292 CURRENTLITERATURE

ment evident in 25-50% of the sarcoid patients, it did not parallel the course of the disease. Ocular involvement was an early manifestation in 90% in cases. The most common ocular presentations were uveitis and lacrimal gland involvement. If glaucoma was involved as well, the result was usually severe visual loss.-D. M. CHAN

Reprint requests to Dr. Jobs: Uveitis and Clinical Immunology Service, Wilmer Ophthalmological Institute, Johns Hopkins Hospitai, 600 North Wolfs Street, Baltimore, MD 21205.

Long Term Stability of Teflon Orbital Implants. Aronowitz JA, Freeman BS, Spira M. Plast Reconstr Surg 78:166, 1986

The authors present their experience with teflon or- bital floor implants with follow-up of almost 20 years. Data were recovered on 31 patients in whom 35 implants had been placed. Early complications (within one month) were reported with 3.9% of implants. Early complica- tions included infection and globe elevation due to over- correction. Complications were resolved by removal of the implant. Late complications occurred in 2.8% of im- plants. An antral-cutaneous fistula was reported that re- solved with removal of the implant. A higher incidence of complications was found with concomitant use of gauze antral packing. The authors found no incidence of im- plant migration or protrusion as has been reported in other studies. No interference in facial growth was seen in growing patients. The authors concluded that Teflon sheet is well tolerated in the orbit on a long-term basis. -BILL WHITLOW

Reprint requests to Dr. Aronowitz: Division of Plastic Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

Modified Caldwell-Luc Approach For The Treatment of Antral Choanal Polps. Myers E, Cunningham M. Laryn- goscope 96:669, 1986

The antral choanal polyp, the most common type of polyp in children, presents as hypertrophic maxillary sinus mucosa herniating into the nose through the natural ostium. Radiographically, it appears as a unilateral opaci- fication of the maxillary sinus with associated ethmoid involvement. A nasopharyngeal mass is confirmed on both anteroposterior and lateral radiographic views. The etiology of the antral choanal polyp in children is chronic bacterial inflammation and/or cystic fibrosis. Allergy rarely appears to be a cause. Medical treatment includes antibiotics, decongestants, systemic steroids, and topical steroids inhalations. Polyp recurrence is common with medical treatment alone. In contrast, surgical excision has been shown to minimize the likelihood of recurrence and infection in children and adults. A Caldwell-Luc ca- nine fossa approach is described for the removal of the polyp and antral mucosa as one unit under direct visual- ization. The authors state that there is no need to create a nasoantral window due to the widening of the natural os- tium by the polyp. This appears to be important in pre- venting damage to unerupted dentition.-MONROE HARRIS

Reprint requests to Dr. Meyers: Department of Otolaryngology, Eye and Ear Hospital, 230 Lothrop Street, Suite 1115, Pitts- burgh, PA 15213.

Nasolabial Musculocutaneous Flap in Reconstruction of Oral Defects. Hagan WE. Laryngoscope 96:840, 1986

This article describes the technique and experience of the author utilizing nasolabial musculocutaneous flaps on six patients to reconstruct the floor of the mouth. For oral reconstruction, the nasolabial flap has been de- scribed as a two-stage procedure: initial development, and subsequent detachment of the tunneled pedicle. Be- cause of the lack of a muscle layer and limited thickness of the nasolabial flap, there is a high tendency for con- traction. Use of the musculocutaneous flap involves a one-stage procedure. The flap is centered over the naso- labial groove. The caudal base is de-epithelialized in a triangular fashion allowing for insertion the of the flap. The donor area is then closed in a primary cosmetic fashion. The success of the flap is based on several prin- ciples: 1) tension must be minimal; 2) the island of tissue must be gently handled; and 3) the patency of the facial artery should be established. The vascularity of the muscles (nasalis and levator labii superior alaeque nasi) promotes rapid healing and adds bulk to the flap. The facial artery runs deep to the muscles and is incorporated into the base of the pedicle. This one-stage procedure has several advantages over the two-stage procedure.-H. KOOTMAN

Reprint requests to Dr. Hagan: 1401 Centerville Road. Suite 708, Tallahassee, FL 32308.

Topographic analysis of Homer’s syndrome. Smith PC, Dyches TJ, Burde RM. Otolaryngol Head Neck Surg 94:451, 1986

Horner’s syndrome, or oculosympathetic paresis, is characterised by several specific findings including: 1) miosis of the involved pupil with anisocoria that is char- acteristically greater in darkness than in light; 2) ptosis of the upper lid which results in a slight narrowing of the palpebral fissure; and 3) anhydrosis over the ipsilateral neck and face. These clinical findings can occur as a re- sult of interruption of the sympathetic pathway at any point from the hypothalamus to the pupillary dilator muscles. The pathway is comprised of mainly three orders of neurons. Lying at about the angle of the man- dible, the superior ganglion transmits 15 postganglionic fibers for every preganglionic neuron that enters. The postganglionic neurons ascend along the surface of the carotid artery within the carotid sheath. Neurons that are responsible for facial sweating ascend from the carotid bifurcation adherent to the external carotid artery, and follow the branches of internal maxillary artery to the vessels of the face. Fibers that supply the pupillary di- lator muscle traverse the petrous bone to enter the middle cranial fossa, pass through the trigeminal gan- glion, and course along the ophthalmic branch of the tri- geminal, nerve as it extends anteriorly through the cav- ernous sinus. The long and short posterior ciliary nerves carry these fibers through the ciliary ganglion without synapsing, ultimately to the ciliary muscles. Postgang- lionic fibers also course along with the opthalmic artery and oculomotor nerve through the cavernous sinus to supply the lacrimal gland and Mueller’s muscle in the upper and lower lid. The diagnosis of Homer’s syndrome should not be made on the presence of ptosis and miosis alone. A complete guide for physical examination and