Vitiligo associated with halo congenital melanocytic nevus (CMN) is rare. There are limited reports in the literature, especially with regard to CMN excision. We present the case of a 5-year-old girl who presented with vitiligo of the periorbital and axillary regions and halo formation around CMN of the buttock. The lesion was excised, and all areas of vitiligo improved, but 18 months postoperatively, a halo of depigmentation appeared around the excision scar and later in the periorbital and axillary regions. In review of literature, there is only one report of excision of halo CMN and resultant improvement of vitiligo. Although initial resolution of vitiligo in this case was promising, the recurrence indicates that this complex process is not reliably controlled with excision of the inciting lesion.
Treating patients with facial trauma remains a core component of plastic surgery and a significant part of the value of a plastic surgeon to a health system.
The purpose of this study was to provide an objective analysis and quantify the intracranial volume change produced by cranial vault distraction osteogenesis. We recently published a technique to expand the cranial vault by distraction in symptomatic patients with findings of cephalocranial disproportion. Resolution of symptoms was documented in that publication. In this current study, we analyzed postdistraction intracranial volume changes in 11 consecutive patients retrospectively from 10/2001 to 11/2010 with institutional review board approval. These 11 patients were treated by cranial vault distraction osteogenesis for symptomatic cephalocranial disproportion. Pre- and postoperative CT DICOM data were analyzed using specialized software to generate finite element models. Intracranial and ventricular volumes were calculated. Topographical surface maps were generated to document and quantify areas of change. Possible effects on brain physiology are discussed. Pre- and postoperative CT scans were obtained at an average of 3.5 months prior to, and 4.2 months following distraction, respectively. Average age at distraction was 55.72 months (range 26–104 months). Operative time averaged 2 h 44 min (range 127–198 min, SD = 30.6). Intracranial and ventricular volumes increased by an average of 77.01 and 4.85 ml, respectively. Nonventricular intracranial volumes increased by 5.91%, 71.67 ml following distraction. All postoperative volume changes were statistically significant (p ≤ 0.000025). The ability to use the same methodology to quantify ventricular volume changes was unexpected. The fact that all ventricles expanded after distraction at approximately 10% of the total intracranial volume increase indicates that compensatory mechanisms had been activated. We conclude that this occurs at the expense of cerebral blood flow.
Restoring architectural integrity of the craniofacial skeleton results in significant increased resistance to deformational stresses despite structural weakening caused by harvesting cranial bone.
Edentulous mandible fractures present a unique and challenging surgical problem, particularly because of lack of occlusive dental surfaces to capitalize upon maxillomandibular fixation (MMF). We present a novel technique to achieve MMF using rigid plates spanning the oral cavity to fixate the maxilla to the mandible. The process is rapid and allows stability using the established principles of rigidity, external fixation, and osteosynthesis. This technique allows for a faster MMF than with a Gunning splint and allows for easier oral hygiene. An illustrative case and pre- and postoperative imaging are provided.
Toxic shock syndrome (TSS) is a potentially fatal postoperative complication, and even more so if the diagnosis is delayed. We present the case of a 7-month-old male infant who developed TSS as a complication of tissue expansion using an external port device. There have been 5 documented cases of TSS after tissue expander or breast prosthesis placement occurring in the adult population, however, there has not been a reported case of TSS in an infant. The long interval to development of TSS like symptoms, 4 months in this case, should not exclude TSS from the differential diagnosis. In a pediatric patient, a diffuse macular rash without the severe systemic symptoms on initial presentation can present as a diagnostic challenge. New diagnosis techniques are discussed that can shorten the time to a diagnosis of TSS. In this case, because the local bacterial count was low, the expanded tissue was transferred without complication.
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