Pitanguy's method of protruding ear correction from our own experience: review of 80 cases.

A recent review of the literature revealed more than 20 methods of correction of protruding ears. Pitanguy's cartilage island flap technique is still not widespread. However, it is extraordinarily versatile and effective from our own experience. The aim of this study is to present our own experience in the correction of prominent ears using this method. According to Pitanguy's cartilage island flap technique, 80 patients were operated on at the Private Plastic Surgery Clinic from 1992 to 1999. There were 45 (56%) female and 35 (44%) male patients, aged from 9 to 37 years (22 years on average). All procedures were performed under local anesthesia. In the follow-up period of 1 to 8 years the final aesthetic results were estimated as very good in 68 (85%) patients and good in 12 (15%) patients. Early complications in the form of bleeding occurred in three (3.75%) patients. Asymmetry in the ears' position was qualified as a late complication and occurred in four (5%) patients.

General anesthesia via tracheosubmental intubation from our own experience.

In our department from 1995 to 1998, 30 patients were operated on under general anesthesia via tracheosubmental intubation (TSI). No local or general complications were observed. Operating in the field free from the intubation tube is very comfortable for a surgeon, while for an anesthesiologist the safety of the tube and efficiency of ventilation are very important. TSI, as a technically simple, safe, and efficient procedure, is extremely helpful in the surgical treatment of patients with simultaneous multifragmentaric and comminuted fractures of the maxilla and mandible, and in orthognathic and aesthetic plastic surgery of the face, where assessment of facial symmetry and occlusion is especially important.

Marcus Gunn Jaw-Winking Phenomenon: management and results of treatment in 19 patients.

From 1980-1995, 19 patients displaying the Marcus Gunn Phenomenon (MGP) were treated in the Department of Maxillofacial Surgery of the Jagiellonian University in Kraków, Poland. Sixteen patients were operated on according to the Neuhaus method, in one case bilaterally. In three patients, the upper eyelid, after partial transsection of the levator muscle, was suspended from the frontal muscle on autogenous temporal fascia strips. At postoperative follow-up, the width and symmetry of the palpebral fissures were evaluated as well as persistent symptoms of synkinetic eyelid movement. In 13 (68.4%) patients, proper width and symmetry of the palpebral fissures were obtained, whereas in the remaining six (36.1%) marked improvement and decreased asymmetry of palpebral fissures were achieved. Pathological synkinesis disappeared totally in 16 (84.2%) of the patients on operated.

Comparison of the DNA content in recurrent and nonrecurrent basaliomas of the face.

The ploidy status of 5 recurrent and 7 nonrecurrent basaliomas was investigated using a CAS 200 image analyser. All recurrent basaliomas were aneuploid in contrast to nonrecurrent ones representing the euploid status. The percentage of cells in S phase in recurrent basaliomas was twice as high as in nonrecurrent ones. The authors conclude that aneuploidy in primary tumour can be a warning signal for recurrences and these patients should undergo special control.

Actinomycotic osteomyelitis of the mandible: review of 15 cases.

The authors have analysed 15 cases of actinomycotic osteomyelitis of the mandible. Primary actinomycotic inflammation of the mandible was diagnosed in nine patients, secondary in six patients (following fracture or resection of the mandible). The diagnosis was established on the basis of the clinical examination confirmed by bacteriological and/or histopathological tests. The basic method of treatment was antibiotic therapy of long duration. Surgical treatment was performed in all patients. Twelve of fifteen patients who had received the therapy and proved asymptomatic for 1 year to 23 years were recognized to be cured of the disease. In three patients, a single recurrence of the disease was observed after 1.5-2 months.

Significance of P-53 antigen in malignant melanomas and naevi of the head and neck area.

DO-7 antibody against p-53 antigen was applied for investigation of melanomas of facial skin (25 cases), oral cavity (17 cases), eye (18 cases) and naevi (25 cases). The p-53 index value (% of p-53 positive cells) was correlated with the thickness of the tumour, the presence of metastases and survival time. The difference in p-53 index between naevi and melanomas was statistically significant (p < < 0.01). A significant correlation was found between the p-53 index value and the thickness of the tumour, the presence of metastases and follow-up for patients with skin, oral and ocular melanomas. The possible diagnostic and prognostic significance of p-53 antigen in melanomas and naevi of the head and neck area is discussed.

[Diagnosis and results of treatment of blow-out fracture of the orbital floor]. / Rozpoznawanie i wyniki leczenia rozprezajacego zlamania dna oczodolu.

In the last 20 years, 273 patients with blow-out fracture of the orbital floor were treated. Surgery was performed in 242 of them (88.6%). The typical features of this type of fracture as well as the methods and results of treatment are presented. Criteria of the recovery were disappearance of diplopia and decrease of enophthalmos.

