双颌前突患者正畸辅助微螺钉种植体治疗前后的软组织侧貌

目的 通过直丝弓矫治器辅助微螺钉种植体对双颌前突患者进行拔牙矫治,对矫治前后的数据进行测量分析,评价对面部软组织侧貌的影响程度.方法 选择30例双颌前突患者,采用直丝弓矫治器辅助微螺钉种植体进行拔牙治疗.对矫治前后的头颅侧位X线片进行测量,分析治疗前后面部软组织的变化.结果 上切牙切端平均远中移动6.5 mm,上唇突点平均内收3.8 mm,下切牙切端平均远中移动5.8 mm,下唇突点平均内收5.6 mm,上唇平均向远中移动3.21 mm,下唇平均向远中移动3.67 mm,鼻唇角由治疗前的平均86.7°变为平均103.7°.上下前牙切端移动距离、上下唇突距、鼻唇角的变化差异有统计学意义.结论 直丝弓矫治器辅助微螺钉种植体对双颌前突患者进行拔牙矫治,有效地内收上下前牙,从而有效地改善面部软组织侧貌.     

The value of protruding extraperitoneal fat in predicting contralateral inguinal hernia

The high incidence of bilateral inguinal hernias in the pediatric population and the fact that most of these children undergo contralateral hernia repair months or years after the first intervention for a clinically unilateral inguinal hernia have resulted in numerous examinations aimed at finding a contralateral hernia. We have found that the presence of protruding extra-peritoneal fat on the operated side could be considered a predictor of bilaterality after observing this finding in a large number of children operated upon months or years before for a unilateral inguinal hernia. Correspondence to: M. Kovalivker     

The Cartilage-Sparing Versus the Cartilage-Cutting Technique: A Retrospective Quality Control Comparison of the Francesconi and Converse Otoplasties

From a total of 281 patients with protruding ears who underwent a bilateral otoplasty between 1990 and 2001, a group of 28 (10%) was selected for a retrospective quality control study. The goal was to compare two methods of otoplasty, the Francesconi, a cartilage-sparing technique, and the Converse, a cartilage-cutting technique, in terms of objectively measurable and subjectively discernable differences in results. Objective parameters included measurement of the three cephaloauricular distances and the conchoscapal angle. An independent plastic surgeon performed the evaluation by means of a systematic evaluation system for rating cosmetic surgical procedures and a 5-point visual analog scale for rating satisfaction. The patients subjective rate of satisfaction also was investigated using the 5-point scale. The mean medial and inferior cephaloauricular distances were significantly smaller in the Francesconi group. The concoscaphal angle was 90°, or less in all the patients of the Francesconi group, but more than 90° in eight patients (57%) of the Converse group (p = 0.041). Accordingly, the independent surgeon found adequate correction of protrusion in 86% of the Francesconi group and 50% of the Converse group (p = 0.050). His satisfaction rate was significantly in favor of the Francesconi technique (p = 0.006). Not unexpectedly, the patients satisfaction rate was comparably high in both groups, and there was no statistical difference between them. In conclusion, the quality control led to a clear preference of the Francesconi over the Converse otoplasty. In addition, the assessment of the postoperative results with the systematic evaluation system offered an excellent information base by which to judge the results of otoplasty. Consequent use of this evaluation system will lead to progress in the surgical procedure.     

Pitanguy's Method of Protruding Ear Correction from Our Own Experience: Review of 80 Cases

A recent review of the literature revealed more than 20 methods of correction of protruding ears. Pitanguy's cartilage island flap technique is still not widespread. However, it is extraordinarily versatile and effective from our own experience. The aim of this study is to present our own experience in the correction of prominent ears using this method. According to Pitanguy's cartilage island flap technique, 80 patients were operated on at the Private Plastic Surgery Clinic from 1992 to 1999. There were 45 (56%) female and 35 (44%) male patients, aged from 9 to 37 years (22 years on average). All procedures were performed under local anesthesia. In the follow-up period of 1 to 8 years the final aesthetic results were estimated as very good in 68 (85%) patients and good in 12 (15%) patients. Early complications in the form of bleeding occurred in three (3.75%) patients. Asymmetry in the ears' position was qualified as a late complication and occurred in four (5%) patients.     

