[Esthetic surgery in question].
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Biomedical subjects
Publications and source records attributed to J L Grignon.
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This congenital affection is frequently unrecognized as being a severe entity requiring early diagnosis and treatment, the latter in some cases involving emergency neonatal surgery. Constant surveillance should enable immediate intervention on the first signs of nutritional, infections or respiratory complications. Their repetition requires anterior fixation of the tongue to ensure adequate growth. The nature of the glossoptosis and palatal cleft determines symptoms and course, but these are also affected directly by the neurosomatic context. In these respects, and in order to isolate the syndrome described in this report from within the framework of the diagnostic imprecision of Pierre Robin's syndromes, it can be defined as "glosso-palato-mandibular respiratory distress of hypotrophic infants". This terminology combines elements of the clinical picture with target symptoms for therapy.
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This study concerned a homogeneous series of 233 children operated upon between 1960 and 1972 by the same surgeon, with an unchanging therapeutic attitude and followed up by a permanent team including surgeon, paediatrician, orthodontist, speech therapist. It represents a first critical analysis of the results obtained, here in an age group representing a minimum of 7 years follow up. Computer cards were prepared for each patient involving analysis of more than 400 parameters, in association with ensuring that patients who had not been followed up regularly were sent for and subjected to a complete assussment. The following main areas are covered: anatomoclinical aspects of clefts, associated lesions, initial surgical techniques and the postoperative course, ENT and paediatric problems arising during early childhood, orthodontic needs, investigations and results of speech therapy, complete assessments at 4 and 7 years.
A patient was found to have the first signs of a fibrous dysplasia of the left maxilla 50 years ago. At that time it was thought to be a maxillary sarcoma and was treated by irradiation on two occasions. The authors first saw the patient 20 years ago when he presented for treatment of an extensive degenerated osteoradionecrosis due to the previous irradiation therapy. Excision and reconstructive treatment caused many medical, psychological, and surgical problems. A part from the interest aroused by the numerous surgical repair procedures carried out, the essentially iatrogenic nature of the lesion and its effect on the life of this unfortunate patient convinced the authors of the need for publishing this rather sad history.
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The utilization technique has been slightly modified with use. At present, the glue is prepared in advance and kept in closed 5 ml. syringes. Formalin is no longer applied in the liquid form by means of a syringe and needle; but only with Spongel swabs impregnated with formalin and cut to the size of the bleeding point. This prevents the formalin from leaking on to the mucosae and burning them.
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