John Paul Tutela

Traumatic dislocation of the mandibular condyle into the middle cranial fossa in an elderly patient.

Abstract Dislocation of the mandibular condyle into the middle cranial fossa is a rare traumatic injury caused by transmission of upward force through the condyle onto the glenoid fossa resulting in fracture of the fossa and superior displacement of the condylar head. This type of injury occurs when the “safety mechanisms” of the mandible fail or are absent. The authors present the case of a 72-year-old female patient with multiple comorbidities who suffered a subcondylar fracture of the left mandible and dislocation of the right mandibular condyle into the middle cranial fossa after a fall. Bilateral external fixation of the mandible to the zygomatic arch was utilized to minimize operative time and provide definitive treatment. Many factors must be taken into account when determining the treatment modality for this type of injury, and the final decision should be tailored to each individual case based on several factors including the length of time between injury and presentation, concomitant neurologic deficit, age, and stability of the patient. The goals of treatment are reduction of the dislocation, avoidance of neurologic injury, and restoration of mandibular function. A multidisciplinary effort is necessary to optimize patient care.

Posterior Wedge Resection: A More Aesthetic Labiaplasty

BACKGROUND Hypertrophy of the labia minora is of concern to a subset of adolescents and adult women. The posterior wedge resection is a new labiaplasty technique with an anatomic approach to yield the optimal aesthetic outcome and yet continue the functional achievement of prior techniques. OBJECTIVE The authors describe the results of their posterior wedge resection technique in a retrospective series of patients. METHODS A retrospective chart review was performed of 22 consecutive patients who underwent posterior wedge resection labiaplasty between February 2009 and February 2012. Complications and aesthetic outcomes were reviewed. RESULTS The average age of the patients in this study was 35 years (median, 33 years). Follow-up ranged from 2 weeks to 1.5 years. Two minor complications occurred without further sequelae. At follow-up, none of the patients reported any paresthesias, pain, or problems with penetrating vaginal intercourse. CONCLUSIONS An increasing number of labiaplasties are being performed for aesthetic and functional concerns. The posterior wedge resection enables the surgeon to perform labiaplasty easily, safely, and effectively, ensuring symmetry and maintenance of the natural pigment, color, and texture of the defining free edge of the labia minora.

The Safe Labiaplasty: A Study of Nerve Density in Labia Minora and Its Implications

BACKGROUND Surgical techniques to alleviate labia minora hypertrophy are gaining popularity. Due to the rapidly growing number of labiaplasties performed around the world, there is concern for the safety of these procedures with respect to maintaining sensitivity to the genitalia and/or implications for sexual arousal. OBJECTIVES An anatomic study aimed at identifying the nerve density distribution of the labia minora was performed to provide unique insight into performing labiaplasty while preserving sensation. METHODS Four fresh tissue cadaver labia minora were analyzed. Each labia minora was divided into 6 anatomic areas. The samples from each of the 6 anatomic locations were analyzed for presence of nerve bundles using both a routine hematoxylin and eosin (H&E) stain and a confirmatory immunohistochemical staining for S100 protein. Nerve density was analyzed under light microscopy, counted, and then expressed as percentage nerve density as well as number of bundles per square millimeter. RESULTS Upon gross analysis, the raw data reveal that labia minora have a heterogeneous population of sensory nerves. When looking at percent nerve density, the data do not reveal any statistical differences between the anatomic locations. CONCLUSIONS Most labiaplasty techniques can be performed safely and are unlikely to cause loss of sensation as the nerve density distribution in labia minora is heterogeneous.

The Double Opposing Semiocclusive Drain Dressing

Suction drainage with a Jackson-Pratt, Blake, or Hemovac drain is commonly employed for postoperative drainage of a variety of sites including the abdomen, pelvis, cutaneous tissue flaps, and skin grafts.1-3 Some patients may express complaints of discomfort and pain around the skin at the tubes insertion site and/or where it is sutured in place.4 There is no consensus in the literature on the ideal drain dressing; techniques vary and are mainly performed based on surgeon preference or accepted institutional norms. A simple, quick, and inexpensive method for minimizing patient efforts for drain dressing care and potentially, their discomfort, is described. After the suction drain has been placed and secured, two double opposing semiocclusive film dressings are placed around the suction tube at the site of insertion. At our facility, two 6x8 inch Tegaderm (3M, St. Paul, MN, USA) dressings are used. One of these clear semiocclusive dressings is placed on one side of the tube, with half of the dressing in contact with the skin and the other half supporting the tube (Figure 1A). The second is placed on the other side of the tube, directly opposite from the first dressing, again with half of it in contact with the skin, and the other half around the tube (Figure 1B). …

Abstract 222: PRESERVING NIPPLE SENSATION IN BREAST REDUCTION SURGERY

Background: Since its inception, Reduction Mammoplasty has matured considerably. Primary evolution in clinical research and practice has focused on developing techniques to preserve tissue viability; breast parenchyma, skin, and nipples. However, surgery today involves not only preserving tissue viability, but also function in terms of sensation. The nipple serves as a sensate unit in erectile function and plays a large part in the physical intimacy of women. Nipple sensation has shown to be a valuable part of womens psychological and sexual health. The authors review the current literature of nipple innervation, perform anatomical studies, and apply their  ndings to the clinical setting to identify a safe zone for Reduction Mammoplasty to preserve nipple sensation.