Postrhinoplasty epistaxis. Role of vitamin E?

Postrhinoplasty epistaxis occurred in two patients, both of whom were found to be ingesting megadoses of vitamin E. The rate of vitamin E consumption in a population of 100 uncomplicated nasal operations during this same period was 16%. A review of the medical literature on vitamin E found recent evidence demonstrating a marked decrease in platelet adhesiveness with megadose ingestion of vitamin E. It is concluded that this should be avoided in the perioperative period.

The fixation of malar fractures with the transnasal Kirschner wire.

Our experience with a rapid and reliable method for the repair of selected unstable malar fractures using external pin fixation is reported. Following reduction through a Gillies temporal incision, a Kirschner wire is introduced on the contralateral side, advanced through the nasal vault and septum and the reduced malar bone is engaged. This method of immobilization can be used in isolated malar fractures or in conjunction with the repair of other facial injuries. In 38 patients where this procedure was utilized, there was low morbidity as well as excellent cosmetic and functional results. The advantages of this technique as well as a comparison with other available methods of malar fixation are discussed.

The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study.

A prospective study was performed to evaluate the efficacy of noncompression miniplates in the repair of mandible fractures treated at a large regional trauma center. The study included 54 cases of all types of adult mandible fractures with the exception of fractures of the condylar neck and ascending ramus. Cases were excluded in which preexisting infection was present. The technique consisted of a transoral approach followed by monocortical juxtaalveolar and subapical osteosynthesis without long-term intermaxillary fixation. Overall, there were 7 complications associated with this technique (13%): 4 infections (7.4%), 1 malunion (1.9%), and 2 mental nerve paresthesias (3.7%). These results compare favorably with those reported in the literature and suggest that mandibular osteosynthesis using miniature malleable plates is a useful and effective method for the repair of selected mandible fractures.

Optical method for measurement of ear canal length.

A noninvasive optical method using an operating microscope was developed to measure the length of an ear canal under both open and occluded conditions. The method is based on the optical measurement of the distance between a reference point at the eardrum and a second point on the lateral aspect of an earmold-occluded ear canal. To estimate the occluded canal length, the length of the earmold is then subtracted from results of the previous measurement. The method was also used to determine the open ear canal length (the lateral reference point was the ear canal entrance), and averaged results agreed closely with previously reported data.

Probe-determined hearing-aid gain compared to functional and coupler gains.

In this investigation, hearing-aid gain as measured by a probe-earmold system was compared with gain determined from couplers (HA-2 coupler and ear simulator) and functional-gain measurements. Fifteen subjects with moderate sensorineural hearing loss were tested under aided and unaided conditions in the sound field. In order to determine the effect of the occluded ear canal length on these results, an optical method was developed using an operating microscope to measure the length of the individual subject's occluded ear canal. The results indicate that gain, as measured by the probe-earmold system, corrected for effects of occluded ear canal length, agrees closely with functional and ear-simulator gain through 4.0 kHz. At the frequencies of 5.0 and 6.0 kHz the probe-earmold system underestimated gain particularly when compared to measurements conducted with the ear simulator. Other comparisons were also made between gain measured in a HA-2 coupler and functional gain. The average differences between these measurements of gain agree with several previous investigations, but individual variation around the average difference was smaller than previously reported.

Chondrocalcinosis of the temporomandibular joint. A parotid pseudotumor.

Chondrocalcinosis, ie, calcium pyrophosphate dehydrate (CPPD) crystal deposition disease, has a spectrum of clinical manifestations ranging from an absence of symptoms to a severely destructive arthropathy. We recently treated a patient with CPPD deposition adjacent to the temporomandibular joint, which simulated a parotid tumor. The CPPD crystals are weakly positively birefringent under a polarizing microscope. Most frequently they are found roentgenographically as asymptomatic deposits in fibrocartilaginous structures, especially the knee meniscus. A less frequent manifestation is "pseudogout" acute arthritis. Rarely, joint destruction is found.

Deep neck abscesses secondary to methylphenidate (Ritalin) abuse.

Methylphenidate (Ritalin) abuse has been and continues to be a major medical and social problem. In the past 6 months, we have seen five deep neck abscesses secondary to intravenous Ritalin abuse. This constitutes more than 50% of the deep neck abscesses seen by us in the same time period. The pathogenesis is related to an inflammatory foreign-body reaction to the fillers in the methylphenidate tablets, followed by superinfection by oral or cutaneous flora. Mixed flora infections with weakly pathogenic organisms may also occur.