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Pericranial turndown flap for coverage of soft tissue defects
J Oral Maxillofac
Surg
49.912-916. 1991
Abstracts tients, Japanese typically seek augmentation rhinoplasty to the dorsum. The technique for obtaining cartilage from the dorsum of the ear is described. Procurement of two separate linear strips per ear is recommended to prevent deformities of the donor site. If additional cartilage is required, the contralateral ear is used. Through a rim incision on the nares, up to four pieces of cartilage are stacked and passively inserted. No internal fixation is required in this technique. Almost all the patients were satisfied with the esthetic results. Complications occurred in 51 patients. Forty-two had malpositioning of the graft and six had localized infections. Advantages reported include ease of procurement as compared to bone or septal cartilage, rejection of the graft never occurring, and ease of fitting and contouring. Disadvantages stated include possible graft resorption in large augmentations, and ear deformities if improperly obtained. Technical difficulty and length of the procedure make it less suitable for children. The authors state that this seems to be the best technique for Japanese patients.-S.R. REHM
A Comparative Study of Surgical Results With RotationAdvancement and Triangular Flap Techniques in Unilateral Cleft Lip. Chowdri NA, Darzi MA, Ashraf MM. Br J Plast Surg 4355 1, 1990 This investigation was a randomized study comparing the surgical results of 58 Millard rotation-advanced flaps with 50 modified Tennison’s triangular flap repair of unilateral cleft lip. All repairs were done by the same surgeon over a 6-year period. Patient follow-up varied from 1 to 6 years. Between the two methods of repair, no significant differences were found in overall postoperative appearance of the lip and nose. Surgical results were superior for incomplete clefts compared to complete clefts regardless of repair technique used. The authors conclude that either technique can be recommended for unilateral cleft lip repair; the end result reflects the extent of deformity and the surgeon’s skill.-K.S. SWANSON Reprint requests to Dr Darzi: Sher-i-Kashmir
Institute of Medical Sciences, Soura. Srinagar, Kashmir, India, Post bag No. 27, Pin-190 011.
Reprint requests to Dr Endo: Department of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, The University of Tsukuba, Tsukuba-city, Ibaraki 305. Japan.
One-Stage Repair of Blepharophimosis. Nakajima T, Yoshimura Y, et al. Plast Reconstr Surg 87:24, 1991
Stemocleidomastid Muscle Transfer and Superficial Musculoaponeurotic System Plication in the Prevention of Frey’s Syndrome. Casler J, Conley J. Laryngoscope 101:95, 1991
Congenital blepharophimosis is an autosomal dominant anomaly characterized by multiple eye abnormalities including bilateral ptosis, telecanthus, epicanthal inversus, and shortening of the horizontal fissure of the lid. Commonly, a two-staged surgical approach is recommended for treatment. This begins with a medial canthoplasty using the Mustarde method. Three to 4 months later, suspension of the upper lid is then performed. It has been believed that when a medial canthoplasty and levator resection are performed at the same time, tension in the eyelid becomes too strong to achieve favorable results. The authors, however, have successfully treated 11 patients over a 9-year period using a single-stage approach. Their results have been favorable and patients undergo one less surgical event.-R.A. CHMIEL
As a sequela of parotidectomy, patients may notice significant facial asymmetry and an incidence of gustatory sweating (Frey’s syndrome). Superior and inferior based sternocleidomastid muscle (SCM) flaps and posterior plication of the musculoaponeurotic system were evaluated for their ability to relieve both conditions. Sixteen patients with SCM flaps and 16 patients with superficial musculoaponeurotic system plication were compared to a control group of 104 patients who underwent parotidectomy. The incidence of Frey’s syndrome was 47% in the control group, 12% in the SCM flap group, and 0% in the superficial aponeurotic plication group. The authors present surgical technique descriptions for all procedures. The prevalence of Frey’s syndrome is discussed according to age, sex, radiation therapy, and type of parotidectomy. The authors describe the indication and contraindications of the surgical techniques described in the article.-A.R. FORFAR
Reprint requests to Dr Nakajima: Department of Plastic and Reconstructive Surgery, Fujita Health University School of Medicine, I-98 Dengakugakubo. Kutsukake, Toyoake, Aichi 470-l 1 Japan.
Augmentation Rhinoplasty: Observations on 1200 Cases. Endo T, Nakayama Y, lto Y. Plast Reconstr Surg 87:54, 1991
Reprint requests to Dr Casler: Assistant Chief. Otolaryngological Service, Letterman Army Medical Center, Presidio of San Francisco, CA 94129.
