Michael Gilhooly

Total nasal reconstruction using composite radial forearm free flap and forehead flap as a one-stage procedure with minor revision

The refashioning of the many distinct structures necessary for successful anatomical and aesthetic reconstruction of the nose after total rhinectomy is difficult. Several significant operations are needed to produce good aesthetic results with functional patency of the nasal airway. We describe a method using autologous grafts that has produced good results on both occasions when it was done. It has the advantage of only one major operation and one subsequent minor revision.

The nasopharyngeal airway: reliable and effective tool for marsupialisation

arsupialisation is a recognised, and often the preerred, method for initial treatment of large odontoenic cysts.1,2 Its use for the initial management of arge unicystic ameloblastomas is increasingly being eported.3 Operation typically involves removing the bony wall of an ccessible area of the cyst where an incisional biopsy specmen of the cystic lining is taken. Several surgical methods nd tools have been described for maintaining the patency of he opening into the cystic cavity.1,2 We have successfully used a nasopharyngeal airway for his purpose for many years as it has several advantages ver other methods. Fixation by suturing the flange to the eighbouring mucosa is reliable, and the tube is availble in various diameters and can be altered in length o suit the size of the cavity. The tube is radio-opaque nd this facilitates the monitoring of its position within he cavity during decompression. Nasopharyngeal tubes are elatively cheap, are readily available in operating thetres, and allow for regular irrigation of the cavity by he patient. Their use eliminates the need for a laboratory r technician to construct a prefabricated acrylic obturator Figs. 1 and 2).

Minimal-access technique for harvest of the radial forearm flap

he radial forearm flap has been widely used for reconstructons of the head and neck since it was first described by Yang t al. in 1981.1 It has a long vascular pedicle, predictable natomy, and is easy to harvest. With the advent of perforaor flaps (anterolateral thigh and medial sural), the primacy f the radial forearm flap has been challenged.2 It is likely, owever, that it will remain necessary on rare occasions, such s when double paddles of thin pliable skin are required,3 or hen small vascularised segments of bone are needed for tructural support.4

Apparently aberrant fixation of a fracture of the oblique angle of the mandible.

A 56-year-old man presented with a fracture of the angle of is left mandible after a fall. Through a transbuccal approach, e did an open reduction and achieved internal fixation of the racture with a single 2 mm miniplate on the lateral surface f the mandible. We extracted the lower left third molar to elp us with the reduction. The postoperative plain radiographs showed that the fixtion plate was distal to the position of the fracture although e had a good postoperative occlusion (Fig. 1). Threeimensional computed tomography (CT) showed a fracture f the buccal cortex of the angle of the mandible, which we ad correctly plated (Fig. 2). We did not see this fracture line

Use of double skin paddle for pharyngoesophageal reconstruction using tubed radial forearm free flap

r c econstruction of pharyngeal defects are complex and ely upon advanced microsurgical skill to ensure success. hese can also be compromised by the effect radioherapy necessitating delayed reconstructive surgery to orrect soft tissue stricturing of the pharynx many years ater. We describe how adaptations in flap design can help adeuately reconstruct the pharynx and prevent tension in the adiation treated neck. Following laryngectomy strictures may develop in the harynx or oesophagus and impede bolus passage and voice roduction. This can be related to tight surgical closures, adiation therapy and post-operative infections. Post laryngectomy patients use small valves to create air esonance and tracheoesophageal speech. Tightness here can ffect the patients voice quality and hence directly impact pon their quality of life. Patient A had a total laryngectomy and neck dissection in 006 following which they had radiotherapy and remained isease free. The patient was fitted with a Blom-Singer voice rosthesis for voice reproduction. Over the proceeding 6

Cook-Swartz Implantable Doppler: The UK experience - a retrospective analysis

domain than did Crouzon’s patients (p=0.017). Females with Apert’s syndrome had a statistically poorer QoL in the social domain than Apert’s affected men (p=0.037). Conclusions: Following a literature search, we think this is the first such study in the UK and the largest in the world to date. Overall, these patients represent a resilient group who may have responded well to previous psychological support. Management strategies should be targeted towards the social domain, particularly in female patients with Apert’s syndrome.