Use of the free fibular flap in the immediate reconstruction of pediatric mandibular tumors: report of cases.
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Anastomosis, Surgical↗
Biomedical subjects
M D Wells
Publications and source records attributed to M D Wells.
Fetal bone gap healing in utero.
The healing of fetal tibial bone after osteotomy with and without stable fixation has been reported previously. The present study was designed to evaluate fetal bone gap healing using a tibial ostectomy model in fetal sheep. Eighteen time-dated pregnant ewes (20 fetuses, 34 experimental hind limbs) underwent intrauterine surgery at 95 days gestation (term, 145 days). A titanium miniplate was applied to the anterior aspect of the tibia and a longitudinal length of bone approximately 1.5 times its diameter was removed and the incision closed. The pregnancies were then allowed to progress until the ewe was killed at postoperative weeks 1, 2, 4, or 7. Assessments at that time included evaluation of gross morphology, histologic and radiologic appearance, and collagen analysis and hydroxyproline determination of the tissue within and at the borders of the gap. At 7 weeks, seven of nine bone gap specimens exhibited radiographic and histologic evidence of union with woven and lamellar bone. Hydroxyproline concentrations gradually increased within the bone gap over the period of the study. At all intervals, type I collagen composed over 90% of the collagen within the healing bony gap. Histologically and biochemically, the process appears to be similar to postnatal bone healing, albeit occurring at an accelerated rate.
Animals↗
One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap.
This is the first series of total penile reconstructions with the free sensate osteocutaneous fibula flap. The main advantages of this flap lie in its intrinsic rigidity, its superior donor-site location, and its long vascular pedicle. The fibula flap provides better bone volume than does the radial forearm flap, which commonly results in a floppy phallus in the absence of bone. Penile prostheses in other flaps have enjoyed limited success. Forearm donor-site complications can be avoided. The donor site in the lower extremity can be readily covered with a sock. The vascular pedicle of the fibula flap is of sufficient length to allow end-to-side anastomosis of the flap to the femoral artery. Interpositional vein grafts are unnecessary, and dissection of the inferior epigastric artery system to serve as a donor artery may be avoided. The appearance of the neophallus is excellent. We present only the first four continuous cases of the six we have performed because sufficient follow-up data are available only for these four. The advantages and disadvantages of fibula and forearm donor sites, the long-term fate of the bony component, the importance of sensation, and the vascularized urethral reconstruction are discussed. High patient satisfaction and the advantages of the technique convince us that the fibula osteocutaneous flap is superior for total penile reconstruction.
Adult↗
Fetal tibial bone healing in utero: the effects of miniplate fixation.
Although clinical and experimental findings have demonstrated that fetal soft-tissue wounds heal without scarring, very little is known about the process of fetal bone healing. This study examined fetal long bone healing in utero, both histologically and biochemically, with and without fracture fixation in a fetal sheep model. Our study group consisted of 25 live fetuses (from 16 ewes). There were 50 fetal tibias in this group; 12 were control, 17 were fixed (miniplate fixation), and 21 were nonfixed. A midshaft osteotomy of the tibia, either fixed or non-fixed, was performed on fetal sheep at 95 days' gestation (term = 145 days) in utero. The sheep were then killed at one of five postoperative time intervals (weeks 1, 2, 3, 4, and 7), and fetal bone healing was examined. The variables reviewed included gross morphology, histology, radiology, and collagen analysis (proportions of types II to I and III to I collagen). Fetal bone healing without fixation was accompanied by a large callus with rapid and abundant cartilage and collagen deposition. Bone healing was characterized by malunion or nonunion at 7 weeks. However, with miniplate and screw fixation, callus formation was minimal; primary bone healing occurred by 3 weeks and did not adversely affect long bone growth. Analysis of callus samples revealed a minimal amount of type III collagen, whereas the proportion of type II collagen was variable and proportional to the content of callus cartilage.
Animals↗
Pregnancy-induced hypertension and congenital hearing loss.
It has been suggested that pregnancy-induced hypertension (PIH--pre-eclampsia or toxaemia of pregnancy) may cause sensorineural hearing loss (SNHL) in the offspring. To establish the validity of this concept a clinical survey of the prevalence of congenital hearing loss in relation to PIH in the South East Kent Health District in the United Kingdom over a period of 4 years was undertaken. Description of the temporal bones in a case of PIH is presented. The total number of live births in this period was 12,927, out of which 512 mothers (3.9%) were diagnosed as having PIH. To date 17 cases of bilateral SNHL have been diagnosed in this period (excluding known syndromes, conductive hearing loss and unilateral SNHL). One of the mothers of these children had PIH. It is possible that otologists, in the absence of any obvious cause, have attributed the cause of bilateral SNHL to PIH. Histopathological findings in temporal bones from a 29-week fetus, whose cause of death was severe maternal hypertension, showed massive haemorrhages in the inner ear and middle ear and internal auditory meatus, a frequent finding in temporal bones obtained at autopsy from fetuses and neonates who were born prematurely. This study suggests that PIH per se is unlikely to cause SNHL in the newborn.
Deafness↗
Mode of growth of acquired cholesteatoma.
A histopathological study of acquired cholesteatoma in four temporal bones from two adults and one child is presented. The findings suggest that the cholesteatoma originated from the retraction pockets of the tympanic membrane and there was active growth of the squamous epithelium of the retraction pockets, which may be enhanced in the presence of otitis media.
