Reduction malarplasty using a zygomatic arch-lifting technique.

BACKGROUND: Broad or excessive malar protrusion is a trait associated with aggression and old age in Asian cultures. Although various methods of shifting the zygoma have been introduced for reduction malarplasty, soft tissue sagging and inadequate bony union still remain great challenges. We have devised an arch-lifting technique that helps overcome these issues. An analysis of surgical outcomes is presented herein. METHODS: A total of 54 patients subjected to lifting malar reductions between January 2013 and November 2014 were retrospectively reviewed. The reduction procedure entailed an L-shaped osteotomy of the zygomaticomaxillary junction via an intraoral approach. In addition, a prefabricated U-shaped microplate was applied for arch fixation in the lifted position. The follow-up period ranged from 6 to 18 months (average, 9.2 months), during which medical records, photographs, and facial bone computed tomography (CT) images were obtained to assess the postoperative results. RESULTS: Patients were generally satisfied with aesthetic outcomes, thus rating the procedure excellent in terms of zygomatic prominence, midfacial width, symmetry, and resistance to cheek drooping. There were no major complications, such as facial nerve damage or trismus. An inadequate bony contact occurred in two instances due to unanticipated trauma, with immediate reduction and fixation thereafter. Minor wound infections developed in three patients but responded well to antibiotics. CONCLUSION: Zygomatic reduction procedures must consider the dynamics of the adjacent muscles, which are stabilized through arch fixation. The use of our arch-lifting technique for reduction malarplasty efficiently elevates the zygomatic complex, thereby ensuring an adequate bone-to-bone contact. Predictable and accurate outcomes are thereby achieved.

[Hereditary multiple exostoses]. / Multiple kartilaginäre Exostosenkrankheit.

BACKGROUND: Hereditary multiple exostosis (HME) is a hereditary autosomal dominant disease in which multiple exostoses occur. Typically, the exostoses are primarily located at the metaphysis and migrate with continued growth towards the diaphysis. Clinical problems are caused by local pain, impingement of muscle tendons and neurovascular structures, malformation - especially in the forearm - and malignant transformation - especially exostoses at the trunc and pelvic girdle. METHODS: A causal therapy is currently not available. Mechanical irritation is an indication for resection of the exostosis. Axial deviation of the lower extremity is treated according to the same principles as primary malalignments (temporary hemiepiphysiodesis/corrective osteotomy). RESULTS: The indication for correction of axial deviation at the upper extremity depends on age, extent as well as functional and cosmetic impairment. This should be discussed with the patient in detail. The patient has to be informed about the risk of malignant transformation after cessation of growth. Growing mass or new occurrence of symptoms after end of growth are suspicious and require further diagnostic examinations.

Utilidad de la hemiepifisiodesis en el manejo del Genu Valgo en la osteodistrofia renal / Usefulness of hemiepiphysiodesis for the management of Genu valgum in renal osteodystrophy

Introducción: La osteodistrofia renal provoca desejes progresivos en los miembros inferiores, siendo la deformidad más frecuente el genu valgo. El crecimiento guiado (hemiepifisiodesis) es útil en la corrección de deformidades angulares en la edad pediátrica. El objetivo de este trabajo es evaluar los resultados y complicaciones de esta técnica quirúrgica aplicada a fisis patológicas. Materiales y métodos: Se presentan 11 pacientes (20 rodillas) con diagnóstico de insuficiencia renal crónica y genu valgo, tratados en nuestro servicio con hemiepifisiodesis transitoria. Se colocaron placas en 8 en 3 pacientes (5 rodillas) y en 8 pacientes, grapas (15 rodillas). Se evaluó el eje mecánico radiográfico pre y post operatorio y las complicaciones relativas a cada implante. Resultados: Se logró la corrección completa en 4 pacientes, 1 caso sobrellevó deformidad rebote, y en los restantes se obtuvo mejoría sin llegar a la normalización óptima del eje mecánico. Conclusiones: La corrección obtenida se relaciona claramente con la normalidad de la función renal. Los pacientes trasplantados consiguieron normalización en el crecimiento óseo remanente. No tuvimos diferencia en los resultados ni en las complicaciones entre los dos tipos de implantes empleados.

