Holy Communion--chalice or challicles?
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Biomedical subjects
Publications and source records attributed to J B Janeke.
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A 13-year-old White boy was operated on for a penetrating craniofacial injury caused by a speargun fishing harpoon. The missile penetrated the left nasal ala, traversed the maxillary sinus and the postero-medial wall of the latter and penetrated the posterior nasopharyngeal soft tissue and mucous membrane, almost abutting the anterior surface of the atlas. At an emergency procedure the missile was retrieved via a combined lateral rhinotomy/Caldwell-Luc approach. In spite of the horrific appearance of the accident there was no neurological deficit and vascular findings were minimal.
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The osteoplastic flap technique as an approach to the frontal sinus has been a well-established concept since the 19th century. However, obliteration of the frontal sinus with homografts or allografts is a relatively modern contribution. All techniques preserve and replace the anterior bony frontal sinus wall, acting as a trapdoor to the obliteration material. In the technique described, a synthetic material (polymethacrylate)is used to obliterate the frontal sinus. The bony anterior frontal sinus wall (osteoplastic flap) is not replaced. The synthetic material is easily sculptured (manually or with a power drill) to the contour of the forehead. This procedure is time-saving and reduces surgical morbidity. A concomitant and separate abdominal incision to obtain a free fat implant becomes superfluous.
The 'suture-only' technique for correcting 'bat' ears provides an anesthetically pleasing result. The ear contour can be altered and remodelled without cutting the pinna cartilage, thereby avoiding possible permanent disfigurement. The object of the 'suture-only' procedure is to normalize a somewhat ridiculous and embarrassing physical appearance which may cause permanent psychological and personality damage.
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An eclectic, modified radical technique for the treatment of advanced middle ear and mastoid disease is described. This technique is safe and makes the ear easy to inspect. The reconstruction technique, using heterografts, homografts or alloplastic ossicular prostheses, minimizes lateralization or the tympanic membrane and provides satisfactory hearing results. From my experience the concept of Mr Bondy of a basic, modified radical technique for advanced ear lesions has withstood the test of time, and all credit is due to him.
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