Aesthetic contouring of the facial support system.

The skeletal foundation and its attachments provide a basis for changing the basic structure of the face. Detailed preoperative evaluation and a clear understanding between the patient and surgeon of the aesthetic goals are essential prior to proceeding with surgery. Besides a knowledge of the normal aesthetic and arthropologic measurements, the surgeon must have an understanding of the range of methods available prior to proceeding with surgery.

Biological boundaries: a concept in facial skeletal restructuring.

The concept of biological boundaries is based on observations of craniofacial restructuring. It describes the body's intrinsic sense of physical surface and how this knowledge can be used to determine when to use bone grafts, segment shifts, or synthetic material.

Psychosocial outcome of craniofacial surgery in children.

Thirty-four children between the ages of 7 and 15 years with congenital craniofacial anomalies underwent psychosocial evaluation before and 12 to 18 months after surgery. Also evaluated were healthy children matched to the craniofacial subjects by sex, age, intelligence, and economic background. Preoperative assessment revealed the craniofacial group to have multiple but not severe psychosocial limitations.

Electrical stimulation of onlay bone grafts.

An animal model was developed to determine the ability of capacitively coupled electrical fields to enhance onlay bone graft survival in the craniofacial skeleton. Fifteen male New Zealand white rabbits were divided into control and stimulated groups. Blocks of iliac bone were transplanted as onlay grafts to the mandibular rami.

General body growth in children with cleft palate and related disorders: age differences.

Clefts of the lip and palate, separately or in combination, are among the most frequent congenital defects seen today. Their etiology is heterogeneous and may include hormonal factors, which suggest the possibility of growth effects. Whether affected children are smaller than others has not been determined.

Orbital reconstruction in hypertelorism.

Orbital hypertelorism as defined by increased bony interorbital distance is a complex manifestation of many congenital anomalies. As such, it is associated with a multitude of orbital, adnexal, and surrounding soft-tissue deformities. Treatment of these problems requires extensive experience and a comprehensive team, permitting adequate preoperative evaluation, diagnosis, and treatment.

Short-term hormone treatment as a chemopreventive method against mammary cancer initiation in rats.

Because previous data had suggested that short-term treatment with pharmacological doses of estradiol and progesterone might be an effective means of preventing mammary cancer initiation, additional experiments were performed to confirm this observation and to determine if lower doses of the hormones would also have chemopreventive activity. Rats treated with the steroids for five weeks and administered the carcinogen (methylnitrosourea) three weeks later were observed for one year for the appearance of mammary cancers. Hormone pretreated rats exhibited a reduction in number of mammary cancers of approximately 90% from rats receiving the steroid vehicle.

Aglossia with congenital absence of the mandibular rami and other craniofacial abnormalities.

We describe a severe first branchial arch abnormality including nearly complete absence of mandible, hypoplasia of the maxilla and the zygomatic arches, and complete gingival fusion in a chromosomally normal child born to a nonconsanguineous couple who deny prenatal exposures. A tight orbicularis oris muscle caused the lips to be constantly pursed. Intraoral contents could only be defined after the fused gingiva were separated.

Aesthetic augmentation of the malar-midface structures.

Based on extensive experience with bone grafts for augmentation of the midface-malar region, an implant design has been developed using Proplast. After careful preoperative assessment, a very specific surgical method, described herein, allows precise implant positioning without the need for suture fixation. In many instances, the 6-mm implant can be inserted unchanged.

Craniosynostosis: an analysis of the timing, treatment, and complications in 164 consecutive patients.

Treatment options for the craniosynostoses vary from conservative observation until completion of growth to radical remodeling in infancy. To further define the timing and type of treatment necessary in these complex disorders, we have retrospectively analyzed all patients operated on for this deformity during the past 12 years. One-hundred and sixty-four patients with craniosynostosis were analyzed and subgrouped into asymmetrical (predominantly unilateral) and symmetrical (bilateral) deformities, in addition to segregation by age and type of procedure performed.

Diagnosis of gestational diabetes by capillary blood samples and a portable reflectance meter: derivation of threshold values and prospective validation.

Paired capillary-venous samples were obtained from 255 women undergoing a glucose challenge test and 116 women undergoing an oral glucose tolerance test. The capillary equivalents for the venous threshold values were calculated by regression analysis. The glucose challenge test predictions of either normal or abnormal agreed in 82%.

Ocular and adnexal complications of unilateral orbital advancement for plagiocephaly.

