The lateral conchal resection otoplasty.

A procedure for surgical correction of protruding ears has been utilized in 118 cases. The technique incorporates steps to correct the most common deformities found on preoperative evaluation. The lateral conchal resection com bined with mattress sutures is not complex and thus readily learned by residents. It has yielded consistently excellent cosmetic results combined with an exceedingly low complication rate. The procedure is adaptable to well over 90 percent of patients seeking an otoplasty procedure.

Laryngotracheoesophageal cleft: the anterior approach.

Laryngotracheoesophageal cleft was reported by Richter in 1792 after he examined an infant at autopsy and found a common lumen of esophagus and laryngotrachea. The next case was not noted until 1949 by Finlay. A recent review shows 40 cases in the world literature to date. Successful surgical approaches to some of these problems have basically employed a lateral pharyngotomy technique. In the case presented herein, the exact pathology was obscured by a severe tetralogy of Fallot and recurrent pneumonitis from a suspected high H-type tracheoesophageal fistula. The length of this cleft prompted an anterior approach with laryngo-fissure, cricoidotomy, and division of four tracheal rings for a complete and successful repair. Thorough endoscopy of all infants suspected of any laryngeal anomaly would yield an earlier diagnosis and opportunity for reconstruction of the cleft.

External fixation in maxillofacial surgery.

The role of external fixation in the treatment of facial fractures is well defined. If standard open reduction and internal fixation techniques do not yield a satisfactory result, external fixation techniques may be required. Open reduction has the advantage of effecting precise approximation of fragments. However, this type of fixation may be inadequate, either because no stable point is available or because the angle of traction involved in fixation may result in displacement of the reduced fracture and subsequent malunion. When the facial skeleton is fractured, it tends to collapse inward, and if injury is severe, an external traction point anterior, lateral, or superior to the facial skeleton may be required to obtain a satisfactory result. There are occasions when intermaxillary fixation may be inadvisable, and in these instances external fixation techniques may be an appropriate means of immobilization. Finally external fixation techniques may be required in instances in which massive tissue loss precludes the use of standard open reduction and internal fixation techniques. It must be reemphasized that the methods of external fixation described here are not meant to supplant the standard techniques of open reduction and interosseous wiring, but when judicially employed complement them in achieving the desired result of precise reduction and firm fixation of the fractured facial skeleton.

Cicatricial pemphigoid confined to the larynx.

The main features linking and yet distinguishing bullous pemphigoid from cicatricial pemphigoid have been discussed. This report demonstrates the usefulness of direct immunofluorescence study in establishing a diagnosis of cicatricial pemphigoid when lesions are confined to a single and unusual site such as the larynx.

The effects of preservation methods on homologous incus transplants in cats.

Experimental incus transplants were performed in cats. The gross findings and histologic data were recorded and correlated to the use of four preservation methods for homografts (alcohol, Cialit, formalin, and freezing). The formalin preserved incudes produced the least middle ear reaction and ossicular fixation. These incudes also exhibited a uniform perivascular bone remodeling throughout the homograft while the bones preserved in Cialit and alcohol were replaced much faster and ossicular chain fixation occurred. The incus bones preserved by freezing were better tolerated than the Cialit and alcohol ones but not as well as the formalin ones.

Styloid process neuralgia: myth or fact.

Five cases of enlogated styloid processes sent in a 12-month period prompted a review of this subject and a reevaluation of the condition as it relates to other neuralgias of the head and neck. We review the head and neck pain syndromes and offer diagnostic criteria that will aid in the differential diagnosis and will facilitate appropriate management.

Laryngeal carcinoma in a Lynch syndrome II kindred.

Hereditary nonpolyposis colorectal cancer (HNPCC) accounts for about 4% to 6% of the total colorectal cancer burden. It is subdivided into Lynch syndrome I and II. Lynch syndrome I is characterized by an autosomal dominant inheritance pattern for site-specific, early onset, adenocarcinoma of the colon, with proximal predominance and an excess of synchronous and metachronous colonic cancers. Lynch syndrome II (cancer family syndrome) shows these same colon cancer characteristics, but differs in that there is an excess proclivity of other forms of cancer, particularly of the endometrium and ovary. This article documents a family that shows features of Lynch syndrome II. Unique aspects pertain to a patient who is in the direct genetic lineage (whose five brothers manifested colonic cancer), but who developed carcinoma of the uterine cervix at age 34 and laryngeal cancer at 60. The pedigree also shows uterine cervical carcinoma among other patients at genetic risk. Her son, who is a nonsmoker and nondrinker, manifested laryngeal cancer at age 31. These observations appear to add new information about tumor heterogeneity in HNPCC.