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Various complications can result from titanium plate internal fixation, including infection, exposure, pain, cold intolerance, and palpability. The incidence of such complications has become a topic of recent interest with the advent of resorbable plating. We undertook a retrospective review to determine complication rates of titanium fixation in a facial fracture population. Out of 266 patients with operative management of traumatic facial fracture between 1991 and 2004, 135 patients had titanium plate fixation. We evaluated 16 panfacial fractures, 22 zygomatic-orbital complex fractures, 49 midface fractures, and 48 fractures of the mandible. Overall, 33.3% (45/135) of patients had plates removed; 64.4% (29/45) of plate removals were for complications, ie, discomfort, exposure, and infection; 35.6% (16/45) were removed during secondary reconstruction. The most common complication was discomfort related to palpability, cold intolerance, and pain. This constituted 72.4% (21/29) of all plate removals for complications. Higher rates of plate discomfort were noted near the supraorbital, infraorbital, and mental foramina.

Anterior (anterolateral and anteromedial) thigh flaps based on the descending branch of the lateral circumflex femoral vessels provide a long vascular pedicle and a large flap without sacrificing main vessels and muscles. Twenty-eight de-epithelialised anterior thigh flaps were transferred for reconstruction of head and neck defects following tumour ablation. Two flaps were lost in patients that had previously undergone high-dose radiotherapy following free tissue transfer. Vascularised fibula, vascularised iliac bone and other tissues were combined with anterior thigh flaps in 13 cases utilising the distal end or derivative branches of the vascular pedicle. Salivary fistula was seen in only one case, although there were many minor and major complications. In five cases, double skin flaps were harvested from the ipsilateral thigh. One of these flaps was used for coverage of intraoral defects, while the other was placed in the submandibular area to fill dead space. Compared with other methods, this multi-flap method is considered to be most suitable for dead space filling and contour correction.

Previous studies indicate that cat jaw-muscle spindle afferents can be divided into two types (type I and II) on the basis of their axonal trajectories. The present study examined the relationship between spindle afferent fibers and their target masseter alpha-motoneurons in the cat by using the intracellular horseradish peroxidase (HRP) injection technique, and provided several new findings on the synaptic organization generated between the two. Five type I afferent fiber-motoneuron pairs and nine type II afferent-motoneuron pairs were well stained with HRP. The following conclusions were drawn: 1) A motoneuron received contacts from only one collateral of any given spindle afferent. 2) The number of contacts made between an afferent and a motoneuron ranged from one to three. 3) The contacts made by a spindle afferent were on the same dendrite or dendrites branching from the same primary dendrite. 4) The vast majority of the contacts made by an afferent on a motoneuron were distributed in the dendritic tree within 600 microns from the soma, i.e., in the proximal three fourths of the dendritic tree. The differences observed between the two afferent types were as follows. First, type II afferent terminals made contacts on more distal dendrites of the motoneurons than did type I afferent terminals. Second, the contacts made between a type I afferent and a motoneuron were clustered together, but those made between a type II afferent and a motoneuron were widely dispersed. The present results provided the general rules of synaptic contacts between the spindle afferents and masseter alpha-motoneurons, and demonstrated that the spatial distribution of synaptic contacts on the dendritic tree was different between type I and type II afferents.

A case of mesenteric panniculitis is presented in which the main signal was an abdominal pulsable mass and severe obstruction of the lymphatic vessels of the mesentery. A review of the literature was done.

Benign neoplasms are rare events in the extrahepatic biliary ducts, and scanty literary references on the subject are available. Four cases of obstructive jaundice caused by benign tumours of the extrahepatic biliary ducts have been reviewed. Two of them have also displayed lithiasis of the gallbladder and common bile duct. In three cases histopathologic confirmation was obtained, in contrast to the remaining case in which only a gross pathologic presumptive diagnosis was possible. Three patients underwent surgical resection, and in one of them hepatojejunostomy was performed. The patient with a presumptive diagnosis of "inflammatory polyp" was not submitted to surgery, due to the special circumstances of the case. The undisturbed follow-up of the four cases attested to the worthiness of the surgical procedures.