Mandibular angle augmentation and reduction

The mandibular angle is receiving more attention as now every area of the craniofacial skeleton is a candidate for aesthetic modification. Both reduction and augmentation of this posterior area of the mandible are addressed. Surgical techniques, results, and complications are described after the cosmetic problems are demonstrated. Representative cases are presented.     

Temporal augmentation with methyl methacrylate

Concavity in the temporal area reflects a deficiency in the bulk of the temporalis muscle or overlying temporal fat pad. It may be a reflection of senescence, low body fat, exaggerated adjacent skeletal or soft-tissue contours, idiopathic progressive atrophy, or postsurgical deformities. The authors describe the application of methyl methacrylate (MMA) to fill depressions in the temporal area. In instances in which no previous surgery has been performed or when the temporal area has served as a dissection plane for surgery in adjacent areas (eg, a subperiosteal facelift), the implant material is placed beneath the temporal muscle through a limited incision in the hair-bearing scalp. When previous reconstructive surgery has been performed in the temporal area, the area of depression is accessed through existing surgical incision scars to place MMA over the temporal muscle. These operative techniques have been reliable, durable, and relatively free of complications.     

Medpor在颧骨颧弓低平畸形矫正治疗中的应用

目的：介绍高密度多孔聚乙烯（Medpor）在颧骨颧弓低平畸形矫正中的临床应用。方法：对49例先天性或外伤所致颧骨颧弓低平畸形以Medpor作为移植材料,在颧骨颧弓表面贴附充填。结果：随访6月～7年,49例颧部低平畸形均获得矫正,外形效果满意,无感染、假体外露等并发症。结论：Medpor置入颧骨颧弓低平畸形,是一种安全有效的方法。     

Prolactin secretion in women after plastic breast augmentation and reduction

Prolactin secretion in women undergoing augmentation and reduction mammaplasties was studied by determining serum prolactin concentrations preoperatively, intraoperatively, and for one year postoperatively. Thyrotropin-releasing hormone tests for prolactin secretion were performed in a small subgroup of these patients. The subjects were 7 women undergoing reduction mammaplasty, 13 women undergoing augmentation mammaplasty, and 14 normal control women. Short-term (up to three days postoperatively) but not long-term changes in prolactin secretion were identified. Persistent hyperprolactinemia does not appear to be a common complication of plastic breast operations.     

颧骨L形截骨扩展术矫正颧骨过小畸形

目的：探讨一种口内入路矫正颧骨过小畸形的新方法。方法：2000年4月～2007年12月,对28例半侧颜面短小畸形患者的颧骨过小畸形,采用口内入路颧骨L形截骨扩展术进行整复治疗,扩展间隙中植入自体骨或珊瑚人工骨。结果：28例患者术后随访3月～5年,重塑的颧骨颧弓形态自然,突度和宽度得到明显改善,术后效果满意。结论：颧骨L形截骨扩展术设计合理,并发症少,为整复颧骨过小畸形提供了一条新的途径。     

Free DIEP flap breast augmentation following excessive reduction.

A two-stage procedure using bilateral free DIEP flaps to correct excessive bilateral breast reduction is described. The reconstructive challenge was to achieve satisfactory breast projection on a large torso without recourse to prosthetic implants or extensive back scars. The literature on the use of TRAM and latissimus dorsi flaps in subtotal breast reconstruction for various other breast deformities is reviewed. We have not found a similar case to ours in the literature.     

Nipple reduction �C An adjunct to augmentation mammaplasty

Nipple hypertrophy is an occasional deformity in Asians and a rare one in Caucasians. Lately, it has been showing up more often in plastic surgeons’ offices across North America and elsewhere, owing to the influx of Asian immigration worldwide, as well as to the rising interest in esthetic surgery among Asian communities.A simplified technique for nipple reduction is described herein. It is very easy to execute, delivers accurate results and is extremely safe. It tackles both the excessive ‘projection’ and the less frequent excessive ‘width’ of the nipple. It may be used separately or incorporated as an adjunct to mammary augmentation or mastopexy. Excellent esthetic results are obtained, while both the nipple innervation and its lactiferous ducts are preserved. The patient’s and surgeon’s satisfaction is high.     

Breast augmentation after reduction mammaplasty: getting the size right

Although patients are typically satisfied after reduction mammaplasty, a subgroup later deems the volume of remaining breast tissue inadequate and presents for breast enhancement. Our purpose was to identify patient and procedural risk factors that may contribute to an over-reduced breast and the desire for breast augmentation after initial reduction. Seven patients were identified who had breast augmentation an average of 13 years after breast reduction. Four patients were satisfied with breast size immediately after reduction mammaplasty but lost breast volume subsequent to weight loss or childbearing. Three patients with a body mass index of 18 to 20 were dissatisfied immediately after reduction. Body image improved in 100% of patients after enhancement. Getting the size right depends upon thorough discussion with the patient regarding desired size, insurance requirements, and potential for decreased size after weight loss or childbearing. Breast augmentation may improve body image in patients with small breasts after reduction.     

老年性胸腰椎骨折复位固定骨水泥充填的探讨

目的探讨老年人脊柱压缩骨折复位后,注射骨水泥充填后的疗效。方法50例老年性脊柱压缩骨折患者行内固定撑开复位后,将伤椎经椎弓根注入骨水泥充填。结果术后摄片复查,骨折均复位满意,骨水泥充填良好,无神经受损表现。38例获随访,时间6～24（11.12±4.76）个月,均未见伤椎高度丢失和内固定断裂现象。结论老年人脊柱压缩骨折在行骨折椎体复位的同时,将伤椎注入骨水泥充填,缩短了伤椎的修复过程,增加了脊柱的强度和支撑力,可早期下床活动,防止长时间卧床的并发症。     

Usefulness of the picture archiving and communications system for augmentation and reduction rhinoplasty

PACS is part of the digital radiography package that supports digital technology. PACS allows rapid electronic linear and caliper measuring tools. When making a preoperative real estimation of the planned dorsal profile, these tools may be used in measuring a real estimate of augmentation or reduction for rhinoplasty.     

