Eyelid grafting as a preprosthetic measure for restoring facial defects

Prosthetic restoration of a facial defect involving the loss of an eye and associated orbital tissues may be restricted by incorrect orientation of the prosthesis if the reconstructed tissue bed is uniform and without distinctive orbital landmarks. A surgically grafted eyelid is useful in this situation. The lower eyelid graft serves to provide an anatomical guide with which to position the ocular component of the orbital prosthesis in relation to its established visual axis. This assists the subsequent orientation of the adjoining tissue portion of the orbital prosthesis, contributing to a well-positioned and cosmetically pleasing result.     

Amyloidosis with oral involvement. Case report

A patient with chronic renal failure was investigated after complaining of oral discomfort which was found to be due to macroglossia and generalized involvement of the oral soft tissues by amyloidosis. A search for multiple myeloma proved to be positive. She also had a previous history of Carpal-tunnel syndrome. Despite an initial good response to treatment with phenylalanine nitrogen mustard (melphalan hydrochloride), she finally succumbed to end-stage renal failure.     

Melanotic neuroectodermal tumour of infancy: an immunohistochemical and ultrastructural study

Two cases of melanotic neuro-ectodermal tumour of infancy (MNTI)—a rare neoplasm arising in the first year of life—are reported, with the results of immunohistochemical and ultrastructural examination. The tumours consisted of a biphasic cell population in a fibrous stroma. The small, darkly staining cells comprising the first population stained positively for synaptophysin, showing them to be neuroblasts, and the large epithelioid cells comprising the second cell population stained positively with the antibodies HMB-45 and NKI-Beteb, showing them to be melanocytes. Ultrastructural examination of the second case confirmed the biphasic nature of the tumour cells, with secretory granules and neurofilaments in the neuroblastic population, and melanosomes in the epithelioid population. These results add to the evidence supporting the neural crest origin of MNTI and confirm its formation from two distinct cell lines. Both cases have responded to local excision, with no recurrence more than a year after initial treatment.     

Open mandibular condylotomy (osteotomy) with precision scaphoid staple osteosynthesis and meniscopexy. A description of the operation

The technical minutiae of the operation of open mandibular condylotomy and precision scaphoid staple osteosynthesis with meniscoplasty or meniscopexy is described and illustrated. The operation is regarded as an evolution of closed condylotomy described by Ward in 1961 and is indicated for those cases of severe and persistent temporomandibular joint pain and crepitus unresponsive to skilled conservative treatment over a reasonable time. The success of the procedure is probably the sequel of a partial denervation of the joint capsule associated with arthrotomy, the interruption of venous hypertension, the relocation of the mandibular condyle and enlargement of the joint space. The operation is also applicable to cases of active (and inactive) mandibular condylar hyperplasia wherein a condylar neck ostectomy and staple is used to ablate an active growth centre or correct a lesser degree of mandibular asymmetry.