Novel use of unilateral galeopericranial flaps for closure of sino-orbital cutaneous fistulas

Sino-orbital cutaneous fistulas are a well-documented complication of orbital exenteration and sinonasal carcinoma resection. Challenges to successful closure of this common complication include complex anatomy, communication with sinonasal mucosa, persistent mucopurulent drainage, compromised wound healing due to previous irradiation, and wound infection. We describe a novel approach for closure of sino-orbital cutaneous fistulas in two patients using a galeopericranial flap. The galeopericranial flap is ideal due to its thin, pliable nature and predictable, abundant vascularity. Additionally, it obviates the need for a more cosmetically disfiguring closure. Although used successfully in a variety of skull base and ophthalmologic surgeries, the galeopericranial flap has not been previously described for closure of sino-orbital cutaneous fistulas. Both patients' defects have remained closed at follow-up with excellent cosmetic results.     

裸鼠面瘫模型诱导型一氧化氮合酶表达分析

目的 结合形态学技术分析免疫缺陷小鼠的面神经损伤特点,为进一步深入探讨面神经修复再生的神经免疫病理机制提供实验基础.方法 制备周围性面神经外伤模型.分别于术后3d、2周灌注固定动物,收集脑干切片,免疫组化分析模型小鼠面运动神经元诱导型一氧化氮合酶(inducible nitricoxide synthase,iNOS)...     

129例颜面再发性皮炎患者斑贴试验临床分析

目的：通过斑贴试验研究颜面再发性皮炎的病因。方法：对临床诊断为颜面再发性皮炎的133例患者进行问卷调查和斑贴试验（瑞典产“瑞敏牌”斑贴试剂）。结果：133例检测患者中有116例斑贴试验阳性，占受试者的87.22％，其中对1种阳性者42例（35.90％），对2种阳性者37例（31.62％），对3种阳性者19例（16.24％），对4种及4种以上阳性者19例（16.24％）。阳性发生率较高的前6位过敏原依次为甲醛、卡巴混合物、重铬酸钾、硫酸镍、硫酸汞、对苯类。阳性率与年龄、环境相关，与性别、化妆品的使用无关。结论：颜面再发性皮炎的发生与接触变应原关系密切，斑贴试验是指导颜面再发性皮炎治疗的一个有力手段。     

Advantages of early management of facial clefts in Africa

Objective

Facial clefts are frequent morphological accidents occurring during the 2nd embryonic month. The management period of these affections varies, depending on the area or on the treatment habits. In the African context, there is lot of stigma surrounding this condition, often leading to rejection or even infanticide of the affected newborn. Such a psychosocial environment requires us to adapt our treatment schedule by initiating an early management.The aim of this study was to show our experience in the early treatment of facial clefts through 70 children operated in their neonatal period.

Methods

It was a retrospective study conducted over 3 years, from 2004 to 2006 at the department of Maxillo-facial surgery and Stomatology in a teaching hospital (CHU Treichville Abidjan) and in a general hospital (Dabou, Côte d’Ivoire). Newborn aged 0 to 28 days, affected with facial cleft and operated in the neonatal period were considered for this study.

Results

70 newborn suffering from facial clefts among which one at least was suffering from cleft lip were selected and operated. The study population was predominantly male (43 out of 70, meaning 61.4%). The distribution according to anatomo-clinical aspect showed 39 cases (55.7%) of cleft lip, 23 cases (32.9%) of cleft lip-alveolar process and 8 cases (11.4%) of cleft lip alveolar process and palate. The results achieved by the early surgical treatment of these affections are not very different from those of the schools which advocate that children should be a little bit older before the surgery.

Conclusion

The earliness of surgical treatment of facial clefts is borne out by the sociological and psychological context of African environment that promotes rejection and infanticide. Some factors such as anesthetic safety, physiology and anatomy favor an early surgery intervention on facial clefts.     

Extensive Infection of Face by Mycobacterium chelonae: An Unusual Presentation

Mycobacterium chelonae is a rapidly growing mycobacteria, causes cutaneous, soft tissue, and rarely lung infections. Here we present a rare case of extensive infection of face at multiple sites by Mycobacterium chelonae, with an unusual presentation, diagnosed by using conventional methods.     

Surgical Findings to Differentiate Between Facial Nerve Schwannoma and Vestibular Schwannoma

Objectives

Facial nerve schwannomas may be misdiagnosed as vestibular schwannomas (VSs) if the tumor is confined to the internal auditory canal (IAC) without involvement the geniculated ganglion or labyrinthine segment of facial nerve. Because facial nerve schwannomas may be misdiagnosed as VSs, we investigated the differences between the two.

Methods

The study included 187 patients with a preoperative diagnosis of VS. Of these, six were diagnosed with facial nerve schwannomas during surgery. We reviewed the preoperative evaluations and surgical findings of facial nerve schwannomas mimicking VSs.

Results

No useful preoperative predictors are available for facial nerve schwannomas mimicking VSs. Facial nerve schwannomas are usually confined to the IAC. After opening the dura of the IAC, a facial nerve schwannoma can be diagnosed after identifying a normal-appearing nerve located lateral to the tumor. When this was the case, we performed facial nerve preservation surgery or decompression.

Conclusion

Facial nerve schwannomas can be differentiated from VSs by identifying specific findings during surgery.