Two-Stage Treatment of a Large Premaxillary Defect.

ABSTRACT: Bilateral cleft lip and palate (CLP) patients commonly require surgical management to treat maxillary hypoplasia following the primary repair. Rarer is the CLP patient who also presents with a missing premaxillary segment. Here the authors present the case of a 19-year-old female with a history of bilateral CLP who demonstrated significant maxillary hypoplasia in addition to a large premaxillary defect. To correct this deformity, LeFort I advancement with fibular reconstruction of the maxilla and dental implant placement was performed as a single surgical procedure. The authors discuss the advantages of undergoing this single-staged operation. By utilizing virtual surgical planning (VSP) and incorporating a multidisciplinary team within the operating room, the patient was able to successfully undergo maxillary reconstruction and dental implant placement in a single operation.

Closed traumatic rupture of the thenar muscles from the origin: a case report and review of the literature.

Closed traumatic rupture of the thenar muscles is an unusual and rare injury. Traumatic musculotendinous injuries in the hand and wrist occur primarily from penetrating trauma. Only 2 such cases were identified in medical literature. We report a case of closed traumatic rupture of the thenar muscles in an otherwise healthy 33-year-old female nurse who sustained a hyperabduction injury of her right thumb and wrist during a daily occupational routine, resulting in complete avulsion of the right abductor pollicis brevis and opponens pollicis from their origins. After declining initial surgical management, the patient subsequently returned 6 months later reporting continued pain, paresthesias, and thenar deformation, and requested surgical intervention. On examination, she continued to exhibit weakness of thumb abduction and mild weakness with opposition. She was again offered an open carpal tunnel release with exploration of the thenar eminence and possible tendon transfer, although she adamantly refused any tendon transfer. An open right carpal tunnel release was performed with exploration and direct muscle repair through a lateral thenar incision. Primary muscular reattachment was accomplished by suturing the abductor pollicis brevis and opponens pollicis to the flexor retinaculum and the trapezium. Functional results 15 months after surgery were satisfactory with improvements in abduction and opposition of the thumb and restoration of the thenar contour. The chosen surgical technique for repair resulted in good functional outcome, while avoiding the need for tendon transfer.

How Substance Users With ADHD Perceive the Relationship Between Substance Use and Emotional Functioning.

OBJECTIVE: Although substance use (SU) is elevated in ADHD and both are associated with disrupted emotional functioning, little is known about how emotions and SU interact in ADHD. We used a mixed qualitative-quantitative approach to explore this relationship. METHOD: Narrative comments were coded for 67 persistent (50 ADHD, 17 local normative comparison group [LNCG]) and 25 desistent (20 ADHD, 5 LNCG) substance users from the Multimodal Treatment Study of Children with ADHD (MTA) adult follow-up (21.7-26.7 years-old). RESULTS: SU persisters perceived SU positively affects emotional states and positive emotional effects outweigh negative effects. No ADHD group effects emerged. Qualitative analysis identified perceptions that cannabis enhanced positive mood for ADHD and LNCG SU persisters, and improved negative mood and ADHD for ADHD SU persisters. CONCLUSION: Perceptions about SU broadly and mood do not differentiate ADHD and non-ADHD SU persisters. However, perceptions that cannabis is therapeutic may inform ADHD-related risk for cannabis use.

Muscle hernias of the leg: A case report and comprehensive review of the literature.

A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment.

Les auteurs présentent le cas d'un vétéran âgé retraité ayant une hernie symptomatique du muscle court péronier responsable d'une compression du nerf péronier superficiel associée à une intervention chirurgicale précise. Les hernies symptomatiques des muscles des membres se produisent surtout dans la jambe et constituent de rares causes de douleurs chroniques de la jambe. Par le passé, les chirurgiens militaires traitants ont consigné les premiers cas de hernies de la jambe observés chez les recrues militaires actives. Une anomalie aponévrotique focale peut provoquer la herniation d'un muscle, une masse sous-cutanée palpable entraînant de la douleur et des symptômes au potentiel neuropathique associés à une atteinte nerveuse. On n'en connaît pas la véritable incidence, mais l'étiologie est classée comme secondaire à une faiblesse aponévrotique congénitale (ou constitutionnelle) ou à une anomalie aponévrotique acquise, qui découle habituellement d'un traumatisme direct ou indirect. On pense que l'occurrence la plus élevée s'observe chez les jeunes hommes physiquement actifs. L'atteinte du muscle tibial antérieur est la plus courante, mais d'autres muscles peuvent être touchés. L'échographie dynamique ou l'imagerie par résonance magnétique permet souvent de confirmer le diagnostic et d'orienter le traitement. La plupart des cas symptomatiques répondent bien à un traitement prudent, la chirurgie étant réservée aux cas réfractaires. Il existe diverses techniques chirurgicales, de la fasciotomie à la réparation anatomique de l'anomalie aponévrotique, mais aucun consensus ne se dégage quant au traitement optimal. Les cliniciens doivent se souvenir d'envisager les hernies musculaires dans le diagnostic différentiel des douleurs chroniques ou des neuropathies de la jambe. Une analyse approfondie des hernies musculaires de la jambe est présentée afin d'en faire ressortir les antécédents, l'occurrence, la présentation, le diagnostic et le traitement.