Anatomy of alar cartilages in blacks.

We conducted a morphologic and anatomic study on 24 alar cartilages in 12 Black American male cadavers. Measured parameters included the greatest height and width of each lateral crus and the distance of the caudal boarder of the lateral crus from the alar rim. The average height of the lateral crura was 1.2 cm and the average width was 1.8 cm. These measurements approximate those reported for Caucasians. They suggest that contrary to popular impression, the alar cartilages in Black Americans as a group may not be significantly smaller than in Caucasian Americans. The Black American alar cartilages in our study were found to be approximately the same distance from the nostril rim as those in the Caucasians. Three morphologic types of alar cartilages were found in our study. The most common shape was the convex-concave, found in 50%, followed by the smooth convex shape (33.3%). The simple-symmetrical and simple-interlocking (male-female) relationships of the medical crura were found in 50% and 41.7% of our specimens, respectively. There was one specimen of complex-interlocking (complex-symmetrical) relationship. These findings were compared with those described in Caucasians. The variability in the width of the alar cartilages in our study was found to be consistent with our division of the Black American nose into three types: type A (African), type B (Afro-Caucasian) and type C (Afro-Indian). The clinical significance of the results is discussed.

The African-American nose: Part II.

Nasal anthropometric studies were performed on 69 African-American adults (28 men and 41 women). Seven parameters were measured: nasal length, width of bridge, width of nose, protrusion, length of columella, nasolabial angle, and nasofrontal angle. Six area proportion indices were calculated from these measurements. Normal nasal measurements (defined as those within mean +/- 2 SD) were found in 95.2% of the 483 measurements; 72.3% of the measurements were within +/- 1 SD of the mean. The normal variation ratio ranged from 8.9 to 31.9%, indicating great variability as a result of the triethnic origin of African-Americans. Harmonious indices (mean +/- 2 SD) were present in 70% of the 414 indices. Optimal indices (mean +/- 1 SD) were present in 68.1%. The mean constituted only 1.9% of the optimal indices. Disproportionate indices (those greater than mean + 2 SD or less than mean - 2 SD) were present in 4.6%. The nasal measurements and indices were compared with those of North American Caucasians. The range of normal measurements and harmonious indices in this study define the linear parameters of the abstract concept of African-American ethnicity. Successful rhinoplasty is achieved through restoration of harmony, which is defined as optimal relationships between proportions. Our study provides those optimal values. Good preoperative measurements combined with understanding of the normal African-American nasal measurements and indices will improve aesthetic decisions at surgery and facilitate the achievement of harmony.

Nasal bones and pyriform apertures in blacks.

The nasal bones and pyriform apertures of 20 skulls were measured for length and width. There were 6 skulls from the Ashanti tribe in West Africa, 5 black American skulls, 5 skulls from Austria in northern Europe, and 4 American Indian skulls. The nasal bones were measured for length and width at the narrowest and widest portions and the pyriform apertures were measured for height and for width at the base, the mid section, and near the apex at the nasomaxillary suture line. The Ashanti nasal bones were the shortest with a length of 2.18 cm. They were the narrowest with mean widths of 0.47 and 0.83 cm. The Austrian nasal bones were the longest (mean, 3.02 cm). The mean widths were 0.68 and 1.11 cm. The Indian nasal bones had a mean height of 3.0 cm and were the widest with mean widths of 0.61 and 1.28 cm. The measurements of the American black nasal bones fell between the Ashanti on the one hand, and the Austrian and Indian on the other, with a mean height of 2.79 cm and mean widths of 0.49 and 1.03 cm, reflecting the triethnic origin. The pyriform aperture in the Ashanti was oval whereas the white and Indian pyriform apertures were triangular. The black American pyriform apertures varied from oval to triangular, also reflecting the triethnic origin. The clinical implication of these differences in black rhinoplasty are discussed.

The black American nose.

A study of 201 black American noses has led us to divide the black American nose into three groups, i.e., Groups A, B, and C, which we have called the "African," the "Afro-Caucasian," and the "Afro-Indian." Belonging to the African group (Group A) were 44% of the noses, 37% were Afro-Caucasian (Group B), and 19% were Afro-Indian (Group C). Fifty-three percent of the African noses had a concave dorsum, whereas only 10% of the Afro-Caucasian and 8% of the Afro-Indian group had a concave dorsum. On the other hand, 36% of the Afro-Caucasian group had a hump as did 63% of the Afro-Indian group. Only 18% of the African group had a hump. The most common nostril types were type IV (20%), type V (27%), and type VI (25%), the distribution of which varied with the nasal type. Anthropometric measurements showed variations according to type, with the African noses being the shortest and widest, the AFro-Caucasian the narrowest, and the Afro-Indian being the longest. Cadaver dissection showed that the alar cartilages varied from small and thin in the African group to large and thick in the Afro-Indian. All were covered by a heavy layer of fibrofatty tissue. The value of this grouping in the evaluation and surgery of the black American nose is discussed.

The role of topical thrombin in skin grafting.

