A method of repair for unilateral macroglossia: Case report

ABSTRACTS

782

psychiatric survey, ophthalmologic consultaassessment, neurological extion, auditory amination, radiological examinations including tomography, dental surveys and preparation of cap splints when indicated, and laboratory investigations. The details of the operative surgery are described, including a step by step symmary of the authors modification of the brilliant work established by Paul Tessier. The aftercare of these operative patients is listed. both as to acute and postintensive care unit states, Complications, including immediate general, ophthalmic, nasal, psychological, and esthetic are also listed. The article in general provides an excellent overview to the new and growing held of craniofacial surgery. Indications and contraindications to surgery, as well as the operative techniques and postoperative

B. Sokol

results are provided.-A. Orbital

Expansion

Micro-orbitism. E. Achord,

and

Surg. 59486-491

for

D. C.

Anophthalmia

Morchoc,

Dufourmentel.

and

J. Cophignon, Plus. and Recon.

(April), 1977.

This report deals with a radical method of orbital expansion with the patient presenting with either late (and neglected) or severe microphthalmos with a very small remnant of the orbital cavity. In these cases, surgical approaches for orbital expansion are necessary. In the usual case, where microphthalmos is associated with a sufficient cavity. a smaller conformer can be introduced during the first weeks of life. Thereafter, rapid expansion of the orbital cavity can occur with the use of progressively enlarging conformers, thus obviating surgery. A review of the surgical approaches for orbital expansion is given. The authors’ operation is unique in that it expands the orbit in all directions to overcome the facial asymmetry as well as the microphthalmos. The operation is performed through facial and cranial exposure. The operation requires the use of a special surgical facility and medical and surgical personnel who are familar with the craniofacial reconstructions as pioneered by surgical Tessier. The operation, therefore. should be confined to the centers where these facilities and personnel are available.--A. B. Sokol The

Acquired

Auricular

Deformity.

Plos. and Recon. Surg. 59:475-485

6.

Brent.

(April), 1977.

The repair of acquired deformities of the ear in 130 cases over the past 3 yr is presented in a systematic and topographical fashion by the

author. Ear deformities are classified as structural, helical. upper third, middle third. lower third, and ear lobe. The various techniques available for the repair of these deformities, whether they be due to trauma or cancer excision. are given tn a lucid and beautifully illustrated fashion by pictorial methods. The article will provide a handy guide to the understanding of the emergent and reconstructive care of traumatic ear deformities. A. B. Sokol The

Sphincter

Procedure Silverton.

Pharyngoplasty

in

Cleft

Plos.

as

Palates.

and

a

Secondary

1. Jackson

Recon.

Surg.

and

J.

59~518-524

(April), 1977.

The method presented consists of a pedicled flap of the palatopharyngus muscle mass of the posterior faucial portion of the pharynx raised bilaterally, These flaps are sutured to each other and to a superiorly based pharyngeal flap. The latter change makes the procedure different from the one originally presented by Orticochea. where he advocated an inferiorly based pharyngeal Rap. The results of this operation, performed on 74 patients followed over one year. have shown improvement occuring in 67 or 90.5”“. Five and four tenths percent were These unchanged and 4.1”,, became hyponasal. results were based upon the evaluations of ten speech herapists. Complications were discussed and both of these were minor requiring four secondary revisionary procedures for either wound breakdown or hyponasality. The procedure appears to be an excellent one and offers a physiologically correct approach to the problem of velopharyngeal insufficiency. .4. B. Solid A

Method

glossia: Pefersen.

of Case Plas.

Repair Report.

and

for J.

Unilateral Pfers

Recon.

ond

Surg.

Macro-

K.

Roed-

59:439-442

(March), 1977.

An operation is described for the surgical correction of unilateral macroglossia. The goals of the operation are preservation of sensitivity to the tip of the tongue by reconstructing the remaining tongue with normal tissue from the healthy side and preservation of the intact lingual nerve. A patient is described with macroglossia secondary to a plexiform neurofibroma followed by a review of the literature of similar conditions. Neurotibromatosis occurs with a frequency of I in 2000 people. and only a few of these patients have macroglossia. The article is accompanied by clearly illustrated

7B3

ABSTRACTS

operative operative

techniques and preoperative and postclinical photos. .4 B. S&o/

is excised.

