Faculty Bibliography

13 cases of Goldenhar-Gorlin syndrome are presented in which numerous central nervous system anomalies have been found. These include occipital encephalocele, hydrocephalus, aqueductal stenosis, agenesis of corpus callosum, multiple congenital lipomas and many others. Pertinent literature has been reviewed. It is concluded that any part of the central nervous system can be involved in this condition and that careful evaluation is indicated in order to rule out a treatable intracranial anomaly

Malignant lesions of the nasopharynx and paranasal sinuses often encroach upon the orbit. A series of nineteen patients who underwent partial or radical maxillectomy is presented to summarize the eyelid and orbital findings that required further treatment. Fifteen of these patients were left with an intact globe and a visually useful eye, but the defects of epiphora, eyelid malposition, dacryocystitis, and diplopia were visually threatening and required treatment. The cosmetic deformities and diplopia following maxillectomy and radiation are partially amenable to treatment with late bone grafting. Lacrimal outflow deficiencies were successfully treated with dacryocystorhinostomy. Only patients with ocular complications following maxillectomy are included in this series; therefore, the range of problems and their treatment confronting the ophthalmologist is summarized

Vertical wedge excision of the lower lid is advocated in selected patients undergoing blepharoplasty to prevent postoperative ectropion. Candidates for "V" excision include patients with a predisposition for senile ectropion. Diagnosis and surgical technique are described.

In using autogenous vein grafts in microvascular surgery, maintenance of compliance at the site of anastomosis is of importance in achieving patency. Using high-frequency, 20 MHz, pulsed Doppler ultrasonography to monitor blood flow velocity through the vein graft, we have evaluated the effects of continuous and interrupted suture technique on anastomotic compliance in vessels less than 1.5 mm in diameter. In 15 dogs, 15 procedures of each technique, using the continuous technique in one limb and the interrupted technique on the contralateral limb, patency rates for both techniques, documented by arteriography, are 100% at a mean follow-up of 11 weeks. There were no significant differences in the blood velocity profile and pulsatility proximally, distally, and at the graft site between continuous and interrupted technique. This study confirms the suggestion that autogenous vein graft has sufficient elasticity to maintain normal arterial blood velocity waveforms.

The author's experience with 10 gluteus maximus myodermal free flap breast reconstructions is reviewed against the current methods of reconstruction using silicone implants, latissimus dorsi flaps, regional skin flaps, and rectus abdominis myodermal flaps. The superior gluteal free flap can achieve a reliable, permanent, and aesthetic reconstruction of the breast without silicone implants. The softness, projection, natural appearance, and patient satisfaction are excellent compared with other methods. It is particularly useful in patients who object to the use of artificial implants, are not suitable for regional flaps, or have disappointing results from previous reconstructions. Technical modifications of the flap design and selection of the recipient vessels are important.

Laser Doppler flowmetry (LDF) is a noninvasive and continuous method of monitoring dermal blood flow in free flaps. There are two LDFs available for clinical application: the LD5000 Laser Doppler Perfusion Monitor and the Periflux Laser Doppler Flowmeter. Varying degrees of arterial (N = 46) and venous (N = 28) occlusion were induced in saphenous island flaps of the dog, while simultaneous measurements with the LD5000 and Periflux LDFs were made. The millivoltage output of both the LD5000 and the Periflux showed a high degree of correlation with arterial and venous occlusion and with each other.

Extracts from Escherichia coli cells induced for the adaptive response have been prepared that are capable of repairing O6-methylguanine, O4-methylthymine, and the phosphotriesters produced on the DNA backbone by alkylating agents such as N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). The phosphotriesters are repaired by a methyltransferase distinct from the one that demethylates O6-methylguanine. We propose that this increased capacity to repair phosphotriesters accounts for much of the increased resistance to MNNG toxicity seen in cultures induced for the adaptive response.