Rhinoplasty in the cleft lip patient.

Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.

Simultaneous manometry and electromyography in the pharyngoesophageal segment.

Whether the occlusion between hypopharynx and esophagus is established by anatomical relations and tissue elasticity or by a functional resting tone of the muscle fibers is not quite clear. This study describes simultaneous electromyography (EMG) and electromanometry in the pharyngoesophageal segment to solve this problem and investigate the complex mechanism of deglutition. To register the EMG from the hypopharyngeal constrictor muscle and the upper esophageal sphincter (UES), two copper wire electrode pairs with hooked bare ends were used. These electrodes were introduced into the muscles through a rigid esophagoscope. It is demonstrated that at rest muscle activity is present in the UES. This activity disappears during the relaxation period. Simultaneous manometry and EMG is a valuable supplement to diagnostic procedures in dysphagia patients.

Surgical aspects of radiation enteritis of the small bowel.

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.