Strabismus, ptosis, lateral canthal dystopia, nasolacrimal obstruction, and cranial nerve palsy were noted preoperatively in 32%, 21%, 14%, 12%, and 9% of 34 patients, respectively, undergoing ophthalmologic evaluation prior to unilateral orbital advancement for plagiocephaly. Thirty-two percent of the patients had normal preoperative ocular and adnexal examination results. Ptosis, strabismus, and amblyopia were frequently acquired postoperative abnormalities in 29%, 18%, and 18% of the patients, respectively.

The craniofacial dysostoses: guidelines for management of the symmetric and asymmetric deformities.

Although great diversity marks the craniosynostoses, our experience related to that from other centers allows us to draw certain conclusions for their management. For the asymmetric synostoses, operative intervention should be carried out in infancy or early childhood. Although the unilateral approach is our preferred method, the bilateral approach can yield equally satisfactory results.

Psychosocial considerations in craniofacial deformity.

The authors evaluate the hypotheses that duration and severity of craniofacial malformations correlate with psychosocial adjustment. Reviewing data from congenital and traumatic craniofacial malformation patients of varying ages, they find partial support for the hypothesized associations; however, the relationship between psychosocial adjustment and craniofacial deformity is far from straightforward.

General body growth in children with clefts of the lip, palate, and craniofacial structure.

This paper discusses general body growth in children with craniofacial clefts. Body growth is important in such patients because morphology reflects the cumulation of metabolism over time. The same hormones that direct general body growth also govern the ontogeny of the head and face.

Three-dimensional computed tomographic imaging.

Recent developments in imaging techniques now allow reconstruction of actual three-dimensional images from computed tomographic data. This article discusses the basic concepts involved in three-dimensional imaging and reviews its potential as a diagnostic and management tool for the clinical ophthalmologist. New computer techniques allow review of actual three-dimensional images in both static and dynamic formats.

Suppression by pregnancy of chemically induced preneoplastic cells of the rat mammary gland.

Since a previous study suggested that pregnancy either eliminated preneoplastic cells or increased their latency period in rat mammary glands, additional experiments were performed to determine the fate of these cells. Following administration of the carcinogen dimethylbenzanthracene, few mammary cancers appeared after rats completed pregnancy and lactation. Because these results are similar to those previously obtained with N-methyl-N-nitrosourea (MNU), the effect of pregnancy appears to be independent of the carcinogen used to induce cancer.

Facial form analysis of the lower and middle face.

Structural form analysis identifies the major structural members of the middle and lower face through their high- and low-light areas, provides measurements and relationships between the key points, and explains the angular relationships in constructing a geometric form corresponding to these members. The six key points define the superior and inferior and anterior and posterior angles. The angles and planes then lead to a geometric form of the lower and middle face.

The relationship between capillary and venous glucose concentration during pregnancy.

Previous attempts to construct capillary equivalents of venous glucose values for prognostic purposes have failed. We examined the relationship between capillary and venous glucose concentration during pregnancy in 258 women who had samples taken at four different time intervals in relation to two different standardized meals. Capillary glucose concentration was determined with the Chemstrips bG and an Accu-Chek reflectance colorimeter and venous plasma glucose concentration was measured by the hexose kinase technique on an AutoAnalyzer.

Aesthetic surgery of the supraorbital ridge and forehead structures.

A physical anthropologic basis for aesthetic evaluation of the supraorbital ridges and forehead is described. The structures included for evaluation and possible treatment are the supraorbital ridges, relation of the orbital walls to the eyes, the temporal ridges, and slope of the forehead. All can be altered by reduction contouring or augmentation using methods described.

Cost efficacy of routine screening for diabetes in pregnancy: 1-h versus 2-h specimen.

Undetected gestational diabetes mellitus (GDM) is associated with a two- to fivefold increase in perinatal morbidity and mortality. Widespread screening of the obstetric population (resulting in identification and treatment) should reduce these rates. Seven hundred ninety-eight women were examined during a 13-mo period of universal glucose challenge testing (GCT).

Effect of age on horizontal eye movement latency.

Reaction time to initiate an eye movement to a target which suddenly appeared 2.8 degrees from fixation was measured for older and younger adults. Healthy men and women were tested in a series of trials; on one-half of these trials prior knowledge of the target's location was given (simple reaction time), whereas on the remaining trials the target could appear to left or right of fixation with equal probability (choice reaction time).