This report discusses the authors’ experience with augmentation rhinoplasty and presents a technique of cartilage graft procurement. From January 1975 to December 1988, 1,263 cases of aesthetic augmentation rhinoplasty on Japanese patients were done with cartilage grafts. Forty percent had previous silicone augmentations, and 60% were previously unoperated. The major complaint of patients having silicone implants was either a too-high or too-large prosthesis. As opposed to Indo-European pa-
Pericranial Turndown Flap for Coverage of Soft Tissue Defects. Flint P, Cummings C. Laryngoscope 101:42, 1991 Often full-thickness avulsion wounds of the forehead pose a dilemma to the patient and practitioner searching for an acceptable cosmetic result. Full-thickness wounds of the forehead involving the frontalis muscle and peri912
913
CURRENT LITERATURE
cranium often leave step defects when covered with skin grafts alone or result in failure of the graft over bare bone. Advancement flaps used to cover full-thickness defects usually result in a secondary defect and poor cosmetic results. Tissue expanders used require significant amounts of time to achieve adequate expansion. The authors of this article present a two-stage procedure to improve the cosmetic result obtained when treating this type of wound. They advocate the usage of a pericranial turndown flap followed by a split-thickness graft. The anatomical considerations as well as technique are discussed. They conclude that this procedure achieves a predictable result with the morbidity of a split-thickness graft.-A.R. FORFAR
the local immune response in oral LP. In this model, keratinocyte surface antigens are modified, then targeted by the cytotoxic cell response that characterizes oral LP: mast cells and antigen-presenting Langerhans cells are key cellular elements in the evolving lesion. These mast cells degranulate, inducing adhesion molecule expression on endothelium. This promotes the homing of lymphocytes to the tissues. Lymphocytes and keratinocytes display adhesive interactions that are thought to be important determinants in the effector phase of the lesion. Chronicity could be promoted by cytokines produced by both lymphocytes and keratinocytes, thus influencing the local immune response. Modulation of immunologic events may be a therapeutic approach for LP.-C.M. WORLEY
Reprint requests to Dr Flint: Department of OtolaryngologyHead and Neck Surgery. University of Washington, Seattle. WA 98195.
Reprint requests to Dr Walsh: Department of Dermatology, versity of Pennsylvania, Philadelphia, PA.
Electron Microscopic Study of the Effect of Capsaicin on the Mouse Chorda Tympani Nerves. Hiura A. Arch Oral Biol 35:913. 1990
Ischemic Heart Disease and Platelet Aggregation: The Caerphilly Collaborative Heart Disease Study. Elwood PC, Renaud S. Sharp D. et al. Circulation 83:38, 1991
The chorda tympani nerve contains gustatory fibers and parasympathetic secromotor fibers that innervate the tongue, submandibular, and sublingual glands. Capsaicin acts selectively on substance P-containing nociceptive neurons of primary sensory ganglia, and depletes their contents in both central and peripheral areas. Some studies have shown the cat chorda tympani to contain mechanosensitive and thermosensitive fibers and cannot rule out nociceptive fibers. The purpose of this investigation was to determine whether the mouse chorda tympani contains nociceptive fibers sensitive to capsaicin. This study treated three mice with capsaicin (50 mg/kg) on day 2 after birth, with one mouse receiving similar doses on day 2 and 3. The results showed that one or two injections did not significantly change the composition of the nerve fibers. Therefore, it did not induce degeneration of its nerve fibers. Also, neonatal treatment with capsaicin does not induce degeneration of sympathetic and parasympathetic efferent fibers or salivatory nucleus. In conclusion, the mouse chorda tympani does not contain capsaicin-sensitive nociceptive fibers other than gustatory and secretomotor fibers. Capsaicin did not damage the geniculate ganglion and presynaptic parasympathetic fibers, therefore gustation and secretion of saliva is not influenced by capsaicin.-L.C. METZGER
The hypothesis of this study was that a correlation could be made between platelet aggregation activity and ischemic heart disease. A total of 2,398 men aged 49 to 66 years were evaluated. Their past history of ischemic heart disease was noted. Blood samples were collected and platelet aggregation was induced by experimental methods and measured using turbidometrics. A significant correlation between previous myocardial infarction and high platelet aggregation activity was demonstrated by the results of this study. In fact, the strongest relation indicated more than a twofold increase in the odds of a past myocardial infarction in subjects of the highest fifth of ADPinduced primary platelet aggregation compared with the lowest fifth. Therefore platelet activity and hemostatic factors may be an important part of the etiology of ischemit heart disease. Treatments aimed at the correction of increased hemostatic activity may play an important role in the prevention of ischemic heart disease.-A. BLUHM
Reprint requests to Dr Hiura: First Department of Oral Anatomy, School of Dentistry, Tokyo Medical and Dental University, I-5-45. Yushima, Bunkyo-ku, Tokyo 113. Japan.
