Typical changes in the viscerocranium in acromegaly.
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Acromegaly↗
Biomedical subjects
D K Ousterhout
Publications and source records attributed to D K Ousterhout.
The course of the inferior alveolar neurovascular canal in relation to sliding genioplasty.
The anterior course of the inferior alveolar neurovascular canal was determined in 52 hemimandibles using high-resolution radiographs. Significant variability was found in its course. It was noted that if the osteotomies for sliding genioplasty were performed at least 6 mm below the inferior border of the mental foramen, injury to the mental nerve would be reduced.
Chin↗
Recipient vessels for microvascular transplants in patients with hemifacial microsomia.
Hemifacial microsomia is a developmental abnormality involving structures derived from the first and second branchial arches. Microvascular transplants are increasingly being used to improve facial contour in patients with this condition. We have reviewed 9 patients with this abnormality to determine which recipient vessels have been used. In 6 patients, the facial vessels were located and used for flap revascularization. In 3 patients, the facial vessels could not be identified intraoperatively, and the occipital artery and a branch of the external jugular vein were used as recipient vessels. In this series of hemifacial microsomia patients, therefore, the facial vessels could not be located in 3 patients. We recommend that surgeons performing microsurgical transplants in cases of hemifacial microsomia be prepared to explore the external carotid and external jugular systems for recipient vessels.
Face↗
Transconjunctival lower eyelid blepharoplasty.
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Eyelid Neoplasms↗
Mandibular angle augmentation and reduction.
The mandibular angle is receiving more attention as now every area of the craniofacial skeleton is a candidate for aesthetic modification. Both reduction and augmentation of this posterior area of the mandible are addressed. Surgical techniques, results, and complications are described after the cosmetic problems are demonstrated. Representative cases are presented.
Bone Transplantation↗
Aesthetic improvement of the forehead utilizing methylmethacrylate onlay implants.
Forehead augmentation occasionally is necessary for obtaining a desirable upper facial contour. The final contour must be sexually appropriate and must project beyond the cornea of the eyes an amount that makes the contour aesthetically pleasing. Methylmethacrylate onlay implants, preformed or sculpted at the time of surgery, lend themselves to obtaining a desirable contour which can be modified easily at surgery, which is completed in a one-stage procedure, has few complications, and yields an aesthetically pleasing result. The methods for fabricating and implanting the onlay prosthesis in a single step and the results of such procedures, which have been performed over a 12-year period without complications, are presented.
Forehead↗
Histologic evaluation of the coronal sutures in trigonocephaly.
Thirteen cases of trigonocephaly, seven isolated and six syndromic cases, were evaluated by preoperative neurologic and genetic evaluation and by radiographic evaluation (CT scans). All 13 were treated in an identical surgical manner. Specimens from the coronal sutures were obtained during surgery for histologic evaluation. All of the isolated cases, except one, showed normal coronal sutures and had a good-to-excellent result from surgery. All of the syndromic or secondary cases showed an abnormality of the coronal sutures. Four of the six cases had bad results; two required subsequent surgical procedures. It is our opinion that if a coronal suture abnormality is noted on preoperative CT scans or if preoperative evaluation demonstrates an associated syndrome or CNS malformation, the results from surgery must be guarded.
Cranial Sutures↗
Long-term follow-up on a case of untreated trigonocephaly.
Trigonocephaly is typically treated during the second 3 months of life by metopic suture synostectomy, orbital rim advancement, and cranioplasty. The results are generally very pleasing in nonsyndromic patients. We have not, however, seen adults with residual deformity who preceded the present basic approach to treatment first described by Hoffman and Mohr (1976). Dominguez et al (1981) described 15 individuals who improved without treatment. The question that arises is whether we are treating this congenital problem unnecessarily, particularly in nonsyndromic patients. We present a 38-year-old untreated woman who still has residual signs of the deformity seen in early childhood photographs.
Adult↗
Combined suction-assisted lipectomy, surgical lipectomy, and surgical abdominoplasty.
Although combined suction-assisted lipectomy (SAL) and surgical abdominoplasties have been described, the surgical excisions have in general been small and limited to the lower portion of the lower abdomen (i.e., just above the pubis). For the obese patient this is an insufficient lipectomy. SAL alone is unsatisfactory because the marked skin excess will not shrink sufficiently to allow a desired final result. Surgical abdominoplasty alone is also insufficient in the obese patient because the thickness of the abdominal panniculus is not reduced and, additionally, secondary to tissue tension with wound closure, some necrosis of skin above the pubis is not unusual. In this article results are described from a small consecutive series of obese patients treated with a combined extensive SAL, surgical lipectomy, and surgical abdominoplasty. The sequence of fat removal is different than that which has been previously described. In all of the patients the results were pleasing, and there were only two relatively minor complications.
Abdomen↗
Posttraumatic condylar hyperplasia.
Posttraumatic condylar hyperplasia can result in complex facial asymmetry composed of degrees of condylar and ramus overgrowth, malocclusion, and complementary maxillary deformity. Three patients with unilateral condylar hyperplasia are described to illustrate the scope of surgical and orthodontic treatment required to restore facial symmetry. Condylar hyperplasia with facial asymmetry should be recognized as a possible consequence of condylar injury, and further delineation of the onset and natural history of this deformity could lead to investigations or intervention before the establishment of all the components of the deformity.
Adolescent↗
Retrognathism.
Retrognathia is a common deformity that generally requires both orthodontics and surgery for correction. The surgical correction of the problem is best completed in the majority of cases with the sagittal splitting osteotomy. While the surgery is generally successful, relapse is a formidable problem. Instrument registration methods for properly positioning the condyles are being developed, but at this time are not totally successful. Lag screw fixation of the segments is very stable and seems to limit relapse but requires a facial incision with a resulting scar. Future technology probably will allow for internal placement of lag screws. Until such techniques are available, the use of intermaxillary fixation followed by an elastics activated registration bite splint to facilitate healing is recommended.
Adult↗
Placement of the umbilicus in an abdominoplasty.
The location of the umbilicus was measured in 100 randomly selected non-obese subjects. It was found that a line drawn from the highest level of the crest of one ilium to the same point on the other side will transect the umbilicus in 96 percent of the subjects. This relationship can be of use during an abdominoplasty, when determining the location for the umbilicus.
Abdomen↗
Correcting craniofacial abnormalities.
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Adolescent↗
Pediatric neurosurgical implications of the amniotic band disruption complex. Case reports and review of the literature.
Defects caused by the amniotic band disruption complex (ABDC) may vary from simple malformations caused by digital constriction to major scalp, craniofacial, and visceral malformations. ABDC may cause 7-14% of stillbirths. The etiology is unclear, but the most commonly accepted mechanism involves rupture of the amnion followed by fetal malformation, deformation, and compression. This mechanism does not adequately explain all anomalies such as hydrocephalus and holoprosencephaly that are seen in the ABDC. The use of prenatal ultrasound has allowed the diagnosis of the ABDC in utero. Since 1980, four children with the ABDC who required neurosurgical intervention were seen at the University of California, San Francisco; the presentation and subsequent surgical treatment of 2 of these children are discussed. A combined craniofacial team approach to the management of these children can maximize reconstructive and neurologic outcome.
Abnormalities, Multiple↗