Squamous cell carcinoma arising in an odontogenic cyst. Report of three cases.

Primary intraosseous carcinoma of the jaws is an uncommon lesion. The majority of these develop in preexisting odontogenic cysts. Three cases of primary intraosseous squamous cell carcinomas of the mandible and maxilla, with evidence of origin in the odontogenic cysts are described. The recent literature on carcinomas arising in jaws cysts is reviewed.

An application of MIB antibody to the retrospective study of melanomas of oral mucosa and facial skin.

A new monoclonal antibody prepared against a fragment of Ki-67 antigen MIB, from Dianova, was applied for investigation of malignant melanomas of facial skin (25 cases) and the oral cavity (25 cases), which were routinely embedded in paraffin. The values of the Ki-67 index (expressed as a percentage of positive nuclei) were correlated with TNM characteristics of tumors and patient survival. Significant correlation was found between the Ki-67 index and the level of lymph node involvement (N value), the presence of distant metastases and the time of patient survival. A positive relationship between the Ki-67 value and tumor size was also observed although it lacked statistical significance.

Lacrimal drainage system obstruction: management and results obtained in 70 patients.

Causes and types of acquired obstruction of the lacrimal drainage system are discussed in 70 patients, as well as the results of their surgical treatment. Obstruction of the lacrimal drainage pathway, according to frequency, was due to: trauma (mainly naso-orbital and LeFort II fractures), post-inflammatory stenosis of the nasolacrimal duct, tumours and latrogenic injuries of the naso-lacrimal drainage system often following Caldwell-Luc operations of the maxillary sinus. The ages of patients ranged from 3-70 years. Canalicular obstruction was diagnosed in 9 (12.9%), obstruction of the lacrimal sac in 2 (2.8%), while obstruction of the naso-lacrimal duct in 50 (71.4%) patients, including 3 bilaterally. And in 9 (12.9%) patients, injury to the lacrimal system following excision of tumours of the eyelids and the medial canthal region occurred. In patients with canalicular obstruction intubation of the canaliculi was carried out and both ends of the drain were inserted into the nasal cavity for 6 months via a dacryocystorhinostomy. Total recovery was obtained in 44.5%. In lacrimal sac and nasolacrimal duct obstruction Dupuy-Dutemp's dacryocystorhinostomy was performed and 90.4% of the patients recovered. When fibrosis or extensive damage of the lacrimal sac had occurred, wide anastomosis with the nasal duct was indicated. After tumour excision, the lacrimal pathways were reconstructed by conjunctivo-rhinostomy, conjunctivo-sinusostomy or conjunctivo-dacryocystorhinostomy. In 40% of the patients who underwent conjunctivo-dacryocystorhinostomy a successful outcome ensued.

[Personal experience and the results of surgical treatment of blepharoptosis]. / Wlasne doswiadczenia i wyniki operacyjnego leczenia opadniecia górnej powieki.

UNLABELLED: The authors discuss the indications for the operation, the surgical technique and results obtained in 92 patients who have been operated for ptosis (109 operations) by the modified method of Berke and Neuhaus. From the experience of the authors it appears that the best approach is a subciliary one especially in congenital ptosis. The Neuhaus method showed to be successful in patients with ptosis connected with the "jaw-winking" Marcus-Gunn phenomenon; in these patients one obtained the elevation of the upper lid and liquidation of the synkinesis. RESULTS: in congenital unilateral ptosis very good result was achieved in 63 p.c., a good one in 32.3 p.c., a poor one in 4.8 p.c. In bilateral ptosis very good result could be achieved in 36.8 p.c., a good one in 52.5 p.c. and a poor one in 10.6 p.c. of cases. Insufficiency of the lid closure as a principal complication of operation was seen in 6 patients (6.5 p.c.) without any consecutive pathological changes in the eye.

[Our experience with surgical treatment of post-traumatic diplopia]. / Wlasne doswiadczenia w chirurgicznym leczeniu pourazowej diplopii.

On the basis of analysis of patients with posttraumatic diplopia pathomechanism, diagnostic procedure, methods of surgical treatment and its results were discussed. In the group of 1196 patients with injuries of the organ of vision posttraumatic diplopia was diagnosed in 536 (44.8%) patients, of which 331 (61.8%) underwent surgery. In this group recovery was obtained in 182 (55.0%) patients, while in remaining marked improvement was stated. Lack of knowledge in this field among specialists was pointed out and was confirmed by mistakes in diagnostics and methods of treatment. These factors markedly worsen final results of proper treatment.

Malignant tumours of the maxilla. Management and follow-up results of treatment of 128 patients.