Immunopathogenesis of Oral Lichen Planus. Walsh LJ, Savage NW, Ishii T, et al. J Oral Path01 Med 19:389, 1990 Oral lichen planus (LP) is a common disorder of unknown etiology in which mucosal and/or skin surfaces are affected. Cell mediated immunity is thought to play a role in the pathogenesis of LP. Available evidence supports the notion that LP is a predetermined condition rather than a simple cause and effect disorder. Serologic studies demonstrate an association between the HLA-DRl tissue type and both drug-related and idiopathic lichenoid lesions, supporting the view that a genetic predisposition to the development of LP exists. This article presents a hypothesis which integrates cellular and molecular signals in
Reprint requests to Dr Elwood: MRC Epidemiology Richmond Road. Cardiff CF2 3AS. United Kingdom.
Uni-
Urut. 4
Familial Trigeminal Anesthesia. Keys CL. Sugar J, Mafee MF. Arch Ophthalmol 108: 1720. 1990 Congenital trigeminal anesthesia has been reported both as an isolated neurologic defect and in association with other congenital abnormalities. This disorder can involve one or more branches of the trigeminal nerve both unilaterally or bilaterally. The authors reported three family members, including a father and two sons, each of whom demonstrated bilateral cornea1 involvement, bilateral hypesthesia of the ophthalmic and maxillary distributions of the trigeminal nerve. and nasal septal collapse secondary to self-traumatization. The overall pattern of inheritance of this disorder is consistent with autosomal dominant transmission with incomplete penetrance. The pathogenesis appears to be congenital hypoplasia of the trigeminal nerves and gasserian ganglia as revealed by magnetic resonance imaging findings.-T. WONG Reprint requests to Dr Linberg: Department of Ophthalmology. Cleveland Clinic Foundation. One Clinic Center. 9500 Euclid Ave. Cleveland, OH 44192.
Surg
49.912-916. 1991
Abstracts tients, Japanese typically seek augmentation rhinoplasty to the dorsum. The technique for obtaining cartilage from the dorsum of the ear is described. Procurement of two separate linear strips per ear is recommended to prevent deformities of the donor site. If additional cartilage is required, the contralateral ear is used. Through a rim incision on the nares, up to four pieces of cartilage are stacked and passively inserted. No internal fixation is required in this technique. Almost all the patients were satisfied with the esthetic results. Complications occurred in 51 patients. Forty-two had malpositioning of the graft and six had localized infections. Advantages reported include ease of procurement as compared to bone or septal cartilage, rejection of the graft never occurring, and ease of fitting and contouring. Disadvantages stated include possible graft resorption in large augmentations, and ear deformities if improperly obtained. Technical difficulty and length of the procedure make it less suitable for children. The authors state that this seems to be the best technique for Japanese patients.-S.R. REHM
A Comparative Study of Surgical Results With RotationAdvancement and Triangular Flap Techniques in Unilateral Cleft Lip. Chowdri NA, Darzi MA, Ashraf MM. Br J Plast Surg 4355 1, 1990 This investigation was a randomized study comparing the surgical results of 58 Millard rotation-advanced flaps with 50 modified Tennison’s triangular flap repair of unilateral cleft lip. All repairs were done by the same surgeon over a 6-year period. Patient follow-up varied from 1 to 6 years. Between the two methods of repair, no significant differences were found in overall postoperative appearance of the lip and nose. Surgical results were superior for incomplete clefts compared to complete clefts regardless of repair technique used. The authors conclude that either technique can be recommended for unilateral cleft lip repair; the end result reflects the extent of deformity and the surgeon’s skill.-K.S. SWANSON Reprint requests to Dr Darzi: Sher-i-Kashmir
Institute of Medical Sciences, Soura. Srinagar, Kashmir, India, Post bag No. 27, Pin-190 011.
Reprint requests to Dr Endo: Department of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, The University of Tsukuba, Tsukuba-city, Ibaraki 305. Japan.
