Chemical face peeling.

The author reviews his approach to the use of phenol for chemical face peeling. A discussion of preoperative, intraoperative, and postoperative care is included. Indications, benefits, and possible complications of the procedure are discussed.

Immunohistologic studies of cytoplasmic immunoglobulins in rheumatic diseases including two patients with monoclonal patterns and subsequent lymphoma.

Tissue specimens from five patients with rheumatic disease who developed lymphadenopathy were studied by an immunoperoxidase method; available biopsy material was examined for cytoplasmic immunoglobulin determinants. Three patients had follicular hyperplasia of lymph nodes with polyclonal patterns. Two patients with Sjogren's syndrome had monoclonal patterns; both of these patients subsequently developed lymphoma with similar monoclonal patterns. Implications of the monoclonal patterns with regard to the biology of these lymphoproliferative disorders are discussed.

Traumatic facial arteriovenous malformations.

Traumatic arteriovenous malformations (AVM) represent an abnormal communication between arteries and veins and are usually complex. They occur most commonly in the extremities and are noted most often in military casualties. In the literature there are approximately 25 cases of traumatic AVM of the facial region which are angiographically documented. To these are added five documented cases from this paper, one which was proven at surgery, and one which was suspected from classical signs and symptoms but not diagnosed. The trauma leading to the AVM may be: penetrating, blunt, postsurgical, or inflammatory. A swelling of the face, pulsatile tinnitus, throbbing headache and bleeding comprise the main presenting symptoms. A bruit and thrill are usually present. Doppler ultrasonography and selective arteriography will provide the essential diagnostic information. Embolization therapy may be a helpful preoperative adjunct or may be the total therapy if surgery cannot be performed. Proper identification of the feeder vessels, surgical control of these vessels, total excision of the AVM with functional and cosmetic reconstruction of the tissue defect remain the basic principles of therapy.

Unilateral tonsillar enlargement.

Unilateral tonsillar enlargement may result from infection, chronic inflammatory response, or neoplasm. Neoplasms that commonly produce a unilaterally enlarged tonsil include lymphomas (lymphocytic and histiocytic types) and squamous cell carcinomas. Rarer tumors include extramedullary plasmacytomas, Hodgkin's disease, leukemia, and metastatic neoplasms. Sixteen cases of unilateral tonsillar enlargement owing to causes other than squamous cell carcinoma are reviewed. When examining a patient with unilateral tonsillar enlargement, diagnosis of a neoplastic disease must be considered.

Traumatic injuries in the parotid region.

The facial nerve, parotid duct, and external ear canal are at risk from penetrating injuries in the parotid region. The areas of the face supplied by the major branches of the facial nerve should be checked in the emergency department so that repair of a cut nerve can be performed while the distal end is able to be stimulated electronically. The parotid duct can be probed and lacerations repaired. The external ear canal should be repaired and stented to prevent stenosis.

Dacryocystorhinostomy utilizing an anterior lacrimal sac flap to periosteum technique.

Dacryocystorhinostomy is used in the effective treatment of epiphora secondary to obstruction of the lacrimal drainage system. Common causes of obstruction include canalicular disruption, lacrimal sac fibrosis, and external and internal nasal trauma. Most techniques of dacryocystorhinostomy attempt to suture the lacrimal sac mucosa to the nasal mucosa. At best this is technically difficult, and the mucosa frequently tears. A technique is presented using an anteriorly based lacrimal sac pedicle flap sutured to the periosteum of the anterior lacrimal crest. The sutured flap is quite strong, and the procedure is technically simpler than others. A brief description of the causes of lacrimal obstruction is given. The Jones primary and secondary dye tests for lacrimal system patency are reviewed.

External ear injuries.

The unique shape of the external ear depends on the underlying cartilaginous framework. Injuries of the external ear are common. In dealing with lacerations, subperichondrial hematomas, perichondritis, burns and frostbite, particular care should be taken to maintain the cartilaginous framework and to prevent infection. In this way cosmetic deformities of the external ear can be prevented.