Nasofrontal heterotopic ossification following lymphangioma resection.

Heterotopic ossification (HO) is the formation of mature lamellar bone in soft tissues. Heterotopic ossification can occur locally following surgical trauma, most commonly after total hip arthroplasty. Periosteal stripping, organizing hematoma, and extensive soft tissue dissection have been associated with subsequent HO. Craniomaxillofacial HO is rare and almost always associated with injury to the muscles of mastication. We present a report of biopsy-established HO of the cranium. An 18-month-old boy presented with a soft, compressible mass in the forehead midline, which did not extend intracranially on computed tomography scan. Surgical exploration revealed a poorly marginated lymphangioma infiltrating the periosteum of the nasofrontal region. This was debulked to restore nasofrontal contour. Two months postoperatively, after minor accidental trauma, the patient developed a subperiosteal hematoma that was evacuated in the clinic. Eight months postoperatively, the patient returned with a visible nasofrontal prominence overlying a firm immobile mass. Computed tomography scan revealed a 3-cm horn-like osseous structure extending inferiorly from the frontal bone across the nasofrontal junction. The bony mass was resected via a coronal approach and confirmed as HO with hematopoietically active marrow.

The Graf/Biggs flap to increase upper pole projection in breast reductions with free nipple grafts.

BACKGROUND: Macromastia necessitating breast reduction with free nipple grafts often results in a breast shape that lacks upper pole projection. This study aimed to describe and review the experience with use of the Graf/Biggs flap to improve upper pole fullness in patients requiring breast reductions with free nipple grafts. METHODS: A retrospective review evaluated patients treated by the senior author who had breast reductions with free nipple grafts and simultaneous use of the Graf/Biggs flap. Reduction amount, aesthetic result, and complications including hematoma, seroma, infection, fat necrosis, wound breakdown, and nipple hypopigmentation were studied. RESULTS: A total of six patients, with an average follow-up period of 22 months, underwent breast reductions with free nipple grafts and simultaneous use of the Graf/Biggs flap. The average reduction amount was 2,583 g per side. There were no complications except for some early wound breakdowns at the lower T incision of the inframammary fold. These wounds resolved with local care. All the patients exhibited hypopigmentation of the grafted nipples and desirable breast shape, with excellent upper pole projection. All were universally happy with their result. CONCLUSION: The Graf/Biggs flap is a reliable technique for increasing upper pole projection in the patient requiring breast reduction with free nipple grafts.

Techniques for labia minora reduction: an algorithmic approach.

BACKGROUND: Aesthetic reduction of the labia minora has gained popularity, and a number of different techniques have been described. Each procedure has its own set of advantages and disadvantages. However, no algorithm has been defined for pairing the degree of deformity with the optimal surgical procedure. METHODS: Patients were stratified into one of four groups based on labial size. The surgeon chose one of three reduction techniques based on the degree of labial hypertrophy and the patient's aesthetic preferences for labial edge color and contour. Three reduction techniques were used including the edge excision technique, the inferior wedge resection technique, and deepithelialization reduction labioplasty. The success of aesthetic reduction was evaluated, as was symptomatic relief. RESULTS: The 12 procedures performed included five deepithelialization techniques, four edge excision techniques, and three inferior wedge resection techniques. As reported, 92% of the patients were "very satisfied" with their aesthetic and functional results. The complications were minimal, with three patients experiencing minor wound healing difficulties that resolved spontaneously. One patient who underwent the edge excision technique was "not satisfied" and complained of overreduction. CONCLUSION: The authors found all three techniques for labia minora reduction to be useful in different clinical situations. A novel algorithm is described for matching the optimal surgical technique for each patient based on her degree of hypertrophy and aesthetic goals.

Reconstruction of full-thickness calvarial defect: a role for artificial dermis.

The reconstruction of scalp defects presents a clinical challenge. Free tissue transfer has played an increasingly important role in the reconstruction of complex scalp defects. In many cases, patient medical comorbidities along with the length of the operative procedures incurs significant patient risk. Artificial dermis, used extensively in burn reconstruction, has emerged as a reconstructive option for the coverage of many complex posttraumatic and postoncologic defects; however, none have described its use for the reconstruction of full-thickness calvarial defects with exposed dura.We report a clinical case of an elderly, medically compromised patient with a full-thickness scalp defect, who underwent successful reconstruction with artificial dermis.The use of artificial dermis and subsequent skin grafting, as was performed in this case, provides a less invasive, less intensive, and satisfactory means of soft tissue reconstruction for full-thickness calvarial defects.

Defining the role for submental intubation.

Submental intubation, a less invasive alternative to tracheostomy, was first described for acute airway management of maxillofacial trauma patients, where nasoendotracheal intubation was contraindicated and oral intubation was not possible due to the desire to establish dental relationships perioperatively. While submental intubation is used most commonly in trauma patients, the range of indications for its use has broadened to include many orthognathic and skull base surgical procedures. Submental intubation is a safe, effective technique for many maxillofacial procedures, requiring the cooperation of both anesthesiologists and maxillofacial surgeons.

Minimally invasive lateral canthopexy (MILC).

Many techniques have been described for lateral canthopexy. Here, we describe a technical modification of lateral canthopexy that involves percutaneous placement of a canthopexy suture through the confluence of the lateral superior and inferior grey lines or lateral canthal angle. A total of 52 canthopexies in 26 patients have been performed with excellent results and few complications. Our lateral canthopexy modification is a minimally invasive technique that is simple to perform, with absolute assurance of capturing the lateral canthal tendon.

Polyamines regulate beta-catenin tyrosine phosphorylation via Ca(2+) during intestinal epithelial cell migration.

Polyamines are essential for early mucosal restitution that occurs by epithelial cell migration to reseal superficial wounds after injury. Normal intestinal epithelial cells are tightly bound in sheets, but they need to be rapidly disassembled during restitution. beta-Catenin is involved in cell-cell adhesion, and its tyrosine phosphorylation causes disassembly of adhesion junctions, enhancing the spreading of cells. The current study determined whether polyamines are required for the stimulation of epithelial cell migration by altering beta-catenin tyrosine phosphorylation. Migration of intestinal epithelial cells (IEC-6 line) after wounding was associated with an increase in beta-catenin tyrosine phosphorylation, which decreased the binding activity of beta-catenin to alpha-catenin. Polyamine depletion by alpha-difluoromethylornithine reduced cytoplasmic free Ca(2+) concentration ([Ca(2+)](cyt)), prevented induction of beta-catenin phosphorylation, and decreased cell migration. Elevation of [Ca(2+)](cyt) induced by the Ca(2+) ionophore ionomycin restored beta-catenin phosphorylation and promoted migration in polyamine-deficient cells. Decreased beta-catenin phosphorylation through the tyrosine kinase inhibitor herbimycin-A or genistein blocked cell migration, which was accompanied by reorganization of cytoskeletal proteins. These results indicate that beta-catenin tyrosine phosphorylation plays a critical role in polyamine-dependent cell migration and that polyamines induce beta-catenin tyrosine phosphorylation at least partially through [Ca(2+)](cyt).