Congenital multiple fibromatosis (infantile myofibromatosis).

A female newborn had a rare case of congenital multiple fibromatosis, consisting of multiple fibrous lesions that histologically resemble myofibromas. Bony and soft-tissue lesions usually undergo spontaneous resolution, but excision may be required if vital structures are compromised as was the case in this patient. When the lesions involve the viscera in a generalized form of the disease, the result is often fatal.

Complications of the external (combination) rhinoplasty approach.

More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.

Thyroid cartilage flap reconstruction of the larynx following vertical partial laryngectomy: a preliminary report in two patients.

Reconstruction of the larynx following vertical partial laryngectomy may be undertaken with many techniques. Methods using soft tissue employ readily accessible structures within the operative field with straightforward reconstructive designs. However, decannulation is often delayed, and variable degrees of atrophy must be planned for. Methods using cartilage may lead to early decannulation without long-term atrophy as a problem. However, grafts or flaps are less accessible, and reconstructive designs are often complex. In addition, chondritis may be a significant problem, especially in radiated patients. A supraglottic thyroid cartilage flap is described that is readily accessible and maintains its blood supply from external and internal perichondrium, as well as internal mucosa. Its use is reserved for unilateral glottic lesions without supraglottic spread. Experience with this technique is described in two patients.

External (combination) rhinoplasty approach for trans-sphenoidal adenectomy.

The external (combination) rhinoplasty approach and the sublabial approach to trans-sphenoidal adenomectomy have been used at this institution for seven years. A summary of experience with the external (combination) rhinoplasty technique in 10 patients is reported; and a comparison is made between this approach and the sublabial approach in 12 patients. Advantages unique to this approach are: the distance to the sphenoid sinus is decreased allowing greater ease of instrumentation, the Hardy speculum may be opened widely to increase exposure, uniquely this allows synchronous cosmetic or reconstructive septorhinoplasty, and this technique is also invaluable for revision surgery--especially when septal cartilage has been removed by a previous sublabial approach. Disadvantages of this technique are the external incision across the columella, which leaves an imperceptible scar of no clinical significance, and postoperative nasal tip edema, which resolves with time.

The external (combination) rhinoplasty approach for the problem nose.

The external (combination) rhinoplasty approach has gradually gained acceptance as an approach to expose the nasal infrastructure. Its wide exposure has sharpened diagnostic skills by correlating pre-operative clinical impressions with specific anatomic deformities found at surgery. Its wide access has greatly increased as well as simplified the range of surgical maneuvers used in reconstruction. Following a review of the external approach, attention is focused on some of the problem nasal deformities where this approach has been helpful in obtaining good results. Nasal valve obstruction, nasal tip problems, nasal pyramid depression, and the crooked nose are discussed in terms of pathological anatomy and techniques of repair.

Autologous fascia grafts in head and neck plastic surgery.

Using an experimental animal model, we studied the stability of the size (gross morphology) and structure (histomorphology) of the fascia autograft. Fascia from a rabbit's leg was grafted in the subcutaneous tissue of the ear and abdomen and also into the intra-abdominal cavity. The weight and size of the autograft were recorded during the study period. Our findings showed that the size of the autograft remained stable, but there was a substantial weight reduction. Microscopic examination of histopathologic sections disclosed that there was no inflammatory response to the fascia. It also appeared to maintain its histomorphologic structure. Clinical trials with patients receiving facial plastic surgery are also reported. We believe a fascia autograft can be used to augment facial areas. We base this conclusion on the findings from previous reports, our animal experiment, and clinical trials.

Antiviral effect of cyclic amines on a 1969 isolate of A2 influenza.

Cyclooctylamine and amantadine inhibit the growth of 1969 isolates of A(2) influenza virus to a significant degree. There was slightly more inhibition of the virus by the cyclooctylamine (COA) than the amantadine; however, the dose of COA used was greater than the dose of amantadine. There was no significant difference between flasks treated 3 or 4 hr and those treated 2 hr. However, there was a curious relationship of more plaques in the flasks exposed to the two drugs for the longer intervals. Other experiments done with slight modifications in technique support the antiviral effect demonstrated in this experiment when the cell system is pretreated prior to virus infection. In two experiments, pretreating the cells for 2 hr with COA at 100 mug/ml but removing the drug solution and washing the cells prior to virus inoculation revealed no differences in plaque counts between controls and treated cells. This would indicate that the antiviral effect required the presence of the drug during the early stages of penetration of the cells by the virus particles.