Complications of mandibular fractures.

Timely repair of mandibular fractures remains an effective means to reduce pain, restore function, and prevent complications. This study addresses the effect of the time interval between injury and treatment on the overall complication rate, the complication rate between various treatment modalities (mandibular-maxillary fixation [MMF] alone, MMF with intraosseous wire bone fixation, and MMF with rigid internal fixation), and the relationship of inpatient vs. outpatient management. Cost was also examined with respect to choice of management. We report a retrospective series of 308 consecutive patients managed at the University of Miami/Jackson Memorial Hospital. Patients who received treatment 3 to 10 days following injury were found to have a lower complication rate than earlier or later repair. We postulate that most patients with mandibular fractures may be managed on an outpatient basis, which represents a considerable savings in cost.

The use of 3-dimensional models in auricular reconstruction.

Reconstruction of the microtic auricle is a difficult process requiring considerable experience and dedication to detail. It is a multistage proposition requiring the talents of both the reconstructive surgeon and the otologic surgeon. Reconstruction of the external ear usually precedes the reconstruction of the middle ear. Often, a template is used by the reconstructive surgeon to aid in this complicated process. Traditionally, templates used by the reconstructive surgeon have been 2 dimensional (usually x-ray paper) and made from the opposite normal ear or another normal ear in cases of bilateral microtia. Use of a 2-dimensional model only provides a rough estimate of the cartilage framework needed. Considerable experience is therefore needed to get this cartilage framework "just right." We have developed a number of 3-dimensional synthetic templates to aid in the creation of an accurate cartilage framework implant. These templates serve as a more accurate guide in the complex cartilage carving and assembly process. The use of 3-dimensional templates has improved our technical reconstructive results in a small number of patients. We present these results and propose future application of these ideas.

Complications of thyroid surgery.

The current study reports complications from thyroidectomy in 253 consecutive patients from 1988 to 1992. There were 10 temporary cases of hypoparathyroidism. After total thyroidectomy, one of 34 patients (3.2%) developed permanent hypoparathyroidism. Complications of recurrent laryngeal nerve (RLN) injury or hypoparathyroidism were no more common following completion thyroidectomy than total thyroidectomy. Unplanned RLN injury was seen in 13 patients of which 7 were permanent (2.1% of 334 nerves at risk). All 13 patients with RLN injury experienced a reduction in speech "loudness", but only 3 reported "hoarseness". The RLN may be injured without serious vocal disability. Eleven of 171 right RLN's at risk were injured as compared to 2 of 163 left RLN's. The volume of thyroid tissue resected was positively associated with RLN injury (p < 0.05) and not hypoparathyroidism. These findings are discussed. Hypoparathyroidism, not "symptomatic" RLN injury, is the most problematic complication impacting on the decision whether or not to perform total or completion thyroidectomy.

Holmium YAG laser-assisted osteotomies in plastic and reconstructive surgery: a preliminary report.

An Omnipulse holmium-yttrium aluminum garnet (YAG) laser was used to assist in the harvesting of outer table or split calvarial bone grafts in cadaver skulls. Two- or 4-mm depth and 0.55-mm width holes in the outer cortex of cadaveric calvarium were formed without apparent gross periosteal or bony injury. Osteotomes were then used to shave or split calvarial grafts by connecting the 2- and 4-mm depth holes, respectively. The procedure was efficient as well as precise. We believe that this method of bone graft harvesting may have the added benefit of safety by decreasing the incidence of inadvertent dural penetration. This study will lead to further analysis of the potential use for additional bony work with the Omnipulse holmium-YAG laser.

Variation's in the use of SMAS (superficial musculoaponeurotic system) to prevent Frey's syndrome after parotidectomy.

Since 1979, the SMAS (Superficial Muscular Aponeurotic System) has been used in over 100 parotidectomies to ameliorate the sunken facial appearance, and to prevent Frey's Syndrome. The procedure involves a rhytidectomy incision followed by variations including superior rotation, posterior advancement and plication of the SMAS. Appropriateness of such variations considers the defect from the surgery, and the histology of the tumor.

Serum 13C-bicarbonate in the assessment of gastric Helicobacter pylori urease activity.

Noninvasive detection of Helicobacter pylori (HP) requires serum or salivary antibody testing or the CO2 breath test. Since gastric HP produces a potent urease, a meal rich in 13C-labeled urea should lead to a measurable quantity of isotopic CO2 in the serum. This study investigates the feasibility, sensitivity, specificity, and potential of the measurement of serum 13C-bicarbonate (13CHCO3) in determining the presence of gastric HP. Nineteen patients with upper gastrointestinal symptoms assessed by intensity-duration questionnaire underwent endoscopy and biopsies for histology, Giemsa stain, and urease activity testing by CLOtest. Patients also consumed a 13C-urea-rich meal (5 mg/kg body weight, 99% 13C, MSD Isotopes, Montreal Canada). Serum was collected every 30 min for 3 h for quantitative determination of 13C by mass spectrometry. Fractional elevation of 13C after the enriched meal was then correlated with endoscopy, histology, and CLOtest. Fourteen of the 19 patients studied had histologic evidence of gastritis; 11 of 19 had positive CLOtest and had HP by histology and Giemsa stain. All HP-positive patients had significant elevation of 13CHCO3, compared with HP-negative patients. The mean maximum absolute change from baseline was 15.3 delta 13CHCO3 (range, 6.7-29.9) and occurred from 15 to 90 min; 13CHCO3 in HP-negative patients was significantly less (p < 0.05) than HP-positive patients with a mean value of 2.3 delta 13CHCO3 (range, 0-5.3). We conclude that serum 13CHCO3 analysis accurately reflects HP gastritis. This novel method is noninvasive, less labor intensive, less time consuming, and may have a value as a diagnostic screening tool for humans or in the assessment of the results of therapy in patients with HP infection.

A misdiagnosis of carotid pseudoaneurysm.

We report a case of blunt injury of the neck associated with the use of an imported plastic rock-guard designed for use in motorcycle scrambling. The injury may have important implications for the future use of this particular guard.