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Leporine (cleft lip) nose
344
ABSTRACTS GENERAL CONSIDERATIONS
Intraoperative Fluid and Electrolyte Management in the Pediatric Surgical Patient, Ji F. Mayhew. South Med J
70:1193-1195 (October), 1977. A comprehensive plan for intraoperative fluid and electrolyte maintenance in the pediatric surgical patient should be made before the start of anesthesia and carried out carefully but aggressively. There must be careful assessment of intraoperative blood loss, accurate calculation of the volume of clear fluids given, and frequent measurement of electrolyte levels, blood gas levels, and hematocrit values, particularly during long operative procedures. The author tabulates maintenance fluid requirements, suggested fluid replacement schedules, and formulas for determining blood volume and allowable blood loss, plus a regimen for blood replacement.--George Holcomb INTEGUMENT AND CONNECTIVE TISSUE Optimal Size of Resection Margin for Thin Cutaneous Melanoma. A. Breslow and S. D. Macht. Surg Gynecol Obstet
145:691-692 (Novem her), 1977. The question of how much normal-appearing skin to remove when resecting a cutaneous melanoma has troubled surgeons for years. Suggestions range from 2 to 15 cm without convincing evidence to support either figure. Sixtytwo patients ranging in age from 18 to 76 yr who were disease-free survivors for 5 or more yr were evaluated with respect to size of the lesion and margin of resection. The thickness of the melanoma measured 0.76 mm or less. The width of the resection margin ranged from 0.10 to 5.50 cm with 32% being 1.0 cm or less. None of these patients had a local recurrence or distant metastases. It appears that these thin tumors should be treated conservatively, the size of the resection margin being dependent upon the anatomic location of the tumor. In most instances the authors do not think skin grafting is necessary.--George Holcomb Symmetrical and Bilateral Dry Gangrene of the Upper Extremities in an Infant, T. Casanueva and M. Aguirre. Bol
Soc Cast Ast Leon de Ped 17:595, 1976. An uncommon observation of a symmetrical dry gangrene of both hands in an ll-mo-old boy is presented. --C. M. Almoyna HEAD AND NECK Leporine (Cleft Lip) Nose. J. L. Frontera Vaca and A. J. Pardins. Aesth Plast Surg 1:295-300 (Number 3), 1977.
The authors describe an operative technique utilized in 234 cases of cleft lip nose. In leporine noses, the involved side of the nose is characterized by a specific alar deformity due to a malposition of both the medial and lateral alar crus. The slumped alar rim is due to this malposition of the lateral alar crus and characterized by a lack of height at the columellar area as well as an alar slumping. The technique described is unique in that the authors recommend not only a repositioning of the lateral crus to the height of the uninvolved alar cartilage, but a modification of the uninvolved cartilage to match the newly reconstructed involved side as well. The technique involves bilateral rim incisions with a di-
vision of both the involved and uninvolved cartilage in the lateral crus so that these structures can be sewn one to another. In addition, the remaining lateral crus is scored to further modify the nasal tip. The purpose of the technique is to create a more symmetric balance of the tip on both the cleft and non-cleft side. The technique appears to be simple and is supported by excellent clinical pre- and postoperative photographs as well as diagrammatic illustrations of the operation.--A. B. Sokol Velopharyngeal Insufficiency in Hemifaciat Microsomia.
E. A. Luce, B. McGibbon, andJ. E. Hoopes. Plast Reconstr Surg 60:602-606, 1977. In hemifacial microsomia, also called the first and second branchial arch syndrome, there is a maldevelopment of the palatal muscles as well as their nervous innervation. Despite this fact, there has been no association of velopharyngeal insufficiency reported with this craniofacial deformity. The authors report 18 patients with bemifacial deformity, of whom six (one-third) d e m o n s t r a t e d velopharyngeal insufficiency to a significant degree. It was noted that the patients with velopharyngeal insufficiency tended to have more severe soft tissue and skeletal deformities. The authors recommend speech evaluation as an essential part of the management of these patients along with fiberoptic nasopharyngoscopy. Cinefluoroscopy was not helpful in diagnosing velopharyngeal insufficiency.--A. B. Sokol Early Surgery for Isolated Craniofacial Dysostosis. L. A.
