Alan R. Patterson

Tapia's syndrome after repair of a fractured mandible

A 41-year-old gentleman underwent surgical repair of the fractured right parasymphisis and left condyle of his mandible. Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapias syndrome was made.

Diffuse heterotopic calcification of fibula flap: a previously unreported case

We describe what is, to the best of our knowledge, a new henomenon, in which small multiple foci of heterotopic calification developed in a fibular free flap that had been used o reconstruct a maxillary defect. Calcification of the vascular pedicle is a recognised omplication1,2 and has been linked to increased osteogenic ctivity of periosteum that remains attached during the harest of the flap.3 However, its development seems to be revented when the periosteum is dissected from the proximal eroneal vascular pedicle.1 Heterotopic calcification away rom the pedicle has also been described, and presents as a ew mass in the neck.2 We describe a diffuse ossification throughout the soft tisue component of a fibular flap, in which multiple small foci eveloped only a few months after the flap was inserted. A 56-year-old man presented with a T4a N0 M0 squaous cell carcinoma of the maxilla (Fig. 1), for which he was reated with a right hemimaxillectomy and reconstruction ith an osseofascial fibular free flap. He presented at follow up two months later (before treatent with radiotherapy) complaining that the reconstruction as bulky and caused him problems when he was chewing. e was unable to achieve an occlusion, so we debulked the ap under general anaesthesia.

Atraumatic Percutaneous Transfer of an Externally Ported Distractor Activation Arm

F i istraction osteogenesis is an established technique or the treatment of the mandibular deformities found n hemifacial microsomia, Treacher-Collins syndrome, evere micrognathia, and temporomandibular joint nkylosis. Distraction osteogenesis of the ramus of the andible can be achieved with either internal or xternal distraction devices. Internal distraction deices are better tolerated; however, lack of space and