J. C. van der Meulen

A Morphogenetic Classification of Craniofacial Malformations

A new classification of malformations of the face and cranium is proposed, based on embryologic studies and observations concerning a great number of patients seen by the authors. First of all, one should distinguish between cerebral craniofacial (with brain and/or eyes involved) and craniofacial malformations. Craniofacial malformations may be characterized by dysostosis and by synostosis. Malformations with dysostosis may be produced by transformation as well as differentiation defects. Synostosis is always caused by a differentiation defect. A new nomenclature is introduced.

The hand of the musician: The kinematics of the bidigital finger system with anatomical restrictions

Tendons of the fingers are frequently interconnected by anatomic structures that limit the displacements of these tendons relative to each other. In this paper a bidigital finger system in which such interconnections between tendons are present is kinematically modelled. Using this model, an exhaustive description of the effects on finger movement of connections between the different tendons of the fingers is given. The study provides a context for the interpretation of typical difficulties of finger coordination in musicians, especially in pianists and string players.

Biomechanics of the finger with anatomical restrictions - The significance for the exercising hand of the musician

Exercise and teaching of musicians presupposes in the individual the constitutive ability to freely execute the finger movements required in the playing of the instrument. However, in the hand anatomical restrictions may exist that limit the mobility of the fingers and, thereby, the possibility to determine their movements voluntarily. In this article we investigate the kinematics of a monodigital system in which restrictions are present.

The use of mucosa-lined flaps in eyelid reconstruction: a new approach.

: In this paper, a review is given of the conditions that should be fulfilled for optimal eyelid reconstruction and of the principles on which modern techniques are based. A new approach to upper-eyelid reconstruction using a bipedicled flap from the lower eyelid that is lined with a mucosal graft but has no cartilaginous support is described. Also introduced is the use of similarly lined monopedicled flaps for the reconstruction of lower-eyelid defects. With these procedures, eyelid reconstruction has become less complicated. Flaps taken from forehead or cheek are scarcely ever necessary, and problems with reconstruction can be restricted to patients who have had radiotherapy or to the rare patients in whom defects in both eyelids have to be closed.

Treatment modalities for hypospadias cripples

Hypospadias cripples can be defined as patients with remaining functional complications after previous hypospadias repair. A retrospective followup study was per formed on the long-term results of a group of 94 patients disabled by hypospadias. The records of 94 patients showed that they presented with the following problems: 82 had a major meatal dystopia (87 percent), 43 (46 percent) had residual curvature of the penile body, 19 (20 percent) showed meatal stenosis, and only 5 (5 percent) had one or more fistulas. The techniques used to solve these problems were circumferential advancement of penile skin, dorsal transposition flap of preputial skin, distally based transposition flap of penile skin, and full-thickness skin graft. Between one and nine operations were needed to achieve the desired result (mean and median of two operations). The complications after these procedures were 11 fistulas in nine patients, meatal stenosis caused by tight scarring in six patients, and a residual curvature after an orthoplasty that had to be released once before a urethroplasty could be performed. Forty-three men were seen at long-term follow-up (range, 2 to 25 years; mean, 12 years). Functional complaints that were seen included spraying at micturition (5 patients, 12 percent), dribbling (6 patients, 14 percent), and deviation of urinary stream (7 patients, 16 percent). No patients complained of painful miction, hesitation, or straining. At physical examination, 4 patients had a residual curvature (three of which were mild without functional problems), 5 had a skin surplus, 1 presented with a fistula after an operation in another hospital, and 13 had a penile torsion. Only 6 patients had a penile torsion greater than 10 degrees, which was evenly distributed to the left and right. There was no correlation between any functional complaint and the presence of a physical abnormality.

Columellar elongation in bilateral cleft lip repair : early results

: Flattening of the nasal tip and shortness of the columella are two of the deformities that remain following successful repair of a bilateral cleft of the lip. Until now, correction has not been possible without producing undesirable scars on the surface of the nose or lip. A three-dimensional Z-plasty on the alar rim achieves columellar lengthening and forward projection of the tip, but it does not have these disadvantages.

Use of a temporal musculoperiosteal flap in the treatment of craniofacial abnormalities: experimental study

In 15 juvenile Yorkshire pigs averaging 23.5 kg in weight, 15 periosteal flaps based on the temporal muscle were raised on each side. One side served as control after the temporal arteries were severed. These periosteal flaps were transposed into the infraorbital region and were fixed to the maxillary periosteum by means of a subciliary incision. Radiographic follow-up over 1 year revealed new bone formation. Sample biopsies were microscopically examined and demonstrated the presence of new bone.

Discussion: Early Excision of Nasal Hemangiomas: The L-Approach

The presence of a nasal hemangioma may have a severe negative effect on the personality of a child. Early surgery in the involution phase has proved to be beneficial in this respect. The treatment of a consecutive series of nine patients who had surgery shortly after they were first seen for consultation is discussed. An extended rhinotomy (L-approach) was used in four of these patients. The results were uniformly good.