New approach to the nasopharynx: the maxillary swing approach

A new approach to expose the nasopharynx and the paranasopharyngeal space is described. The maxilla, severed from its bony connections, is swung laterally to provide exposure of the nasopharynx. Tumors in the nasopharynx and the paranasopharyngeal space can be adequately resected and tubings for afterloading brachytherapy can be positioned accurately during surgery. The blood supply of the maxilla is from the attached cheek flap and masseter muscle. Three illustrative cases are presented. The wounds in all of them healed primarily with minimal morbidity. The only disadvantage is the development of mild trismus, which responded to conservative treatment.     

Free dermis-fat graft to correct the whistle deformity in patients with cleft lip.

Vermilion notching or 'whistle deformity' is a common secondary deformity of the vermilion in patients with cleft lip. The free border of the lip is a composite structure consisting of the orbicularis oris and the overlying tissues, namely subcutaneous fat, vermilion and mucosa. A deficiency of all or one of these structures is responsible for the vermilion notch. An absolute shortage of the muscle or subcutaneous tissue necessitates the use of tissue from another source to correct the deformity. Dermis fat grafts have been used to augment the free border of the lip and correct this deformity. The technique is simple and reliable. The tissue is available in plenty, easy to harvest and could be repeated if necessary, i.e. in case of resorption. From June 1996 until January 2000 the technique was used in 10 patients. Of these 10, one was a bilateral cleft and nine were unilateral cleft lip deformities. A degree of graft resorption was seen in one patient, one had a partial graft loss due to ulceration and exposure. The first patient had a further augmentation.     

Upper and lower lip augmentation by buried,deepithelialized local flaps: An alternative to the use of foreign material implants when shortening the lips

Augmentation of the lips has become a new request among patients searching for aesthetic improvement, although it is a very old goal among plastic surgeons when enhancing facial harmony. The simplicity of injecting synthetic material may have contributed to this request; nevertheless, the short-term duration and bizarre results seen with these materials, convinces us to the beneficial effects of our good, old-fashioned surgical methods with autologous tissues.     

A novel transvaginal approach to correct recurrent apical prolapse after failed sacral colpopexy: case series

Introduction and hypothesis

The objective of the study was to describe the transvaginal approach utilizing the existing sacral colpopexy (SC) graft for recurrent apical prolapse following failed SC.

Methods

Twenty-two patients with recurrent vaginal vault prolapse following a prior SC were treated between January 2000 and December 2009. Twelve patients had a standard uterosacral ligament cuff suspension (USLS) performed. In ten patients, the vaginal cuff was suspended to the left uterosacral ligament and reattached to the graft material from the prior SC. One of these ten subsequently failed and a standard USLS was performed. Patient characteristics, preoperative pelvic floor assessment, operative information, and postoperative follow-up were collected. Cases in which the graft material was used were compared with those undergoing standard USLS.

Results

Demographic characteristics and preoperative Baden-Walker scores were similar. Of 23 cases, 21 (91?%) were a consequence of graft separation from the vagina and not the sacrum. Two of nine patients with follow-up where the SC graft was utilized transvaginally had recurrent prolapse. One required reoperation. Of 13 patients in the group that underwent traditional USLS, 2 had asymptomatic recurrent anterior prolapse; neither required additional surgery.

Conclusions

A transvaginal surgical approach for recurrent vaginal prolapse after a history of failed abdominal SC should be considered. If feasible, the SC graft material can be used when performing USLS instead of the right uterosacral ligament for these patients with a prior history of abdominal SC.     

下颌骨外板劈除术联合颏前下滑行内缩术矫治短面型方颌

目的 探讨应用下颌骨外板劈除术及颏前下滑行内缩并配合嵌入式植骨术矫治短面型方颌的可行性及效果评价.方法 2005年7月至2009年10月,对57例短面型方颌伴颏部过方、过短及后缩的患者,应用下颌骨外板劈除术及颏前下滑行内缩并配合嵌入式植骨术进行矫治,以缩小下颌宽度、增大下颌平面角、延长并缩窄颏部,从而获得协调流畅的面部轮廓.术前和术后拍摄定位标准面像、X线头影测量片、全景片等,以评价矫正效果.术后进行6～24个月的随访,调查患者满意度.结果 术后57例患者伤口均一期愈合,下颌平面角增大至25°～30°,下颌角开张度增大至120°,两下颌角间距明显减小,下颌整体宽度缩窄,颏部尖翘,下颌轮廓协调,效果评价均满意.结论 联合应用下颌骨外板劈除术及颏前下滑行内缩术,可有效地矫治短面型方颌,使下颌骨轮廓达到较为理想的美学标准.

