Cheek repair.

The cheek, one of the most important facial aesthetic units, adjoins key facial structures including the mouth, nose, and eyelids. When undertaking cutaneous cheek defect repair, these functional structures must remain undisturbed. Indeed, the size, depth, and position of each defect must be critically assessed in relation to surrounding donor tissue and landmarks. This article reviews cheek anatomy, surface landmarks, and the various surgical options for achieving successful aesthetic and functional repair.

Quality-of-life outcomes after osteoplastic frontal sinus obliteration.

Frontal sinusitis and its treatment remain controversial. Although several authors have evaluated the results of traditional endoscopic sinus surgery, few have assessed patient outcomes and quality of life after osteoplastic frontal sinus obliteration. This retrospective study evaluates these outcomes in a postoperative review and questionnaire of 39 patients treated at the University of Washington from 1991 to 1994. Most patients were satisfied with the results of this procedure, had significant improvements in their Chronic Sinusitis Survey scores, and reported decreased clinic visits and antibiotic use. However, approximately half thought nonsurgical treatments were more effective and continued to require other medical therapy; 30% required additional surgical intervention. Such outcomes may reflect the ineffectiveness of frontal sinus obliteration to treat the chronic symptoms of patients affected by the refractory underlying disease process of chronic sinusitis; however, despite these mixed results, we found a significant decrease in annual days of lost work or activity in this study group after osteoplastic obliteration.

Nasal reconstruction using the inferior turbinate mucosal flap.

Reconstruction of nasal defects can be a difficult task if large amounts of nasal mucosa are missing. We have found the inferior turbinate mucosal flap to be a reliable and effective flap in a series of 16 patients undergoing nasal reconstruction or repair of septal perforations. Most of these patients had insufficient mucosa to use traditional flaps harvested from the nasal floor or the lateral nasal wall. Eight patients underwent reconstruction of septal perforations, 9 patients underwent nasal reconstruction of large nasal defects after tumor extirpation, and 1 patient underwent closure of a palatal fistula. Six of the septal perforations were closed completely and 3 were reduced in size by 50%. All 11 turbinate flaps used for nasal reconstruction (2 patients had bilateral flaps) survived. Two flaps underwent mild superficial epidermolysis without flap necrosis or exposure of overlying cartilage grafts. The turbinate flap is based anteriorly and provides large amounts of well-vascularized mucosa. The turbinate is rotated anteriorly and bivalved and the conchal bone is removed to increase the dimensions of the flap. The flap is sometimes staged to allow transfer of mucosa to distant sites, such as the septum, the nasal ala, and the nasal wall. An anatomical dissection of 10 turbinate flaps on 5 fresh cadaver specimens demonstrated an average flap size of 4.97 cm2. The average length of the flap was 2.83 cm, which is sufficient length to reach the nasal dorsum. A description of the surgical technique and the vascular supply of this flap will be discussed.

The Internet and the World Wide Web.

The Internet offers easy, unrestricted access to an incredible volume of information. Once cumbersome methods of information retrieval and communication, the Internet and World Wide Web are now vital tools in medical practice. This article discusses current Internet technology and provides the basics necessary to incorporate this useful medium into your practice.

The extended Abbé flap.

Large upper lip defects that include the surrounding aesthetic subunits of the midface are difficult to reconstruct. Abbé flaps have been a popular method of dealing with small upper lip defects but, as classically described, they are insufficient for larger defects. We performed cadaver injections to evaluate the vascular territory supplied by the inferior labial artery with particular attention to the submental area. Extended Abbé flaps were then designed and used in combined upper lip and midfacial reconstruction. Three cases and guidelines for the use of the extended Abbé flap are presented.

Organ distribution of the Ro (SS-A) antigen in the guinea pig.

Using an anti-Ro (SS-A)-specific "sandwich" enzyme-linked immunosorbent assay (ELISA) and Western immunoblotting, we determined the Ro (SS-A) content (both quantitative and qualitative) in saline-perfused organs of the guinea pig. All tissue extracts contained substantial concentrations of Ro (SS-A) antigen and could be grouped into 3 categories based on quantitative reactivity in the sandwich ELISA. The 60-kd and 52-kd molecular forms of Ro (SS-A) present in tissue extracts were similar to those described in Wi-L2 extracts, and the 54-kd molecular form of Ro (SS-A) in guinea pig erythrocytes was similar to that found in human erythrocytes. The tissue distribution of the isoforms of Ro (SS-A) was shown by Western immunoblotting to vary in different tissues, and the reactivity to the 60-kd Ro (SS-A) was correlated with the activity seen in the ELISA. Both the 60-kd and 52-kd Ro (SS-A) bands in guinea pig liver extracts were very weak on Western immunoblots, in contrast to the high concentration of Ro (SS-A) antigen in the ELISA. Other data suggest the possible existence of a unique form of Ro (SS-A) in the liver. Guinea pig tissues have 4 Y RNA that are equivalent to the 4 human RNA--hY1, hY3, hY4, and hY5--present in HeLa cells, while guinea pig red blood cells have only one Y RNA, which is equivalent in size to human hY4.(ABSTRACT TRUNCATED AT 250 WORDS)