Cadaver Nerve Grafts: Past, Present and Future.

Nerve grafts represent an invaluable tool, when reconstructing nerve defects of more than 1 cm. Historically, the criterion standard use of autografts has relied on the premise of using nonessential sensory nerves to fulfill the principle of replacing "like with like," while simultaneously minimizing the infliction of undue morbidity on the patient. The reconstructive surgeon thus faces a dilemma when extensive nerve damage requires reconstruction, or when donor nerves are not available or limited such as in the pediatric population. Cadaver nerve grafts (CNG) uniquely allow for reconstruction of large nerve lesions without the presence of host morbidity. The following article reviews the use of CNG, its indications, advantages, and disadvantages, as well as provides some case studies of real-world application. In addition, an insight into the future perspectives of CNG is provided.

Anterior Tongue Microglossia: Impact on Face Development.

Microglossia is an extremely rare developmental condition that might impact the patient's respiratory, feeding and speech functions, in addition to other intraoral structures. Embryologically, the tongue has 2 origins, which when affected, will determine whether the patient has microglossia or aglossia. A multidisciplinary team should adopt an organized approach based on confirmation by direct laryngoscopy, determination whether associated airway anomalies, mandibular deformities are present; followed by assessment of the ventilatory and feeding status. The involvement of multiple factors, the presence of several anatomical anomalies and the growth exerted by patients, confer microglossia a rather dynamic clinical entity. Two cases of microglossia depicting these features are presented along with review of the literature and a management algorithm.

The Management of Facial Fractures: The Legacy of William Milton Adams.

Dr Adams was one of the most prominent members of the American Association of Plastic Surgeons and served as secretary and president (1954) of the American Society of Plastic Surgery. Although Dr Adams died unexpectedly at 51 years of age (1957), he described many new techniques and published several outstanding and innovating papers. He was the first to report, in 1942, the use of subcutaneous wires for internal fixation of fractures of the upper jaw. The purpose of this historical paper is to point out the contribution of Dr Adams in the evolution of management of facial fractures.

Isolated Frontosphenoidal Suture Craniosynostosis: Treatment Approaches and Literature Review for a Unique Condition.

BACKGROUND: Craniosynostosis isolated to the frontosphenoidal suture is an extremely rare entity, distinct from other types of synostotic anterior plagiocephaly, from the embryologic, phenotypic and endocranial morphology viewpoints. Embryologically, the sphenoid bone has two origins, which morphogenetically represent 2 distinct subunits. Depending on the region involved, unique craniofacial features involving the forehead, temporal region and orbit will be demonstrated. A case of frontosphenoidal suture synostosis depicting these features is presented. In addition, a literature review was performed and a treatment algorithm is proposed.

Mid-Term Outcome of Mandibular Distraction Osteogenesis in Pierre Robin Sequence.

The aim of the present study was to present a single center's experience with mandibular distraction osteogenesis (MDO) in Pierre Robin sequence (PRS) patients. A retrospective chart review was performed to identify patients with PRS that underwent MDO at our institution from 2003 to 2012. Inclusion criteria were as follows:Evaluation included demographic information, postoperative complications, and surgical outcomes. Twenty-four patients met the inclusion criteria. No complications related to our distraction technique were reported. Most of the patients who had a tracheostomy were successfully decannulated and the rest were able to avoid a tracheostomy. Two patients had superficial infections that were treated conservatively with topical antibiotics. One patient, who was our first case in the series, required 3 episodes of distraction osteogenesis. Another patient demonstrated recurrent symptoms of obstructive sleep apnea after MDO and was treated with continuous positive airway pressure. Over-correction during MDO in PRS is an efficient method for preventing future airway problems. Patients who required a tracheotomy pre-distraction and cases in whom distraction was performed at older age (>2 months of age), had a lower success rate in achieving de-cannulation and a higher rate of complications. Laryngomalacia, gastro-esophageal reflux disease, cardiac, and GI anomalies are not associated with increased failure rates of MDO in PRS.

[Endoscopy and bariatric surgery. A new challenge?]. / Endoscopia en cirugía bariátrica. Un nuevo reto?

BACKGROUND: Obesity in Mexico appears with a frequency of 38.4% in men and 43.3% in women. Within the therapeutic options, bariatric surgery is defined as the only effective treatment in the long term, and the number of procedures is increasing. Postoperative complications are sometimes challenging for those who are evaluating them. We undertook this study to describe and to correlate endoscopic findings with gastrointestinal symptoms in patients who have undergone a bariatric procedure. METHODS: This was a descriptive, prospective and longitudinal study that included all patients who underwent bariatric surgery between January 2004 and October 2006 and who presented gastrointestinal symptoms requiring postoperative endoscopic evaluation. RESULTS: Thirty-six patients were subjected to 45 videoendoscopies between January 2004 and October 2006. The most frequent endoscopic findings were normal postsurgical anatomy (18 patients, 50%), marginal ulcer (5 patients, 13.8%), stomal stenosis (8 patients, 22.2%), and migration of gastric band (1 patient, 2.7%). Abdominal pain was the most frequent symptom, appearing in 58.3% of patients, mainly in those with normal endoscopy. Nausea and vomiting were reported in 55.5% of the cases; 25% of the procedures done in the first 6 months were normal as compared with 75% of the cases that were done after 6 months. CONCLUSIONS: Normal videoendoscopy was the most frequent finding among patients who had undergone a bariatric procedure. Stomal stenosis was the most frequent abnormality. The presence of abdominal pain beginning 6 months postoperatively is a characteristic that predicts normal videoendoscopy.

Endoscopia en cirugía bariátrica: un nuevo reto? / Endoscopy and bariatric surgery: a new challenge?

BACKGROUND: Obesity in Mexico appears with a frequency of 38.4% in men and 43.3% in women. Within the therapeutic options, bariatric surgery is defined as the only effective treatment in the long term, and the number of procedures is increasing. Postoperative complications are sometimes challenging for those who are evaluating them. We undertook this study to describe and to correlate endoscopic findings with gastrointestinal symptoms in patients who have undergone a bariatric procedure. METHODS: This was a descriptive, prospective and longitudinal study that included all patients who underwent bariatric surgery between January 2004 and October 2006 and who presented gastrointestinal symptoms requiring postoperative endoscopic evaluation. RESULTS: Thirty-six patients were subjected to 45 videoendoscopies between January 2004 and October 2006. The most frequent endoscopic findings were normal postsurgical anatomy (18 patients, 50%), marginal ulcer (5 patients, 13.8%), stomal stenosis (8 patients, 22.2%), and migration of gastric band (1 patient, 2.7%). Abdominal pain was the most frequent symptom, appearing in 58.3% of patients, mainly in those with normal endoscopy. Nausea and vomiting were reported in 55.5% of the cases; 25% of the procedures done in the first 6 months were normal as compared with 75% of the cases that were done after 6 months. CONCLUSIONS: Normal videoendoscopy was the most frequent finding among patients who had undergone a bariatric procedure. Stomal stenosis was the most frequent abnormality. The presence of abdominal pain beginning 6 months postoperatively is a characteristic that predicts normal videoendoscopy.