Sadao Tajima

The importance of the musculus nasalis and the use of the cleft margin flap in the repair of complete unilateral cleft lip

The deformities of the lip and nose in cleft lip patients are intimately inter-related and their repair should not be independent procedures. The reconstruction should be dynamic, taking into account the different functions of the groups of the perioral musculature. For the lip repair, attenuation of the musculus nasalis of the sound side and the formation of the levator sling are believed to be important. Nasal repair consists of upward transpositioning of the origin of the musculus nasalis and of plicating the nasal fascia, followed by the transfer of the bi-lobed cleft margin flap to the piriform margin.

A longitudinal study on electrical pulp testing following

A longitudinal study of electrical pulp testing was carried out in 27 cases, or 53 maxillary halves following Le Fort type fractures and Le Fort type osteotomies. On the average, most teeth required positive responses around 7 months or around 11 months afterwards. The central and lateral incisor teeth demonstrated poor results; only 8 percent and 36 percent responded positively at 8 months, and at 14 months, 23 per cent and 50 per cent, respectively. The overall percentage of responsive teeth was 29 percent at 6 months and 85 percent at 14 months. These results are discussed and compared with those of segmental maxillary osteotomy, together with the value of pulp testing in the diagnosis in fracture and osteotomy.Summary A longitudinal study of electrical pulp testing was carried out in 27 cases, or 53 maxillary halves following Le Fort type fractures and Le Fort type osteotomics. On the average, most teeth re-acquired positive responses around 7 months or around 11 months afterwards. The central and lateral incisor teeth demonstrated poor results; only 8% and 36% responded positively at 8 months, and at 14 months, 23% and 50%, respectively. The overall percentage of responsive teeth was 29% at 6 months and 85% at 14 months. These results are discussed and compared with those of segmental maxillary osteotomy, together with the value of pulp testing in the diagnosis in fracture and osteotomy.

Surgical treatment of malunited fracture of zygoma with diplopia and with comments on blow-out fracture

Summary Blow-out fracture is discussed and its classification is described, based on the factors producing the restriction of extra-ocular muscle (EOM) movement. Zygomatic fracture is complicated by EOM restriction and diplopia is present in 15% of recent and 56% of late fractures respectively. The mechanism of EOM restriction in malunited fracture of the zygoma if postulated and the rational surgical treatment is described in detail, together with the favourable results. Surgical intervention is aimed at the creation of a normal bony orbit and thus the establishment of conditions under which the EOM are minimally affected by tethering by intra-orbital scars. Orbital and antral approaches to the orbital contents are available via a single incision and an en bloc resection of a segment of the orbital rim, anterior part of orbital floor and anterior wall of antrum. Partial ostectomy along the proposed line of section is sometimes useful for easy reduction of a malunited fracture of the zygoma. For reconstruction of an extensive bony defect of the orbital floor, or for the fixation of a bone graft or for the creation of the base on which the bone graft is to be placed, the insertion of a short Kirschner wire (K-wire) is useful.

Malar bone fractures: experimental fractures on the dried skull and clinical sensory disturbances.

To improve understanding of malar bone fracture, experimental fractures on dried skulls and clinical sensory dysfunctions were investigated. In the experimental study, the fracture lines are largely confined to the suture lines between the zygoma and neighbouring bones in addition to the maxillo-ethmoidal suture. Antral walls, anterior and posterior, are relatively free from fracture lines in the region of the superior dental plexus. This coincides with the findings of dento-alveolar sensory disturbances which are relatively lower in incidence and earlier in recovery than those following Le Fort type fractures. To study this sensory status gives interesting information about the fracture lines and the anatomical course of the superior dental nerves.

Microvascular dissecting forceps complete with irrigator

FREQUENT irrigation is essential for successful microvascular surgery. Not only does it remove blood and prevent drying, but it opens up the cut vessel ends (Kleinert and Neale, 1974) and indeed will dilate them (Rigg, 1975); it also floats off the adventitia around the anastomosis and makes suturing easier and safer. To obtain most help from irrigation, timing must be precise. This is impossible if, without an assistant, one has to lay down one’s instruments and pick up an irrigator like those described by Rigg (1975) and Freshwater (1976); even with an assistant, precision is much inferior to that obtained when irrigation is completely under the operator’s control. Bipolar coagulating forceps with an attached irrigation nozzle have been described (Ring and Worpole, 1972; Dujovny et al., 1975) but are not fine’enough for microvascular surgery. The following instrument1 is foot controlled and has proved a valuable aid. The control “pedal” is a plastic bag filled with a heparm/saline solution and is attached to the forceps by a length of plastic tubing, containing a non-return valve which ensures that fluid emerges immediately from the nozzle on the slightest foot pressure (Fig. I). The nozzle is firmly attached to the inner side of one arm of the forceps

Temporal double inversion method in reshaping the temporal bulging in a case of Apert's syndrome

A case is reported of Aperts syndrome with severe bilateral balloonings of the temporal region in addition to other typical craniofacial deformities. He had had three previous strip craniectomies. His mentality and intelligence were normal. In order to improve his deformities, the following steps were carried out: 1. 1.5 cm frontal advancement with reshaping the horizontal arc of the supraorbital ridge by out-fracturing. 2. Bilateral temporal double turnover method with internal decompression of the temporal lobe by resection of the sphenoid wing abnormally roofing the temporal lobe. 3. Reduction of the height of the cranial vault. The result was gratifying.