The mandibular foramen: an anatomic study and its relevance to the sagittal ramus osteotomy.

The sagittal split ramus osteotomy is the most commonly used procedure to reposition the mandible surgically. Because it is more technically difficult and associated with a higher incidence of complications compared with other mandibular osteotomies, thorough knowledge of the anatomy of the mandibular ramus is a prerequisite. Anatomic measurements related to the mandibular foramen were obtained from 57 formalin-preserved non-Asian hemimandibles. As shown in previous reports, great variability was noted in the position of the mandibular foramen. However, these studies utilized Asian mandibles with a clear discrepancy in key anatomic measurements in comparison with the authors' data. This brings into question the validity of these earlier studies when applying their data to non-Asian groups. The "fade-out" point of the internal oblique ridge was found not to be a reliable anatomic reference for placement of the horizontal osteotomy along the medial ramus. Thus, familiarity with the described relationships of the mandibular foramen will assist in performing properly a sagittal split of the ramus and will reduce the chance for an unfavorable split.

Congenital primitive neuroectodermal tumor of the hand: a case report.

A congenital peripheral primitive neuroectodermal tumor of the hand demonstrating aggressive behavior by rapid growth and ulceration, as well as early diffuse metastasis is presented. Management consisted of below-elbow amputation and chemotherapy. Despite the tumor's initial response, intracranial metastases occurred 7 months later. The patient died shortly thereafter, 15 months after presentation.

Use of a tourniquet in panniculus resection.

The tourniquet technique is simple and provides an efficacious method for panniculectomy. Time spent during surgery and anesthesia can be offered. Furthermore, less fat necrosis can be anticipated because of the reduced use of electrocautery, which in turn should decrease the risk of seroma formation and infection.

Chronic expanding hematoma within a periprosthetic breast capsule.

Three cases of chronic expanding hematoma occurring within the capsule surrounding breast implants are described. All developed at least 4 years after the last operation. No identifiable etiology could be demonstrated. Although this pathologic entity has been widely reported in other anatomic locations, a periprosthetic chronic expanding hematoma of the breast has not been described previously.

Scores of the Wechsler Individual Achievement Test and the Kaufman Test of Educational Achievement-Comprehensive Form for emotionally conflicted adolescents.

Subtest scores on the Wechsler Individual Achievement Test and the Kaufman Test of Educational Achievement-Comprehensive Form were compared for 27 emotionally conflicted adolescents. Correlations between subtests paired for assumed comparability ranged from .79 to .91 (median r = .69), and one of five mean comparisons was significant (Wechsler Mathematics Reasoning > Kaufman Mathematics Applications). The results suggest that these selected Wechsler subtests possess utility for assessing academic achievement and provide an acceptable alternative to the K-TEA.

Lateral force compared with frontal impact nasal fractures: need for reoperation.

Patient concern over the outcome of correction of nasal fractures is usually extremely high; often, a secondary procedure is necessary. Therefore, thorough consultation is mandatory. The clinical data of 50 patients who sustained nasal fractures was retrospectively reviewed to determine if there was any predictive value to classification of nasal fractures and the likelihood of a secondary surgical procedure. Using Stranc and Robertson's nasal fracture classification, 41 of 50 patients were described as lateral force fractures and 9 of 50 were frontal impact fractures. Five of 50 patients underwent a secondary surgical procedure, 4 from the frontal impact and 1 from the lateral force fracture group. The number of patients reoperated on approximately equaled the number who were dissatisfied with the result of the initial procedure (5 versus 6). However, objective assessment by the primary surgeon revealed 21 patients with an anatomic or functional defect. Of these, 15 were lateral force fractures (15 of 41, or 37%) and 6 were frontal impact fractures (6 of 9, or 67%). These results illustrate the difficulty in restoring preinjury nasal anatomy and function, especially in the more severe and complicated frontal impact types of nasal fracture. Using this information can aid in obtaining satisfactory informed patient consent.

Hemangiopericytoma of the palate: case report.

A case of hemangiopericytoma of the palate is presented. This is a locally aggressive tumor with a high propensity for recurrence and metastasis. Proper management is by wide local excision. Long-term follow-up is mandatory because this neoplasm can recur after several years.

Postpartum depression.

The occurrence of mood changes in the postpartum period is common. This presentation will discuss three cases of postpartum mood changes illustrating the "normal" changes, depression with suicidal ideation requiring brief hospitalization, and psychotic depression requiring intensive psychiatric treatment.

Haloperidol analgesia.

Haloperidol was observed to be an effective analgesic, alone and in combination with opiates, in a patient with severe radiation fibrosis and necrosis. Previously, high doses of methadone and morphine, along with amitriptyline, had caused dangerous sedative side effects without providing adequate pain relief. This case adds further support to the previous reports that haloperidol has significant analgesic or analgesic-potentiating properties. We suggest double-blind, controlled clinical trials and neurophysiologic studies to further clarify this exciting new role for haloperidol.