New and Successful Technique for the Management of Parry-Romberg Syndrome's Soft Tissue Atrophy.

UNLABELLED: Parry-Romberg syndrome (PRS) is an infrequent, acquired disorder characterized by progressive hemiatrophy of the skin and soft tissue of the face and, in some patients, results in atrophy of muscles, cartilage, and the underlying bony structures.The disease process exhibits varying speeds of development, with onset occurring in early infancy or adolescence. Clinicians have classically reserved treatment until the end of the process. Various treatment modalities have been attempted with differing results. Described treatments include free tissue transfer (omentum, rectus, latissimus, serratus, diep, scapula, and parascapular), pedicled flaps, autologous tissue (dermis-fat, bone and cartilage, and fat), and biomaterials (silicone, polyethylene, and Alloderm).In this article, the authors present a patient of Parry-Romberg syndrome in a young boy who had undergone a free flap previously, which failed to fill the atrophy of the right hemifacial soft tissues. The authors used Integra, which is a bilayer porous matrix of cross-linked bovine tendon collagen and glycosaminoglycan, and a semipermeable polysiloxane (silicone layer) and fat grafts enriched with Harvest PRP, to produce volume and symmetric contour on the affected side. The patient had a follow up of 2 years with excellent esthetic and functional results. OBJECTIVE: The authors present a technique of volume replacement in patients with hemifacial atrophy because of Parry-Romberg syndrome, which has never been reported before in the international literature. STUDY: Microsurgical reconstruction is considered the gold standard to restore facial symmetry. Given a free flap morbidity and risk of complications, some patients opt for less extensive procedures. The authors present the case of a 12-year-old boy with a history of Parry-Romberg syndrome with resultant right hemifacial atrophy. Consistent with the usual pattern of atrophy, the onset of the patient's disease began at the age of 5 years. METHODS: The senior authors used a combination of a stacked Integra cheek implant and fat grafts enriched with Harvest PRP to produce volume and symmetric contour on the affected side. The patient was discharged home the next day after the surgical procedure from the recovery room, without complications. RESULTS: The patient was followed for 2 years. He has had no complications and maintains an excellent symmetric result. The patient is highly satisfied with his result and has not required any further surgery. Preoperative and postoperative photos at year of follow up are presented. DISCUSSION: Less invasive treatment options exist for hemifacial atrophy from Parry-Romberg syndrome.

Prevalence of Obstructive Sleep Apnea After Orticochea Pharyngoplasty for Velopharyngeal Insufficiency Management.

BACKGROUND AND PURPOSE: The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with velopharyngeal insufficiency after at least 1 year of the surgical procedure. DESIGN: Case series prospective descriptive study. MAIN OUTCOME MEASURES: At FISULAB, a rehabilitation center for patients with cleft palate, we studied 37 patients who were treated elsewhere with Orticochea pharyngoplasty for velopharyngeal insufficiency; these patients may or may not have had clinical symptoms related to OSA. All participants underwent a polysomnography sleep study, which was also done in different institutions. We applied the Epworth Sleepiness Scales during the clinical investigation because it is an effective instrument used to measure average daytime sleepiness. Another questionnaire to identify cases of OSA was used. Among other variables studied, the apnea/hypopnea index was the main outcome, while age and type of cleft were secondary variables. RESULTS: From 37 patients who were studied (100%), we obtained the following results: normal apnea/hypopnea index: seven patients (18.9%); mild apnea/hypopnea index: 14 patients (37.8%); moderate apnea/hypopnea index: eight patients (21.6%); and severe apnea/hypopnea index: eight patients (21.6%). CONCLUSIONS: In this study, we found that more than three quarters (81%) of the patients who were treated for velopharyngeal insufficiency with Orticochea pharyngoplasty presented obstructive sleep apnea when analyzing the apnea/hypopnea index in the polysomnography sleep study.

Unusual Dermatological Manifestations of Gout: Review of Literature and a Case Report.

BACKGROUND: Gouty panniculitis is a rare clinical manifestation of gout, characterized by deposits of monosodium urate crystals in the hypodermis. Our aim was to describe atypical and rare clinical presentations of gouty tophi. METHODS: We searched relevant English and Spanish literature of unusual gout manifestations using the following keywords: giant, gout, panniculitis, gouty panniculitis, gouty tophi, rare manifestations of gout, gouty, tophi, tophus, monosodium urate, uric acid, and unusual. Well-described case reports, case series, and review articles were evaluated and included in the literature review. RESULTS: International literature has reported fewer than 10 cases of gouty panniculitis worldwide. In this case report, the patient presents a rare manifestation of gouty panniculitis, with typical joint injuries, gouty tophi in both lower and upper extremities, chronic gouty tophi in the nose, for which only 3 cases have been reported in literature, and great hypertrophy of adipose tissue in the lower back. CONCLUSIONS: Tophi can be found in atypical locations, which increase morbidities and deformities caused by the disease. We report an interesting case of gouty panniculitis associated with great hypertrophy of the adipose tissue, a rare manifestation of gout, and unusual locations of tophi. These clinical manifestations in our patient have not been recorded before, which leads us to think that we are in the presence of a new dermatological manifestation of gout.

Sphenoid sinus and sphenoid bone fractures in patients with craniomaxillofacial trauma.

Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.