[Posttraumatic rhinoplasty and rhinopoiesis].
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Biomedical subjects
Publications and source records attributed to P Tessier.
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Maxillonasal dysostosis, described by Binder in 1962, is probably more common than one would think from the small number of cases that have been published (fewer than 40). We have seen 37 cases of this syndrome over a period of 8 years. Diagnosis of the syndrome is easy because of its characteristic anomalies of the upper lip and nose: smallness of the nose, a groove under the columella, a "half-moon" appearance of the nasal apertures, absence of the nasal spine, and projection of the chin. In addition, we have observed several associated abnormalities: convergent strabismus (2 cases), mongolism (1 case), labiomaxillopalatine cleft (1 case), and, of particular note, numerous abnormalities of the cervical spine, frequently associated with mandibular prognathism. In view of the frequency of the latter abnormalities. Binder syndrome might well be called a "nasomaxillovertebral syndrome."
Craniospinal and cervicospinal malformations were found in 15 (53.5%) of 28 cases of maxillonasal dysostosis (Binder syndrome) in which a complete radiographic analysis could be done. These anomalies have not been reported previously. Analysis of the anomalies suggested a common induction factor, or, at least, a simultaneity in the development of the maxillonasal and vertebral dysplasias that characterize Binder syndrome. The following procedures are recommended: (1) examination of the cranial and cervical spine in all subjects with symptoms of Binder syndrome, and (2) regular examination of patients with spinal malformations, so that any neurologic damage may be detected early.
Treatment of maxillonasal dysostosis (Binder syndrome) varies according to the age of the patient. In the newborn, respiratory and alimentary problems resulting from the anomaly may necessitate the insertion of endonasal and gastric tubes. In children, occlusal problems and orofacial dysfunctions caused by maxillonasal dysostosis should be treated as soon as possible with an orthodontic mask. Once a patient reaches adulthood, surgery may be performed. If orthodontic treatment has been successful and there is normal occlusion, the surgery may consist simply of placing the muscles of the nose and upper lip in normal; anatomic position. If occlusion is abnormal, osteotomy may be performed.
To evaluate whether the presence of a left atrial appendage (LAA) thrombus increases the embolic risk of percutaneous mitral commissurotomy (PMC), we reviewed 240 transesophageal echocardiographic studies performed before intended PMC for mitral stenosis. We found 14 patients (5.8%) with left atrial clots, 12 located in the LAA (none detected by transthoracic echocardiography [TTE]) and two in the body of the left atrium. In the two patients who had a left atrial body thrombus, TTE did not unequivocally show the thrombus. Seven patients with an LAA thrombus underwent PMC by the double-balloon technique. The hemodynamic and echocardiographic results were comparable to those of the larger series. No embolic complications were noted either during the procedure, in the 48 hours of observation after the procedure, or at a mean follow-up of 12 months. We conclude that PMC by the double-balloon technique can be performed safely in patients with an LAA thrombus who have been given anticoagulants. Transesophageal echocardiography is still indicated before PMC because TTE is suboptimal for detection of left atrial clots.
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