Mandibular reconstruction: free flap vs AO plate.

The purpose of this study was to compare the use of the AO reconstruction plate with immediate free vascularized bone graft mandibular reconstruction. From April 1989 to December 1993 we performed 13 cases of mandibular reconstruction. Reconstruction plates were used in 4 and immediate free bone grafts were used in 9 patients. The overall success rate for use of the plate was 2 of 4 (50%). In one of the plate failure patients, the plate was removed eight months postoperatively. She was able to wear a dental prosthesis. Cancer destruction and microvascular anastomosis of the first seven free flaps were performed by one surgical team. Only 4 free flaps were successful (success rate was 44%). We found that the use of AO plate with flap for lateral defect was relatively safe, simple, functional, time-saving, cosmetically acceptable and could be used successfully in post-operative irradiated patients. Success rate of the free flap was better with two surgical teams. The long-term result of the free flap was more reliable than the AO plate.

Thyrotracheal anastomosis in children: 1989-1996.

OBJECTIVE: Surgical thyrotracheal anastomosis has been performed in adults for many years with few complications. However, this procedure has not been performed in children due to lack of knowledge about the effects on laryngeal growth after the operation. After long-term research and follow-up, Ranne (1991) and Monnier (1993) reported normal laryngotracheal growth in their paediatric patients. Their rates of decannulation after single open procedures were very high. This study was conducted to study the effects of thyrotracheal anastomosis on laryngotracheal growth. METHODS: Three patients aged 9, 6, and 6 years underwent this operation in March, May, and June 1989 because a lumen of the subglottic stenosis could not be found. Another patient aged 9 years had this operation performed in July 1996. RESULTS: There were no immediate complications, and the patients were decannulated shortly after the operation. We were able to follow up on the third patient in August 1995. The study revealed normal laryngeal growth in the four patients. CONCLUSION: This finding supports the previous reports regarding laryngeal growth. We had 100% success in four children. Together with Ranne (1991), Monnier (1993, 1995), and Molter (1995), these results represent a success rate of 97% (40/41 cases) in relieving the subglottic stenosis after a single open procedure.

Inexpensive cochlear implant device.

We have developed a cochlear implant (CI) device modified from the House/3M cochlear implant device. The cost of raw materials was about $25. We used a new and simple technique for coating the implanted coil. We modified the circuit and removed the amplitude-modulated circuit. With this modification, the device uses less electricity and fewer transistors. There are slightly more than 3,000 patients using CI devices all over the world. Millions of profoundly deaf patients are poor and cannot afford the CI device that is now commercially available. Any university with well-trained otolaryngologists and physicists or electrical engineers can perform this technique.

Facial paralysis following blunt head injury.

Schirmer's test is not a reliable test to localize the level of facial nerve damage. From our results of Schirmer's test (greater than 30%), 53.3 per cent of the cases had facial nerve damage below the geniculate ganglion. Conservative treatment is recommended for delayed palsy.