Whitaker, L. Schut, and L. P. Kerr. Plast Reconstr Surg 60:575-581 (October), 1977. The authors postulate that premature closure of specific sutures or the actual bony underdevelopment of the skull results in craniofacial dysostosis. The manifestations of this deformity are due to an inability of the skull to respond to the expanding forces of the brain, the ocular globe, and the occlusal and masticatory developments of the lower face. Early surgical release, by or before the age of I yr, would allow the existence of these molding influences. The experiences with craniofaeial surgery in 8 patients at less than 9 mo of age with isolated craniofacial dysostosis is given. The 2-3 hr operation is described in detail, accompanied by diagrammatic illustrations and pre- and postoperative photographs. In addition, there is a detailed section on the function of facial, brain, and eye growth forces of the upper and lower face on the developing child.--A. B. Sokol Vertical Ramisection for Prognathism. T, R. Broadbent and R. M. Woolf Plast Reconstr Surg 60:735-743 (November), 1977. Prognathism is one of the most frequent forms of craniofacial asymmetry. Forty-four cases of surgically corrected prognathism (class II malocclusion) are the basis of this article. The average age was 20.4 yr. Preoperative planning consists of orthodontic care, cephalometric x-rays and tracings, dental plaster model casts, and a thin acrylic bite plate fashioned for interoperative use. The goals of the surgical procedure are the improvement in appearance and dental occlusion. The surgical procedure consists of a vertical mandibular ramisection through a small incision made 2 cm below the angle of the mandible. The jaw
ABSTRACTS GENERAL CONSIDERATIONS
Intraoperative Fluid and Electrolyte Management in the Pediatric Surgical Patient, Ji F. Mayhew. South Med J
70:1193-1195 (October), 1977. A comprehensive plan for intraoperative fluid and electrolyte maintenance in the pediatric surgical patient should be made before the start of anesthesia and carried out carefully but aggressively. There must be careful assessment of intraoperative blood loss, accurate calculation of the volume of clear fluids given, and frequent measurement of electrolyte levels, blood gas levels, and hematocrit values, particularly during long operative procedures. The author tabulates maintenance fluid requirements, suggested fluid replacement schedules, and formulas for determining blood volume and allowable blood loss, plus a regimen for blood replacement.--George Holcomb INTEGUMENT AND CONNECTIVE TISSUE Optimal Size of Resection Margin for Thin Cutaneous Melanoma. A. Breslow and S. D. Macht. Surg Gynecol Obstet
145:691-692 (Novem her), 1977. The question of how much normal-appearing skin to remove when resecting a cutaneous melanoma has troubled surgeons for years. Suggestions range from 2 to 15 cm without convincing evidence to support either figure. Sixtytwo patients ranging in age from 18 to 76 yr who were disease-free survivors for 5 or more yr were evaluated with respect to size of the lesion and margin of resection. The thickness of the melanoma measured 0.76 mm or less. The width of the resection margin ranged from 0.10 to 5.50 cm with 32% being 1.0 cm or less. None of these patients had a local recurrence or distant metastases. It appears that these thin tumors should be treated conservatively, the size of the resection margin being dependent upon the anatomic location of the tumor. In most instances the authors do not think skin grafting is necessary.--George Holcomb Symmetrical and Bilateral Dry Gangrene of the Upper Extremities in an Infant, T. Casanueva and M. Aguirre. Bol
Soc Cast Ast Leon de Ped 17:595, 1976. An uncommon observation of a symmetrical dry gangrene of both hands in an ll-mo-old boy is presented. --C. M. Almoyna HEAD AND NECK Leporine (Cleft Lip) Nose. J. L. Frontera Vaca and A. J. Pardins. Aesth Plast Surg 1:295-300 (Number 3), 1977.
The authors describe an operative technique utilized in 234 cases of cleft lip nose. In leporine noses, the involved side of the nose is characterized by a specific alar deformity due to a malposition of both the medial and lateral alar crus. The slumped alar rim is due to this malposition of the lateral alar crus and characterized by a lack of height at the columellar area as well as an alar slumping. The technique described is unique in that the authors recommend not only a repositioning of the lateral crus to the height of the uninvolved alar cartilage, but a modification of the uninvolved cartilage to match the newly reconstructed involved side as well. The technique involves bilateral rim incisions with a di-
vision of both the involved and uninvolved cartilage in the lateral crus so that these structures can be sewn one to another. In addition, the remaining lateral crus is scored to further modify the nasal tip. The purpose of the technique is to create a more symmetric balance of the tip on both the cleft and non-cleft side. The technique appears to be simple and is supported by excellent clinical pre- and postoperative photographs as well as diagrammatic illustrations of the operation.--A. B. Sokol Velopharyngeal Insufficiency in Hemifaciat Microsomia.
E. A. Luce, B. McGibbon, andJ. E. Hoopes. Plast Reconstr Surg 60:602-606, 1977. In hemifacial microsomia, also called the first and second branchial arch syndrome, there is a maldevelopment of the palatal muscles as well as their nervous innervation. Despite this fact, there has been no association of velopharyngeal insufficiency reported with this craniofacial deformity. The authors report 18 patients with bemifacial deformity, of whom six (one-third) d e m o n s t r a t e d velopharyngeal insufficiency to a significant degree. It was noted that the patients with velopharyngeal insufficiency tended to have more severe soft tissue and skeletal deformities. The authors recommend speech evaluation as an essential part of the management of these patients along with fiberoptic nasopharyngoscopy. Cinefluoroscopy was not helpful in diagnosing velopharyngeal insufficiency.--A. B. Sokol Early Surgery for Isolated Craniofacial Dysostosis. L. A.
Whitaker, L. Schut, and L. P. Kerr. Plast Reconstr Surg 60:575-581 (October), 1977. The authors postulate that premature closure of specific sutures or the actual bony underdevelopment of the skull results in craniofacial dysostosis. The manifestations of this deformity are due to an inability of the skull to respond to the expanding forces of the brain, the ocular globe, and the occlusal and masticatory developments of the lower face. Early surgical release, by or before the age of I yr, would allow the existence of these molding influences. The experiences with craniofaeial surgery in 8 patients at less than 9 mo of age with isolated craniofacial dysostosis is given. The 2-3 hr operation is described in detail, accompanied by diagrammatic illustrations and pre- and postoperative photographs. In addition, there is a detailed section on the function of facial, brain, and eye growth forces of the upper and lower face on the developing child.--A. B. Sokol Vertical Ramisection for Prognathism. T, R. Broadbent and R. M. Woolf Plast Reconstr Surg 60:735-743 (November), 1977. Prognathism is one of the most frequent forms of craniofacial asymmetry. Forty-four cases of surgically corrected prognathism (class II malocclusion) are the basis of this article. The average age was 20.4 yr. Preoperative planning consists of orthodontic care, cephalometric x-rays and tracings, dental plaster model casts, and a thin acrylic bite plate fashioned for interoperative use. The goals of the surgical procedure are the improvement in appearance and dental occlusion. The surgical procedure consists of a vertical mandibular ramisection through a small incision made 2 cm below the angle of the mandible. The jaw