The authors present their own experience in the management, methods of treatment and follow-up results of 128 patients with malignant tumours of the maxilla. There were 77 males and 53 females (sex ratio 1.5: 1). Patients ages ranged from 3 to 83 years with an average of 53 years. Epithelial tumours were diagnosed in 69.5% and nonepithelial in 30.5%. In most cases the maxillary sinus was the primary focus of the tumour (40.3%). 94.4% of patients had epithelial tumours in stages III and IV (UICC classification, 1973). Radical treatment was carried out in 94 patients in 4 radiotherapy only (lymphatic tumours), in 90 patients surgery with adjuvant radio- and/or chemotherapy mainly in the postoperative stage. During the follow-up local recurrence was diagnosed in 36.5% of radically treated patients, who subsequently underwent reoperation. A five-year survival rate was obtained in 45.1% of patients with epithelial tumours and in 14.3% of patients with nonepithelial tumours. The authors carried out their own method of prosthetic rehabilitation, mainly immediate, in 82 patients operated on. Immediate prosthetic rehabilitation is a final step in the surgical procedure. This method significantly diminishes functional disturbances, mainly in speech and mastication and remarkably improves the aesthetic result.

Primary malignant melanoma of the oral cavity. A review of 20 cases.

Twenty patients with primary malignant melanoma of the oral cavity have been described. They formed 3.9 percent of the total number of patients with malignant neoplasms of the oral cavity. The upper gingiva was most commonly affected. In this series, there were 14 male patients and 6 female patients who ranged in age from 26 to 80 years (average 58 years). The first symptom of melanoma was hyperpigmentation of the mucosa in 10 patients, tumor in 7, and pain in 3 edentulous patients with prostheses. Radical surgery was performed in 13 patients, followed by chemotherapy and radiotherapy in 9 cases. Only 1 patient survived 9 years. The remaining 12 died 11 to 18 months after radical treatment. Palliative therapy was applied in three patients, two patients were treated symptomatically, and two patients refused treatment. Early detection of melanoma is an indication for radical treatment and may increase the survival rate of patients with this disease, which is still very low.

Foreign bodies in the orbit. Review of 20 cases.

The interdisciplinary problem of foreign bodies in the orbit is presented on the basis of personal experience in the treatment of 20 patients. These foreign bodies often cause severe injuries to the organ of sight and even threaten life. Early removal of a foreign body is technically easy, prevents infection and facilitates anatomical reconstruction of the damaged structures. Only in exceptional cases may removal be avoided. Of the 20 patients treated, only 9 were early admissions to our Department where the foreign body was removed and primary surgery performed. The others were admitted after some delay, which made correct treatment more difficult. Data on the injuries found in 20 patients, surgical technique, follow up and results are presented. Total recovery was obtained in 7 patients, improvement in vision in 2, enucleation of the globe was necessary in 5, and in 2 loss of vision was a sequel to a lesion of the optic nerve. Depending on the indications, reconstructive plastic surgery and prosthetic rehabilitation gave good aesthetic results. The necessity for interdisciplinary collaboration in the diagnosis and treatment of patients with foreign bodies in the orbit is emphasized.

Blow-out fracture of the orbit. Diagnostic and therapeutic considerations, and results in 90 patients treated.

On the basis of 90 patients with blow-out fracture of the orbit the authors present diagnostic methods, the treatment and follow-up results, mainly as regards visual function (diplopia) and aesthetics (enophthalmos). Surgery was performed in 77 cases, 6 patients were treated conservatively by eye muscle training, and 7 patients refused surgery. Surgery consisted in primary reconstruction of the orbit, exploration of the fracture site, freeing the entrapped soft tissues (periorbital tissues, eye muscles) and reconstruction of the defect with autogenous bone graft, followed by eye muscle surgery in cases of failure. After surgery no complications were observed. Results of treatment were evaluated by established methods elaborated by the authors, in the same order before and after surgery. Of 77 patients treated surgically recovery was obtained in 63.6%, marked improvement in 23.4%, slight improvement in 13.0%. In conclusion the authors state that: 1) in all cases ophthalmological examination is most important, 2) approach to the orbital floor or medial wall is best obtained by transconjunctival or subciliary incision, 3) in cases with a defect with a defect of the orbital floor the best material is autogenous bone graft. In linear fracture of the orbital floor and medial wall it is sufficient to free the entrapped tissues, 4) in all surgical patients eye muscle training proved effective.

Value of oculomyodynamometry in traumatic diplopia. Direct ocular muscle force measurements.

In 21 patients with traumatic diplopia, oculomyodynamometry (OMD) was used to examine the force of the extrinsic ocular muscles. In nine patients with blow-out fracture of the orbit, the greatest impairment in the active force and function of the incarcerated muscle was found in linear fractures. In 12 cases of traumatic paresis of the cranial nerves, OMD enabled the degree of paresis of particular extraocular muscles to be assessed, was helpful in establishing a correct diagnosis as well as prognosis for the restoration of function of the affected muscles, and provided data useful in planning the operative procedure.