used eight reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve. Six flaps were based on the branch to the index finger and two flaps were based on the branch to the thumb. All flaps survived completely, and successful flap coverage was achieved in all patients with minimal morbidity.

Reverse neurofasciocutaneous flaps for soft-tissue coverage of the lower leg.

The evolution of neurocutaneous flaps has created a new concept in reconstructive surgery. These flaps, based on the arterial network around the superficial sensory nerves, are gaining popularity in soft-tissue coverage. Various flaps can be planned based on the neurocutaneous perforators. These kinds of flaps are available for extremity reconstruction. In the lower leg, reverse neurocutaneous flaps have been used successfully. Although these flaps in the lower leg are called neurocutaneous, they have been elevated with the underlying fascia like fasciocutaneous flaps, and thus the authors call these flaps neurofasciocutaneous flaps. They have used 11 reverse neurofasciocutaneous flaps (6 saphenous and 5 sural) since 1995. All flaps survived completely, and stable coverage of soft-tissue defects of the lower leg was achieved in all patients.

An unusual case of hypoglossia-hypodactyly syndrome.

Hypoglossia-hypodactyly syndrome is seen very rarely and its appearance is sporadic. Different degrees of tongue hypoplasia and transverse deficiencies in the upper extremities are seen. In the patient presented there was a sulcuslike deformity at the midline of the lower lip, and the continuity of the orbicularis oris muscle was disturbed at this location, in addition to the classic findings of hypoglossia-hypodactyly syndrome. A description of this variant and its treatment are described.

Malignant transformation of a giant proliferating trichilemmal tumor of the scalp: patient report and literature review.

Proliferating trichilemmal tumors are benign epitheliomas that may show malignant transformation. We present a trichilemmal tumor 15 x 15 x 10 cm in size and emphasize malignant transformation criteria.

Uncommon Klinefelter's variant (49,XXXXY) with cleft palate.

The karyotype 49,XXXXY is a rare form of Klinefelter's syndrome. Various anomalies can be found in this variant--more than other variants of Klinefelter's syndrome. Cleft palate is rarely seen among these anomalies. A cleft palate deformity can be diagnosed early and easily. This deformity should cause one to suspect an uncommon variant of Klinefelter's syndrome. Here we present a patient with an uncommon variant of Klinefelter's syndrome who was diagnosed with the help of the presence of an incomplete cleft palate deformity.

The surgical management of incomplete testicular feminization syndrome in three sisters.

Three sisters with incomplete testicular feminization syndrome are presented. Most of the patients with this syndrome are females and surgery is an important part of their multidisciplinary treatment. Two of the sisters had gonadectomies, herniorrhaphies, vaginoplasty with neurovascular pudendal thigh flaps, reduction clitoroplasty and labia minora reconstruction. The third sister had sufficient vaginal depth and had release of an introitus skin web, clitoroplasty and labia minora reconstruction. All patients had a good result. The reconstructed vaginas are stable and sensate.

H-plasty: a new modification for correction of nasal stenosis.

Unilateral complete nasal stenosis is a rare condition and is usually acquired. The alar wing and nasal vestibule may be disturbed because of stenosis. We operated on 2 patients with complete nasal stenosis by using the H-flap technique described in this paper. Anterior nares are formed by this technique and, in one case, we used a cartilage graft for creating symmetry of the alar wings. Functional and aesthetic anterior nares are obtained by this technique.

Reverse W-M plasty in the repair of congenital syndactyly: a new method.

A W-M plasty is described as a means of establishing an interdigital web in the repair of congenital syndactyly. 25 cases of congenital syndactyly were operated using this method. The web created did not advance distally, nor cause a transverse scar-band.