Thorium dioxide, a radioactive contrast material, was commonly used for cerebral angiography prior to recognition of its radiation hazard. Extravasation of the material into the extravascular tissue in the neck results in granuloma formation, thorotrastoma, long-term morbidity, and an increased incidence of benign and malignant tumors. We report our experience with the management of 2 patients who underwent cerebral angiography with thorotrast more than 25 years ago. Aggressive surgical excision of involved tissue is warranted to ameliorate symptoms and diminish the risk of malignancy.

The authors' philosophy and regimen of treatment, based on experience with 103 pressure ulcers in 75 patients, are presented. This experience illustrates that the problem of pressure ulcers can be managed well by the application of sound surgical principles in a community hospital with a rehabilitation unit. With some simplification, the standard treatment procedures can be applied easily in this setting.

Between the ages of six months and six years, longitudinal lateral headfilms were taken on 54 patients with palatal clefts or with unilateral and bilateral clefts of the lip and palate. They were measured and were compared to data on both normals and subjects with clefts of the lip only. The objectives of the study were: 1. To sutdy the effects of palatal surgery on the growth of the soft palate. 2. To compare the growth of the soft palate and nasopharynx among the patients with various types of clefts and normals. 3. To study the growth acceleration or so-called catch-up growth after palatal surgery at various ages. (Anterior palatal surgery at 14 months +/- 2 months. Posterior palatal surgery at 16 months +/- 2 months.) 4. To evaluate the relationship between velopharyngeal growth in cleft groups and voice quality.

652 P-A X-ray headfilms of 51 unilateral cleft lip and palat, UCLP; 27 bilateral cleft lip and palate, BCLP; and 62 isolated cleft palate, CP were studied longitudinally at 0-3 months, 4-6 months, and annually from 1:0-6:0 years. Breadth change, height change, and growth direction of nine paired landmarks were investigated by means of the rectangular coordinate system with right to left zygomatico-frontal suture (Zf) point line as the X-axis and the perpendicular line to this X-axis at the mid-point between the right and left Zf points as the X-axis. Major findings were: (1) Study of Sphenoid body, interorbital, bizygomatico-frontal suture, and bizygomatic arch breadths showed that BCLP had a significantly broader face than either UCLP or CP. An apparent tendency to hypertelorism still remained at 6:0 in this group while UCLP and CP groups were both close to the Bolton Standards. (2) Nasal and maxillary bredths of BCLP and UCLP were significantly wider during the first year than in CP, but they showed only a slight growth change after the age of one year, compared to constant growth in CP. (3) All marked structural differences disappeared by 6:0 suggesting the effects of lip and/or palate surgery. (4) A slight cross-bite was found in UCLP and BCLP, but there was no such cross-bite in CP. (5) The effect of clefting was seen in mandibular dimensions where the bigonial notch was slightly broader than in non-cleft averages. (6) Upper facial height occlusal height, and posterior total facial height in each cleft group seemed to be larger than the Standard, though both maxillary height and gonial notch height approximated the Standard by 6:0 (7) From 0:3-6:0, there was no noteworthy difference among the cleft groups in either growth direction or facial symmetry of upper face and mandible. It was only in the mid-facial and dental areas that notable characteristics peculiar to the type of cleft were found. The landmarks of nasal aperture, maxilla, and dental arch showed a slight medial displacement on the affected side, although the degree and amount depended on the cleft-type.

In past years the statement has often been made that surgical interven« tion in cleft lip/palate cases would have a traumatic effect, i.e., a growth-stultifying effect, upon the palate—labial complex, more specifically the palate and the total maxillo—palatine complex It has been our feeling, here at Lancaster, that conservative surgery (properly timed, and offering a minimum of muco-periosteal involvement) should not result in deviant and /or dysplastic maxillo—facial growth. Hence, we are here testing such an hypothesis, which may be framed somewhat as follows: Operative intervention in cleft palate cases which minimally involves bone—growth potential will guide and facilitate maxillo~ facial growth in the individual so that post—operative growth, in a catchrup manner, will provide for the achievement of an acceptably normal cranio-facio—dental growth pattern. Drs. Krogman, Mazaheri, Harding and Ishiguro are affiliated with the H.

The increasing complexities in medicine, in medical education, and in plastic surgery seem to almost defy resolution. The best way to cope with these complexities, and to provide opportunity on an individual or a group basis, is by adherence to quality training program of the type which has served us well and in which the objective is constant. This implies the selection of high-quality candidates for training, and the control of resident flow, so that we may continue as a learned profession. History witnesses change--and time will bring new philsophies, new surgeons with changing values, and a public oriented to a different system of medical care. Shakespeare said, "when the day ends, the end will be known." I am confident that plastic surgery, with its traditional emphasis on quality and excellence, will long endure as a most learned profession.

International Abstracts of Plastic and Reconstructive Surgery: Congenital Anomalies: Cleft Lip and Palate: PDF Only

1Chief of Plastic Surgery at Harrisburg Hospital and Harrisburg Polyclinic Hospital (in Harrisburg, Pa.) and at the Lancaster Cleft Palate Clinic, and is Associate Clinical Professor in College of Medicine of the Pennylvania State University Lancaster, Pa. 2Chief of Dental Services at the Lancaster Cleft Palate Clinic, 24 North Lime, St. Lancaster, Pa. 17602

From the Departments of Surgery (Plastic) of the Harrisburg Hospital and the Harrisburg Polyclinic Hospital, Harrisburg, Pa.

Harrisburg, Pa From the Department of Surgery (Plastic) of the Pennsylvania State University College of Medicine, the Harrisburg Hospital, and the Harrisburg Polyclinic Hospital

The photocopy method of cast analysis permits a better understanding of the dimensional changes occurring during various stages of arch development. The statistical evaluation of the measurements described, and the changes in arch dimension as a result of growth and surgery gave us a better understanding of cleft patients. We found a wide variation in initial arch form among the groups and a variable pattern of arch development from birth to age 5.