Desmond A. Kernahan

Dermal and epidermal response to soft-tissue expansion in the pig

To evaluate the dermal and epidermal response to soft-tissue expansion in the pig, round tissue expanders were placed dorsally under tattooed patterns and inflated over 6 weeks. Surface area, skin thickness, histologic changes, and collagen content were evaluated at 6-week intervals. Epidermal thickening and dermal thinning were observed. Dermal thinning persisted 36 weeks after expansion. Dermal collagen content was decreased, although collagen density remained unchanged. Total collagen content calculated within an expanded square grid increased. These data support a theoretical gain in the dermal layer as well as epidermal layer in response to tissue expansion.

Long-term assessment of early alveolar bone grafts using three-dimensional computer-assisted tomography : A pilot study

&NA; Fifteen patients with complete unilateral cleft lip and palate who had primary alveolar bone grafting were studied with computer‐assisted tomography at a mean age of 12 years. Keeping the maxillary alveolar crest parallel to the plane of the scan, 1.5‐mm cuts of the maxilla were made from the infraorbital rim to the gingival third of the crowns of the teeth. A single operator reformatted the data into three‐dimensional images using the Maxiview 3200 computer workstation. This allowed examination of the position, size, and spatial relationship of the grafted area and quantification of the amount of bone coverage of root surface and bone height of the alveolus in or adjacent to the graft site. Ten patients showed a lateral incisor in the line of the cleft. The average bony coverage of these tooth roots was 76.5 percent. In the five patients in whom there was lateral incisor agenesis, the canine root had average bony coverage of 82.6 percent. The average height of bone at the lateral incisor was 8.7 mm; at the canine, 14.1 mm. In two patients in whom there was only 42 percent tooth root coverage, the teeth were still viable, stable, and without mobility. Computed tomographic (CT) scans of the 15 patients demonstrated good graft survival with adequate volume. The functional and aesthetic status of the dentition in the area of the cleft also was demonstrated. (Plast. Reconstr. Surg. 99: 1840, 1997.)

The anatomy of the orbicularis oris muscle in unilateral cleft lip based on a three-dimensional histologic reconstruction.

The midface of a full-term, stillborn infant with a right complete unilateral cleft lip and palate has been examined by serial histologic sections and a three-dimensional model has been created. The arrangement of the orbicularis oris muscle fibers observed differs markedly from previous descriptions. There is a chaotic arrangement of muscle fibers with no separate muscle layers distinguishable. Muscle fibers on both sides of the cleft insert into the dermis, although the amount of muscle on the medial side is quite sparse compared with the lateral side. There is no evidence of muscle bundles paralleling the cleft margins. An unexpected finding is a significant number of muscle fibers streaming over the cleft ala. In view of these findings, differing as they do from previous reports, there would seem to be strong justification for histologic investigation of the arrangement of muscle fibers in cleft lip to be repeated as further specimens become available.

The Long-Term Survival of Onlay Bone Grafts??? A Comparative Study in Mature and Immature Animals

Onlay bone grafting was studied with regard to age of the animal and type of bone graft used (membranous bone or endochondral bone with or without periosteum, and decalcified homograft). The bone grafts were placed in the nasal dorsum in a group of mature and immature New Zealand rabbits. Volume displacement studies were carried but. Graft survival was greatest in membranous bone and least in endochondral grafts. There was significantly greater absorption of endochondral grafts in immature animals than in the mature group. Presence or absence of periosteum did not make a significant difference in graft survival.

Incorporation of the W-plasty in repair of macrostomia

Macrostomia is an uncommon deformity, the features of which have been outlined. The importance of accurate preoperative marking of the normal landmarks and three-layered repair are stressed. Our technique combines triangular mucosal flaps at the commissure, reconstruction of the oral and buccal musculature, and skin closure using a W-plasty. This skin closure results in a less conspicuous scar while still preventing lateral drift of the commissure. We feel this is an effective surgical procedure that yields consistent clinical results.

