Bruce B. Horswell

Primary hemihypertrophy of the face: Review and report of two cases

Two patients who underwent surgical correction for facial hemihypertrophy are presented with a one year follow-up. The aid of computerized tomography in planning the procedures and assessing the stability of the result is discussed.

The double-reversing Z-plasty in primary palatoplasty : Operative experience and early results.

The double-reversing Z-plasty of Furlow for closure of the soft palate was used in 34 children with various types of cleft palate. Mean age at repair was 12.8 months. Intraoperative experience was favorable, with acceptable operating time and blood loss. Length of hospitalization averaged 1.9 days. Postoperatively, two children experienced temporary stridor, which resolved within 24 to 48 hours. One child had dehiscence of the hard palate (Von Lagenbeck repair) 4 weeks postoperatively, and three children developed small oronasal fistulae. Early speech evaluation demonstrated adequate soft palate mobility in 33 of 34 patients, with observable velopharyngeal function. Twelve children had mild velar compromise, with eight exhibiting slight nasal air escape.

Cephalometric and anthropomorphic observations of Binder's syndrome: a study of 19 patients

Binders syndrome (maxillonasal dysplasia) is a disorder characterized by nasomaxillary hypoplasia. To ascertain the extent of underdevelopment of the midfacial skeleton and soft tissues, 19 of 29 patients with Binders syndrome were retrospectively evaluated, both with cephalometry and anthropometry. Ten females and nine males were placed collectively into three age groups: 6 years, 10 years, and 16 to 17 years. Cephalometric measurements disclosed a short anterior cranial base (S-N), a normal length of the vertical maxilla (SE-PNS), a decreased horizontal maxilla (PNS-A, Co-A), a recessed orbitale (SNO), and a high-normal mandibular length (Co-Gn). Anthropometry revealed a large nasofrontal angle, acute nasal inclination and nasolabial angle, decreased nasal prominence (Sn-Prn), a decreased columellar length (C-Sn), and a normal vertical nose (N-Sn) and upper lip (Sn-Sto) length.

Nonporous hydroxylapatite in the repair of alveolar clefts in a primate model: clinical and histologic findings.

Twelve adult Rhesus monkeys with surgically created alveolar clefts (ACs) underwent repair that used nonporous hydroxylapatite (NPHA) granules on one side and autogenous particulate bone in the contralateral defect. Clinical and radiographic evaluations at 1, 2, 3, 6, and 12 months postoperatively disclosed some displacement of granules initially, but this stabilized by 2 months. Three of 12 sites repaired with NPHA and four of 12 sites repaired with bone dehisced; however, all of these healed by 2 months. No untoward inflammatory or resorptive changes were observed beyond 3 months. The repaired alveolar processes were similar in bulk and contour in sites grafted with NPHA and with bone. Histologically, giant cells were noted at 3 months, but the number decreased at 6 months and remained at that level up to 12 months. The NPHA granules were embedded in mature fibrous connective tissue with osseous ingrowth evident in eight of the 12 defects. It was concluded that NPHA granules are an acceptable implant material for repair of residual alveolar clefts in which erupting teeth and orthodontic movements are not factors.

Resident Work Hours

Purpose of review The Accreditation Council for Graduate Medical Education has mandated new requirements for work hours for all US resident physicians that became effective in July 2003. Member countries of the European Union are also implementing a reduction in work hours for trainee physicians as per the European Work Time Directives. The following review provides a summary of the basis of limiting work hours for residents, steps taken towards limiting the working hours for resident doctors, and implications to residents, institutions, and states. Recent findings Reduction of work hours for physicians in training is a much awaited and necessary change. Though the framework for such a reduction is in place in most countries, implementation of the policies has been slow thus far, mainly due to financial and manpower constraints. Setting of deadlines for compliance and legislation to penalize the defaulting institutions and programs may help to put the recommendations on work hours into practice. Summary Long work hours contribute to stress, fatigue, and mood changes in trainee physicians that are potentially deleterious to the physician and patients. Recommendations have been made across the globe to reduce resident doctor work hours and legislation is in place to monitor institutional compliance with these recommendations. Once these regulations are complied with, follow-up studies will be needed to evaluate their effects on physician well-being and patient care.

The incidence and relationship of cervical spine anomalies in Cleft Lip/Palate

Session IV: Orthognathic Surgery and alleviation oJ pain, but sensory recovery is not perfect.