Fathers of children with disabilities comment on health services.

AIM: A study to investigate the experiences of fathers of children with disabilities generated comments about hospital-based services received around the time of diagnosis. METHODS: Fifteen fathers were interviewed in-depth using an inductive qualitative methodology. Interview transcripts were subjected to computer-assisted analysis in order to identify patterns, themes and categories. RESULTS: Analysis of the data produced a dimension identified and labelled by the authors as negative service evaluation. The components of this dimension were related to poor interpersonal skills by medical staff while breaking bad news, and different expectations of physicians of and fathers over the practical implications of diagnosis. CONCLUSIONS: These results support previous findings and indicate that physicians must take more responsibility for breaking bad news in a way that parents find acceptable.

Clinical applications of the rhomboid flap.

The Limberg Dufourmentel, and Webster 30 degrees transposition flaps are reviewed. Twenty-two cases are reported. These cases show that preoperative design and attention to placement in relation to skin extensibility is important. However, these cases also demonstrate that placement of incision lines in proper anatomical locations for resulting camouflage and preservation of undue tension is critical to success.

Head and neck skin cancer: preplanned pathologically controlled excision and reconstruction.

Over a seven year period, 168 basal cell and squamous cell carcinomas of the head and neck area were treated. These were excised under rigid pathological control. Immediate repair was performed using preplanned geometrically designed closures. A broad overview of the literature that prompted the beginning of this seven year prospective study has been given. The treatment procedures have been described in detail. The accuracy of rapid frozen sections is proven and the results of preplanned pathologically controlled resection are given. No recurrences were seen in 168 cases. The reconstructive procedures were based on the preplanned geometry and the cosmetic results are successful in most cases (94%).

The overall management of salivary gland disorders.

Two studies are reported in an attempt to give a broader interpretation of the management of salivary gland disorders. One study analyzes 232 patients seen over a six year period and divides the grouping into parotid, submaxillary, and accessory salivary gland disorders. The numbers and percentages of patients who underwent surgery are reported along with a pathological break-down of the various lesions encountered. Eighty-five (36%) of the 232 patients had a documented surgical procedure. Thirty-eight of the entire 232 patients had tumor involvement, for a 16% incidence of neoplasia. At the same time 244 patients had various sorts of salivary gland surgery in the four local hospitals. Of these, 210 had either a parotidectomy or submaxillary gland excision. A surgical and pathological breakdown of the 117 neoplastic lesions fairly well corresponds to most of the published series, but fails to relay the overall picture that the head and neck surgeon encounters in dealing with salivary glands.

Closure of large nose-cheek groove defects.

Reconstruction of large defects involving the nose-cheek groove area present technical and cosmetic problems. A combination of a cheek falp with a dorsal-nasal rotation flap gives excellent survival and cosmesis for the nose as well as the cheek. The techniques of the dorsal-nasal flap alone and in combination with a cheek advancement flap are demonstrated.

Pseudomonas meningitis complicating head and neck surgery.

Three patients, each of whom had Pseudomonas meningitis as a sequela of an extensive head and neck operation, have been treated successfully. All three patients had cerebrospinal fluid leaks, and operative management of this complication is discussed. Antibiotic management included the parenteral administration of the recently developed drugs gentamicin, carbenicillin, and intrathecal gentamicin. Since extensive head and neck operations are being performed, with increasing frequency and since infectious complications are inevitable, it is mandatory that the otolaryngologist be familiar with current methods of managing these potentially lethal conditions.