Anatomy of the Orbicularis Oris Muscle in Incomplete Unilateral Cleft Lip Based on Histological Examination

Histological sections of tissue removed from three incomplete cleft lips at the time of repair, a natures scar line, and a noncleft lip were examined serially in the horizontal and saggital planes. The findings confirm previous data from electrical stimulation studies of clefts and a three-dimensional histological model of the orbicularis oris in a complete cleft lip. There is a disorganized mass of muscle fibers with numerous dermal insertions and no evidence of well-defined muscle bundles running parallel to the cleft margins. The fibers are somewhat hypoplastic and less abundant than those present in noncleft lips.

Splinting of oral commissure electrical burns in children

traditional culture technique for detection of group A betahemolytic streptococci. J Clin Microbiol 20:824, 1984. 8. Gerber MA, Spadaccini L J, Wright LL, Deutsch L: Latex agglutination tests for rapid identification of group A streptococci directly from throat swabs. J PEDIATR 105:702, 1984. 9. Otero JR, Reyes S, Noriega AR: Rapid diagnosis of group A streptococcal antigen extracted directly from swabs by an enzymatic procedure and used to detect pharyngitis. J Clin Microbiol 18:318, 1983. 10. Petts DN: Early detection of streptococci in swabs by latex agglutination before culture. J Clin Microbiol 19:432, 1984. 11. Halfon ST, Davies AM, Kaplan O, et al: Primary prevention of rheumatic fever in Jerusalem school children. II. Identification of beta-hemolytic streptococci. Isr J Med Sci 4:809, 1968. 12. Kaplan EL, Top FH Jr, Dudding BA, Wannamaker LW: Diagnosis of streptococcal pharyngitis: Differentiation of active infection from the carrier state in the symptomatic child. J Infect Dis 123:490, t971. 13. Kaplan EL, Couser R, Huwe BB, McKay C, Wannamaker LW: Significance of quantitative salivary cultures for group A and non-group A/3-hemolytic streptococci in patients with pharyngitis and in their family contacts. Pediatrics 64:904, 1979. 14. Stillerman M, Bernstein SH: Streptococcal pharyngitis: Evaluation of clinical syndromes in diagnosis. Am J Dis Child 101:476, 1961. 15. Bresse BB, Disney FA, Talpey WB, et al: Beta-hemolytic streptococcal infection: The clinical and epidemiologic importance of the number of organisms found in cultures. Am J Dis Child 119:18, 1970.

Radiographic analysis of the midface of a stillborn infant with a unilateral cleft lip and palate.

The midface of a full-term stillborn infant with a right complete unilateral cleft lip and palate was studied with plain-film radiography and tomography, xeroradiography, and computerized axial tomography. Gross skeletal and soft-tissue deficiencies on the cleft side were evident as compared to the noncleft side and involved the entire bony maxillary complex and antrum, the orbit, and the nasal pyramid and intranasal structures. The area on the cleft side was 19 percent less than the noncleft side, and the maximal anteroposterior dimension was 16 percent less. The cleft bony palatal shelf was 12.5 mm wide compared to 20 mm on the noncleft side. The findings demonstrate the deficient and abnormal functional matrix inherent in the cleft condition.

Experience with Electrothrombosis in the Treatment of Angiomas

We report unsatisfactory results of electrothrombosis for the treatment of venous angiomas. After we reviewed a report of successful use of electrothrombosis for treating cirsoid angiomas of the face and scalp and varices of the leg, a clinicaltrial was begun with 6 patients in whom previous conventional surgery was relatively unsuccessful and in whom further surgery had not been recommended owing to the high risk or probability of unsatisfactory results. Two patients had objective clinicalimprovement, resulting in no further treatment in 1 patient and allowing secondary surgical correction in the other. Four patients had no significant improvement. We now recommend and will continue further laboratory research with electrothrombosis for the treatment of angiomas before treating additional clinical cases.

Pediatric facial plastic and reconstructive surgery

Craniofacial syndromes - sequences and anomaloids auricular congenital abnormalities with reconstruction otoplasty congenital nasal masses nasal surgery for congenital and acquired diseases congenital neck masses vascular lesions facial nerve abnormalities orbital the cleft palate multidisciplinary team the unilateral cleft lip the bilateral cleft lip cleft palate velopharyngeal incompetence secondary repairs secondary repair of cleft nose benign and malignant tumours of childhood trauma - soft tissue trauma - skeletal fractures scar revisions and wound healing in children dermatological problems orthognathic surgery.