M. M. Al-Qattan

Klumpke's birth palsy. Does it really exist?

Erb’s palsy is the most common obstetric brachial plexus injury followed by total plexus palsy. The distribution of Klumpke’s birth palsy with modern obstetric practice is unknown. In this paper, we studied the distribution of Klumpke’s birth palsy in our series of 235 consecutive cases of obstetrical brachial plexus injury and determined the incidence of this type of palsy to be 0.6% as cited in the English literature over the last decade.

The Prognostic Value of Concurrent Horner’s Syndrome in Total Obstetric Brachial Plexus Injury

The prognostic value of concurrent Horner’s syndrome in infants with total birth palsy was investigated. The records of 48 cases with total palsy were reviewed. Poor spontaneous return of the motor function of the limb was found for both with and without concurrent Horner’s syndrome. Fisher’s exact test (P=0.02) indicated that the presence of concurrent Horner’s syndrome is a significant prognostic factor for poor spontaneous recovery of the limb.

The prognostic value of concurrent clavicular fractures in newborns with obstetric brachial plexus palsy

This study investigates the prognostic value of concurrent clavicular fractures in newborn babies with obstetric brachial plexus palsy. The records of 183 consecutive newborn babies with brachial plexus birth injury from 1988 to 1993 were reviewed retrospectively. Poor outcome, specifically insufficient spontaneous return of motor function of the limb necessitating primary brachial plexus surgery, was assessed for infants both with and without concurrent clavicular fractures. 13 newborn babies had concurrent clavicular fractures, and of these two required primary brachial plexus surgery. On the other hand, surgery was required for 43 of the remaining 170 infants with intact clavicles. Using Fisher’s exact test, P = 0.2. Concurrent clavicular fractures in newborns with obstetrical brachial plexus palsy have no prognostic value in predicting spontaneous recovery.

Carpal tunnel syndrome in children and adolescents with no history of trauma

Four cases of carpal tunnel syndrome in children and adolescents with no history of trauma are discussed. The pertinent literature and a classification of the different causes of carpal tunnel syndrome in this age group is presented.

Nasal glioma: is dermis involvement significant?

Nasal gliomas are rare, benign, congenital masses more accurately referred to as sequestered glial tissue. Seven patients with nasal glioma treated by Hugh G. Thomson over the last 28 years are presented with special reference to tumor recurrence after excision and associated naso-ocular cleft. Three of our patients had an associated ipsilateral naso-ocular cleft, and three similar cases have been reported. This association is probably more frequent because a naso-ocular cleft can exist as a forme fruste and be easily overlooked. The first two tumors resected in our series recurred within 10 months; however, no recurrences were seen after a new treatment protocol was initiated in 1972. This consisted of total excision of the skin overlying the tumor if the skin adhered to the mass or if glial elements were seen within the dermis on frozen section. Deep resection margin was also assessed by frozen section of the nasal mucosa or fibrous stalk of the tumor. Accordingly, unnecessary intracranial procedures were avoided without increasing the risk of recurrence.

Congenital giant pigmented nevi: Clinical features and risk of malignancy

MJ Weinberg, M Al-Qattan, RM Zuker, HG Thomson, WK Lindsay. Can J Plast Surg 1996;4(2):94-98. There is general agreement that congenital giant pigmented nevi (CGPN) are precursors to malignant melanoma; however, the magnitude of the risk of malignant transformation is the subject of wide controversy. The goal of this study was to present the authors’ experience with CGPN and more specifically their experience with the risk of malignancy. To identify the general features of CGPN a detailed retrospective chart review was performed at The Hospital for Sick Children in Toronto (1979 to 1994, n=84). There were 39 boys and 45 girls. The average size at presentation was 5.24% of the body surface area, and 36.9% of the nevus were located on the head and neck. An important finding was the high percentage of associated extra cutaneous disorders in patients with CGPN (23%) including a case of leptomeningeal melanocytosis. Tissue expansion was the most commonly used treatment modality. One case of malignant melanoma arising from CGPN was identified. To ensure that all cases of malignant melanoma were identified in this cohort, a questionnaire was sent to all plastic surgeons in Ontario (n=118), and data from the Ontario Cancer Registry were reviewed using the diagnostic codes for malignant melanoma and for pigmented nevus. One case of malignant melanoma was identified in all records. Thus CGPN poses a significant management challenge to the plastic surgeon and the risk of malignancy is low.

Type 4 Median Nerve Entrapment after Elbow Dislocation

A rare case of median nerve entrapment after posterior elbow dislocation is reported. Nerve entrapment was both in the healed medial epicondyle fracture and within the elbow joint and we recommend placing this type of entrapment separately in an extended classification of median nerve entrapment following elbow dislocation.

Two rapidly growing fatty tumors of the upper limb in children: Lipoblastoma and infiltrating lipoma

One case of lipoblastoma and another case of infiltrating lipoma of the upper limb in infancy are reported. These rare benign fatty tumors may be congenital and may grow rapidly soon after birth. The classification of these fatty tumors and their management are presented to increase awareness of the benign nature of these tumors despite their rapid growth and to demonstrate that complete surgical excision should be done to prevent local recurrence.

On the neglected entity of unilateral gynecomastia.

Although there are many articles in the literature on the etiology, classification, and management of gynecomastia, the entity of unilateral gynecomastia has not received much attention. In this article, 15 consecutive males (seen over a 10-year period) with unilateral gynecomastia were retrospectively reviewed. The study showed the unique presentation in this group of patients. One third of the patients (n = 5) had “cancer phobia” and were worried either because of the presence of a mass (n = 2) or because of the unilaterality of their disease (n = 3). The study also showed the predominance of true (glandular) gynecomastia, and this has also been observed in other cases of unilateral involvement in the literature. All patients underwent preoperative mammography. Mammographic findings were consistent with gynecomastia in all patients, including the 2 patients with concurrent breast masses. All patients underwent subcutaneous mastectomy, and histologic examination confirmed the diagnosis. Finally, the literature on unilateral gynecomastia was reviewed.

The Use of a Shunting Catheter for a Ruptured Brachial Artery Following Open Elbow Dislocation

A rare case of rupture of the brachial artery with distal ischaemia following open elbow dislocation in a child is reported. The use of a shunting catheter successfully maintained the distal circulation until definitive brachial artery reconstruction was performed.