One-Stage Repair of Blepharophimosis. Nakajima T, Yoshimura Y, et al. Plast Reconstr Surg 87:24, 1991
Stemocleidomastid Muscle Transfer and Superficial Musculoaponeurotic System Plication in the Prevention of Frey’s Syndrome. Casler J, Conley J. Laryngoscope 101:95, 1991
Congenital blepharophimosis is an autosomal dominant anomaly characterized by multiple eye abnormalities including bilateral ptosis, telecanthus, epicanthal inversus, and shortening of the horizontal fissure of the lid. Commonly, a two-staged surgical approach is recommended for treatment. This begins with a medial canthoplasty using the Mustarde method. Three to 4 months later, suspension of the upper lid is then performed. It has been believed that when a medial canthoplasty and levator resection are performed at the same time, tension in the eyelid becomes too strong to achieve favorable results. The authors, however, have successfully treated 11 patients over a 9-year period using a single-stage approach. Their results have been favorable and patients undergo one less surgical event.-R.A. CHMIEL
As a sequela of parotidectomy, patients may notice significant facial asymmetry and an incidence of gustatory sweating (Frey’s syndrome). Superior and inferior based sternocleidomastid muscle (SCM) flaps and posterior plication of the musculoaponeurotic system were evaluated for their ability to relieve both conditions. Sixteen patients with SCM flaps and 16 patients with superficial musculoaponeurotic system plication were compared to a control group of 104 patients who underwent parotidectomy. The incidence of Frey’s syndrome was 47% in the control group, 12% in the SCM flap group, and 0% in the superficial aponeurotic plication group. The authors present surgical technique descriptions for all procedures. The prevalence of Frey’s syndrome is discussed according to age, sex, radiation therapy, and type of parotidectomy. The authors describe the indication and contraindications of the surgical techniques described in the article.-A.R. FORFAR
Reprint requests to Dr Nakajima: Department of Plastic and Reconstructive Surgery, Fujita Health University School of Medicine, I-98 Dengakugakubo. Kutsukake, Toyoake, Aichi 470-l 1 Japan.
Augmentation Rhinoplasty: Observations on 1200 Cases. Endo T, Nakayama Y, lto Y. Plast Reconstr Surg 87:54, 1991
Reprint requests to Dr Casler: Assistant Chief. Otolaryngological Service, Letterman Army Medical Center, Presidio of San Francisco, CA 94129.
This report discusses the authors’ experience with augmentation rhinoplasty and presents a technique of cartilage graft procurement. From January 1975 to December 1988, 1,263 cases of aesthetic augmentation rhinoplasty on Japanese patients were done with cartilage grafts. Forty percent had previous silicone augmentations, and 60% were previously unoperated. The major complaint of patients having silicone implants was either a too-high or too-large prosthesis. As opposed to Indo-European pa-
Pericranial Turndown Flap for Coverage of Soft Tissue Defects. Flint P, Cummings C. Laryngoscope 101:42, 1991 Often full-thickness avulsion wounds of the forehead pose a dilemma to the patient and practitioner searching for an acceptable cosmetic result. Full-thickness wounds of the forehead involving the frontalis muscle and peri912
913
CURRENT LITERATURE
cranium often leave step defects when covered with skin grafts alone or result in failure of the graft over bare bone. Advancement flaps used to cover full-thickness defects usually result in a secondary defect and poor cosmetic results. Tissue expanders used require significant amounts of time to achieve adequate expansion. The authors of this article present a two-stage procedure to improve the cosmetic result obtained when treating this type of wound. They advocate the usage of a pericranial turndown flap followed by a split-thickness graft. The anatomical considerations as well as technique are discussed. They conclude that this procedure achieves a predictable result with the morbidity of a split-thickness graft.-A.R. FORFAR
the local immune response in oral LP. In this model, keratinocyte surface antigens are modified, then targeted by the cytotoxic cell response that characterizes oral LP: mast cells and antigen-presenting Langerhans cells are key cellular elements in the evolving lesion. These mast cells degranulate, inducing adhesion molecule expression on endothelium. This promotes the homing of lymphocytes to the tissues. Lymphocytes and keratinocytes display adhesive interactions that are thought to be important determinants in the effector phase of the lesion. Chronicity could be promoted by cytokines produced by both lymphocytes and keratinocytes, thus influencing the local immune response. Modulation of immunologic events may be a therapeutic approach for LP.-C.M. WORLEY
Reprint requests to Dr Flint: Department of OtolaryngologyHead and Neck Surgery. University of Washington, Seattle. WA 98195.
Reprint requests to Dr Walsh: Department of Dermatology, versity of Pennsylvania, Philadelphia, PA.
