Faculty Bibliography

Fifteen patients with paralysis of the 7th and 5th nerves or the 7th nerve alone were treated with an encircling silicone prosthesis. There has been no serious ocular complication observed over the last 3 years. The prosthesis has been removed in 9 of the 15 patients in whom good 7th nerve recovery has occurred. In the remaining 6 patients, the prosthesis is being well tolerated

A three-dimensional, multiplane cephalometric analysis is presented. This analysis permits visualization of skeletal midlines at selected depths of the craniofacial complex. When the midlines and associated anatomic structures are studied sequentially, the individual midlines may be combined conceptually into a warped midsagittal 'plane.' This localizes craniofacial asymmetry in the posteroanterior and basilar views. The study of structures in various coronal and transverse planes makes it possible to measure and record the three-dimensional relationships of anatomic structures to one another. A case of hemicraniofacial microsomia in which this analysis was used is presented

Various attempts to describe the skeletal characteristics of unilateral craniofacial microsomia have been made with the use of cephalometric and panoramic roentgenograms. Previous studies have been only descriptive in nature. To date, a detailed (quantitative) cephalometric analysis of the mandibular deformity has not been reported. The purpose of this study was to describe the skeletal jaw deformity by means of cephalometric landmarks in the lateral view. The patient population consisted of sixteen boys and eight girls who ranged in age from 6 to 16 years. They were compared to the University of Michigan normal control population for the following measures: gonial angle, mandibular plane angle, overall oblique length of the mandible, ramal height, and body length. The affected side showed a larger gonial angle and mandibular plane angle. The oblique length of the mandible (Cd-Gn) was decreased on both sides, as were ramal height and body length. Paradoxically, body length appeared shorter on the unaffected side than on the affected side. This paradoxical observation could be attributed to a shift of the mandible in relation to the midsagittal plane of the cranial base, the film cassette, and the path of the x-ray beam. Observation of the mandible in the basilar cephalogram explained the geometry of the projection error found in the lateral view. Similar projection errors exist for patients with other types of craniofacial asymmetry. It is suggested that two radiographic views, orthogonal to each other, should be used to define the x, y, and z planes for studies of craniofacial abnormality

A quantitative norepinephrine assay was used to follow tissue norepinephrine concentrations serially in bipedicle delayed pig flank flaps. In contrast to a previous study by Palmer, norepinephrine concentration decreased significantly after 24 hr, but then gradually returned to normal at 10 days. This suggests that the pig flank flap maintains much of its adrenergic innervation following bipedicle delay. It appears unlikely that adrenergic denervation explains the delay phenomenon in this model. The combined results of this study and others suggest that the degree of adrenergic denervation of a flap is determined by the anatomic layout of the flap with respect to the underlying cutaneous adrenergic neural anatomy. This experiment suggests that the effectiveness of adrenergic blocking agents in improving flap survival is dependent on the degree of adrenergic denervation of the flap.

Skin flap survival was studied experimentally in porcine flaps of constant width and varied lengths. No significant differences in flap surviving lengths were noted between 4 by 12 cm and 4 by 18 cm flaps. The concept that arteriovenous shunting in the distal portion of the flap adversely affects flap survival leads to the expectation longer flaps will have shorter surviving lengths than shorter flaps of the same width. Results of this study contradicted this hypothesis. If skin flap survival is determined by a progressive decrease in perfusion pressure as distance from the base of a flap increases, then vascular demand distal to the line of capillary perfusion should be of no consequence. Results of this study are consistent with this hypothesis.