Effects of prior augmentation and reduction mammoplasty to sentinel node lymphatic mapping in breast cancer

Previous plastic surgery procedures such as breast augmentation or reduction mammoplasty can potentially alter the lymphatic drainage of the breast. The purpose of this study is to determine the success rates of sentinel node lymphatic mapping in patients with previous plastic surgical procedures of the breast. A total of 83 patients with a history of plastic surgery of the breast that underwent subsequent sentinel node mapping between 1996 and 2008 were retrospectively analyzed. Eight-three patients that underwent a total of 108 sentinel node biopsies. Hundred cases (93%) previously underwent breast augmentation and eight cases (7%) previously underwent reduction mammoplasty. The mean time between the previous plastic surgical procedures and the sentinel node biopsy was 10.3 years (range: 2 months-32 years). Indications for the mapping procedure were invasive cancer (n = 64), ductal carcinoma in situ (n = 17), and prophylactic mastectomy (n = 27). The identification rate of the sentinel node was 95.3% (103/108). The success rate based on type of procedure was 96% (96/100) for augmentation and 87.5% (7/8) for reduction mammoplasty. With a mean follow-up of 3.4 years, there has been only one local axillary recurrence that occurred at the time of an ipsilateral breast recurrence following lumpectomy. Lymphatic mapping can be successfully performed in patients who have previously undergone plastic surgery operations.     

Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ

Methods  

Fourteen patients with aseptic fractures that failed to unite after intramedullary nailing (IMN) of the femur were treated by augmentation of fixation by dynamic compression plate (DCP) with the nail in situ. In six of them that had axial or rotational malalignment, direct reduction of the bone fragments and plating were done. Iliac bone grafting was performed in nine cases, when there were gaps between the fragments and in atrophic non-unions. Patients were followed-up for an average of 26 months.     

Simultaneous transareolar breast augmentation with areola and nipple reduction by inner areolar "donut" excision

Simultaneous areola-nipple reduction and augmentation mammaplasty were performed by the inner areolar donut excision technique with translocation of the periareolar scar to the peri-nipple area in order to create a more acceptable scar in a patient whose areolar border is not distinct.     

鼻翼外侧真皮脂肪复合组织在鼻翼缩小合并鼻尖成形术中的应用

目的：探讨鼻翼缩小术后切除组织所形成的真皮脂肪复合组织用于鼻尖成形术的可行性及效果分析。方法：对要求同时行鼻翼缩小及鼻尖成形术的就医者,去除双侧鼻翼外侧切除组织表皮,剩余真皮及皮下组织经整修后,移植于鼻尖皮下,使鼻尖获得满意的高度和突出度,并对此类就医者实行定期随访。结果：2006年6月～2010年3月共有18名就医者接受了该项手术,通过3个月～2年的随访,所有就医者对术后效果皆十分满意,无一例并发症出现。结论：应用鼻翼外侧真皮脂肪复合组织的鼻翼缩小合并鼻尖成形术简单易行,效果良好,是一种安全可靠的手术方式。     

Optimization of tumor volume reduction and cement augmentation in percutaneous vertebroplasty for prophylactic treatment of spinal metastases

OBJECTIVE: Spinal metastatic disease occurs in up to one-third of all cancer patients. Metastasis can lead to vertebral burst fracture and consequent neurologic compromise. Percutaneous vertebroplasty (PV) is a minimally invasive procedure aimed at restoring vertebral stability by augmentation of weakened vertebrae with bone cement. PV is associated with a complication rate of 10% in treating vertebral metastases. Tumor ablation before cement injection has been suggested to improve PV outcome in the metastatic spine. The objectives of this study were to quantify the effects of volumetric tumor reduction and cement augmentation in the metastatic spine and to develop a protocol for recommended cement volume to achieve sufficient restoration of intact (nonpathologic) vertebral body stability. METHODS: A biphasic parametric finite element model of an L1 spinal motion segment was developed and validated against previously collected experimental data. Using this model, 12 scenarios were simulated to represent tumor volume reductions of up to 60% and cement augmentation from 1 to 8 mL. CONCLUSIONS: Restoration of intact vertebral stability is possible in metastatic vertebrae after 30% tumor ablation and 1 to 2 mL bone cement augmentation. A protocol was developed on the basis of the findings of this study suggesting recommended cement volume for injection as a function of remaining tumor volume after ablation. These findings may motivate refined methods of prophylactic treatment of metastatic vertebrae.     

Temporal factors in the reduction of myocardial infarct volume by methylprednisolone.

With a canine model of myocardial infarction [ligation of the left anterior descending (LAD) coronary artery] and an intracellular stain for lactic dehydrogenase (LDH) to directly measure size of infarction, the influence of 30 mg. per kilogram of methylprednisolone sodium succinate was evaluted. The intravenous administration of a pharmacologic dose of methylprednisolone one, 2, or 3 hours after the onset of myocardial infarction significantly reduced the ultimate extent of myocardial necrosis, with the greatest reduction seen following the injection of the drug one hour after ligation. The left atrial pressure was significantly decreased by corticosteroid administration, whereas the cardiac index and peripheral vascular tone were improved insignificantly. Inconsistent and/or insignificant effects were observed in the systemic and coronary sinus blood gases and in those indices of myocardial metabolism which were determined. The potential impact of these findings on the clinical applicability of methylprednisolone sodium succinate in acute myocardial ischemia is discussed.