Kenneth Pickrell

Congenital giant nevi: clinical and pathological considerations.

A clinical and pathological review of 67 cases of congenital giant nevi and of 5 cases of malignant transformation in congenital giant nevi brings out the following. 1. The lesions should be regarded as premalignant. 2. An aggressive approach is advocated to remove the lesion before school age. 3. Staged excisions, combined with skin grafting and/or local rotation flaps, are advocated. 4. Any nodularity or ulceration developing within a congenital giant nevus should be regarded as an ominous sign. 5. A long-term follow-up is necessary in those patients having subtotal excisions.

Subpectoral augmentation mammaplasty.

We have done subpectoral augmentations on 100 women to enlarge the small or hypomastic breast to a pleasing degree. These operations were performed in a major hospital operating room, under local anesthesia, on an ambulatory basis. No complications were encountered. Our goal, and that of our patients, was to enlarge the small breast to a pleasing degree which would harmonize with the body contour and form, and to maintain the natural consistency of the breast and the normal sensation of the nipple and the breast as a whole. This goal was reached and our patients have been appreciative and pleaded. There was no postoperative weakness of the pectoralis muscle, and we have seen no evidence of capsule contracture. The group represents about one percent of our overall experience with augmentation mammaplasty.

CONGENITAL ANHIDROTIC ECTODERMAL DYSPLASIA; REPORT OF TWO CASES.

From the Department of Plastic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio,* and the Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina.† ‡ Dr. Quinn is Prof. of Orthodontics at Duke Universitv. This study was conducted while Dr. Hartwell was a member of the Division of Plastic and Reconstructive Surgery of Duke University Medical Center, and was supported by NIH Grant No. CRT-5143 and DEO1899, National Institutes of Health, Bethesda 14, Maryland. COCKAYNE 1 lists nearly 20 different ~GI~._~’~~TE ~ types of hereditary ectodermal defects which may involve separately or in combination hair, teeth, nails and eyes. Disorders of sweat and sebaceous glands are included. One distinct category is that of patients suffering with the triad of anhidrosis, hypotrichosis, and anodontia or severe abnormalities of the teeth-

Dynamic correction of unilateral paralysis of the lower lip.

We present a simple operation, performed under local anesthesia, to restore essential movement to the side of a lower lip paralyzed by injury to the mandibular branch of the facial nerve. The operation consists of a limited lateral resection of the paralyzed lower lip, plus transposition of the segment of orbicularis muscle from the paralyzed lower lip to the normal upper lip, through a subcutaneous tunnel.

Dermal cylindroma (turban tumor). Case report.

We present an unusual case of massive dermal cylindroma (turban tumor), occupying the entire scalpand forehead. It was treated by a total scalping procedure and skin grafting in two stages. Additional tumors of the face, neck, chest, shoulders, and back were excised and closed. The nose was treated by shoving and dermabrasion, similar to a rhinophyma. The lip was treated by dermabrasion. There has been no evidence of recurrence in the scalp which was treated by excision and grafting. There is now a papular quality of the skin over the nose and on the uppler lip, indicating that regrowth may occur. The etiology, pathology, and a review of the literature are presented.

Treatment of cleft lip and palate patients

Abstract The multidisciplined treatment approach to the congenital cleft lip and palate problem is of great value to the patient and to the ultimate success of treatment. Treatment objectives were accomplished through surgical correction of developmental defects, proper direction of growth potential in establishing the most nearly normal tooth and arch relationship, and maintenance of tooth and arch relationships through sound restorative procedures. The patient now experiences a feeling of comfort, dental stability, and personal well-being.

Treatment of mandibular prognathism in cleft palate patients

T he purpose of this article is to outline procedures for diagnosis and treatment of mandibular prognathism in patients with cleft lip and/or palate. Mandibular prognathism is mueh more common in the cleft lip/palate population than in the general population. Its appearance is often due more to the lack of soft-tissue balance than to the bone or skeletal profile relationship. With rare exceptions, however, all clefts are characterized by tissue hypoplasia. A deficiency of soft tissue is sometimes more difficult to demonstrate than a deficiency of hard tissue. We have had little success in treating true mandibular prognathism by orthodontic procedures alone,l? 2 but we have achieved most gratifying results in the orthodontic treatment of mandibular pseudo-prognathism in patients with clefts of the maxilla. In order to provide the most valuable service, the orthodontist should examine a cleft lip/palate infant at birth, in conjunction with the surgical review. The orthodontist and especially the restorative dentist will be treating the patient during and long after the surgical treatment period,

An abnormal speech pattern associated with an orofacial anomaly.

The speech of a 24-year old white female with multiple oralfacial anomalies was studied by articulations testing and connected speech samples. Speech physiological characteristics were investigated by using cinefluorographic analysis. The results of these studies, as well as the unique pattern of compensatory articulatory movements were reviewed.

Prostheses, stents, and splints for the oral cancer patient†

There are definite indications for the use of prosthetic devices in the treat ment of oral cancer. However, the use of these devices is not as widespread and well established as might be de sired. Furthermore, supportive and re habilitative prosthetic care of the oral cancer patient has not received the learned attention required to produce a sophisticated discipline. Few persons have given concentrated effort toward overcoming the lack of agreed opinion, uniformity in technique, discovery or application of new materials, nor have we acquired an adequate knowledge of predictable tissue response to pros theses and other mechanical devices. Although detailed guidelines might not be universally accepted at this time, it has been the intent of this com mittee to be as specific as possible in offering suggestions for treating the oral cancer patient and in presenting suggestions that are based upon cur rent experience and knowledge. It seems fitting in this study to recommend ideal standards for the use of prostheses in the therapy of oral cavity malignancy, since anything less might detract from the opportunities for eradicating the disease, for achiev ing long-term survival among patients

Plastic surgical conditions in infancy and childhood.

A number of operations, if mastered, will produce excellent results in repair of cleft lip. The optimal age is between the first and second months of life.Correction of cleft palate is highly specialized and technically difficult. A good age for repair is between 14 and 18 months.Protruding ears can be corrected before the child enters school.Surgical separation of syndactylous fingers may be postponed until the age of four or five years unless normal growth and development are prevented or the thumb is involved.A transplant operation using the gracilis muscle has been successful in many cases of rectal incontinence and has also been used to correct urinary incontinence. Five to six years seems to be the best age for the operation.