Electron Microscopic Study of the Effect of Capsaicin on the Mouse Chorda Tympani Nerves. Hiura A. Arch Oral Biol 35:913. 1990
Ischemic Heart Disease and Platelet Aggregation: The Caerphilly Collaborative Heart Disease Study. Elwood PC, Renaud S. Sharp D. et al. Circulation 83:38, 1991
The chorda tympani nerve contains gustatory fibers and parasympathetic secromotor fibers that innervate the tongue, submandibular, and sublingual glands. Capsaicin acts selectively on substance P-containing nociceptive neurons of primary sensory ganglia, and depletes their contents in both central and peripheral areas. Some studies have shown the cat chorda tympani to contain mechanosensitive and thermosensitive fibers and cannot rule out nociceptive fibers. The purpose of this investigation was to determine whether the mouse chorda tympani contains nociceptive fibers sensitive to capsaicin. This study treated three mice with capsaicin (50 mg/kg) on day 2 after birth, with one mouse receiving similar doses on day 2 and 3. The results showed that one or two injections did not significantly change the composition of the nerve fibers. Therefore, it did not induce degeneration of its nerve fibers. Also, neonatal treatment with capsaicin does not induce degeneration of sympathetic and parasympathetic efferent fibers or salivatory nucleus. In conclusion, the mouse chorda tympani does not contain capsaicin-sensitive nociceptive fibers other than gustatory and secretomotor fibers. Capsaicin did not damage the geniculate ganglion and presynaptic parasympathetic fibers, therefore gustation and secretion of saliva is not influenced by capsaicin.-L.C. METZGER
The hypothesis of this study was that a correlation could be made between platelet aggregation activity and ischemic heart disease. A total of 2,398 men aged 49 to 66 years were evaluated. Their past history of ischemic heart disease was noted. Blood samples were collected and platelet aggregation was induced by experimental methods and measured using turbidometrics. A significant correlation between previous myocardial infarction and high platelet aggregation activity was demonstrated by the results of this study. In fact, the strongest relation indicated more than a twofold increase in the odds of a past myocardial infarction in subjects of the highest fifth of ADPinduced primary platelet aggregation compared with the lowest fifth. Therefore platelet activity and hemostatic factors may be an important part of the etiology of ischemit heart disease. Treatments aimed at the correction of increased hemostatic activity may play an important role in the prevention of ischemic heart disease.-A. BLUHM
Reprint requests to Dr Hiura: First Department of Oral Anatomy, School of Dentistry, Tokyo Medical and Dental University, I-5-45. Yushima, Bunkyo-ku, Tokyo 113. Japan.
Immunopathogenesis of Oral Lichen Planus. Walsh LJ, Savage NW, Ishii T, et al. J Oral Path01 Med 19:389, 1990 Oral lichen planus (LP) is a common disorder of unknown etiology in which mucosal and/or skin surfaces are affected. Cell mediated immunity is thought to play a role in the pathogenesis of LP. Available evidence supports the notion that LP is a predetermined condition rather than a simple cause and effect disorder. Serologic studies demonstrate an association between the HLA-DRl tissue type and both drug-related and idiopathic lichenoid lesions, supporting the view that a genetic predisposition to the development of LP exists. This article presents a hypothesis which integrates cellular and molecular signals in
Reprint requests to Dr Elwood: MRC Epidemiology Richmond Road. Cardiff CF2 3AS. United Kingdom.
Uni-
Urut. 4
Familial Trigeminal Anesthesia. Keys CL. Sugar J, Mafee MF. Arch Ophthalmol 108: 1720. 1990 Congenital trigeminal anesthesia has been reported both as an isolated neurologic defect and in association with other congenital abnormalities. This disorder can involve one or more branches of the trigeminal nerve both unilaterally or bilaterally. The authors reported three family members, including a father and two sons, each of whom demonstrated bilateral cornea1 involvement, bilateral hypesthesia of the ophthalmic and maxillary distributions of the trigeminal nerve. and nasal septal collapse secondary to self-traumatization. The overall pattern of inheritance of this disorder is consistent with autosomal dominant transmission with incomplete penetrance. The pathogenesis appears to be congenital hypoplasia of the trigeminal nerves and gasserian ganglia as revealed by magnetic resonance imaging findings.-T. WONG Reprint requests to Dr Linberg: Department of Ophthalmology. Cleveland Clinic Foundation. One Clinic Center. 9500 Euclid Ave. Cleveland, OH 44192.