Abstract：

Objective To evaluate the the feasiblility and effectiveness of narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy technique to reshape a square jaw in short face. Methods From July 2005 to October 2009, a total of 57 patients received narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy procedure to correct square jaw in short face.All the patients had standard frontal and lateral cephalometric radiographs, panoramic radiographs, and were photographed preoperatively and postoperatively to assess their face contour. The alteration of mandibular angle, mental contour and width of lower face was observed for 6 to 24 months postoperatively.Questionnaires were used to assess the patients' satisfactory. Results It showed that the postoperative lower face had narrowed and become softer, slender and oval, with a slick mental region. The final aesthetic outcomes were quite satisfactory in all cases from both the view of surgeons and patients.Conclusions Narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy procedure could efficiently adjust the shape and position of chin to obtain a good proportion of the lower face, and to change square and short face to slender oval one by single operation in accordance with the fashionable aesthetics in orientals.     

软骨划痕及折叠法联合应用矫正Stahl耳畸形

目的：介绍一种St ahl耳畸形矫正的方法。方法：针对一组17例患者,联合应用软骨划痕法及软骨折叠法矫正畸形。结果：16例患者第三对耳轮脚得到完全纠正,1例在耳轮处有较小的异常对耳轮脚的残余。在所有的病例中原较宽的耳舟均被纠正至正常宽度,对耳轮及其上脚的连续性得到较好的保留。所有的患者及其家人对手术的最终效果表示满意,没有手术并发症。结论：软骨划痕法和软骨折叠法联合矫正Stahl畸形简单实用,术后效果满意。     

Laminectomy combined with posterolateral stabilisation: a muscle-sparing approach to the lumbosacral spine

Summary We report our experience with a technique of midline posterior decompression in combination with the Wiltse muscle splitting approach for posterolateral spinal fusion and pedicle screw fixation. The technique is suitable for cases of lumbar spinal stenosis and dise herniation where stabilisation is required and has significant advantages over other reported methods. This combined approach has been used in 52 patients since 1990 with no complications from the approach itself.     

Perioperative approach to a patient with Brugada syndrome

Brugada syndrome is a recently described cardiac anomaly that may be responsible for up to one half of all sudden cardiac deaths in young adults without structural heart disease. It may also be worsened by beta-blockers, and it is almost unreported in the English language anesthesia literature.     

Repair of the bilateral cleft lip: a personal approach.

The author presents his personal method of repairing a bilateral cleft lip, focusing on both the embryogenic factors of this condition and its anatomic-functional abnormalities. The surgical technique used enables correction in a single operation through suture of the lateral portions at the midline and elevation of the bifurcated flap of the prolabium to form the columella and the nasal floor. The deep psychological, social, and economic impact of the pathology is discussed, and the importance of a one-step surgical correction of the defect for the particular patient population at question is stressed.     

The orbicularis oris muscle: a functional approach to its repair in the cleft lip

Using electrical stimulation the different muscular components of the orbicularis oris muscle are defined at the time of operation for repair of the cleft. By wide dissection and differential re-arrangement, these muscular components can then be brought into their normal position. Not only is a better cosmetic and functional result achieved immediately but it is suggested that some common growth deformities will be avoided.     

Bilateral cleft lip and palate: experience from a center with a multidisciplinary approach

The aim of this work is to analyse the global experience of a center where a pluridisciplinar approach of the child affected with a cleft lip and palate is regularly done. Since january 1980 until january 2000, a total of 36 children (8 F, 28 M) with bilateral cleft lip and palate were treated. Only 5 children were born at this hospital. The others (n = 31) were referred soon after birth (24/31) or later for treat sequels. A multidisciplinary team evaluated every case. The parameters analysed were: surgical protocol, aesthetic and speech outcome, hearing disturbance, complications and the number of secondary lip surgeries. Surgical approach consisted on a soft palate closure before 3 months follow by a bilateral cheiloplasty (6 months) and a hard palate closure before 4 years of age, in the majority of cases (24/36). The esthetical result was evaluated in 25 children and was acceptable in the great majority (22/25). 16 children were submitted to tympanic draining in order to treat their secretory otitis. Speech outcome was analysed in 27 children and was good in 23. With a follow-up of 8.4 years, 15 children (8 treated soon on this center and 7 that came for their sequels) were treated for complications. There was a media of 4.5 surgeries per children.     

