Robert M. Oneal

Surgical anatomy of the nose

Knowing the details of nasal anatomy is absolutely necessary when undertaking the responsibility of rhinoplasty surgery. It is the essential first step. Careful study of these details makes for a more confident, prepared practitioner.

Diagnosis of silicone gel breast implant rupture by ultrasonography

&NA; To prospectively evaluate the efficacy of ultrasonography in the diagnosis of ruptured silicone gel breast implants, 98 patients (192 implants) underwent preoperative breast ultrasonograph) prior to silicone gel breast implant removal. The prevalence of implant rupture confirmed at surgery in this group of patients was 62 of the 192 implants (32 percent). Of the 60 implants diagnosed as ruptured by ultrasonography, 46 were confirmed as having visible defects at surgery (true positive) for a positive predictive value of 77 percent. Of the 132 implants diagnosed as intact by ultrasonography, 116 were confirmed as intact at surgery (true negative) for a negative predictive value of 88 percent. Overall, the sensitivity of ultrasonography for implant rupture was 74 percent, and the specificity was 89 percent. These findings demonstrate that ultrasonography is an effective imaging modality for the diagnosis of silicone gel breast implant rupture. Compared with mammography, ultrasonography appears to offer superior sensitivity and specificity without radiation exposure or discomfort. Although magnetic resonance imaging has shown considerable promise in the diagnosis of implant rupture, ultrasonography provides comparable sensitivity at a fraction of MRIs cost. (Plast. Reconstr. Surg. 97: 104, 1996.)

Skin expansion as an adjunct to reconstruction of the external ear

This case report illustrates the use of a Radovan tissue expander in a patient undergoing reconstruction of the upper two-thirds of the external ear. The expansion facilitated draping of the superior retro-auricular skin over the autogenous costal cartilage framework that was used for the skeletal reconstruction of the ear.

Surgical Anatomy of the Nose

A detailed understanding of nasal anatomy is essential when undertaking rhinoplasty surgery. This article describes the nasal anatomy, careful study of which makes for a more confident, prepared practitioner.

THE NEW AUTOMOBILE WINDSHIELD AND ITS EFFECTIVENESS IN REDUCING FACIAL LACERATIONS

FACIAL LACERATIONS FROM HEAD IMPACT TO THE NEW AUTOMOBILE WINDSHIELD ARE MARKEDLY REDUCED IN NUMBER, EXTENT, AND SEVERITY. PREVIOUSLY, WHEN THE PRE-1966 THINNER LAMINATE WINDSHIELD WAS IMPACTED BY THE HEAD, SLICING LACERATIONS WERE TYPICALLY FOUND. HEAD IMPACT TO THE NEW WINDSHIELD WILL TYPICALLY PRODUCE ABRASIONS AND SMALL LACERATIONS OF THE FOREHEAD AND NOSE THAT OFTEN DO NOT REQUIRE SURGICAL CLOSURE. ONLY RARELY IS THE LAMINATE OF THE NEW WINDSHIELD TORN. WHEN THIS DOES OCCUR, THE HEAD-TO-GLASS IMPACT SPEED IS MORE THAN DOUBLE THAT REQUIRED TO PERFORATE THE OLD THIN LAMINATE WINDSHIELD. IN THOSE FEW CASES WHERE THE THICKER LAMINATE IS TORN BY THE HEAD, SLICING LACERATIONS ARE SUSTAINED; BUT THESE TEND TO BE LESS EXTENSIVE AND LESS SEVERE THAN THOSE PREVIOUSLY NOTED ON THE OLD TYPE OF WINDSHIELD. THERE IS NO EVIDENCE THAT THE INCIDENCE OF INTRACRANIAL OR NECK INJURY IS INCREASED BY STRIKING THE NEW WINDSHIELD. /SRIS/

SURGICAL ANATOMY OF THE NOSE

It is imperative to know the details of the anatomy of the nose before understanding any surgical procedure performed on the nose. The details presented in this article should help the experienced and the novice surgeon accomplish the difficult task of a rhinoplasty.

Prolongation of skin homografts in rabbits, using cyclophosphamide

Summary 1. Cyclophosphamide can significantly prolong the survival of skin homografts in rabbits. 2. The histologic immune response in the regional lymph node and spleen was suppressed. 3. These results appeared to be a direct and specific effect of cyclophosphamide upon the immune mechanism, and not a nonspecific inhibition arising from a toxic state of the animals.