Scandinavian journal of plastic and reconstructive surgery and hand surgery. Supplementum最新文献

Post-traumatic craniofacial deformities may result from failure to diagnose craniomaxillofacial injuries or from less than adequate repair. The skeletal deformities may be corrected by procedures employing extended craniofacial exposure, segmental osteotomies and bony repositioning. A graduated approach to the correction of regional bony post-traumatic deformities has been formulated. Bony depressions are corrected by onlay grafts, rigidly fixed with lag screws. Malposition of anatomically normal bone is corrected by osteotomy and repositioning. Anatomically abnormal bone is replaced with bone grafts. The use of rigid fixation techniques prevents the late skeletal relapse seen with previous techniques. In the established post-traumatic deformity, soft tissue distortion from contracted underlying scar tissue and adherence to bony depressions and defects is the limiting factor in restoring the pre-injury appearance.

Correction of vertical orbital dystopia is an important component part of providing facial symmetry in a number of conditions of varied etiology having facial imbalance and asymmetry. The most important step is the initial one of making a proper diagnosis, since some conditions represent globe dystopia rather than true orbital dystopia, and can be treated by extracranial procedures. However, if an intracranial procedure is felt indicated, it adds to the safety rather than the complexity of the procedure, and one should not hesitate advocating this to the patient.

The present study deals with various factors affecting speech, particularly its resonance, in patients with isolated cleft palate. For that purpose a method to evaluate hypernasality was developed. The degree of hypernasality was assessed in terms of hypernasality indexes by means of a modified cul-de-sac hypernasality test. The phonetic content of the test words was chosen so as not to bias the evaluations by compensatory articulations. The reliability and validity of four variations of hypernasality indexes were examined. All these four indexes proved reliable, valid and feasible for evaluating hypernasality. The hypernasality indexes were compared with nasalance scores derived from the Model 6200 Nasometer (The Nasometer 1987, Fletcher et al. 1989). Reference nasalance scores for normal Finnish speech were measured. The mean percent nasalance and the standard deviation were 13 and 8, respectively. In addition to the present hypernasality test modification, more traditional descriptive speech analysis was used in some studies. The effect of the age at primary palatal repair on speech was examined in three year old children with isolated cleft palate. The effect on speech of two techniques for primary palatal repair - a Veau-Wardill-Kilner V to Y push back procedure and the Cronin modification - were compared in young adults with isolated cleft palate. The effect on speech of two techniques for a secondary velopharyngeal flap - a Sanvenero-Rosselli and modified Honig flap - were compared in patients with various ages and cleft types. One third had cleft lip and palate or submucous cleft palate. The rest had isolated cleft palate. The quality of speech was significantly dependent on the age at primary palatal repair. The children, whose palatal repair was performed at the average age of 22 months demonstrated, significantly more frequently, hypernasality and misarticulations related to velopharyngeal insufficiency than the children operated upon earlier. The children operated upon between the average ages of 12-18 months, demonstrated normal speech in about 3/4 of the cases. If the palate was operated on later, about 1/4 of the patients demonstrated normal speech. The technique for primary palatal repair had a significant influence on the quality of speech. Hypernasality assessed in terms of hypernasality indexes was less frequent in the speech of patients with the Cronin modification than with the Veau-Wardill-Kilner push back procedure. The technique for the secondary velopharyngeal flap also affected speech significantly. The patients with a modified Honig velopharyngeal flap eliminated more efficiently hypernasality from their speech than those with a Sanvenero-Rosselli flap.(ABSTRACT TRUNCATED AT 400 WORDS)

I. The rabbit flexor tendon within the synovial sheath contains segments with fibrocartilage-like areas. These segments have a higher proteoglycan and a lower collagen and non-collagen protein synthesis compared to the segment with "true" tendon tissue. Cell proliferation is also lower within the proximal segment than in the intermediate and distal segments. These regional variations should be considered when interpreting experimental data. They may also be of importance for the variable healing capacity of different flexor tendon regions. II. Recombinant human insulin-like growth factor, insulin and fetal calf serum stimulate matrix synthesis and cell proliferation in a dose dependent manner in flexor tendon explants cultured for three days. rhIGF-I was more potent than insulin in stimulating cell proliferation and matrix synthesis. rhIGF-I also stimulated matrix synthesis to a higher degree than FCS. III. In long-term culture of flexor tendon explants, the addition of rhIGF-I to the culture medium stimulates matrix synthesis, but does not influence turn-over rates. The total hexosamine and collagen contents in tendons cultured in medium with rhIGF-I remain at the same level, while non-collagen protein content decreases. There are no major differences in matrix metabolism between tendons cultured in medium supplemented with FCS or with rhIGF-I only. rhIGF-I may therefore be used as a growth factor supplement in serum-free culture of tendon tissue. IV. Dehydration inhibits in vitro matrix synthesis and cell proliferation in tendon explants. These effects are counteracted by keeping the exposed tendon segments moist with physiological saline solution during preparation. The sensitivity of tendon tissue to dehydration should be considered during tendon surgery. V. Tendon explants, cultured in a diffusion chamber, survive and exhibit an intrinsic capacity for healing. In healing tendon segments incubated for three weeks, protein synthesis remains unchanged and collagen synthesis decreases, whereas the rate of cell proliferation increases as compared with native tendons. VI. Endotenon cells of the rabbit flexor tendon can restore the injured tendon surface and bridge the tendon gap. The rabbit flexor tendon is a morphologically and biochemically heterogeneous tissue with an intrinsic capability for healing. Tendon tissue is susceptible to dehydration and during exposure quickly looses its viability. The metabolic and proliferative capacity of the tendon is stimulated by growth factors and rhIGF-I may be of importance in tendon healing.