[Post-traumatic nasal retrusions (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Stricker.
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The sequelae of hare lip, of mixed origin, malformative and surgical, require careful analysis of the deformities present in order to ensure their correction. The basic concept is replacement of the cleft in its initial position, i.e.: --re-opening of the cleft, --exposure of the bony edges, --excision of scar tissue. Restoration is then performed starting deep and working upwards, with primary attention paid to the skeleton with the complex concern of: --normalisation of the underlying bone and of occlusion, --re-establishment of oro-nasal muscular equilibrium, --esnuring nasal ventilation. without neglecting the overall morphology. With this in mind, complete repair in one stage is most likely to result in a harmonious overall result.
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Dacryography is the only means of exploring the permeability of the lacrymal ducts and to conclude as the whether watering of the eyes is organic or functional. Pre-operatively, it is indispensable in order to orientate the surgical intervention, it is definitely indicated if there is a relapse of watering of the eyes. The appearance of new surgical techniques, such as the use of venous or arterial grafts, has given rise to a new interest in this technique, which up to now had been considered as an exceptional investigation.
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In spite of a certain reduction in their numbers, facial injuries still raise frequent problems for general surgeons. Car accidents are now less commonly responsible than motorcycle accidents. In the most complex cases, one may find lesions of the soft parts and bony lesions in association. The wounds should be examined carefully, all foreign bodies removed and should only be sutured if one is certain tht the subjacent structures are undamaged, e.g. facial bony canals are often damaged in vertical wounds of the cheek situated behind the anterior border of the masseter muscle. As far as bony lesions are concerned, they rarely give rise to typical breakdowns of the suture lines described by Lefort, but more commonly cause true dislocations which are impossible to describe. Fractures are often undiagnosed owing to oedema which masks them, e.g. those of the malar bone and of the orbit and even those of the nose. This failure to diagnose them is serious for, at a later stage, surgical correction is more difficult and the prejudice is then not only esthetic but also functional, e.g. causing diplopia. Clinical examination of a patient with trauma of the face includes a series of simple gestures which a general surgeion should carry out in order to avoid failure to diagnose such lesions. Although he may not treat them all, he sould recognise them and decide which have priority in the treatment of multiple injuries. Careful inspection and palpation usually permit one to detect bony lesions which XRays then demonstrate only by careful choice of appropriate views.
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