Median cleft lip with associated midline sinuses.

Midline upper lip sinuses alone are rare entitities, with less than 25 cases reported previously. Midline upper lip sinuses with associated cleft lip are even more rare. A patient report of median cleft lip with associated upper lip sinuses in a 16-year-old boy is presented. Controversy exists as to whether these abnormalities are related. This report demonstrates the plausibility of a cause-and-effect relationship between midline clefts and sinuses.

Role of mini- and microplate fixation in fractures of the midface and mandible.

Le Fort defined the classic weak points of facial fractures. Fractures of the midface and mandible are believed to require management with standard rigid fixation. Recent work has allowed mini- and microplating of multiple fracture fragments into more manageable larger segments for reduction and subsequent plating with rigid fixation to peripheral buttresses. The technique and indications for use are outlined.

Facial skeletal growth after timed soft-tissue undermining.

This study was designed to answer the following questions: (1) Does aggressive bilateral soft-tissue undermining of the nasomaxillary complex in an immature animal without an iatrogenically produced cleft lip significantly inhibit growth? (2) If so, is the early timing of this undermining crucial? Fifty New Zealand White rabbits were used in this study, and bilateral buccal sulcus incisions with extensive nasomaxillary supraperiosteal undermining were performed in the experimental groups. There were five groups: (1) control, (2) undermining at 3 to 4 days, (3) undermining at 7 to 10 days, (4) undermining at 18 to 21 days, and (5) undermining at 50 to 56 days. The animals were sacrificed at 6 months of age, and direct osteometric measurements were made. Results demonstrated that a significantly retruded, constricted, and vertically shortened maxilla was produced as a direct result of bilateral nasomaxillary soft-tissue undermining alone regardless of the timing.

Nasoethmoid orbital fractures. Current concepts and management principles.

The proper management of nasoethmoid orbital fractures relies upon early accurate diagnosis and treatment. A surgical plan must be established after careful review of the physical examination and CT scans. Identification of the extent and type of fracture pattern determines the operative approach. Extended (wide) exposure, using craniofacial techniques, facilitates precise reduction and rigid fixation of all bone fragments. Transnasal reduction of the canthus-bearing central segment (medial orbital rim) is the critical operative maneuver required to achieve normal intercanthal distance. Immediate bone grafting replaces severely comminuted or missing bone fragments. The skin overlying the nasoethmoid area is carefully redraped by gentle pressure from padded external compression bolsters. These principles form the basis for superior aesthetic and functional results.

Dermal wound repair: role of collagen matrix implants and synthetic polymer dressings.

The effects of two different polymeric wound dressings and a new collagen matrix (CM) implant on the healing and scarring of full-thickness excision wounds were studied in swine. The synthetic polymers comprised an occlusive O2-impermeable hydrocolloid dressing (HCD) and an occlusive O2-permeable polyurethane film (PUF). The CM implant consisted of an acellular collagen sponge fabricated from purified bovine tendon type I collagen. Wounds were evaluated for granulation tissue--production capacity by measuring 14C proline incorporation into collagenase-sensitive protein. Epidermal resurfacing and wound contraction were measured by computerized morphometric image analysis of wounds made on a tattooed grid. In comparison with air-exposed wounds, the relative collagen synthetic capacity was greater in the granulation tissue of wounds treated with HCD, PUF, or CM with occlusion. Both HCD and PUF accelerated by 40% the epidermal resurfacing over the granulating wound bed. Wound contraction was significantly reduced by CM but was not altered by the occlusive dressings.