Aged↗
Penile replantation.
Amputation of the penis is thankfully an uncommon injury. Because of its rarity, a uniform plan of management to deal with this difficult injury has yet to be agreed on. We describe a man who sustained such an injury and his subsequent clinical course. The relevant history and pertinent anatomy is highlighted. Additionally, a systematic approach to dealing with this devastating injury is presented.
Amputation, Traumatic↗
Periosteal suspension of the lower eyelid and cheek following subciliary exposure of facial fractures.
Following craniofacial procedures that involve stripping of the periosteum and soft tissue over the zygomatic maxillary complex, descent of soft tissue with a decrease in anterior projection over the malar area and increase in fullness in the nasolabial fold have been seen to be a problem by these authors. Simple repositioning of the soft tissues to their normal anatomic position may be used to alleviate this problem.
Cheek↗
An uncommon case of parotid sialolithiasis.
A vivid example of parotid sialolithiasis diagnosed with an anterior-posterior radiograph and subsequently followed with a superficial parotidectomy is presented. The case presentation is preceded and followed by a discussion of the pathogenesis and treatment of such an abnormality.
Fibrosis↗
Surgical management of facial palsy.
Patients with facial palsy present with a multitude of different problems to which individual solutions must be carefully tailored. Although numerous surgical options exist, the results of reconstruction are rarely ideal. This article discusses different surgical procedures for reconstruction of the eye and mouth with special emphasis on the newer technique of microsurgical transfer of muscle tissue for reanimation.
Facial Expression↗
Experimental reconstruction of cutaneous defects with microvascular jejunal transplants.
In a rat model, island and free flap transfers of jejunal segments were performed to provide a vascularised base in surgically created wounds. These thin, pliable flaps were subsequently stripped of mucosa and skin-grafted to provide a durable cutaneous cover. Histological evaluation of the flaps was performed. Advantages and disadvantages of the procedure are discussed.
Animals↗
Vertigo in a district NHS hospital.
Thirteen general ENT clinics are held for a population of 600,000 people. The present study comprises an individual experience in managing patients with dizziness seen in three general ENT clinics. Eighty-six patients with a complaint of dizziness were seen over a period of 10 years from 1974 to 1984. Postural vertigo in elderly patients was the commonest cause of vertigo (50 per cent) in the present study. Most of these patients suffered from momentary dizzy spells with excessive neck movements. Symptomatic relief was achieved with reassurance and advice to avoid precipitating neck movements in most of the cases. Menière's disease was the second commonest cause of dizziness, which was seen in 15.1 per cent of the patients. Most of the cases were managed successfully with firm reassurance and a short course of treatment with either Betahistine or Cinnarizine. Only two patients showed a very moderate deterioration in hearing and only one patient needed saccus decompression surgery for uncontrolled vertiginous spells. Three patients with congenital unilateral total deafness showed a characteristic picture of secondary hydrops. One needed chemical destruction of the labyrinth to control the dizziness. Two cases (2.4 per cent) had posterior fossa lesions, one with an acoustic neuroma and the other with a large subarachnoid cyst. Both these cases were successfully managed by surgery.
Adult↗
Oculo-auriculo-vertebral dysplasia. A temporal bone study of a case of Goldenhar's syndrome.
A case of oculo-auriculo-vertebral dysplasia is presented, with histopathological findings in the temporal bone and eye, and some radiological features. The syndrome consists of anomalies of the first and second branchial arch derivatives associated with ophthalmic and vertebral anomalies. Although clinical features and radiological findings of oculo-auriculo-vertebral dysplasia are documented in the literature, there have been very few reports of the histopathological findings of abnormal temporal bones. These vary from our own findings. The prominent features in our case are: a small middle ear cleft, an absence of ossicles, an aberrant facial nerve, and dysplastic, short lateral and superior semi-circular canals, as well as a narrow internal auditory meatus.
Cochlea↗
Role of retraction pockets in cholesteatoma formation.
Temporal bones were obtained from 100 routine cases at post mortem who died of causes other than otological. The tympanic membranes were examined under the operating microscope and retraction pockets were seen and photographed in 12 cases. Radiological examination of these 12 mastoid bones showed a sclerotic mastoid in 8 cases. On serial histopathological examination of the temporal bones there was evidence of old or recent chronic otitis media in each case. In 3 cases a sac with a narrow neck leading to the retraction pocket was seen. In 2 cases squamous epithelial 'pearls' in close proximity to the retraction pockets were seen. The significance of these findings in the pathogenesis of retraction pockets and cholesteatoma is discussed.
Cholesteatoma↗
Educational technology for beginners.
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Audiovisual Aids↗
Childhood fibrous dysplasia presenting as blindness: a skull base approach for resection and immediate reconstruction.
Fibrous dysplasia is an abnormal fibroosseous process of bone of unknown cause. The incidence of skull involvement varies, painless enlargement being the most common presenting symptom. Change in vision is a rare but recognized finding. We report a 3-year-old boy with extreme fibrous dysplasia involving the skull base, who presented with blindness. He underwent exposure osteotomies of the frontal bones and orbits to provide access for skull base tumor removal. The orbital roofs were reconstructed with microplate-fixed cranial grafts. One and one half years after tumor excision followed by immediate reconstruction, the boy retains facial symmetry, and his ocular function has not deteriorated.
Blindness↗