Bilateral extraperitoneal uterosacral suspension: a new approach to correct posthysterectomy vaginal vault prolapse

Restoration of apical vaginal support remains a challenging problem for the pelvic reconstructive surgeon. The transvaginal use of the uterosacral-cardinal ligament complex is gaining increasing popularity in the surgical treatment of uterovaginal and posthysterectomy vault prolapse. We describe an extraperitoneal surgical approach using this ligamentous complex to reattach the vaginal apex in women with posthysterectomy vault prolapse and report our surgical experience with this procedure in 123 women over 5 years. The relevant anatomy related to the procedure and risk of ureteric injury with uterosacral suspension is also reviewed. Extraperitoneal vault suspension can be combined with the use of polypropylene mesh if required. The extraperitoneal approach is an alternative procedure in women with vault prolapse with or without concomitant enterocele or where access to the Pouch of Douglas is difficult particularly after previous pelvic surgery. We believe this procedure to have less risk of ureteral injury than the intraperitoneal approach.     

Acute compartment syndrome of the forearm in association with ulnar shortening osteotomy: a case report

A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.     

Pharmacologically induced preconditioning with diazoxide: a novel approach to brain protection

Background. Ischemic preconditioning is an endogenous mechanism whereby brief periods of ischemia render neurons resistant to subsequent lethal insults. This protection appears to alter cellular apoptosis and can be induced by potassium channel openers acting on the inner membrane of the mitochondria (mitoK_ATP). To test the hypothesis that pharmacologic preconditioning could provide neuroprotection, the mitoK_ATP opener diazoxide was used in a canine model of brain injury induced by hypothermic circulatory arrest (HCA).

Methods. Seventeen dogs were placed on cardiopulmonary bypass (CPB) and cooled to 18°C. After 2 hours of HCA, animals were rewarmed and weaned from CPB. Six dogs received intravenous diazoxide (2.5 mg/kg bolus 15 minutes prior to CPB, then 0.5 mg/min until circulatory arrest, then restarted for the first hour of rewarming). Six animals received vehicle only. Five received diazoxide and the mitoK_ATP blocker 5-hydroxydecanoate (5-HD). Using a modified Pittsburgh Canine Neurological Scoring System (0 = normal, 500 = brain death), animals were evaluated every 24 hours for 3 days. The brains were removed and histologic sections of four regions characteristically injured in this model were scored (0 = no injury, 4 = infarction) by a neuropathologist in a blinded fashion.

Results. Clinical scoring showed marked improvement in the diazoxide group at 48 hours (101 ± 10.5 vs 165 ± 14.8, p < 0.01) and 72 hours (54 ± 9.3 vs 137 ± 12.1, p < 0.01). This neuroprotection was attenuated when 5-HD was concomitantly administered. Three of four brain regions typically injured in this model (cortex, hippocampus, and entorhinal cortex) had significant neuron preservation in the diazoxide group. Likewise, combined region scores were significantly improved in the treatment group (1.18 ± 0.2 vs 2.46 ± 0.2, p < 0.01).

Conclusions. Pretreatment with diazoxide resulted in significant improvement in both clinical neurologic scores and histopathology in our model of HCA. This suggests that pharmacologic preconditioning with the mitoK_ATP channel opener diazoxide may offer effective neuroprotection during HCA.     

The long Abbe flap combined with periosteally-vascularised mandibular bone for the simultaneous reconstruction of the upper lip and supportive columella

We did a simultaneous reconstruction of the upper lip and the supportive columella for a midface deformity caused by the wide resection of a squamous cell carcinoma of the nasal vestibule. It was reconstructed with an Abbe flap combined with a periosteally-vascularised outer layer of mandibular bone, which give an aesthetically and functionally acceptable result.     

Extensive subtrochanteric shortening osteotomy enables the conversion of a long lasting resection arthroplasty to a total hip replacement

This case report presents the results of a conversion hip arthroplasty after a long lasting Girdlestone situation of 15 years in combination with an extensive shortening of the leg of 7.2 centimeters. An extensive subtrochanteric shortening osteotomy of 3.5 centimeters was necessary to restore leg length and the rotational centre of the hip. Functional outcome was excellent within the long run and a restoration of the independence of the patient was achieved.     

Stress conditioning: a novel approach to organ preservation

Effective stress conditioning can extend the safe cold storage time of rat kidneys to 48 hours. We demonstrated that planned induction of the stress response, by heat shock, can be used to stress condition the transplant organ and protect it against the damages of cold storage. A powerful and useful protective mechanism exists in a latent form in all cells. This mechanism can be rapidly activated in a controlled and planned way to allow tissues temporarily to resist injury. Through stress conditioning it is possible to provide a high level of protection in situations in which stress can be anticipated and planned for.