Minimizing the Submandibular Incision in Endoscopic Subcondylar Fracture Repair.

Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular incision facilitates reduction in relatively difficult cases and enables clear visualization of posterior border of the mandible to confirm adequate fracture reduction.

Concentric double cables fixation as an alternative suspension method for the endoscopic forehead lift.

Fixation of the elevated eyebrow is an important final step in endoscopic forehead lifting. One of the most common methods of fixation includes temporal fasciae sutures for the tail of the eyebrow, and mini-screws for the body of the eyebrow. The concentric cables fixation is an alternative method for elevation of both the tail and the body of the eyebrow. This technique is compared to temporal fasciae suture and mini-screws fixation. Thirty-one patients were included in this study. They were divided into two groups; group I included patients who underwent fixation using fascia sutures and mini-screws, while group II patients underwent concentric cables suspension. Traditional screw and suture technique elevated the eyebrow tail by 7.2, 6.7, 6.3, and 6.0 mm, while the concentric cables resulted in 7.6, 6.8, 6.5, and 6.3 mm elevation at 1, 3, 6, and 12 months postoperatively, respectively. The mean values of brow body elevation were 6.8, 6.4, 6.2, and 5.9 mm for group I, while the mean values of group II were 6, 5.4, 4.8, and 4.7 mm. The concentric cables technique showed a fewer complications rate compared to traditional fixation. The concentric cables fixation offers an alternative inexpensive method to suspend the tail, and to a lesser extent the body, of both eyebrows simultaneously with long-term stability. A fewer complications rate was documented compared to traditional temporal fasciae sutures and mini-screws fixation.

Venous malformations of the head and neck: a diagnostic approach and a proposed management approach based on clinical, radiological, and histopathology findings.

BACKGROUND: There is no easy road map for venous malformations (VMs) of the head and neck according to which treatment modality can be chosen. The purpose of this study was to identify different types of VMs of the head and neck based on clinical, histopathology, MRI, and venography findings that help in specification of different treatment modalities. METHODS: Sixty-nine patients with VMs of the head and neck were included in this study. RESULTS AND CONCLUSION: Our results proposed a diagnostic approach for VMs of the head and neck. MRI, venography, and clinical examination had important impact in decision-making, whereas histopathology had no impact. A management approach has been suggested for each type and its subtypes.

Color duplex assessment of 4th and 5th internal mammary artery perforators: the pedicles of the medially based lower pole breast flaps.

OBJECTIVE: Reconstruction of a breast after mastectomy using the contralateral lower pole breast flap is an appealing procedure because it uses the tissues that were going to be excised during reduction of the sound breast to achieve symmetry. Literature mentioned that these flaps are supplied by the lower internal mammary artery perforators (IMAPs) with no further details. The aim of this study was to determine the site, size, and number of the 4th and 5th IMAPs by using preoperative color Duplex ultrasound and intraoperative exploration. METHOD: Twenty breasts in 10 patients who presented for reduction mammoplasty were included in this study. Preoperative color duplex was used to determine IMAPs in the 4th and 5th intercostal spaces. These perforators were localized intraoperatively. Intravenous fluorescein injection was used to determine the perfusion of the lower pole breast flap on the basis of these perforators. RESULTS: Statistically, the 4th IMAPs diameters were significantly larger than the 5th IMAPs diameters (P < .05). The lower pole breast flap was perfused through these perforators. CONCLUSION: Color Duplex ultrasound is an accurate tool to preoperatively determine the 4th and 5th IMAPs.

Platelet-rich plasma versus platelet-poor plasma in the management of chronic diabetic foot ulcers: a comparative study.

Non healing diabetic foot ulcers and the resulting potential amputations present significant costs to the health care system and reduce patient quality of life. The goal of diabetic foot ulcer treatment is to obtain wound closure as expeditiously as possible. The use of platelet-rich plasma (PRP) to enhance wound healing has increased dramatically over the last decade. However, controversies exist in the literature regarding the added benefit of this procedure. The aim of this study is to investigate the efficiency of platelet releasate on the healing of chronic diabetic ulcers in comparison with platelet-poor plasma (PPP). This study included 24 patients with chronic diabetic ulcers. They were systematically randomised into two groups: PRP group (n = 12) and PPP group (n = 12). The results showed that healing in PRP group was significantly faster (P < 0·005). PRP enhances healing of chronic diabetic foot ulcers.