Faculty Bibliography

Computerized axial tomography is a new radiologic technique that permits noninvasive study of the skull, brain, and cerebral ventricles. This technique has been applied to the study of craniofacial malformations prior to intracranial surgical correction. The assessment of the cerebral ventricles is valuable as a base line study as well as helpful in detecting unsuspected abnormalities in the brain prior to surgery

Two patients with Goldenhar-Gorlin syndrome showed paralysis of one or more extraocular eye movements on neurologic examination. At autopsy, a third patient showed unilateral agenesis of trochlear and abducens nerves and corresponding brain stem nuclei. Congenital ophthalmoplegia is not infrequent in Goldenhar-Gorlin syndrome and may be due to hypoplasia or agenesis, or both, of extraocular muscles, extraocular nerves, and brain stem nuclei

Sensory skin flaps represent a possible solution for the paraplegic who has the problem of recurrent pressure sores. An intercostal neurovascular island flap has been used in 3 cases to provide coverage for sacral ulcers. Sensation was retained to a variable degree in both adults and children. An attempt at coverage of an ischial ulcer with an intercostal neurovascular free flap is also reported. The practical and theoretical aspects of these procedures are discussed

The reinnervation of full-thickness skin grafts has been studied with single mechanosensory unit recordings. Shortly after transplantation of the skin, most of the incoming fibers conduct impulses at slow velocities, which correspond to the unmyelinated group of sensory fibers. The older skin grafts demonstrated an increasing amount of myelinization as shown by the shorter latencies and faster conduction velocities. However, the critical balance between myelinated and unmyelinated fibers that characterizes normal cutaneous innervation was still disrupted in the grafted groups at 15 months. Whether this imbalance persists indefinitely is uncertain. The introduction of electrophysiological techniques into the study of peripheral nerve injuries, in experimental animals and in man, has given us some insight into the unexplored nature of this field of experimental and clinical investigation. The future promises to be exciting

The use of electrophysiological techniques as an adjunct in the surgical repair of peripheral nerve injuries can improve the quality of the repair and thus the degree of functional recovery. These techniques provide objective information needed to assess the degree of injury and can assist the surgeon in making proper decisions regarding treatment of peripheral nerve lesions. The purposes of this paper are to review: (1) the current theories of the functions of peripheral nerves and their and organs, (2) the development of electrophysiological techniques, (3) the principles involved in their use, and (4) the present and possible future applications of these techniques in peripheral nerve surgery and to outline them

The primary aim in reconstructive surgery of the upper extremity is to provide tactile gnosis to sensory depleted areas. It is essential for restoration of function and successful rehabilitation of the injured hand. Neurovascular free flaps may provide the answer to this catastrophic problem and transform a useless appendage into a functional gripping hand. Sensory mapping techniques can greatly assist the surgeon in precisely defining new donor sites for these transfers. Cutaneous sensibility, cutaneous sensation, and hand function are subjects of great complexity. Much more investigative and clinical work is needed in this challenging field to improve our evaluation of the sensory injury to the hand and to provide new avenues for restoring functional sensibility in the upper extremity

Four patients with clinical features of Goldenhar-Gorlin syndrome who showed facial paralysis on clinical examination are presented. The fourth case died following surgery for cleft lip. Autopsy revealed hypoplasia of the right facial nerve in its intracranial segment, with small right facial nucleus in the brain stem. Nosological aspects of the Goldenhar-Gorlin syndrome are discussed. Peripheral facial paralysis, as a part of this syndrome, is reviewed in the light of clinical and pathological findings and in its relationship to cardiac anomalies. It is suggested that Goldenhar-Gorlin syndrome is a part of a so-called cardiofacial syndrome

We describe a repair that preserves the vermilion border of the upper lip, after a full-thickness excision of a tumor of the upper lip which did not require excision of this structure. A bridge flap technique was employed, similar to the Cutler-Beard technique of eyelid reconstruction