Perry J. Johnson

Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible.

Background: Mandibular reconstruction using free fibular flaps can be performed using various plating techniques. Miniplates (≤2.0 mm) and reconstruction plates (>2.0 mm) have different characteristics that provide theoretical advantages and disadvantages with regard to successful neomandibular fixation. Methods: A retrospective review of 117 patients undergoing free fibular reconstruction of segmental mandibular defects over the past 10 years was performed. Characteristic data and complication rates were recorded; the authors compared patients who had fibular reconstruction of their mandibular defect with miniplates (n = 86) with those who underwent repair using reconstruction plates (n = 31). Results: No statistically significant difference was identified when comparing miniplates and reconstruction plates with regard to overall cumulative complication rates (46 versus 48 percent), flap failure (15 percent versus 27 percent), plate extrusion (23 percent versus 25 percent), malunion or nonunion (14 percent versus 13 percent), and plate fracture (10 percent versus 0 percent). (The cumulative percentage incidence weighs patient data according to length of follow-up.) The authors’ data did suggest a decreased incidence of osteonecrosis in the miniplate group (5 percent versus 38 percent; p = 0.02), but these results must be interpreted cautiously because of the small sample size. Conclusion: Selection of plate size, miniplate versus reconstruction plate, does not appear to affect the overall rate of complications in free fibular reconstruction of the mandible.

The use of full-thickness skin grafts for the skin-abutment interface around bone-anchored hearing aids.

Objective To review the complication rate encountered with the use of full-thickness skin grafts to establish the skin-abutment interface around bone-anchored hearing aid implants. Study Design Retrospective chart review. Setting Tertiary referral center. Patients Fifteen patients who underwent bone-anchored hearing aid placement over a 4-year period. Intervention Each percutaneous titanium implant and abutment was placed into the temporal bone following the standard Branemark technique. Eight procedures were performed in two stages, and seven were performed as single-stage procedures. In all cases, the skin-abutment interface was established by use of a full-thickness skin graft inset around the implant. Main Outcome Measures The incidence of complications resulting in skin graft loss, time from implantation to bone-anchored hearing aid use, additional procedures for revision of the interface, and complicating medical factors in the patient population. Results Seven patients (46.7%) experienced loss of the full-thickness skin graft around the abutment. Four of these seven had complicating medical factors associated with impaired wound healing: two with diabetes mellitus, one of whom was also a smoker, and two patients who were receiving inhaled steroids for treatment of asthma. Of the seven patients who lost skin grafts, two healed by secondary intention, two underwent repeated full-thickness skin grafting, and three underwent galeal rotation flaps with split-thickness skin grafting, one of which eventually required a scalp flap. No patient experienced loss of the implant. Conclusion The use of full-thickness skin grafts for establishment of the skin-abutment interface around bone-anchored hearing aid implants is associated with a high rate of graft loss. Although salvage techniques can successfully establish the interface after skin graft failure, alternative methods should be considered, especially in high-risk patients.

Early Versus Late Gold Weight Implantation for Rehabilitation of the Paralyzed Eyelid

Objectives/Hypothesis The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid.

Carbon Dioxide Laser Ablation of Anogenital Condyloma Acuminata in Pediatric Patients

The treatment of anogenital condyloma acuminata in pediatric patients is difficult, with a wide range of treatment strategies that yield variable success. Treatment regimens must consider the patient age, and etiology, location, and severity of lesions. We report our experience using the carbon dioxide (CO2) laser to ablate these lesions. A retrospective review of a single surgeons series of 17 consecutive patients was performed. A staging system was developed and used to document the extent of disease as related to prognosis, recurrence rates, and treatment options. There were 17 patients (5 males and 12 females). Eleven patients (65%) were treated after failing previous treatment. Perianal disease was noted in 14 of 17 patients (82%). No patients presented with stage I disease, 7 patients (41%) presented with stage II, 5 patients (29%) presented with stage III, and 5 patients (29%) presented with stage IV disease. Recurrence occurred in 4 of 17 patients (23%). Persistent disease occurred in 1 patient (6%). CO2 laser vaporization of anogenital condyloma acuminata in pediatric patients is safe, relatively atraumatic to the child, and associated with favorable recurrence rates. A staging scheme has been proposed in predicting recurrences, complications, and guiding therapy.

Invasive fungal sinusitis following liver or bone marrow transplantation

Invasive fungal infection of the nose and paranasal sinuses occurs almost exclusively in immunocompromised patients and is increasingly recognized as a complication of organ transplantation. We performed a retrospective chart review of 955 bone marrow and 749 liver transplant patients to identify risk factors, presenting signs and symptoms, methods of diagnosis, and successful management strategies. We report on five cases following bone marrow transplantation and one case following liver transplantation. Neutropenia is the single most important risk factor in the development of and recovery from invasive fungal sinusitis. Early diagnosis, combined with antifungal agents, hematopoietic growth factors, and aggressive surgical debridement is the most effective means of management.

Salvage of an infected hydroxyapatite cement cranioplasty with preservation of the implant material.

Preformed hydroxyapatite (HA) implants can be used for reconstruction of cranial and maxillofacial defects. Traditionally, infected alloplastic implants must be removed. The unique chemical composition of preferred HA, as well as the small pore size and lack of a fibrous reaction, confers relative resistance to infection. However, these implants require extensive planning and prefabrication. On the other hand, HA cement mixed with water forms a microporous implant that can be readily and quickly contoured during surgery. In addition, HA cement can be better contoured to fit the defect without any surrounding dead space. Theoretically, this should further the resistance to infection. After careful review of the literature, we report the first case of salvage of an infected HA cement cranioplasty with preservation of the implant material.

Venous hemangioma of the internal auditory canal.

A c o u s t i c schwannomas make up approximately 90% of cerebel lopont ine angle (CPA) and internal audi tory canal ( IAC) tumors. The second most common C P A tumor is men ing ioma followed by pr imary choles teatoma. Vascular tumors of the C P A and I A C are rare. A case of a venous hemang ioma confined to the right I A C simulating an acoustic s chwannoma is presented. A review of the l i terature and discussion of the signs and symptoms that may indicate that a lesion of the C P A or I A C is o ther than an acoustic schwannoma are presented.

Congenital nasal pyriform aperture stenosis.

Congenital nasal pyriform aperture stenosis is a rare, but increasingly recognized, form of neonatal nasal airway obstruction. The condition may occur as an isolated anomaly or in association with holoprosencephaly. Treatment is determined by the overall prognosis of the infant and the symptomatic severity of the stenosis.

Muir-Torre syndrome.

Muir-Torre syndrome is a rare autosomal dominant disorder characterized by unusual sebaceous neoplasms and visceral malignancy. Excluding sebaceous hyperplasia and sebaceous nevus of Jadassohn, sebaceous neoplasms occur so rarely that the presence of a sebaceous neoplasm mandates consideration of Muir-Torre syndrome. Sebaceous neoplasms precede or are synchronous with visceral malignancies in up to 40% or more of patients with Muir-Torre syndrome, and the presence of such a lesion warrants an evaluation for visceral malignancy.

Microvascular Reconstruction of the Head and Neck After Tumor Ablation

Microvascular reconstruction of the head and neck in cancer patients after surgical ablation has significantly improved the quality of life of these patients from both a functional and cosmetic standpoint. Successful management and reconstruction of these patients requires a well-coordinated team approach. Operating room times and hospital stays have significantly decreased with coordination and experience of the team members.