Utilidad de la Hemiepifisiodesis en el manejo del Genu Valgo en la osteodistrofia renal / Usefulness of hemiepiphysiodesis for the management of Genu valgum in renal osteodystrophy

Introducción: La osteodistrofia renal provoca desejes progresivos en los miembros inferiores, siendo la deformidad más frecuente el genu valgo. El crecimiento guiado (hemiepifisiodesis) es útil en la corrección de deformidades angulares en la edad pediátrica. El objetivo de este trabajo es evaluar los resultados y complicaciones de esta técnica quirúrgica aplicada a fisis patológicas. Materiales y métodos: Se presentan 11 pacientes (20 rodillas) con diagnóstico de insuficiencia renal crónica y genu valgo, tratados en nuestro servicio con hemiepifisiodesis transitoria. Se colocaron placas en 8 en 3 pacientes (5 rodillas) y en 8 pacientes, grapas (15 rodillas). Se evaluó el eje mecánico radiográfico pre y post operatorio y las complicaciones relativas a cada implante. Resultados: Se logró la corrección completa en 4 pacientes, 1 caso sobrellevó deformidad rebote, y en los restantes se obtuvo mejoría sin llegar a la normalización óptima del eje mecánico. Conclusiones: La corrección obtenida se relaciona claramente con la normalidad de la función renal. Los pacientes trasplantados consiguieron normalización en el crecimiento óseo remanente. No tuvimos diferencia en los resultados ni en las complicaciones entre los dos tipos de implantes empleados

Osteotomies: the surgical treatment of the valgus knee.

Lateral compartment arthrosis from congenital valgus or the result of previous lateral meniscectomy can be a disabling condition. Realignment osteotomy, which may avoid or delay the need for a total knee replacement, is appropriate for young or middle-aged patients suffering from a painful valgus knee. Medium or large corrections can be managed with distal femoral lateral opening wedge osteotomy while minimal deformities are best treated with medial closing wedge tibial osteotomy.

Luxación congénita de rodilla. A propósito de un caso / Congenital Knee dislocation. A case report

Se hace la presentación de una paciente con una luxacióncongénita de rodilla no tratada que ha evolucionadonaturalmente, y a modo de curiosidad médica y con finesdocentes se exponen sus características clínicas y radiológicas.Se describen además los hallazgos encontrados comoconsecuencia de esta anomalía no corregida en la edadadulta. Se comenta acerca de la importancia del manejoadecuado y oportuno de esta afección

We report a female patient with a congenital knee dislocationno treated which development naturally, and amedical curiosity mode and with purpose teaching weshow the clinical and radiological characteristic. We alsoshow the discovery finds as consequence of this no correctanomaly in the adult age. We comment about of the importanceof the adequate and timely management of thisdisease

[Posteromedial bowing of the lower leg and neuroblastoma with possible neurofibromatosis type I: a case report and literature review]. / Posteromediale Unterschenkelverbiegung und Neuroblastom bei Verdacht auf Neurofibromatose Typ I: Kasuistik und Literaturübersicht.

BACKGROUND: The posteromedial bowing of the tibia is a rare condition that is not yet known to be related to neurofibromatosis. The case of a three month-old boy with the tentative diagnosis of neurofibromatosis is described. He developed paraplegia due to an abdominal neuroblastoma at the age of 9 months. This led us to a review of the literature. METHOD: 122 cases of posteromedial bowing of the tibia in 20 publications of the years 1949 - 2000 were analysed under special respect to gender, side of affection, shortening of the lower leg, treatment and possible cause. RESULTS: The posteromedial bowing of the lower leg seems to affect more boys as well as the left side. As far as described in all but one case it was the first delivery. Regularly, a limb shortening and pes calcaneovalgus is to be found. 99 children were treated conservatively, 21 got an operation of the affected side. In 19 performed osteotomies no pseudarthrosis occurred. One case of a fracture due to an adequate trauma without healing problems is described.

Significance and management of congenital malalignment of the big toenail.

Often misdiagnosed, congenital malalignment of the big toenail is not an uncommon condition. It consists of a lateral deviation of the long axis of nail growth relative to the distal phalanx. This would be of minor importance if it were not for local complications that may arise in infancy and adulthood. Some cases of this inherited dysplasia have demonstrated a tendency to spontaneous improvement. Therefore, photographic surveys should be made at regular intervals to monitor the need for possible surgery.

Hereditary congenital posterior dislocation of radial heads.

We report on 4 patients with congenital posterior dislocation of radial heads in 3 generations of a family. Radiographs of the elbow joints of 3 individuals are presented. All affected subjects have mild limitation of extension and a strong restriction of rotation in the elbows. Comparison with previously described patients shows similarities in the X-ray findings. Congenital posterior dislocation of the radial head can be unilateral or bilateral. This malformation is also found in patients with antecubital pterygium or nail-patella syndrome. This family confirms the autosomal dominant inheritance of congenital posterior dislocation of radial heads.