Hypoglossal nerve paralysis in a burn patient following mechanical ventilation.

Traumatic injury resulting in isolated dysfunction of the hypoglossal nerve is relatively rare and described in few case reports. We present a patient with isolated unilateral palsy of the twelfth cranial nerve (CN XII) resulting from recurrent airway intervention following extensive burn injuries. The differential diagnosis for paralysis of the CN XII is also discussed herein. This case illustrates the significance of comprehensive diagnostic evaluation and the need for refined airway manipulation in patients that require multiple endotracheal intubations.

Une blessure traumatique résultant en un dysfonctionnement isolé du nerf hypoglosse est relativement rare et décrit dans quelques rapports de cas. Nous présentons un patient atteint de paralysie hypoglossal unilatérale isolée à la suite de l'intervention des voies respiratoires récurrentes après de brûlures extensives. Le diagnostic différentiel de la paralysie du nerf crânien (NC XII) est également discuté ici. Ce cas illustre l'importance de l'évaluation diagnostique complète et la nécessité pour la manipulation délicate des voies respiratoires chez les patients qui nécessitent de multiples intubations trachéales.

Treatment of rhinophyma with Er:YAG laser.

BACKGROUND AND OBJECTIVE: Rhinophyma is a benign, disfiguring disorder of the nose which presents the end stage of acne rosacea, and can also occasionally result in nasal airway obstruction. We describe the first series of patients treated with Erbium laser. STUDY DESIGN/MATERIALS AND METHODS: Severe-to-moderate rhinophyma in six patients were treated at our institution between 1995 and 1996, using the Erbium:YAG (Erb:YAG) laser. RESULTS: All patients achieved marked cosmetic improvement, with no complications. Post-operative healing time was seven to fourteen days-significantly shorter than similar other modalities. CONCLUSIONS: The Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period as shown in our study.

Total lower lip reconstruction with innervated muscle-bearing flaps: a modification of the Webster flap.

BACKGROUND: Mohs surgery and other surgical techniques are used for the removal of squamous cell carcinoma of the lower lip and may leave a large defect in the vermilion and underlying tissue. When nearly the entire lower lip is excised, reconstruction of this defect is a challenge. Repair requires the matching of vermilion color, maintenance of oral sphincter function and mouth opening size, and retention of sensation. Several techniques have been suggested. We present a modification of the Webster flap for total lower lip reconstruction using innervated muscle-bearing flaps. OBJECTIVE: To present a surgical technique for the reconstruction of total lower lip defects after excision of squamous cell carcinoma. METHODS: Innervated muscle-bearing flaps are used and demonstrated in one case. The surgical technique is discussed in detail. RESULTS: The reconstructive results were excellent. There were no postoperative complications. CONCLUSION: The use of innervated muscle-bearing flaps is a useful and effective option for the reconstruction of total lower lip defects.

The versatility of the nasolabial flap enhanced by the delay procedure.

BACKGROUND: The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall following Mohs surgery. However, both extirpation of a tumor in the region of the base of the flap or previous use of the flap often destroy the proximal axial blood supply to the flap, excluding its immediate utilization. We describe a different use of the nasolabial flap and a technique for preserving its capacity in the case of reutilization OBJECTIVE: To describe the versatility of the nasolabial flap and a delay procedure that enables its exploitation despite prior disruption of the proximal blood supply. METHODS: Three different uses of the same nasolabial flap are demonstrated in one patient. The surgical techniques are discussed in detail. RESULTS: The reconstructive results were excellent. There were no postoperative complications. CONCLUSION: The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall. When the nasolabial flap has been used before, or its blood supply compromised, the delay procedure can reestablish its applicability.

Turnover forehead flap combined with composite crus of helix graft for partial nasal reconstruction.

Partial lateral nasal defects challenge the plastic surgeon both technically and aesthetically. Many methods for reconstruction of these defects have been described. We have used a turnover forehead flap in conjunction with composite auricular graft for the reconstruction of nasal defects. The forehead flap is turned over so that the forehead skin serves as internal lining in the nose. The composite auricular graft serves as external nasal lining and provides mechanical support to the ala. The technique was used in seven patients and is presented here with illustrations, selected cases, results, and conclusions concerning patient selection.

Elongation by weight of a bipedicle hair-bearing neck flap.

We report a patient in whom weight was applied to a tube flap that was raised as part of an upper lip reconstruction procedure. Because the flap was found too short for transfer, weight was applied and flap elongation was achieved within a few days.

Lateral rhinotomy approach for Mohs micrographic surgery of the anterior septum.

BACKGROUND: Neoplasms of the nasal septum and internal alar surface are very difficult to treat. This is because of the complicated surface, proximity to important anatomic structures, and technical difficulty--both to resection and follow up. Mohs micrographic surgery might be the ideal mode of treatment for such tumors; however, it is very difficult to accomplish through the nostril. OBJECTIVE: To resect the tumor on the nasal septum and internal alar surface using Mohs micrographic surgery. METHODS: Lateral rhinotomy was performed as a preparatory stage to Mohs micrographic surgery of the anterior septum and intranasal alar surface. RESULTS: The ala nasi was detached from the cheek, thus exposing the anterior nasal cavity--enabling direct access to the neoplasms and allowing excellent visualization. CONCLUSION: Lateral rhinotomy, as described in this article, is a simple office procedure and in most cases heals with no visible scar.

[Moh's micrographic surgery: first experience in Israel].

Moh's micrographic surgery is a method by which cancer of the skin may be excised under complete microscopic control. It consistently offers the highest cure rate in the treatment of malignancy of the skin, while the least amount of uninvolved tissue is sacrificed. This, the first center for Moh's micrographic surgery in Israel, started functioning in 1989. The first 50 patients included 33 women (average age 50.7 years) and 17 men (average age 60.6 years) suffering from basal cell carcinoma of the face. 56% of the patients were referred for Moh's surgery after failure of other primary treatments, and the rest were referred due to the problematic location of the lesion or its size. 13 patients (28%) were referred after previous treatment with solcoderm (Mardi's method). In these patients the lesions were especially deep and aggressive.

Pseudolymphoma of the earlobes due to ear piercing.

Keloids are commonly seen as a complication of earlobe piercing. As biopsies are usually not performed routinely in many instances, some of the lesions might, in fact, represent other entities, such as cutaneous pseudolymphoma. Contrary to keloids, for which surgery alone is not recommended, a simple excision or superficial x-ray is sufficient in such cases.

[Resection of invasive orbital tumors and reconstruction with temporalis muscle flap].

3 patients with invasive basal cell carcinoma of the skin which necessitated orbital exenteration are reported. In all 3 treatment was delayed, primary therapy was inadequate and the tumor had reached massive size. Excision of the orbital contents is a radical, mutilating procedure, but in advanced cases of malignant orbital tumors it offers the only chance for survival. The temporalis muscle flap is adaptable, well supplied with blood, and contains a large mass of tissue. Its utilization provides a simple, uncomplicated and effective technique for orbital reconstruction following massive resection. It gives a relatively effective result which is usually acceptable to the patient.