Search

A total of 14 teeth were transplanted to simulated alveolar clefts in 5 monkeys. Autogenous cancellous bone was grafted to the cleft together with the tooth in ten instances. Healing processes were observed 216 or 271 days postoperatively. Another group of four teeth were transplanted in the cleft areas 133 days after bone grafting. These teeth were observed for 138 days before sacrifice. Radiological and histological findings support previous reports on adverse effects to dental tissues when placed in direct contact with fresh transplanted bone. Root resorption and ankylosis occurred to a large extent. Establishment of a normal periodontal membrane could, however, be observed when the tooth was transplanted to an area grafted 4 months previously. An interval before tooth transplantation allowing the cancellous graft to organize and bone to remodel seems to be indicated.

Trophic ulceration of the nose is a rare complication occurring in patients with trigeminal anaesthesia. The etiology is not clear, but self-inflicted injuries to an anaesthetic region are considered to play an important part. The authors' experience with three cases indicates that substitution with skin from the affected area of the face will not give a lasting result. It seems probable that only skin with an intact nerve supply can provide a permanent replacement for skin lost in the dystrophic process. This means that a local flap innervated from a non-affected part of the face would offer the best possibility of a permanent cover for these defects.

About 800 patients are admitted annually to Norwegian hospitals for burn injuries. Among these, about 5% (40) patients have extensive burns, and 80-110 have special burns (skinburns combined with inhalation injuries, burns of the hands and burns of the face). The National Burn Center at Haukeland Hospital was opened in October 1984. In our experience decreased mortality, reduced disability and quicker rehabilitation are achieved when extensive and special burns are treated in specialized burn units.

Patients with spontaneous pneumothorax, who were treated in this department during the period 1950-59, were reviewed in 1963. Since the treatment of this group of patients has changed radically towards a greater surgical activity in the form of suction drainage and thoracotomy, the patients from the next decade, comprising 229 episodes in 202 patients, have now been reviewed to evaluate the results of this attitude. The conclusion from the earlier review, that recidivating pneumothorax should be operated upon, is further supported, and in quite a few patients (9%) thoracotomy had to be performed to control the first attack. Pleural rubbing, as an additional procedure to resection of bullae, seems as safe as partial pleurectomy in prevention of relapse. There were few serious operative complications. A rather protracted suction drainage has been practised in this series. One consequence of the experiences from the present review is that this time has been shortened.

A combined surgical/orthodontic procedure to eliminate the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment is described. The operations have been carried out on 378 patients: 240 males and 138 females. Seventy-two patients had bilateral clefts, making a total of 450 grafted clefts. The optimal age for this secondary bone grafting has been found to be 9 to 11 years. In 292 of the cases, the canine had reached its final position in the arch, which allowed a four-group semiquantitative assessment of the newly obtained interdental septum on dental radiographs. The best results have been achieved in cases where the bone graft was carried out prior to the eruption of the canine. In this group, a normal (category I) interdental septal height was achieved in 64 percent and a slightly lower (category II) interdental septum in 32 percent. Interdental septa classified as type I and II are considered to be acceptable. The cleft space was closed in 90 percent of the cases. No significant difference between unilateral and bilateral cases was found. When the same procedure was carried out after eruption of the canine, the results were less favorable.

All patients with bilateral complete clefts of the lip and some patients with incomplete clefts have a short or almost non-existing columella. This is a characteristic deformity which can only be corrected by surgical lengthening of the columella. Among the numerous methods which have been used for this purpose, the forked falp method as described by Millard (1958) has certain advantages: 1. Sufficient donor tissue is available in the lateral parts of the prolabium to produce full lengthening of the columella and adequate projection of the tip of the nose. 2. Most patients with bilateral clefts need secondary correction of the lip scars and a narrowing of the nostrils after the primary operation. Both of these objectives are achieved as a part of the forked flap procedure. 3. Access is gained both to the lip muscles and to the alar cartilages at the tip of the nose. 4. Narrowing of the lip in the upper part results in a natural eversion of the lower part, and a short lip can be lengthened by letting the remaining central part of the prolabium go down during suturing. 5. The scars left in the upper lip are in an unobtrusive position corresponding to the philtral ridges. During the period 1965-77, 87 patients with bilateral cleft lip have had a columella lengthening performed according to the forked flap method. Our experience with this method has been very favourable. No serious complications have ensued, and the cosmetic results have been most satisfactory in the majority of cases.

The results of secondary bone grafting and orthodontic treatment in 41 patients with bilateral complete clefts of the lip and palate are reported. Good bone formation was found in 98% of the cleft sites grafted before the eruption of the canines, and in 80% of the clefts grafted later. Closure of both cleft spaces by orthodontic means was achieved in 20 of the 21 patients in the first group, and in 14 of the 20 patients in the second group. The bone grafts failed in one cleft site in 4 patients, all of which were regrafted with satisfactory results. In 2 patients one of the canines was later affected by external root resorption, necessitating endodontic treatment. Both the failures and the root resorptions occurred in patients bone grafted at an older age than was considered optimal for bilateral clefts: 10 to 11 years. Seven patients needed a bridge prosthesis, 3 of these over one cleft space only. Even these patients benefited greatly from bone grafting.

A speech evaluation of 203 CLP patients operated on at the Department of Plastic Surgery, Rikshospitalet, Oslo, during the period 1969-75 has been performed. All patients had the posterior palate closed using a modified von Langenbeck technique at an average age of 24.4 months. The speech evaluation, based on 4 clinical tests, was done at the age of 6 years by experienced speech pathologists. The results were considered good concerning articulation and nasality in 86.2% and 80.5%, respectively. Among the 36 patients with moderate or severe nasality, 28 had a pharyngoplasty performed. The final speech results were considered good in 97.3% of the whole sample.

Multiparameter flow cytometric analyses of polymorphonuclear neutrophilic granulocyte (PMNL) functions have been performed longitudinally in ten patients with large burns. The percentage of phagocytosing PMNLs was increased at admission (within 24 hours after injury) and through the first 10 days of hospitalization. The surface binding capacity and the ingestion of Staphylococcus aureus by each PMNL was increased during the same time period, and at day 2 the number of S. aureus ingested per patient PMNL was 35% higher than in the controls. The intracellular killing of Candida albicans was reduced by about 25% at admission. The microbicidal capacity was further compromised during the first 2 weeks after injury, with a reduction of intracellular killing of about 35% 5-10 days after admission. The kinetics of patient PMNL phagolysosomal acidification was altered during the first 20 days, as the initial alkalinization of the phagolysosomes documented in control PMNLs could not be demonstrated in PMNLs from patients with burns. In addition, measurements of maximal phagolysosomal acidification showed a lower pH in patient phagolysosomes than in the controls during the first 5 days. The patient PMNL H2O2 production was reduced at admission and through the first 10 days, with an oxidative burst that was 46% lower than the controls at day 5. The intracellular degradation of S. aureus proteins and DNA was slightly but significantly reduced at day 5 and day 10 after admission. The impairment of PMNL microbicidal capacity correlated with total body surface area burn.(ABSTRACT TRUNCATED AT 250 WORDS)

At the National Burn Center at Haukeland Hospital, early excision and split skin grafting is a standard method for the treatment of extensive burns. In these cases it is important to be aggressive in the surgical treatment in order to avoid sepsis, multi-organic failure and death.