Volar plating in distal radius fractures: A prospective clinical study on efficacy of dorsal tangential views to avoid screw penetration

PurposeThe purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients.Materials and methods100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative –screw– revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated.ResultsAdditional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The median length of revised protruding screws was 22 mm (range, 12–26 mm), and these were changed to a mean length of 20 mm (range, 10–22 mm).ConclusionIn this prospective series of 100 patients, obtaining additional DTV is found to be efficacious as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimise the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard.Level of evidence.Prognostic I     

Otoplasty in children younger than 5 years of age

Objective

The prominent ear is the most common congenital deformity of the auricle. It is often recommended that prominent ears be surgically repaired before children start school and most surgeons seem to perform the surgery after 5 years of age. The aim of our study is to summarize the rationale of performing otoplasty procedure in children under the age of 5, to discuss the advantages and disadvantages, and to review the patient (parent) satisfaction.

Methods

A retrospective study was performed on 10 children under the age of 5 who underwent otoplasty procedure and was followed for over a year.

Results

Ten patients (3 boys and 7 girls) between the ages of 48 months and 59 months, with a median age of 51.5 months were evaluated. Otoplasty was bilateral in 8 patients and unilateral in 2 patients. Global Aesthetic Improvement Scales of the patients were rated as “improved” or “better” at 52 weeks. The patient (parent) satisfaction was measured by a telephone survey. Parents revealed that 9 out of 10 were “very” or “completely” satisfied with the appearance and symmetry of their children's ears. We did not observe any visible disturbance or growth restriction in our patients, even in the unilateral operated group.

Conclusion

Timing of surgery is an issue of concern with regard to otoplasty in children. There may be significant psychosocial benefit to early intervention, particularly in light of changing norms for interaction with peers at ages considerably earlier than what had previously been thought of as the “school age.” Our preference is to plan the otoplasty as young as four years of age, after the child has expressed some concern about the deformity.     

Aesthetic problems of eye protrusion in Orientals

The typical characteristics of Oriental faces are less prominent supraorbital ridges, a flat and broad nose, and thick, bulky upper eyelids. These characteristics make the eye appear protruded even when they are within the normal range or on the borderline of the exophthalmometric data. Prior to correction of the protruding eye, the patient’s medical and psychological status are investigated. The volume of the bony orbit is estimated using 3-D CT scan data and exophthalmometry before and after the operation. The surgical correction is planned to decompress the orbital contents with preservation of the visual axis. The lateral orbital wall is expanded without change of facial width. The medial wall and orbital floor are outfractured with preservation of continuity of the maxillary and ethmoid bone and sinus mucosa to prevent herniation of the orbital contents and disturbance of extraocular muscle dysfunction. Removal of the retrobulbar fat is mainly from the upper half of the orbit. In the past three years, orbital decompression has been performed in eight patients (12 eyes) for aesthetic reasons. The exophthalmometric data ranged from 17.5 mm to 19.5 mm, with an average of 18.3 mm before operation, this changed 2.0 to 7.0 mm with an average of 3.54 mm after operation. The postoperative complications were two cases of subconjunctival hemorrhage and one case of temporary diplopia. After follow-up of 14 months (4–38 months), there were no cosmetic or functional problems. Received: 21 July 1995 / Accepted: 25 September 1995     

Prominent ears and their correction: A forty-year experience

The technique described in this article correcting the protruding ear deformity has evolved over 40 years. The original procedures and our subsequent modifications are described, including 20-year followup results. The possible pitfalls in carrying out this procedure and how to avoid them are also described. A relatively standardized short procedure with minimal morbidity and maximum long-term results yields an aesthetically satisfactory looking ear.