Various

tracheostomy Edward

in

Children.

and

Treatment H.

Biemann

Surgeon, 108-l 13 (February),

of Tracheal Othersen.

Injuries

American

1977.

The author reviews his experience from 1970 to 1975 involving I4 children under the age of I2 wjho were treated for tracheal stenosis. Three had congenital subglottic stenosis and one had sustained external injury, The remaining IO children developed strictures following mtuhation. The treatment employed combines dilation and/or endoscopic resection of the stenotic area with intralesional injection of triamcinolone. An intraluminal stent. as recommended by Birck. was then used for 6 wk. Of the I4 patients so treated. I I have been relived of obstruction and their tracheostomies removed. Two children, both under 6 mo of age when therapy was begun. have required reinsertion of the tracheostomy. A final patient is still under treatment. The anatomical difference between small children and adults is that the narrow point in the adult airway is the glottic area; it is the subglottic area in the child. This explains the occurrence of subglottic stenosis in the latter. A tube may easily pass through the glottis but fit tightly at the cricold and pressure necrosis can occur. Thus proper selection of the endotraceal tube in terms of size and material is important. The Portex polyvinyl endotracheal tube is preferred. Cuffed endotracheal tubes are not used in children. A tracheostomy is advised when severe inflammatory glottic disease is present. when endotracheal intubation will be required for longer than 72 hr, or when respiratory support is necessary for longer than 48 hr. A linear incision through rings 2 and 3 (sometimes 4) is used for the tracheostomy. No tracheal tissue

and

THORAX Silicone Implants

Prevention

tubes

and pictured

J. Berman

Cervical Teratoma in Infants and Children. M. S. I&gut+ and S. Cohen. So. Med. Jour. 70:122123 (January), 1977.

A soft tissue mass of the neck inferior to the hyoid bone in a 6 mo old infant girl showed, on radlograph, two calcitic densities resembling formed teeth. Following excision. histologic examination revealed a benign teratoma containing teeth and tissue representing the three embryologic germ layers. Indicating that teratoma\ should be included in the dityerential diagnosis of neck masses in infants. Gc,or,cr t~l,lUIrllh

endotracheal

tubes are described

for Contour

Deformities

6. Mend&on

and J. Mosson. Recon. Surg. 59:538-544 (April), 1977

Trunk.

of the

Plas.

and

Twelve patients are reported, eight having pectus excavatum and four having soft tis:iue deformities. Of the latter four. two had congenital absence of the pectoralis muscle and two had soft tissue defects asso*:iated with muscle atrophy from traumatic brachial plexus palsies. Reconstruction was carried out with the preoperative fabrication of a preformed :;llicone rubber implant taken from an impression made at a preoperative visit. Each of the twelve cases were interviewed at least one year (and in one case. 84 yr) after surgery. The compllcations were minor and consisted of fluid accumulation in seven of the twelve patients requiring aspirations for up to two months. Ten of the twelve patients were satistied and although no disability. pain, or restriction of activity resulted, the other two had felt the implant did not create the desired cosmetic improvement There have been no limitations in exercise or sports. Indications for surgery in pectus excavatum are proposed and the operator IS cautioned to perform this surgery on only those patients with absent or mild cardiac symptoms. The article gives an excellent review of the reconstructive methods available for contour deformities of the trunk and is accompanied by excellent pre- and postoperative clinical photos A.

B. Sokvl

Surgical

Management

of

Pectus

Deformities.

W. H. Heydorn, R. Zajtchuk, G. f. Schvchmonn, ond 1. E. Strevey. Ann. Thorac. Surg. 23:417-420 (May), 1977. This report concerns 71 patients who had correction of pectus excavatum and I6 patients who had correction of pectus carinatum deformities at Fitzsimmons Army Medical Center in Denver over a 23 yr period. Late follow-up showed the best results in the excavatum patients to be those who had a strut placed and then removed after about a year. In the carinatum patients, only 3 of 16 had a strut of an) sort and these were apparently removed. Results were quite satisfactory in this group. Keith

W. Arhrrafi