James A. Lehman

Does infection play a role in breast capsular contracture

The formation of capsular contracture around silicone implants continues to be the most common complication of augmentation mammaplasty. To date, the etiologic factors in the formation of capsular contractures have remained inconclusive. In the present study, the role of subclinical infection with S. epidermidis as a cause of capsular contracture was evaluated in 16 rabbits using miniature silicone implants. All the implants on the side contaminated with varying concentrations of S. epidermidis developed breast capsular contractures. Using Bakers classification, they were graded III or IV, while the controls were all considered to be either grade I or II. Grossly, the capsules on the contaminated side were firm, fibrous, and 2 to 3 times thicker than the controls, and this was confirmed histologically using micrometry. Implants contaminated with 10(7) bacteria uniformly extruded. The present study seems to indicate that subclinical infection with Staphylococcus epidermidis may be one of the causes of capsular contracture around breast implants.

Surgical orthodontic correction of transverse maxillary deficiency: a simplified approach.

Osteotomy of the zygomaticomaxillary buttress in combination with a rapid palatal exapnsion appliance is a dependable technique for the treatment of horizontal maxillary deficiency in adults. This procedure has been used in 18 patients with excellent expansion in 17. In one patient, expansion was discontinued prior to overcorrection because of pressure necrosis on the palate related to the appliance. This was the only complication. The procedure is indicated mainly in those patients with a horizontal deficiency who do not require subsequent surgery, but for some patients it may be the preliminary procedure. Three patients in this series had subsequent orthognathic surgery. Follow-up has been from 1 to 6 years, and there has been no relapse. In our opinion, the zygomaticomaxillary buttress is the primary area of resistance to lateral movement of the maxilla by rapid maxillary expansion appliances.

Congenital scalp defect with thrombosis of the sagittal sinus. Case report.

A case report of a congenital scalp defect, associated with thrombosis of the superior sagittal sinus, is presented. A thrombectomy of the sinus, followed by skin grafting, was successful in achieving wound closure and a healthy, normal child. We propose that thrombectomy be considered for future similar situations.

Lung herniation into the neck associated with congenital absence of the sternocleidomastoid muscle

This is a case report and literature review involving congenital absence of the sternocleidomastoid muscle (SCM) and simultaneous herniation of the left lung into the neck. To date there have been eight cases of absence of the SCM muscle, but no records of lung herniation alone or in combination with SCM muscle absence. Included is the management course taken to correct this patients defect, CAT scans of the neck, fluoroscopic imaging of the lung and neck, and photographic documentation of the defect.

One-stage Closure of the Entire Primary Palate

Timing of the closure of the anterior palate and alveolus is a subject of debate. Late repair of this defect is complicated by high fistula formation and subjects the patient to the problems of palate fistula for extended periods of time. We have utilized a single procedure performed when the child is 3 months of age that completely closes the anterior hard palate and alveolus along with the cleft lip. Our series consisted of 61 consecutive patients with unilateral clefts of the primary and secondary palate. Mucosal turnover flaps from the vomer along with lateral nasal mucosal flaps provide the nasal lining. A buccal sulcus flap with a Veau flap completes the oral repair. Ninety-five percent (58 of 61) of the patients had complete and stable closure of their anterior palate and alveolus after 1 year. The incidence of fistula formation in our series (3 of 61) is much lower than that reported with the utilization of other protocols. Excellent exposure of the anterior palate and alveolar defect during lip repair, early restoration of anatomic relationships, establishment of a good nostril floor and sill, and very low fistula formation are among the benefits of this procedure. The increase in operative time is considered minimal in light of aforementioned advantages.

Secondary alveolar bone grafting: An outcome analysis

OBJECTIVE To review the outcome of secondary alveolar bone grafting in unilateral and bilateral cleft lip and palate. DESIGN A surgeons experience, by retrospective chart review, of 70 consecutive patients at a tertiary care centre. OUTCOME MEASURE Periapical radiographs were taken at least six months after secondary alveolar bone grafting. The Enemark grading system was used to stratify graft-take. RESULTS In unilateral clefts, 33% were level 1, 36% were level 2, 20% were level 3 and 11% were level 4. In bilateral clefts, 29% were level 1, 50% were level 2, 14% were level 3 and 7% were level 4. There was no statistically significant difference between the level of take and the type of cleft. Complications encountered were infection (n=3), fistula (n=3), pain (n=4) and bone graft exposure that led to failure (n=2). Two patients required reoperation for bone grafting. CONCLUSIONS The iliac crest is a good donor site with excellent results and minimal morbidity.

New sterilization technology and the effects on bone pencil.

BackgroundThe changing technology today with sterilizing surgical tools has called into question the ability to adequately sterilize the bone pencil. Concern has arisen as to the sterilization of bone pencil and whether the new technology used in sterilizing the operating equipment meets the standards set by the Centers for Disease Control and Prevention. This study was performed to compare the older gas sterilizing technology (ETO) with the newer hydrogen peroxide–based Sterrad sterilizer. MethodsAn equal number of standard number 2 pencils were used for both methods of sterilization. Three separate batches were used for a total of 13 pencils in each group. All pencils were cultured at 24 and 48 hours after sterilization. ResultsAll culture plates showed no growth during the incubation process. ConclusionsBone pencil can be sterilized using the new gas sterilization equipment as well as the older equipment.

Secondary repair of bilateral cleft lip deformities: A two-stage approach

A two-stage procedure using previously described principles has been designed to achieve muscle-to-muscle union, narrowing of the philtrum and lengthening of the columella. In addition fistulas may be corrected simultaneously.

Massive Intradural Dermoid Cyst Without Sinus Tract

Abstract Dermoid cysts can present as a rare, benign, congenital intracranial tumor of neuroectoderm origin trapped during embryogenesis. Past clinical reports have reported lesions in the posterior fossa, at the midline, and in the intradural region all in conjunction with a superficial sinus tract. The authors present a unique patient of a completely intracranial, intradural, dermoid tumor of the midline cerebellum devoid of any evidence of sinus tract. The histological characteristics, radiological features, and management of this unusual patient are described.