The nasolabial musculocutaneous flap: clinical and anatomical correlations.

The location of the facial artery beneath the facial mimetic muscles of the nasolabial groove allows surgical development of a true musculocutaneous flap. This report of 20 surgical flaps and six cadaveric dissections highlights the nasolabial musculocutaneous flap with its direct muscle perforating arteries which nourish the overlying skin. The absence of any flap's ischemic failure emphasizes the durability of the flap for various midface and oral reconstructive situations. Inferiorly-based flaps are preferable on the basis of discussed anatomical findings. The musculocutaneous flap is especially suited for circumferential interruption of cutaneous blood supply as in the "V-to-Y" and island pedicle flaps.

Nevus sebaceus of Jadassohn: the head and neck manifestations.

The nevus sebaceus of Jadassohn (SNJ) is a congenitally-occurring, hamartomatous disorder of the skin and its adnexa of infrequent occurrence. This presentation of five cases emphasizes the smooth, waxy, yellow-brown lesion's progression into a thickened sebaceous tumor of premalignant predilection. The incidence of neoplastic degeneration of these hamartomatous nevi may be as high as 30% with the capacity of metastasis occasionally reported. Because of malignancy risks as well as cosmetic considerations, early surgical removal is recommended. Previously unreported problems of dysphagia and malnutrition secondary to pulsion diverticulum at the esophageal inlet and cleft palate, obliterative aural stenosis with associated conductive hearing loss are documented. Regardless of SNJ's occurrence as either an isolated lesion or as the fully developed syndrome, including mental retardation and epilepsy, this congenital malformation of the skin, its hair, and sebaceous glands presents rare and histologically intriguing problems for the practitioner.

Nasolabial musculocutaneous flap in reconstruction of oral defects.

Modern day understanding of the microcirculation of musculocutaneous flaps has initiated this reconsideration of the nasolabial flap with the context of modern flap physiology and nomenclature. Surgical incorporation of the circumoral and facial muscles within the skin of the overlying nasolabial groove constitute a musculocutaneous flap based upon the underlying facial vessels. This thick musculocutaneous flap provides an extremely reliable vascularity for reconstruction of the floor of the mouth and oral sphincter in a one-stage procedure. The donor nasolabial flap is easily accessible in the same surgical field and may be obtained with minimal donor area morbidity. Cosmetic and functional impairment are minimal. Anterior tongue mobility for articulation is preserved. Eleven nasolabial flaps for oral reconstruction following burn reconstruction as well as resections for carcinomas of the labial and oral areas are presented.

Pharyngoesophageal perforations after blunt trauma to the neck.

The neck with cartilaginous framework left intact still requires a high index of suspicion of a pharyngoesophageal perforation after blunt trauma. If the diagnosis is missed and/or prompt surgical drainage of the perforation is delayed, increased morbidity from deep neck abscesses and/or death may result. This is the first reported series of pharyngoesophageal perforations that follow blunt trauma. On the basis of this clinical experience and the literature, I have formulated a treatment protocol for upper aerodigestive tract perforations secondary to blunt trauma.

Primary monomorphic adenoma of the middle ear.

The benign, monomorphic adenoma, derived from the respiratory epithelium of the middle ear, is a well circumscribed, greyish, avascular tumor. Its histology--documented by light and electron micrographs contained in this report--supports a distinct entity and pathogenesis apart from the malignant adenocarcinoma. Utilizing two case reports, this compendium emphasizes the clinical presentations, as well as radiographic and audiometrical characteristics, of the tumor. The first case represents the typical tumor with conductive hearing loss. The second case is the first reported facial paralysis associated with hemorrhagic infarction of an adenoma which was reversible by surgical resection of the tumor. Based on the histology and four year postoperative follow-up, the authors conclude the adenoma may be effectively managed by surgical resection.

Ganglioneuroblastomas of the cervical sympathetic nerve.

Although ganglioneuroblastomas occur infrequently in the head and neck area, if they are recognized and completely excised initially, the chances of cure are greatly increased. Two patients are reported who demonstrate some of the more important aspects of diagnosis and treatment. The first patient, whose retropharyngeal tumor was diagnosed when he was 12 years of age, was treated with transoral excisional biopsy. He is alive and tumor-free 3 1/2 years later. The second patient, a 2-year-old , was treated by incisional biopsy without a major resection. He died on year later. The diagnostic evaluation of a patient with suspected neurogenic tumor includes a complete physical examination for distant adenopathy, abdominal masses, hypertension, and neurological impairment. Intraoperatively, neurosurgical and pathological consultation should be available.

Gunshot injury to the temporal bone: an analysis of thirty-five cases.

By retrospective analysis of 35 surviving gunshot injuries to the temporal bone and by presentation of 6 representative cases, the management and reconstructive procedures of these injuries in the Tulane University affiliated hospitals are presented. The most frequent single injury was facial nerve paralysis (16 cases), followed by external canal injury and conductive hearing loss. Anacusis occurred in 12 cases. In conductive hearing loss the intact posterior wall tympanoplasty with mastoidectomy (16 cases), or the modified radical mastoidectomy (5 cases), allowed middle ear reconstruction. Transmastoid facial canal decompression, combined with the above procedures or with a middle fossa craniotomy, was performed in 6 cases. Delayed facial reconstruction (5 cases) utilized microneural anastomosis between facial-facial and hypoglossal-facial nerves and fascia lata slings. Intracranial complications of thrombosis of internal carotid artery, dural venous lacerations, temporal lobe aphasia, bitemporal hemianopsia, cerebral abscesses and meningitis are also discussed.

Round window ultrasonic irradiation for Meniere's disease with ENG monitoring.

Utrasonic irradiation of the labyrinth via the round window is effective in controlling otological vertigo. This method of surgical management for incapacitating vertigo is presented with demonstrative intraoperative electronystagmograms and irradiated cat neuro-epithelium. Such data suggest that more intense irradiation doses than previously reported should be applied to effectively destroy the diseased labyrinthine end organs. Precise end points of destructive irradiation are defined by characteristic intraoperative electronystagmograms. The authors suggest this is an ideal procedure when the situation of an unaffected cochlea, coexisting with a diseased labyrinth, requires a minimally invasive, destructive procedure which preserves hearing while eradicating vertigo.