Biomedical subjects
Publications and source records attributed to D R Millard.
This is a long-term follow-up of correction of nasolabial folds in conjunction with face lift that was first published in 1987. In the last 200 face lifts, nasolabial lipectomy has been carried out in 90 percent. Refinements and extensions of the procedure are also described with case illustrations.
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The rationale for combining two standard cleft palate procedures is set forth. The circumstances in which this combination is recommended are outlined and diagrammed. By joining the positive qualities of two established and popular methods, it is possible in certain cases to facilitate palate closure while reducing common minor complications by incorporating the good qualities of each procedure and reducing the negative.
The improved combination of surgical and dental teamwork in the primary treatment of clefts presented here is consistent with principles. In fact, this is a staged design for correction of classic clefts of the lip and palate that, based on biological principles, facilitates the continuance of the failed embryonic "migrations" toward a normal end point. Positioning of the alveolar segments, dissection of mucoperiosteum out of the cleft, and union of mucoperiosteum across the alveolar and anterior hard palate cleft make it possible to create a periosteal tunnel across the bony gap and set up a condition conducive to bone formation and eventual tooth eruption in the cleft area. Lip closure by adhesion reduces the tension of the primary lip closure and allows gentle molding until solidification of the arch occurs. Thus a complete cleft has been rendered an incomplete cleft. With a balanced, stabilized maxillary platform, the definitive lip and nose corrections can be carried to completion early (by 2 to 4 years of age). These planned actions bypass a persistent cleft, fistulas, raw areas, malposition of alveolar segments, and probably the necessity for later bone grafting. The only question not totally answered is the effect of this approach on final growth. Although most reports seem to indicate that growth has and will proceed within normal limits, another 10 years of careful follow-up is indicated and, in fact, is in progress.
A new complex of findings caused by cocaine abuse is presented. The complex consists of nasal collapse, septal perforation, palatal retraction, and pharyngeal wall ulceration. The findings and their causes are described. Pathologic evaluation to ensure that a concomitant disease, such as Wegener's granuloma, malignant reticulosis, autoimmune lesion, or various other destructive diseases, was not present was performed on only one patient. Although three patients presented with the findings caused by cocaine abuse, only one patient consented to the biopsy examinations. This case is presented in detail.
A simple approach to correct the constricted ear is described using a V-Y advancement to lengthen the periphery. Then through a posterior incision, an anterior exposure allows the creation of cartilaginous folds with scoring and sutures under direct vision.
The nasal septum can be used with impunity to assist in cosmetic and reconstructive rhinoplasty if an L-shaped bridge with anterior prow is preserved or constructed to maintain normal support to the nose. The septum can serve, of course, as a reservoir of cartilage grafts. Under special conditions, it can spare mucosal and chondromucosal or even osteochondromucosal flaps to aid in the supply of lining and support in reconstructions. The L-shaped septal chondromucosal flap has been found of value in total distal reconstructions and is now offered as a possible adjunct in the correction of certain intact but congenitally flat and/or short noses.
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Previous attempts to improve the nasolabial folds have been disappointing. By extending the face lift skin dissection to the nasolabial fold and up onto the malar prominence, reducing the fat of this fold by excision, and applying direct posterior retraction to the freed facial skin, rather dramatic improvement in the nasolabial folds have been achieved. This is a preliminary report with a follow-up of 8 months or less.
A rare case of nasal clefting was presented to illustrate and emphasize the following points: The workup of nasal clefting should be complete to rule out associated deformities. Marked improvement may be noted with normal growth during the first few years of life. The surgical procedure employed a primary V-Y flap harvested from the central excess of nasal skin based on a very thin vascular area at the nasal columella. At this primary procedure, the flap was telescoped on itself to provide fullness in the nasal tip area. It was also split, and two transposition flaps were inset into the gap left behind by rotating the ala into normal position. The donor area of the V-Y flap provided easy access to the intercanthal area so that the excess skin on the bridge of the nose could be reduced. Two subsequent minor procedures were required for adjusting irregularities in the tip.
This is an up-to-date review of the state of the art in the treatment of the fat neck at the University of Miami School of Medicine, based on twenty-five years of experience including several thousand cases. The combination of submental lipectomy, platysma myectomy, facelift, submandibular lipectomy, platysma myotomy, and posterior muscle traction with suture fixation has consistently produced marked improvement in the fat neck. Under this regimen, when the patient returns in five to ten years for a second lift, it is rare that the neck requires more than the skin tightening that comes with a simple facelift.
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A difficult secondary bilateral cleft lip deformity with nasal distortion was treated with eight local flaps specifically designed for this case. One of these was an Abbe flap in which the coronary vessel in the pedicle was inadvertently divided. The judgment in handling this flap and its fate as a composite lip flap based on a narrow mucosal pedicle is reported.
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A rare acinic cell carcinoma of the soft palate is reported and its potential for recurrence and metastasis discussed. A wide ablation created a speech-crippling defect that was reconstructed with an island flap from the opposite side and a pharyngeal flap for nasal lining and an island flap from the same side for oral cover. Speech is again normal.