A prospective study to evaluate the efficacy of thrombin as a hemostatic agent in burn patients was conducted on 24 patients undergoing debridement and skin grafting. All patients also acted as their own control. Results showed a 43.5% reduction in bleeding on the thrombin-treated sites compared with the control sites. There was no adverse effect on the rate of wound healing from the thrombin, and no difference in the nature of the scar seen at the thrombin-treated site compared with the control site.

Mandibular fractures in an American inner city: the Harlem Hospital Center experience.

A retrospective study of 116 patients treated at Harlem Hospital for mandibular fractures between 1984 and 1987 was performed. Men comprised 84% of the population studied. The mechanisms of injury were assault with fists and blunt objects (33%), falls (10%), kicking (3%), penetrating injuries (3%), and vehicular accidents (1%). The body of the mandible (46%) and the angle (22%) were the most common fracture sites. Intermaxillary fixation with arch bars was the most frequent method of treatment (55%), followed by open reduction and internal fixation (33%). The complication rate with open reduction was relatively low (15%) despite the fact that 73% of these patients were heavy drug or alcohol abusers with documented poor oral hygiene. This study further substantiates the findings that in the poor inner cities, blunt trauma from drug-related violence has become the major cause of mandibular fracture. Treatment of these patients should include prophylactic broad-spectrum antibiotics, improved oral hygiene, and supplemental nutrition.

Cosmetic and reconstructive breast surgery in blacks.

Black women have not embraced cosmetic and reconstructive surgery of the breast with the same enthusiasm as their Caucasian counterparts because of fear of hypertrophic scars. The authors offer suggestions on how to minimize the scarring associated with breast surgery in black women. They feel that intraareolar incisions should be used whenever circumareolar incisions are indicated in augmentation mammaplasty, because the areola, being a favored area, is less likely to produce hypertrophic scars. The Marchac technique of reduction mammaplasty is recommended because it produces a short horizontal scar of 5 to 8 cm confined to the breast without medial and lateral extension, which may hypertrophy in black women. In the reduction of large breasts, secondary excision of dogears 6 or more weeks after mammaplasty reduces the medial and lateral extents of the scar. The use of liposuction as an adjunct to reduction mammaplasty may also accomplish the same thing. Amputation and free nipple-areola grafting should be used with caution in black patients because of the tendency of the grafted areola to hypopigment. In postmastectomy reconstruction, the authors suggest that the techniques described by Ryan and Radovan should be considered first before the techniques of reconstruction utilizing myocutaneous flaps. In these procedures, no new scars which may hypertrophy are created away from the site of reconstruction. Staples should not be used in skin closure in blacks because they cause cross-hatching of the wound even when removed early.

Post-burn contractures in Ibadan.

A review of our experience with post-burn contractures over a ten-year-period at the University of Ibadan is reported. Fifty-two patients (32 males, 20 females) were treated; 52% were under the age of 5 years. In 25% the contractures were due to therapeutic burns. Sixty-two per cent of the contractures occurred in the upper limbs. Best results were obtained by release of contracture, application of split-thickness skin grafts, and splinting for up to six months.

Macrodactyly in blacks.

Fifteen cases of macrodactyly in blacks are reported. In three cases the fingers were affected and in 12 cases the toes were affected. Macrodactyly, while uncommon in whites, appears to be even less common in blacks. When it does occur in blacks, it involves the toes rather than the fingers, whereas in Caucasians, the fingers are predominantly affected. Most cases of metatarsal hypertrophy that have been reported in the literature so far have occurred in non-Caucasians.

Neoplastic change in chronic leg ulcer.

Seventeen cases of chronic leg ulcers were examined, 12 males and five females, with a mean age of 45 years. The average duration of ulcers was 21 years. Eleven of the cancers arose from ulcers that recurrently healed and broke down. Three arose from ulcers that never healed and three from stable scars. Treatment was by various levels of amputation in nine patients and by excision and skin grafting in one. Histological findings showed 16 cases to be squamous cell carcinoma while one case was sarcomatous in appearance. Most of the cases were poorly differentiated and findings of pseudoepitheliomatous hyperplasia were significant. This was thought to represent earlier stages of fetoplasia which in itself may continue for many years and may be a prelude to frank neoplasia. It was therefore suggested by the authors that the laboratory study of fetal antigens or other fetal markers in these types of lesions may be useful. It was also suggested that careful examination of deeper tissues in lesions where pseudoepitheliomatous hyperplasia has been found is necessary to ascertain that there is no undetected malignancy.

Acrocephalosyndactyly with hydrocephalus and dextrocardia in a Nigerian child.

A rare case of dextrocardia and hydrocephalus in a patient with acrocephalosyndactyly is reported. In the patient presented here, barium meal studies showed the gastrointestinal tract to be in normal position. There was no evidence of cardiac disease but the patient showed some neurological retardation at age nine months.

Vitamins and trace elements profiles in chronic leg ulcers in Nigerians.

This report discusses vitamins and trace elements profiles in Nigerians suffering from chronic leg ulcers. The levels of vitamin A, C and E are significantly lower than levels in healthy Nigerian controls. Copper values are almost the same in the two groups, but the results indicate deficiency of zinc. The relationship of these nutrients to wound healing is discussed; the addition of vitamin E in the management of leg ulcers is recommended.